Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Παρασκευή 26 Οκτωβρίου 2018

Effect of a high-fat meal on the relative bioavailability of H3B-6527, a novel FGFR4 inhibitor, in healthy volunteers

Abstract

Purpose

This Phase I study estimated the effect of a high-fat meal on the pharmacokinetics (PK) of H3B-6527, a covalent inhibitor of the fibroblast growth factor receptor (FGFR) 4 in clinical development for hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

Methods

In this randomized, single center, single-dose, open-label, 2-period crossover study 12 healthy male volunteers, aged 18–55 years old, received a single 200-mg dose of H3B-6527 (capsule) following an overnight fast or a high-fat breakfast. PK samples were collected serially up to 36 h postdose. H3B-6527 concentrations were measured using a validated high-performance liquid chromatography tandem mass spectrometry method. PK data were analyzed using a noncompartmental approach based on a mixed-effects model. The safety and tolerability of H3B-6527 were also assessed.

Results

H3B-6527 plasma exposure increased after a high-fat meal with fed/fasted ratios of the geometric means (90% confidence interval) of 174% (102–298%) for Cmax and 246% (146–415%) for AUC0–t. Food delayed and prolonged absorption of H3B-6527, with a fed/fasted ratio for tmax of 200% (137–263%). PK variability was lower under the fed condition, as illustrated by the CV% for Cmax and AUC0–t of 41.9–54.5% (fed) versus 64.3–70.4% (fasted).

Conclusions

A single 200 mg dose of H3B-6527 was safe and generally well tolerated when administered to healthy adult males. A high-fat meal significantly increased exposure to H3B-6527, from 1.5- to 2.5-fold in the systemic circulation, compared to administration under fasted conditions. Food delayed and prolonged absorption of H3B-6527. In general, lower inter-subject variability was observed in the fed state in healthy volunteers.

Trial registration

ClinicalTrials.gov.: NCT03424577.



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Anlotinib for the Treatment of Patients with Locally Advanced or Metastatic Medullary Thyroid Cancer

Thyroid, Ahead of Print.


https://ift.tt/2CIDQNJ

Fear of Recurrence and View of Life Affect Health-Related Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Prospective Swedish Population-Based Study

Thyroid, Ahead of Print.


https://ift.tt/2qd4K95

A High Alanine Aminotransferase/Aspartate Aminotransferase Ratio Determines Insulin Resistance and Metabolically Healthy/Unhealthy Obesity in a General Adult Population in Korea: The Korean National Health and Nutritional Examination Survey 2007–2010

06-2018-0270-dia_10-1055-a-0752-0217-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0752-0217

Aims Early identification of individuals with insulin resistance (IR) and metabolically unhealthy state can help prevent various diseases and improve quality of life. In this study, we investigated a possible marker of IR and metabolic health status, alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio, and aimed to confirm its feasibility in a large population study. Methods A total of 16,371 adults from Korean National Health and Examination Survey were studied. Participants were divided into four groups according to their ALT/AST ratio quartiles. The homeostatic model assessment of insulin resistance level and proportion of people with IR, impaired fasting glucose, and undiagnosed type 2 diabetes were compared for each group. Receiver-operating characteristics (ROC) curve was also used to assess the usefulness of ALT/AST ratio to identify individuals with IR and metabolically unhealthy. Results In the groups with higher ALT/AST ratio, HOMA-IR level, proportion of IR, and proportion of individuals with IFG or type 2 diabetes mellitus was higher than that in those with low ALT/AST ratio. When analyzed with other factors related to IR, the data showed that the ALT/AST ratio was an independent predictor of IR (odds ratio 1.363, 95% confidential interval 1.323–1.405, p<0.001). When ROC curve analysis was done, area under curve (AUC) for identifying individuals with IR was 0.634. In addition, metabolically unhealthy individuals showed significantly higher ALT/AST ratio than metabolically healthy individuals (0.9780 vs 0.8511, p<0.001). Conclusions ALT/AST ratio was well-correlated with IR, IR-related conditions, and metabolic health status. This easily accessible method to estimate IR may facilitate the early screening of IR, which can result in prevention of IR-related morbid conditions.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Do-It-Yourself Microsuture from Human Hair for Basic Microsurgical Training

10-1055-s-0038-1675203_180202-1.jpg

J reconstr Microsurg
DOI: 10.1055/s-0038-1675203

Background Microsuture is an essential material for basic microsurgical training. However, it is consumable, expensive, and sometimes unavailable in the microsurgical laboratory. To solve this problem, we developed a microsuture made from human hair and needle gauge. Methods Do-It-Yourself (DIY) microsuture is made from human hair and needle gauge 32G (BD Ultra-Fine Pen Needles 4 mm × 32G). Methods are explained step by step. This DIY microsuture (labeled as "test microsuture") and nylon 8–0 (Ethilon suture 8–0, labeled as "standard microsuture") were used for teaching orthopaedic residents to perform arterial anastomosis in chicken thighs. All residents practiced without knowing that "test microsuture" was made from the DIY method. After completing the training, quality of both microsutures was evaluated by questionnaire in topics of (1) thread quality (size, strength, elasticity, handing, knot perform, and knot security), (2) needle quality (size, curve, shape, sharpness, handling, and strength), (3) needle–thread interface (size, strength, and smoothness), and (4) overall quality of microsuture. Each category was evaluated by Likert score (5 = excellent, 4 = good, 3 = fair, 2 = poor, and 1 = very poor). Results The DIY microsuture was performed in three steps: (1) insert human hair into needle gauge by microforceps, (2) bend needle into smooth curve, and (3) disconnect needle and create needle–hair interface. The questionnaire was completed by 30 orthopaedic residents and showed that thread quality of DIY and standard microsuture had "good" and "good-to-excellent" quality (mean Likert score: 3.77–4.23 and 3.80–4.27, respectively, with no statistical difference). Thread–needle interface quality of DIY and standard microsuture also had "good" and "good-to-excellent" quality (Likert score: 3.73–4.20 and 4.07–4.33, respectively, with no statistical difference). Needle part of DIY microsuture had lower quality than standard suture (fair-to-good compared with good-to-excellence quality, score 3.30–3.67 vs. 4.20–4.27, respectively, with a statistically significant difference, p-value < 0.05). However, overall quality of DIY suture and standard microsuture had "good" and "good-to-excellent" (mean Likert score: 3.73 and 4.00, respectively, with no statistical difference). Conclusion The DIY microsuture from human hair and needle gauge could be an alternative for basic microsurgical training with lower cost, easy production, and more availability for use in practice with acceptable quality compared with that of standard microsuture.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Progestogen Hypersensitivity: presentation and natural history

To review the published medical literature on the clinical presentation, risk factors, and natural history of hypersensitivity reactions to progestogens.

https://ift.tt/2SjtNnI

Associations of unsafe, unsupportive and underdeveloped neighborhoods with atopic dermatitis in US children

Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting 12.97% of US children1 and 7% of US adults.2 Emotional factors, e.g. anxiety and stress, can also exacerbate AD flares and influence the course of disease.3,4 AD also poses a significant financial burden on society and negatively impacts patient and family quality of life.5,6 However, the relationship between childhood AD and neighborhood conditions has yet to be examined.

https://ift.tt/2z7hwKo

Co-existent TBX1 Mutation and Chromosomal 20q13.13-q13.2 Duplication in an Infant with Abnormal TREC Newborn Screening

An eight day old male, term infant of a diabetic mother with patent ductus arteriosus was transferred from an outlying facility for surgical management of truncus arteriosus (TA), coarctation of the aorta, hypoplastic aortic arch, and anomalous origin of the right subclavian artery. The newborn also had absent thymic shadow on chest radiograph, hypocalcemia, and abnormal newborn screening (NBS) for severe combined immunodeficiency (SCID) measuring T cell receptor rearrangement circles (TRECs); threshold cycle (Ct) was 36.86 (Normal <36).

https://ift.tt/2Sl15CU

Markers of systemic involvement and death in hospitalized cancer patients with severe cutaneous adverse reactions

Cancer patients have increased risk of severe cutaneous adverse reactions, without reliable biomarkers to identify predisposition for associated morbidity and mortality. In hospitalized cancer patients with morbilliform rash, elafin, IL-6, TNF-α were associated with mortality. IL-6, IL-10 were associated with drug-related systemic involvement. These biomarkers may guide future therapeutic research.

https://ift.tt/2PZSZhE

A Phase 2, Randomized Dose-Finding Study of Tapinarof (GSK2894512 Cream) for the Treatment of Plaque Psoriasis

Novel topical treatments for psoriasis have not been developed for many years. Tapinarof, a therapeutic AhR modulating agent, is a potential new treatment option for psoriasis patients. Tapinarof, delivered in a 1% cream, achieved ≥75% improvement in Psoriasis Area and Severity Index in 60% of patients treated once daily.

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Histologic predictors of invasion in partially biopsied lentigo maligna melanoma



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A relapsing peeling of oral mucosa



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Response to “A relapsing peeling of oral mucosa”



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Classic Dermatological Tools: Foreign Body Removal with Punch Biopsy



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Validation of a novel method for localization of parathyroid adenomas using SPECT/CT

Accurate localization of parathyroid adenomas is of critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT is considered the investigation of choice but has limitations reg...

https://ift.tt/2yDknv8

Establishment of Monoclonal Antibody PMab-202 Against Horse Podoplanin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 233-237, November 2018.


https://ift.tt/2PY8eYa

The Augmenting Effects of the tDNA Insulator on Stable Expression of Monoclonal Antibody in Chinese Hamster Ovary Cells

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 200-206, November 2018.


https://ift.tt/2D3TggJ

Detection of Tiger Podoplanin Using the Anti-Cat Podoplanin Monoclonal Antibody PMab-52

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 224-228, November 2018.


https://ift.tt/2PSRRw2

Novel Monoclonal Antibodies Against Native Human Collectin L1, Using the Heteromeric Complex CL-LK as Immunogen

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 207-211, November 2018.


https://ift.tt/2D5rRed

Generation of a Monoclonal Antibody Against Staphylococcal Superantigen-Like Protein 5 (SSL5) That Discriminates SSL5 from Other SSL Proteins

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 212-217, November 2018.


https://ift.tt/2PXRTCZ

DgMab-6: Antihuman DGKγ Monoclonal Antibody for Immunocytochemistry

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 229-232, November 2018.


https://ift.tt/2D6AUM2

Establishment of P38Bf, a Core-Fucose-Deficient Mouse-Canine Chimeric Antibody Against Dog Podoplanin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 5, Page 218-223, November 2018.


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Wem gehört mein Implantat?



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Klarstellungen zum Thema Datenschutz



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Wie würden Sie entscheiden?



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Keine Angst vor dem „bösen Wolf“



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Failure to Accurately Disclose Conflicts of Interest in Article Published in JAMA Otolaryngology–Head & Neck Surgery

To the Editor I write to take full responsibility for failing to report appropriate conflict of interest disclosures in articles published in JAMA Otolaryngology–Head & Neck Surgery and the JAMA Network journals between 2015 and 2018, including "Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx: A Secondary Analysis of a Randomized Clinical Trial," published online on April 9, 2016, and in the September 2016 issue of JAMA Otolaryngology–Head & Neck Surgery. In that article, I had reported nothing to disclose. In the interest of full disclosure, I now report the following financial interests and activities that I had been involved in from 2013 to the present, regardless of potential relevance:

https://ift.tt/2RbWWQc

Missing Conflict of Interest Disclosure

In the Original Investigation titled "Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx: a Secondary Analysis of a Randomized Clinical Trial," published in the September 2016 issue of JAMA Otolaryngology–Head & Neck Surgery, conflict of interest disclosures were not reported accurately by José Baselga, MD, PhD. Dr Baselga has written a Letter to the journal explaining this inconsistent reporting of potential conflict of interest disclosures. This article was corrected online.

https://ift.tt/2ORlMs3

Failure to Accurately Disclose Conflicts of Interest in Articles Published in JAMA Oncology

To the Editor I write to take full responsibility for failing to report appropriate conflicts of interest disclosures in articles published in JAMA Oncology and the JAMA Network journals between 2015 and 2018, including 5 articles published in JAMA Oncology. In 3 of these article I had reported receiving personal fees from Roche, and in 2 articles I had reported nothing to disclose. In the interest of full disclosure, I now report the following financial interests and activities that I had been involved from 2013 to the present time, regardless of potential relevance:

https://ift.tt/2EGYnVw

Missing Conflict of Interest Disclosure

In a number of articles published in JAMA Oncology, conflict of interest disclosures were not reported accurately by José Baselga, MD, PhD. Dr Baselga has written a Letter to the journal explaining this inconsistent reporting of potential conflict of interest disclosures. All articles have been corrected online.

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Pakistan’s quest for coal-based energy under the China-Pakistan Economic Corridor (CPEC): implications for the environment



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Grain size analysis of California waterbodies to determine the spatial extent and temporal trends of depositional areas where hydrophobic organic compounds could accumulate

Abstract

The objective of this study was to summarize the grain size data from 1993 to 2016 from California water bodies and determine the number and percent of sites where sediment samples are primarily depositional sediment (more than 50% silt/clay) or non-depositional sediment (less than 50% silt/clay). Fine grain depositional areas were of interest because these are areas where hydrophobic organic compounds (HOCs) can accumulate if sources exist. Trends analysis of percent silt/clay data were conducted for all nine California Water Board Regions if adequate data for this type of analysis were available. Sediment sampling protocols were reviewed for all the grain size measurements to determine if depositional areas were targeted or random sampling was conducted. Twelve of the 13 sediment sampling protocols targeted depositional areas. Based on 23 years of data from 685 sites (1859 observations) in all 9 California Regions, the summary analysis showed that only 58% of the sites were considered depositional areas even when targeted sampling for depositional areas was used. Since only slightly more than half the sites were reported as depositional areas based on sampling that targets depositional areas, these results would certainly suggest that depositional areas are not dominant. In fact, for the one protocol where random sampling was used, depositional areas were not reported to be dominant. From an ecological risk perspective, the implication of this finding is that HOCs would not be expected to accumulate in the dominant type of sediment found in most California waterbodies. Trends analysis of percent silt/clay data showed mixed results for the various California Regions.



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Enhancement of visible-light photocatalytic activities of BiVO 4 coupled with g-C 3 N 4 prepared using different precursors

Abstract

Graphitic-like carbon nitride (g-C3N4) photocatalyst was synthesized by a facile chemical pyrolysis method, which was built on the self-condensation of different precursors to generate g-C3N4, e.g., melamine, urea, and thiocarbamide. And the different precursors produced a great influence on the photocatalytic activities of g-C3N4. Heterojunctions of g-C3N4 and BiVO4 were synthesized using a facile solvent evaporation method. The formation of BiVO4/g-C3N4 composites were confirmed by XRD, FT-IR, SEM, XPS, and UV-Vis DRS. The photocatalytic activities for RhB degradation were evaluated under visible-light irradiation. The photocatalytic activity of g-C3N4 prepared by urea was higher than that of g-C3N4 prepared by melamine and thiocarbamide, which was attributed to its favorable dispersibility, larger specific surface area, and higher oxidation capacity. The heterojunction composites exhibited higher photocatalytic activity than pure g-C3N4 or BiVO4. The results showed obvious removal efficiency for RhB, and the optimal sample with a BiVO4 content of 10% exhibited higher efficiency than pure g-C3N4 and BiVO4, and 10 wt%BiVO4/CN-U showed the highest photocatalytic activity. The enhanced photocatalytic activity of BiVO4/g-C3N4 composite can be attributed to the intimate coupling between the two host substrates, resulting in an efficient charge separation.



https://ift.tt/2SozAsn

Atmospheric monitoring of organochlorine pesticides across some West African countries

Abstract

Most African countries have ratified the Stockholm Convention on persistent organic pollutants (POPs) and are expected to reduce emissions of POPs such as organochlorine pesticides (OCPs) to the atmosphere. Emerging evidence, however, suggests that there are contemporary sources of OCPs in African countries despite the global ban on these products. This study investigated the atmospheric contamination from OCPs in four West African countries—Togo, Benin, Nigeria, and Cameroon—to ascertain the emission levels of OCPs and the characteristic signatures of contamination. Polyurethane foam (PUF) disk passive air samplers (PAS) were deployed in each country for ca. 55 days in 2012 and analyzed for 25 OCPs. Hexachlorocyclohexanes (HCHs) and DDTs constituted the highest burden of atmospheric OCPs in the target countries, at average concentrations of 441 pg m−3 (range 23–2718) and 403 pg m−3 (range 91–1880), respectively. Mirex had the lowest concentration, ranged between 0.1 and 3.3 pg m−3. The concentration of OCPs in rainy season was higher than in dry season in Cameroon, and presupposed inputs from agriculture during the rainy season. The concentrations of ∑25 OCPs in each country were in the following order: Cameroon > Nigeria > Benin > Togo. There was significant evidence, based on chemical signatures of the contamination that DDT, aldrin, chlordane, and endosulfan were recently applied at certain sites in the respective countries.



https://ift.tt/2z6yjgE

Assessment the activity of magnetic KOH/Fe 3 O 4 @Al 2 O 3 core–shell nanocatalyst in transesterification reaction: effect of Fe/Al ratio on structural and performance

Abstract

Recently, biodiesel production using heterogeneous catalysts has been of great concern. However, simple separation of these catalysts from product mixtures is a problem of the process. In this study, series of magnetic KOH/Fe3O4@Al2O3 core–shell nanocatalysts were synthesized via the incipient wetness impregnation method and the effect of weight ratio of Fe3O4-to-Al2O3 (0.15–0.35) on the catalytic performance was assessed. The samples were characterized by XRD, FTIR, BET-BJH, VSM, SEM, TEM, and EDX analyses and their basicity was measured by the Hammett indicator method. The results revealed that although the magnetic KOH/Fe3O4@Al2O3 nanocatalyst with 25 wt% of Fe3O4 showed less activity as compared to those with 15 wt% of Fe3O4, it exhibited higher surface area and appropriate magnetic properties. The sample presented superparamagnetic properties with the magnetic strength of 1.25 emu/g that was simply recovered by using an external magnetic field. The nanocatalyst converted 98.8% of canola oil to biodiesel under reflux condition at the best operational conditions of 12 M ratio of methanol/oil, 4 wt% of catalyst and 6 h of reaction time. Moreover, the nanocatalyst showed high reusability such that it was reused several times without appreciable loss of its catalytic activity.



https://ift.tt/2Sozq4f

Cleaner emissions from a DI-diesel engine fueled with mahua oil and low carbon ethanol-hydrogen in dual fuel mode

Abstract

This work is all about utilization of more than two low carbon fuels in a diesel engine with a main objective of reducing harmful emissions. Initially, test engine was tested with a non-petroleum-based fuel namely mahua oil, under different load conditions. In the second phase of the work, test engine was modified into dual fuel mode with slight modification in the intake manifold for the admission of a low carbon high octane primary fuel namely ethanol. The engine was tested by varying the ethanol energy share (EES) from 5% to the point at which engine tends to knock at 100% and 40% of the maximum engine power output. Finally, an attempt was made to induct a zero carbon high octane fuel (i.e., hydrogen) in the intake manifold of the dual fuel engine operated with mahua and ethanol and tested for the behavior. Experimental results claimed that inclusion of ethanol improved the brake thermal efficiency (BTE) only at the higher loads. Optimized EES at 100% load conditions was identified as 15%. It is found that injection of ethanol significantly reduced the harmful emissions like smoke and oxides of nitrogen at the price of increased hydrocarbon and carbon monoxide emissions. It is also inferenced that BTE was improved further with the increases of hydrogen flow rate at peak load. Interestingly all the carbon-based emissions were drastically reduced with the inclusion of hydrogen. However, the oxides of nitrogen emission were found to be increased with increase of hydrogen flow rate.



https://ift.tt/2z93iIH

Adolescent-Onset Hidradenitis Suppurativa: Prevalence, Risk Factors and Disease Features

Background/Aims: Hidradenitis suppurativa (HS) is a chronic inflammatory and destructive skin disorder. Early diagnosis and treatment are critical to stop its progression. Data concerning adolescent-onset HS are scarce. The aims of this study are to describe the prevalence of adolescent-onset HS and to explore potential risk factors and the disease features of these patients. Patients and Methods: A cross-sectional study including 134 patients was performed. Results: Adolescent-onset HS occurred in 51.5% (69/134) of patients. Adolescent-onset HS was associated with female sex, positive family history, presence of pilonidal sinus, acne conglobata, longer disease duration and a worse perception of disease severity. Conclusion: Adolescent-onset HS might be more frequent than previously reported. Female sex, positive family history and the presence of elements of the follicular occlusion tetrad identify individuals with a higher risk of early onset. These patients experience a longer disease duration and perceive their disease as severer.
Dermatology

https://ift.tt/2CGMqws

Standardized Photographic Documentation of Hidradenitis Suppurativa/Acne Inversa

Background: Despite existing guidelines and methods for standardized clinical photography in dermatology and plastic surgery, human skin exhibits exquisite site-specific morphologies and functions, and each body region can exhibit an individual pathologic phenotype. The aim of this work was to develop a standardized, representative and reproducible documentation of the multilocular hidradenitis suppurativa/acne inversa (HS) lesions, a disease mostly occurring in skin folds. Method: Optimal body positions for medical photography of candidate areas for HS involvement were evaluated. Pictures of volunteers were taken, and indicative scientific graphics were designed. Results: Due to the variability of HS lesions and the fact of their localization in skin folds, a standardized, reproducible photographic documentation of HS candidate skin areas (50 cm from the skin surface) is proposed. The photographic series includes: (1) right armpit, (2) left armpit, (3) right groin, (4) left groin, (5) genital area, (6) anal area and anal fold, (7) right buttock, (8) left buttock, (9) chest area, (10) mons pubis, (11) right submammary area (females), (12) left submammary area (females). The protocol is accompanied with indicative scientific graphics for photography-proper positioning of the relevant body parts for documentation of potentially flat skin areas. In addition, former proposals for technical standardization of photography in dermatology, regarding instrumentation, environmental lighting and background colour, have to be respected. Conclusion: Standardized photography of candidate skin areas for HS involvement will allow longitudinal intraindividual and interindividual evaluation of the disease course as well as prospective and retrospective comparative studies.
Dermatology

https://ift.tt/2qdOh4C

A good beginning makes a good ending: association between acute pain trajectory and chronic postsurgical pain



https://ift.tt/2SmnG27

Loss of Gimap5 promotes pathogenic CD4+ T cell development and allergic airway disease

Publication date: Available online 25 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Andrew R. Patterson, Paige Bolcas, Kristin Lampe, Rachel Cantrell, Brandy Ruff, Ian Lewkowich, Simon P. Hogan, Edith M. Janssen, Jack Bleesing, Gurjit K. Khurana Hershey, Kasper Hoebe

Abstract
Background

The GTPase of immunity-associated protein 5 is essential for lymphocyte homeostasis and survival. Recently, human GIMAP5 SNPs have been linked with an increased risk for asthma, while the loss of Gimap5 in mice has been associated with severe CD4+ T cell-driven immune pathology.

Objective

To identify the molecular and cellular mechanisms by which Gimap5-deficiency predisposes to allergic airway disease.

Methods

CD4+ T cell polarization and the development of pathogenic CD4+ T cells were assessed in Gimap5-deficient mice and a human patient with a GIMAP5 loss-of-function (LOF) mutation. House dust mite (HDM)-induced airway inflammation was assessed using a complete Gimap5 LOF (Gimap5sph/sph) and conditional Gimap5fl/flCd4Cre/ert2 mice.

Results

GIMAP5 LOF mutations in both mice and humans are associated with spontaneous polarization towards pathogenic TH17 and TH2 cells in vivo. Mechanistic studies in vitro reveal that impairment of Gimap5-deficient TH cell differentiation is associated with increased DNA damage, particularly during TH1 polarizing conditions. The DNA damage in Gimap5-deficient CD4+ T cells could be controlled by TGFβ, thereby promoting TH17 polarization. When challenged with HDM in vivo, Gimap5-deficient mice displayed an exacerbated asthma phenotype (inflammation and airway hyperresponsiveness) with increased development of TH2, TH17, and pathogenic TH17/ TH2 cells.

Conclusion

Activation of Gimap5-deficient CD4+ T cells is associated with increased DNA damage and reduced survival that can be overcome by TGFβ. This leads to a selective survival of pathogenic TH17 cells, but also TH2 in humans and mice, ultimately promoting allergic airway disease.



https://ift.tt/2PrivPu

Advances in Food Allergy in 2017

Publication date: Available online 25 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Corinne A. Keet, Katrina J. Allen

Abstract

This review highlights research and policy advances in food allergy that were published in 2017 in the Journal and beyond. In 2017, many important studies on the treatment of food allergy were published, bringing us ever closer to a standardized treatment for food allergy. Other important advancements included research into other management strategies, including thresholds for avoidance and management of food allergies in schools were published, and development of new guidelines for prevention of food allergy. There were several important epidemiological studies helping us understand the phenotypes of allergic disease, and new hypotheses proposed for how best to prevent food allergy. Finally, there was a welcome increased attention to non-IgE mediated food allergies.



https://ift.tt/2JgDmzx

Supporting caregivers during hematopoietic cell transplantation for children with primary immunodeficiency disorders

Publication date: Available online 25 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jennie Yoo, Meghan C. Halley, E. Anne Lown, Veronica Yank, Katherine Ort, Morton J. Cowan, Morna J. Dorsey, Heather Smith, Sumathi Iyengar, Christopher Scalchunes, Christina Mangurian

Abstract
Background

Caregivers of children with primary immunodeficiency disorders (PIDs) experience significant psychological distress during their child's hematopoietic cell transplantation (HCT) process.

Objectives

This study aims to understand caregiver challenges and identify areas for healthcare system-level improvements to enhance caregiver well-being.

Methods

In this mixed-methods study, caregivers of children with PIDs were contacted in August to November 2017 via on-line and electronic mailing lists of rare disease consortiums and foundations. Caregivers were invited to participate in an on-line survey assessing sociodemographic variables, child's medical characteristics, psychosocial support use, and WHO-5 Well-Being Index. Open-ended questions about healthcare system improvements were included. Descriptive statistics and linear multivariate regression analyses were conducted. A modified content analysis method was used to code responses and identify emergent themes.

Results

Among the 80 caregiver respondents, caregivers had a median age of 34 years (range 23-62 years), were predominantly female, white, and married with male children diagnosed with SCID. In the adjusted regression model, lower caregiver well-being was significantly associated with lower household income and medical complications. Challenges during HCT include maintaining relationships with partners and the child's healthy sibling(s), managing self-care, and coping with feelings of uncertainty. Caregivers suggested several organizational-level solutions to enhance psychosocial support, including respite services, on-line connections to other PID caregivers, and bedside mental health services.

Conclusions

Certain high-risk sub-populations of caregivers may need more targeted psychosocial support to reduce long-term impact of the HCT experience upon their wellbeing. Caregivers suggested several organizational-level solutions for provision of this support.



https://ift.tt/2PsKYEE

Validation of a novel method for localization of parathyroid adenomas using SPECT/CT

Abstract

Background

Accurate localization of parathyroid adenomas is of critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT is considered the investigation of choice but has limitations regarding localization of superior versus inferior adenomas. We proposed a novel method for localization using SPECT/CT by determining the anterior-posterior relationship of the adenoma to a horizontal line in the coronal plane through the tracheoesophageal groove. Our objective was to determine the accuracy, validity, and inter-rater reliability of this method.

Method

This was a retrospective review of patients who underwent parathyroidectomy for a single adenoma between 2010-2017. SPECT/CT images were reviewed by two staff Otolaryngologists, a Radiologist, an Otolaryngology fellow and Otolaryngology resident. Results were compared using intra-operative report as the gold standard.

Overall accuracy in determining superior/inferior and right/left adenomas was calculated, as well as Cohen's Kappa to determine agreement with operative report and inter-rater reliability. The performance was compared to that of the original radiology report.

Results

One hundred thirty patients met criteria and were included. Our method correctly identified the location of the adenoma in terms of both side and superior/inferior position in 80.4% [76 - 84%] of patients, which considerably outperformed the original radiology report at 48.5% [4-78%] accuracy. The agreement level between our method and operative report was high (Kappa=0.717 [0.691-0.743]), as was the inter-rater reliability (Kappa=0.706 [0.674-0.738]).

Conclusion

We report a novel method for localization of parathyroid adenomas using SPECT/CT which outperforms standard radiology reporting. This tool can be used by surgeons and radiologists to better inform and plan for minimally invasive parathyroidectomy.



https://ift.tt/2PrfwGM

CA209-891: Neoadjuvant and Adjuvant Nivolumab as Immune Checkpoint Inhibition in Oral Cavity Cancer

Condition:   Squamous Cell Carcinoma of the Oral Cavity
Interventions:   Biological: Nivolumab, Surgery, Radiotherapy;   Biological: Nivolumab, Surgery, Chemoradiotherapy
Sponsors:   The Clatterbridge Cancer Centre NHS Foundation Trust;   University of Liverpool;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2PVgTKY

Regorafenib Combined With Irinotecan as Second-line in Patients With Metastatic Gastro-oesophageal Adenocarcinomas

Conditions:   Adenocarcinoma of the Stomach;   Adenocarcinoma of the Gastroesophageal Junction
Interventions:   Combination Product: Regorafenib and Irinotecan;   Drug: Irinotecan
Sponsor:   UNICANCER
Not yet recruiting

https://ift.tt/2AsBt07

Conservative Treatment of Retronychia: A Retrospective Study of 25 Patients

No abstract available

https://ift.tt/2PXkNDf

CA209-891: Neoadjuvant and Adjuvant Nivolumab as Immune Checkpoint Inhibition in Oral Cavity Cancer

Condition:   Squamous Cell Carcinoma of the Oral Cavity
Interventions:   Biological: Nivolumab, Surgery, Radiotherapy;   Biological: Nivolumab, Surgery, Chemoradiotherapy
Sponsors:   The Clatterbridge Cancer Centre NHS Foundation Trust;   University of Liverpool;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2PVgTKY

Regorafenib Combined With Irinotecan as Second-line in Patients With Metastatic Gastro-oesophageal Adenocarcinomas

Conditions:   Adenocarcinoma of the Stomach;   Adenocarcinoma of the Gastroesophageal Junction
Interventions:   Combination Product: Regorafenib and Irinotecan;   Drug: Irinotecan
Sponsor:   UNICANCER
Not yet recruiting

https://ift.tt/2AsBt07

Treatment of Hypertrophic Scars Using Laser-Assisted Corticosteroid Versus Laser-Assisted 5-Fluorouracil Delivery

BACKGROUND As the mortality of individuals suffering severe cutaneous injuries decreases, there is an increased need to improve the methods by which physicians treat the resultant scars. Fractional lasers, which create zones of ablation at variable depths, provide a powerful tool in the management of scar complications and deformities. After disruption of the normal skin barrier, these zones may be used to deliver drugs that may enhance scar resolution. OBJECTIVE To determine the differences in clinical outcome for hypertrophic scars treated with laser-assisted corticosteroid delivery, as compared to laser-assisted 5-fluorouracil delivery. METHODS In this prospective, double-blinded, single-subject study of 20 individuals with hypertrophic scars, subjects underwent 3 treatment sessions at 1-month intervals consisting of fractional ablative laser treatment, followed by postoperative application of either topical triamcinolone acetonide (20 mg/mL) or topical 5-fluorouracil (50 mg/mL). RESULTS Three sessions of laser-assisted triamcinolone acetonide and 5-fluorouracil delivery both produced reductions in overall scar area. When compared with one another, there were no statistically significant differences in area reduction between the 2 modalities (p = .603). However, scars treated with 5-fluorouracil were not associated with side effects seen with corticosteroid therapy, such as dermal atrophy or telangiectasia formation. CONCLUSION As 5-fluorouracil was associated with fewer adverse events, these findings support the use of a nonsteroidal agent in the management of traumatic scars by laser-assisted therapy. Address correspondence and reprint requests to: Jill S. Waibel, MD, Miami Dermatology and Laser Institute, Miami, Florida 33173, or e-mail: jwaibelmd@miamidermlaser.com Supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2AsBhOr

Erosive pustular dermatosis of the scalp: a neutrophilic folliculitis within the spectrum of neutrophilic dermatoses. A clinicopathologic study of thirty cases

Publication date: Available online 25 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Carlo Tomasini, Andrea Michelerio

Abstract
Background

It is general opinion that histopathology is nonspecific and of little value in diagnosing erosive pustular dermatosis of the scalp (EPDS).

Objectives

Clinicopathologic correlation of erosive pustular dermatosis of the scalp.

Methods

The clinical and pathological records of patients with a clinicopathologic diagnosis of EPDS, between 2011-2016, at the Dermatopathology Unit of the Turin University were reviewed.

Results

Thirty elderly patients with EPDS were identified, 22 males and 8 females. Androgenetic alopecia was present in 19/30 patients. Triggering factors included mechanical trauma in 10/30 cases, surgical procedures in 4/30, herpes zoster in 1/30. Three patients were affected by autoimmune disorders. The vertex was the most common location. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum. The pathologic changes differed according to the lesion type and disease duration. Interestingly, a spongiotic and suppurative infundibulo-folliculitis was observed in 8/30 cases.

Limitations

This was a retrospective study.

Conclusions

We believe that the primary lesion of erosive pustular dermatosis of the scalp is a spongiotic, pustular superficial folliculitis. The clinicopathologic similarities with other neutrophilic dermatoses, such as pustular pyoderma gangrenosum, suggest this condition should be included in this spectrum, where pathergy plays a pathogenetic role.



https://ift.tt/2qf12Md

Effect of Post-Injection Facial Exercise on Time of Onset of Botulinum Toxin for Glabella and Forehead Wrinkles: A Randomized Controlled, Crossover Clinical Trial

Publication date: Available online 25 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Murad Alam, Amelia Geisler, Melanie Warycha, Kapila Paghdal, Wanjarus Roongpisuthipong, Daniel I. Schlessinger, Brian R. Chen, Kelly A. Reynolds, Dennis P. West, Emily Poon



https://ift.tt/2CJenUC

Development and Implementation of an Order Set to Improve Value of Care for Patients with Severe Stasis Dermatitis

Publication date: Available online 25 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Susan Nedorost, Sheree White, Douglas Y. Rowland, Beth Bednarchik, Susan Flocke, Teresa L. Carman, Lauren Karpinski, Yiwen Shi



https://ift.tt/2qf10E5

Lateral pharyngotomy

Publication date: Available online 25 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): O. Laccourreye, A. Villeneuve, F. Rubin, F.C. Holsinger

Abstract

Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral pharyngotomy for resection of cancers originating from the lateral oro and/or hypopharynx.



https://ift.tt/2At98H6

Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group

Publication date: Available online 25 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): S. Morinière, P. Gorphe, F. Espitalier, D. Blanchard, N. Fakhry, N. Saroul, C. Bach, X. Dufour, C. Fuchsmann, S. Vergez, S. Albert

Abstract
Objective

Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction.

Material and method

A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases.

Results

Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04).

Conclusion

Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.



https://ift.tt/2RfZuwU

Impact of cochlear implantation on peripheral vestibular function in adults

Publication date: Available online 25 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): V. Colin, P. Bertholon, S. Roy, A. Karkas

Abstract
Objective

Cochlear implantation may have a detrimental effect on vestibular function and residual hearing. Our goal was to investigate the impact of cochlear implantation on peripheral vestibular function and the symptomatology that ensues.

Material and methods

A prospective observational study included all adults undergoing cochlear implantation by the same operator between July 2014 and December 2015, with pre- and postoperative (4 months) neurovestibular balance examination comprising a questionnaire and clinical tests [head impulse test (HIT), head-shaking test (HST), skull vibration test (SVT)] and instrumental tests [caloric test of the lateral semicircular canal and cervical vestibular-evoked myogenic potentials (cVEMP)].

Results

Twenty-two patients were included, with a mean age of 62 years and sex-ratio of 1.2. Before implantation, 50% of subjects (n = 11) reported at least one episode of vertigo associated with balance disorder during their life. After implantation, there were 11 cases of vertigo but only one patient described persistent discomfort related to vertigo 4 months after surgery. Patients with impaired vestibular function after 4 months, taking all symptoms together, were all aged more than 75 years. HIT was abnormal in 18% of cases before implantation and in 59% after (P = NS). HST showed nystagmus in one patient both before and after surgery. Only 18% of patients showed nystagmus induced by SVT before surgery, increasing to one-third after surgery (P = NS). Caloric test of the lateral canal showed hypofunction in 50% of cases before surgery, including 10% of cases with areflexia. This rate increased after surgery to 58%, with 18% areflexia (P = NS). cVEMPs were not detected in 68% of cases before implantation and this rate increased to 86% after surgery (P = NS). There were no significant associations (P > 0.05) between test results and symptoms.

Conclusions

In the medium term, although older subjects more frequently presented vestibular disorder, cochlear implantation induced little vertigo or balance disorder, sometimes even improving vestibular function. However, vestibular disorders were frequent preoperatively and increased postoperatively. We tested vestibular function on different stimulation frequencies and yet found no correlation between postoperative test results and postoperative vertigo.



https://ift.tt/2AtsqM9

The ILTS Consensus Conference on NAFLD/NASH and liver transplantation

No abstract available

https://ift.tt/2z5u3hl

Cardiac transplantation across preformed HLA-antibody barriers

No abstract available

https://ift.tt/2SlWPmv

Haploidentical Hematopoietic Stem Cell Transplant complicated by Atypical Hemolytic Uremic Syndrome and Kidney Transplant from the same donor with no Immunosuppression but C5 Inhibition

Background Atypical hemolytic uremic syndrome (aHUS) is life-threatening condition particularly when complicating allograft hematopoietic stem cell transplant (HSCT). In the past, the outcome was very poor with the majority of patients reaching end stage renal disease (ESRD) or dying with little or no chances of kidney transplant (KTx) due to the high risk of relapse. The availability of C5 inhibition has opened up significant therapeutic opportunities and has improved the outcome particularly if complement dysregulation (CD) is the underlying pathogenetic mechanism. Methods: We describe a peculiar case of a girl with aHUS complicating HSCT and her subsequent successful KTx received from the same donor thus performed without immunosuppression but anti C5 inhibition. Results Soon after HSCT performed for acute lymphoblastic leukemia, the patient developed a thrombotic microangiopathy (TA-TMA) due to CD and reached ESRD. After 2 years on dialysis the patient received a KTx from her father who was already the HSCT donor. Given the full chimerism, no immunosuppressive agent was prescribed except a short (2 days) course of steroids and eculizumab to prevent aHUS relapse. Nine months after the KTx the patient is well with normal renal function, no immunosuppression and continues eculizumab prevention of aHUS (1 infusion every 21 days). Conclusions All patients with TA-TMA should be screened for the causes of CD. C5 inhibition with eculizumab is an important therapeutic resource to manage this complication. When KTx is necessary, immunosuppression can be safely withhold in case of same donor for both grafts and documented full chimerism. Correspondence information: Ardissino Gianluigi, Center for HUS Control, Prevention and Management, Fondazione, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 9, 20122 Milan, Italy, e-mail: ardissino@centroseu.org Authorship page Authorship: Ardissino Gianluigi: participated in the writing of the paper Cresseri Donata: participated in the writing of the paper Giglio Fabio: participated in the writing of the paper Onida Francesco.: participated in the writing of the paper Iannuzzella Francesco: participated in the writing of the paper Tel Francesca: participated in the writing of the paper Giussani Antenore: participated in the writing of the paper Messa Piergiorgio: participated in the writing of the paper Longhi Selena: participated in the writing of the paper Vincenti Daniele: participated in the writing of the paper Tedeschi Silvana: participated in the writing of the paper Cugno Massimo: participated in the writing of the paper Ciceri Fabio: participated in the writing of the paper Disclosure: The authors declare no conflicts of interest Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2z56yF3

Preserved Renal-Allograft Function and successful treatment of metastatic Merkel cell cancer post Nivolumab therapy

No abstract available

https://ift.tt/2SlWKiH

Everolimus and Long-term Clinical Outcomes in Kidney Transplant Recipients: A Registry-based 10-year Follow-up of Five Randomized Trials

Background Data regarding the long-term efficacy of everolimus-based immunosuppression for kidney transplantation are lacking. Existing randomised controlled trials are limited by short follow-up duration which limits capacity to assess impact on graft and patient survival. Methods We linked individual trial participants to the Australian and New Zealand Dialysis and Transplant Registry. Using a one-step meta-analysis approach, we investigated the ten-year risk of graft loss, mortality and graft function in 349 participants from five randomised-trials of everolimus-based immunosuppression. Results Two-hundred and forty-two patients randomised to everolimus and 107 control patients were followed for a median of 9-years (IQR 7.1, 9.8 years). There were no significant differences in the risk of all-cause graft loss [adjusted HR (95% confidence interval) 1.16 (0.69-1.94)], mortality [adjusted HR 1.51 (0.78-2.93)] and death-censored graft loss in everolimus versus control [adjusted HR 1.00 (0.50-2.01)). For patients in the early initiation (de novo or

https://ift.tt/2z3c2QD

Comparison of Monitor-Image and Printout-Image Methods in Ki-67 Scoring of Gastroenteropancreatic Neuroendocrine Tumors

Abstract

Gastroenteropancreatic neuroendocrine tumors (GEP-NET) are classified according to tumor grade. Ki-67 and mitotic count are the two determinants of this classification. Therefore, Ki-67 scoring becomes very important in classifying the patients accurately. Eye-balling, counting of cells through the microscope, automated image analysis systems, and manual counting of printed image are the four major scoring methods in use. The aim of this study is to show the agreement between monitor-image method (MIM) and printout-image method (PIM) of Ki-67 scoring. In our study, 120 GEP-NETs from 85 patients diagnosed between January 2005 and July 2017 were evaluated. Thirty-seven cases with either polypectomy or resection material were selected. Seven different scoring methods using either a monitor-image or a printout-image were applied for Ki-67 scoring. They are as follows: whole-PIM, 1/9-PIM, whole-MIM, 1/4-MIM, 1/6-MIM, 1/9-MIM, and 1/12-MIM. In the comparison of Ki-67 scoring methods, intraclass correlation coefficients ranging from 0.951 to 0.999 were found. The Bland-Altman analysis showed near-perfect agreement between whole-MIM and whole-PIM as well as 1/9-MIM and 1/9-PIM. The level of agreements among the other methods were sufficient too, but there was a relative decrease in the level of agreement as the area of counting becomes smaller. The average application time decreased from 373.7 to 41.7 s gradually as the scoring area becomes smaller. Our study shows that there is a remarkable agreement between the MIM and PIM used in Ki-67 scoring.



https://ift.tt/2RgHbrh

Evolution of robotic systems for transoral head and neck surgery

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Howard Poon, Changsheng Li, Wenchao Gao, Hongliang Ren, Chwee Ming Lim

Abstract

Oropharyngeal tumor is traditionally resected from an open approach, often necessitating the need of a midline mandibulotomy in order to remove tumor safely with oncologic margins. The limitations imposed by a transoral route include poor visualization of the inferior extent of the oropharynx, rigid instrumentation, and inability to resect tumor that extends caudally into the supraglottis. While visualization with angled endoscopes, coupled with flexible laser development and microscopic magnification may overcome some of these limitations, this technique suffers from linear trajectory of the instruments which hampers expedient surgical resection in a 3-dimensional fashion. With development of the Da Vinci Surgical System, the safety and oncologic feasibility of removing oropharyngeal tumors are made possible because it provides a 3-dimensional magnification of the surgical field and wristed maneuverability of the surgical instruments which enable surgeons to operate around tight anatomical confines. Nevertheless, this first-generation robot is continually being modified with more flexibility and maneuverability through the development of robots like the FLEX Robotic System and more recently the Da Vinci Single Port System (SP). In this review, we will discuss the historic developments of robots for transoral applications, present the current approved robotic systems, and highlight the upcoming robots for transoral robotic surgery (TORS). Finally, we will also propose an ideal TORS surgical robot by highlighting the engineering technologies to accomplish these challenges.



https://ift.tt/2JilVyG

Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Shearwood McClelland, Janna Z. Andrews, Huma Chaudhry, Sewit Teckie, Anuj Goenka

Abstract

Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.



https://ift.tt/2Pjlqdl

The existence of early stage oral mucosal melanoma: A 10-year retrospective analysis of 170 patients in a single institute

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Yunteng Wu, Lizheng Wang, Xuhui Ma, Wei Guo, Guoxin Ren

Abstract
Background

Oral mucosal melanoma (OMM) is an aggressive tumor with an extremely low incidence, and the current TNM Staging System has classified all OMMs as high stage. However, controversy remains regarding the existence of early stage OMMs.

Patients and methods

The clinical and pathological features, treatments and outcomes of 170 OMM patients treated in a single institution from January 2007 to July 2017 were retrospectively analyzed. Multivariate analysis was performed to identify significant prognostic factors for overall survival (OS).

Results

Multivariate analysis identified positive cervical lymph nodes (p < 0.0001), nodular OMMs (p < 0.0001), ulceration (p = 0.002), and level III or level IV invasion (p < 0.0001) as independent poor prognostic factors for OS. Nodular OMM patients with a tumor size ≤1 cm had a better outcome than those with a tumor size >1 cm (p < 0.0001). Twenty-two patients with superficial invasion had a favorable survival without the need of adjuvant therapy (postoperative chemotherapy or radiotherapy), and the current TNM Staging System was not suitable for those patients. Patients with deep invasion were more likely to suffer from recurrence and distant metastasis.

Conclusions

Tumor size ≤1 cm and OMM in situ, although extremely rare, do exist. It is advisable for AJCC to consider tumor size ≤1 cm and OMM in situ as the early stage of OMM when updating the new Oral Melanoma Staging System.



https://ift.tt/2JgNOXW

Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up

Publication date: Available online 25 October 2018

Source: Allergologia et Immunopathologia

Author(s): M. Alves-Correia, Â. Gaspar, L.-M. Borrego, J. Azevedo, C. Martins, M. Morais-Almeida

Abstract
Introduction

Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary.

Objective

We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA.

Materials and methods

The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells).

Results

The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200 mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127−/dim regulatory T cells were increased after OIT.

Conclusions

OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.



https://ift.tt/2AstSi7

Editorial Board

Publication date: November 2018

Source: Autoimmunity Reviews, Volume 17, Issue 11

Author(s):



https://ift.tt/2CD4tUp

Editorial Board

Publication date: November 2018

Source: Autoimmunity Reviews, Volume 17, Issue 11

Author(s):



https://ift.tt/2CD4tUp

CD84 cell surface signaling molecule: An emerging biomarker and target for cancer and autoimmune disorders

Publication date: Available online 26 October 2018

Source: Clinical Immunology

Author(s): Marta Cuenca, Jordi Sintes, Árpád Lányi, Pablo Engel

Abstract

CD84 (SLAMF5) is a member of the SLAM family of cell-surface immunoreceptors. Broadly expressed on most immune cell subsets, CD84 functions as a homophilic adhesion molecule, whose signaling can activate or inhibit leukocyte function depending on the cell type and its stage of activation or differentiation. CD84-mediated signaling regulates diverse immunological processes, including T cell cytokine secretion, natural killer cell cytotoxicity, monocyte activation, autophagy, cognate T:B interactions, and B cell tolerance at the germinal center checkpoint. Recently, alterations in CD84 have been related to autoimmune and lymphoproliferative disorders. Specific allelic variations in CD84 are associated with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. In chronic lymphocytic leukemia, CD84 mediates intrinsic and stroma-induced survival of malignant cells. In this review, we describe our current understanding of the structure and function of CD84 and its potential role as a therapeutic target and biomarker in inflammatory autoimmune disorders and cancer.



https://ift.tt/2Sicbsx

SLAMF1/CD150 in hematologic malignancies: Silent marker or active player?

Publication date: Available online 25 October 2018

Source: Clinical Immunology

Author(s): Inna Gordiienko, Larysa Shlapatska, Larysa Kovalevska, Svetlana P. Sidorenko

Abstract

SLAMF1/CD150 receptor is a founder of signaling lymphocyte activation molecule (SLAM) family of cell-surface receptors. It is widely expressed on cells within hematopoietic system. In hematologic malignancies CD150 cell surface expression is restricted to cutaneous T-cell lymphomas, few types of B-cell non-Hodgkin's lymphoma, near half of cases of chronic lymphocytic leukemia, Hodgkin's lymphoma, and multiple myeloma. Differential expression among various types of hematological malignancies allows considering CD150 as diagnostical and potential prognostic marker. Moreover, CD150 may be a target for antibody-based or measles virus oncolytic therapy. Due to CD150 signaling properties it is involved in regulation of malignant cell fate decision and tumor microenvironment in Hodgkin's lymphoma and chronic lymphocytic leukemia. This review summarizes evidence for the important role of CD150 in pathogenesis of hematologic malignancies.



https://ift.tt/2z2V459

Pheochromocytoma in Congenital Cyanotic Heart Disease.

Pheochromocytoma in Congenital Cyanotic Heart Disease.

Case Rep Endocrinol. 2018;2018:2091257

Authors: Aresta C, Butera G, Tufano A, Grassi G, Luzi L, Benedini S

Abstract
Studies on genome-wide transcription patterns have shown that many genetic alterations implicated in pheochromocytoma-paraganglioma (P-PGL) syndromes cluster in a common cellular pathway leading to aberrant activation of molecular response to hypoxia in normoxic conditions (the pseudohypoxia hypothesis). Several cases of P-PGL have been reported in patients with cyanotic congenital heart disease (CCHD). Patients affected with CCHD have an increased likelihood of P-PGL compared to those affected with noncyanotic congenital heart disease. One widely supported hypothesis is that chronic hypoxia represents the determining factor supporting this increased risk. We report the case of a 23-year-old woman affected with congenital tricuspid atresia surgically by the Fontan procedure. The patient was admitted to hospital with hypertensive crisis and dyspnea. Chest computed tomography revealed, incidentally, a 6-cm mass in the left adrenal lodge. Increased levels of noradrenaline (NA) and its metabolites were detected (plasma NA 5003.7 pg/ml, n.v.<480; urinary NA 1059.5 µg/24 h, n.v.<85.5; urinary metanephrine 489 µg/24 h, n.v.<320). The patient did not report any additional symptom related to catecholamine excess. The left adrenal tumor showed abnormal accumulation when 131I-metaiodobenzylguanidine scintigraphy was performed. A 18F-fluorodeoxyglucose positron emission tomography showed no significant metabolic activity in the left adrenal gland but intense uptake in the supra- and subdiaphragmatic brown adipose tissue, probably due to noradrenergic-stimulated glucose uptake. The patient underwent left open adrenalectomy after preconditioning with α- and β-blockers and histopathological examination confirmed the diagnosis of pheochromocytoma (Ki-67<5%). Screening for germline mutations did not show any genes mutation (investigated mutations: RET, TMEM127, MAX, SDHD, SDHC, SDHB, SDHAF2, SDHA, and VHL). Clinicians should consider P-PGL when an unexplained clinical deterioration occurs in CCHD patients, even in the absence of typical paroxysmal symptoms.

PMID: 30356369 [PubMed]



https://ift.tt/2O7QqYU

Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism.

Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism.

Case Rep Endocrinol. 2018;2018:8270936

Authors: Sandhu S, Desai A, Batra M, Girdhar R, Chatterjee K, Kemp EH, Makdissi A, Chaudhuri A

Abstract
We report the case of a 54-year-old Caucasian female who presented with a two-year history of persistent hypocalcemia requiring multiple hospitalizations. Her medical history was significant for HIV diagnosed four years ago. She denied any history of prior neck surgery or radiation. Her vital signs were stable with an unremarkable physical exam. Pertinent medications included calcium carbonate, vitamin D3, calcitriol, efavirenz, emtricitabine, tenofovir disoproxil, hydrochlorothiazide, and inhaled budesonide/formoterol. Laboratory testing showed total calcium of 5.7 mg/dL (normal range: 8.4-10.2 mg/dL), ionized calcium of 2.7 mg/dL (normal range: 4.5-5.5 mg/dL), serum phosphate of 6.3 mg/dL (normal range: 2.7-4.5 mg/dL), and intact PTH of 7.6 pg/mL (normal range: 15-65 pg/mL). She was diagnosed with primary hypoparathyroidism. Anti-calcium-sensing receptor antibodies and NALP5 antibodies were tested and found to be negative. During subsequent clinic visits, doses of calcium supplements and calcitriol were titrated. Last corrected serum calcium level was 9.18 mg/dL. She was subsequently lost to follow-up. This case gives insight into severe symptomatic hypocalcemia from primary hypoparathyroidism attributed to HIV infection. We suggest that calcium levels should be closely monitored in patients with HIV infection.

PMID: 30356346 [PubMed]



https://ift.tt/2OP8uMB

Early assessment of acute kidney injury using targeted field of view diffusion-weighted imaging: An in vivo study

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): Hanjing Kong, Chengyan Wang, Fei Gao, Xiaodong Zhang, Min Yang, Li Yang, Xiaoying Wang, Jue Zhang

Abstract

Acute kidney injury (AKI) is a common complication in various clinical settings. In recent years, AKI diagnostics have been investigated intensively showing the emerging need for early characterization of this disease. To verify whether targeted field-of-view diffusion-weighted imaging (tFOV-DWI) is feasible to significantly improve the performance of traditional full field-of-view diffusion-weighted imaging (fFOV-DWI) in the early assessment of AKI. 14 rabbits with unilateral AKI were induced by injection of microspheres under the guidance of digital subtraction angiography (DSA). All rabbits underwent tFOV-DWI and fFOV-DWI immediately after the surgery. Artifacts, distortion and lesion identification were graded by two experienced radiologists, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Apparent diffusion coefficient (ADC) maps were then derived. Blood samples were collected pre- and post-surgery and serum creatinine weres measured. Renal specimen and biopsy were performed as the reference standard. Student t-test was used to ascertain statistical significance between the above parameters for tFOV-DWI and fFOV-DWI. The interobserver agreement and ADC measurements agreement were assessed. A higher percentage of renal lesions (17 out of 19) were detected in tFOV-DWI compared with fFOV-DWI (14 out of 19). Significant differences were observed in ADC value for both techniques between the lesion regions and normal tissues (p < 0.001). Histological findings were inversely correlated with ADC values of tFOV-DWI (r = −0.97, P < 0.001 for cortex; r = −0.98, P < 0.001 for medulla) and fFOV-DWI sequences (r = −0.95, P < 0.001 for cortex; r = −0.98, P < 0.001 for medulla). Those tFOV-DW images rated by the radiologists exhibit superior performance in terms of all assessed measures (P < 0.05), and interobserver agreement was excellent (ICC, 0.78 to 0.92). Besides, the ADC values derived from tFOV-DWI had a satisfactory agreement with those estimated by fFOV-DWI. The animal study demonstrates that the tFOV-DWI strategy provided visually better image quality and lesion depiction than conventional fFOV-DWI for early assessment of AKI.



https://ift.tt/2O5MGal

A Fully Automated Method for Accurate Measurement of Geometrical Distortion in Magnetic Resonance Imaging of a 3D-Lattice Phantom

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): S. Mangione, R. Acquaviva, G. Garbo

Abstract

This paper describes an automated method for extracting the apparent positions of fiducial points from 2D or 3D images of a phantom. We consider a 3D-lattice phantom for two main reasons: first, ease of manufacture and isotropy of its structure with respect to coordinate projections; second, a connected structure allowing to uniquely assess the adjacency relationship between fiducial points even if geometric distortions arising from main magnet inhomogeneity and gradient fields non-linearity is severe as observed in open-bore systems.

In order to validate our proposed method and compare different choices for the parameters of our phantom (i.e. number and distance between grids and thickness of its branches) we developed in-house a software for simulating 2D or 3D volume images of the phantom, using customizable MRI sequence parameters and Spherical Harmonic Coefficients for the fields.

We deem worthy of note that using simulated images is the only way to evaluate the estimated position error, since it allows to compare the estimates to their theoretical counterparts. Furthermore, the use of simulated images allows to evaluate the robustness of the method with respect to image quality in terms of Signal-to-Noise Ratios and geometric distortion, and allows to evaluate different phantom geometries without having to manufacture them. The proposed method can be easily extended to phantoms having an arbitrary overall shape, as long as it is a fully connected structure. Specifically, it is easy to design a phantom with fiducial points laying outside of the homogeneity sphere, so that indirect measurement of the fields becomes possible, for example by using the recent method proposed by Acquaviva et al.

To the best of our knowledge, the proposed method outperforms other state-of-the-art methods, with an average positioning offset of 0.052 mm (with a 0.99 quantile of 0.12 mm) when working on images featuring a differential Signal-to-Noise Ratio within Region-of-Interest (ROI) equal to 105 (20.2 dB) and a ROI-to-background SNR of 20 dB. Estimating the positions of 6859 fiducial points in a volume, our highest density case, was carried out in less than 30 minutes on a desktop personal computer.



https://ift.tt/2OSLLzq

High temperature/pressure MAS-NMR for the study of dynamic processes in mixed phase systems

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): Ali Chamas, Long Qi, Hardeep S. Mehta, Jesse A. Sears, Susannah L. Scott, Eric D. Walter, David W. Hoyt

Abstract

A new MAS-NMR rotor (the WHiMS rotor) has been developed which can reach pressures of 400 bar at 20 °C or 225 bar at 250 °C. These rotors are ideal for mixed phase systems such as a reaction using a solid catalyst with a liquid/supercritical solvent topped with high pressure gas in the head space. After solid and liquid portions of the sample are loaded, the rotor is capped with an o-ring equipped polymer bushing that snaps into a mating groove in the rotor. The bushings incorporate a check valve into the sealing mechanism which allows for pressurization without mechanical manipulation – they will allow gas to flow in but not out. This WHiMS rotor design has enabled experiments on a wide variety of biotic and abiotic mixed-phase systems. Geochemical systems have also been studied, for example, adsorption and confinement studies of supercritical methane/CO2 in clays and other minerals which display pressure dependent 13C chemical shifts. Example data from other mixed-phase chemical and microbial systems are reported. These include monitoring metabolite conversion of extremophilic bacteria found in subsurface systems at elevated pressures and real-time operando reactions in catalysis systems - with liquid-quality resolution for 1H and 13C NMR spectra.



https://ift.tt/2O7QiIU

Human papillomavirus types causing recurrent respiratory papillomatosis in Zimbabwe

Publication date: Available online 26 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Naboth Matinhira, Nyarai D. Soko, Tsitsi Bandason, Ramon G. Jenson, Titus Dzongodza, Christian von Buchwald, Clemence Chidziva

Abstract
Objective

Recurrent respiratory papillomatosis (RRP) caused by human papillomavirus (HPV) is preventable through vaccination. This study was motivated by the recent thrust of the Zimbabwean government to reduce incidence of HPV related cervical cancer in Zimbabwe through vaccination against HPV. We therefore set out to type HPV genotypes causing RRP in Zimbabwe. We also describe for the first time, the demographics of Zimbabwean RRP patients, the characteristics of patients with different HPV types and possible risk factors of HPV infection in our setting.

Methods

We conducted a prospective, hospital based study were patients were recruited from two national otorhinolaryngology hospitals in Zimbabwe. All patients diagnosed with RRP during a twenty four month period were included in the study. A questionnaire was administered per patient to collect both demographic and clinical variables. HPV DNA was extracted from formalin fixed paraffin embedded laryngeal tissue. The extracted HPV DNA was amplified using polymerase chain reaction and next generation sequencing was used to genotype the HPV types.

Results

A total of 52 patients all aged 14 years and under were recruited into the study. Only Juvenile onset RRP cases were observed over the two year period and 64% of the patients were HPV positive. HPV types 6 and 11 were the dominant types observed constituting 85% of all HPV types. The remaining 15% constituted of HPV 16 and HPV 18. 27% of the patients had coinfection with at least two different HPV types. There were no statistically significant differences between the characteristics of HPV positive and HPV negative patients. No statistically significant risk factors were observed.

Conclusion

HPV types 6 and 11 were the predominant genotypes causing RRP in Zimbabwe. Thus the use of quadrivalent or even nonavalent HPV vaccines may play an important role in the prevention and management of RRP in Zimbabwe.



https://ift.tt/2Q2BcXa

Is chemotherapy the best option for chronic lymphocytic leukemia associated Wells’ syndrome? Reply to “Case of Wells’ syndrome: A rare association with the clinical course of chronic lymphocytic leukemia”

The Journal of Dermatology, EarlyView.


https://ift.tt/2D5dtmc

Itching, chloroquine, and malaria: a review of recent molecular and neuroscience advances and their contribution to mechanistic understanding and therapeutics of chronic non‐histaminergic pruritus

International Journal of Dermatology, EarlyView.


https://ift.tt/2PYIM4L

EANM Springer Prizes awarded at EANM’18 in Düsseldorf



https://ift.tt/2qdtYnF

Correction to: A rare presentation of skull-base osteomyelitis with neurovascular sheath extension following external otitis resolved by PET/MRI

The figure in the original published version of this article was omitted.



https://ift.tt/2CIi1xF

The renaissance of functional 18 F-FDG PET brain activation imaging



https://ift.tt/2qaNdhB

U. Fischer, F. Baum, S. Luftner-Nagel. Breast Cancer: Diagnostic Imaging and Therapeutic Guidance



https://ift.tt/2CG8Uxu

Correlation of dose with toxicity and tumour response to 90 Y- and 177 Lu-PRRT provides the basis for optimization through individualized treatment planning

Abstract

Purpose

Peptide receptor radionuclide therapy (PRRT) with 90Y-labelled and 177Lu-labelled peptides is an effective strategy for the treatment of metastatic/nonresectable neuroendocrine tumours (NETs). Dosimetry provides important information useful for optimizing PRRT with individualized regimens to reduce toxicity and increase tumour responses. However, this strategy is not applied in routine clinical practice, despite the fact that several dosimetric studies have demonstrated significant dose–effect correlations for normal organ toxicity and tumour response that can better guide therapy planning. The present study reviews the key relationships and the radiobiological models available in the literature with the aim of providing evidence that optimization of PRRT is feasible through the implementation of dosimetry.

Methods

The MEDLINE database was searched combining specific keywords. Original studies published in the English language reporting dose–effect outcomes in patients treated with PRRT were chosen.

Results

Nine of 126 studies were selected from PubMed, and a further five were added manually, reporting on 590 patients. The studies were analysed and are discussed in terms of weak and strong elements of correlations.

Conclusion

Several studies provided evidence of clinical benefit from the implementation of dosimetry in PRRT, indicating the potential contribution of this approach to reducing severe toxicity and/or reducing undertreatment that commonly occurs. Prospective trials, possibly multicentre, with larger numbers of patients undergoing quantitative dosimetry and with standardized methodologies should be carried out to definitively provide robust predictive paradigms to establish effective tailored PRRT.



https://ift.tt/2qajJ3o

Lale Umutlu, Ken Herrmann (Eds.). PET/MR Imaging: Current and Emerging Applications



https://ift.tt/2CGBIWH

The influence of PSA flare in mCRPC patients treated with alpha-emitting radiopharmaceuticals



https://ift.tt/2qdBM8W

Correction to: a risk stratification model for nodal peripheral T-cell lymphomas based on the NCCN-IPI and posttreatment Deauville score

Unfortunately, the original version of this article contained several errors made during final step of article production. In the results section (fourth sentence) of the Abstract, the incomplete sentence,", 31.4% in high-risk group and 4.7% in treatment failure group.



https://ift.tt/2CEOSUg

Clinical translation of [ 18 F]ICMT-11 for measuring chemotherapy-induced caspase 3/7 activation in breast and lung cancer

Abstract

Background

Effective anticancer therapy is thought to involve induction of tumour cell death through apoptosis and/or necrosis. [18F]ICMT-11, an isatin sulfonamide caspase-3/7-specific radiotracer, has been developed for PET imaging and shown to have favourable dosimetry, safety, and biodistribution. We report the translation of [18F]ICMT-11 PET to measure chemotherapy-induced caspase-3/7 activation in breast and lung cancer patients receiving first-line therapy.

Results

Breast tumour SUVmax of [18F]ICMT-11 was low at baseline and unchanged following therapy. Measurement of M30/M60 cytokeratin-18 cleavage products showed that therapy was predominantly not apoptosis in nature. While increases in caspase-3 staining on breast histology were seen, post-treatment caspase-3 positivity values were only approximately 1%; this low level of caspase-3 could have limited sensitive detection by [18F]ICMT-11-PET. Fourteen out of 15 breast cancer patients responded to first–line chemotherapy (complete or partial response); one patient had stable disease. Four patients showed increases in regions of high tumour [18F]ICMT-11 intensity on voxel-wise analysis of tumour data (classed as PADS); response was not exclusive to patients with this phenotype. In patients with lung cancer, multi-parametric [18F]ICMT-11 PET and MRI (diffusion-weighted- and dynamic contrast enhanced-MRI) showed that PET changes were concordant with cell death in the absence of significant perfusion changes.

Conclusion

This study highlights the potential use of [18F]ICMT-11 PET as a promising candidate for non-invasive imaging of caspase3/7 activation, and the difficulties encountered in assessing early-treatment responses. We summarize that tumour response could occur in the absence of predominant chemotherapy-induced caspase-3/7 activation measured non-invasively across entire tumour lesions in patients with breast and lung cancer.



https://ift.tt/2EIVun2

Nuclear medicine RIP (radiation induced phobia); improving the image



https://ift.tt/2qdtXA7

Radiomics analysis of pre-treatment [ 18 F]FDG PET/CT for patients with metastatic colorectal cancer undergoing palliative systemic treatment

Abstract

Background

The aim of this study was to assess radiomics features on pre-treatment [18F]FDG positron emission tomography (PET) as potential biomarkers for response and survival in patients with metastatic colorectal cancer (mCRC).

Methods

Patients with mCRC underwent [18F]FDG PET/computed tomography (CT) prior to first- or third-line palliative systemic treatment. Tumour lesions were semiautomatically delineated and standard uptake value (SUV), metabolically active tumour volume (MATV), total lesion glycolysis (TLG), entropy, area under the curve of the cumulative SUV-volume histogram (AUC-CSH), compactness and sphericity were obtained.

Results

Lesions of 47 patients receiving third-line systemic treatment had higher SUVmax, SUVpeak, SUVmean, MATV and TLG, and lower AUC-CSH, compactness and sphericity compared to 52 patients receiving first-line systemic treatment. Therefore, first- and third-line groups were evaluated separately. In the first-line group, anatomical changes on CT correlated negatively with TLG (ρ = 0.31) and MATV (ρ = 0.36), and positively with compactness (ρ = −0.27) and sphericity (ρ = −0.27). Patients without benefit had higher mean entropy (p = 0.021). Progression-free survival (PFS) and overall survival (OS) were worse with a decreased mean AUC [hazard ratio (HR) 0.86, HR 0.77] and increase in mean MATV (HR 1.15, HR 1.22), sum MATV (HR 1.14, HR 1.19), mean TLG (HR 1.16, HR 1.22) and sum TLG (HT1.12, HR1.18). In the third-line group, AUC-CSH correlated negatively with anatomical change (ρ = 0.21). PFS and OS were worse with an increased mean MATV (HR 1.27, HR 1.68), sum MATV (HR 1.35, HR 2.04), mean TLG (HR 1.29, HR 1.52) and sum TLG (HT 1.27, HR 1.80). SUVmax and SUVpeak negatively correlated with OS (HR 1.19, HR 1.21). Cluster analysis of the 10 radiomics features demonstrated no complementary value in identifying aggressively growing lesions or patients with impaired survival.

Conclusion

We demonstrated an association between improved clinical outcome and pre-treatment low tumour volume and heterogeneity as well as high sphericity on [18F]FDG PET. Future PET imaging research should include radiomics features that incorporate tumour volume and heterogeneity when correlating PET data with clinical outcome.



https://ift.tt/2CGBIGb

Prostate-specific antigen flare induced by 223 RaCl 2 in patients with metastatic castration-resistant prostate cancer

Abstract

Purpose

Prostate-specific antigen (PSA) flare is a well-known phenomenon in patients with prostate cancer, but its impact during radium-223 dichloride (223RaCl2) therapy is still unclear. This radioisotope has shown to improve overall survival in metastatic castration-resistant prostate cancer (mCRPC). We sought to evaluate the impact of PSA flare on survival and its relation with metabolic parameters on 18F-labeled sodium fluoride PET/CT.

Methods

We conducted a retrospective study of 168 patients with mCRPC (median age 69; median PSA 29.7) receiving 223RaCl2. Overall survival (OS) and progression-free survival (PFS), estimated by the Kaplan–Meier method and compared using a log-rank test, were evaluated for patient groups corresponding to different definitions of PSA flare. Metabolic 18F-fluoride PET/CT data were analyzed as well.

Results

Immediate PSA decline was observed in 49 patients (29.2%), whereas no PSA response was observed in 59 patients (35.1%). PSA flare (defined as rise after the first cycle followed by decrease below the baseline) was observed in 20 patients (11.9%) and PSA flare followed by a decrease from peak but not below baseline was observed in 40 (23.8%). The first flare subgroup had a median PFS and OS of 20.8 and 23.9 months, respectively. These outcomes were not significantly different from patients with immediate PSA decrease, but were significantly better than in patients with persistent PSA elevation (3.1 months for PFS and 11.5 months for OS, p < 0.001). Moreover, the PSA flare group showed an alkaline phosphatase (ALP) decrease significantly greater than non-responders (p = 0.003). Metabolic 18F-fluoride PET/CT data were available in 35 patients at baseline and during 233RaCl2 therapy. The tumor burden reduction, expressed by ΔTLF10 and ΔFTV10, was more evident within PSA flare group below baseline than non-responders (p = 0.005 and 0.001, respectively).

Conclusions

This report suggests that a flare does not necessarily indicate lack of response to 223RaCl2 therapy.



https://ift.tt/2qfbnaJ

30 Years of Neuroendocrinology: technological advances pave the way for molecular discovery

Journal of Neuroendocrinology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2CH2sGH

Exercise-Induced Anaphylaxis: Literature Review and Recent Updates

Abstract

Purpose of Review

This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.

Recent Findings

Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.

Summary

EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.



https://ift.tt/2ONge1L

Potential new targets for drug development in severe asthma

In recent years there has been increasing recognition of varying asthma phenotypes that impact treatment response. This has led to the development of biological therapies targeting specific immune cells and cy...

https://ift.tt/2AsoyuX

Exercise-Induced Anaphylaxis: Literature Review and Recent Updates

Abstract

Purpose of Review

This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.

Recent Findings

Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.

Summary

EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.



https://ift.tt/2ONge1L

Can the classification of low-grade endometrial stromal tumors still be improved?



https://ift.tt/2PpTvZ5

Epidemiologic and genetic data suggest the presence of an endemic form of pemphigus foliaceus in Gran Canaria, Spain

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2CJasan

Mohs Micrographic Surgery for the Treatment of Cutaneous Metastases in a Patient With Papillary Thyroid Carcinoma

imageNo abstract available

https://ift.tt/2SfLbJY

Risk Factors for Basal Cell Carcinoma in Men Younger Than 40 Years: A Case–Control Study

imageBACKGROUND Basal cell carcinoma (BCC) is the most common malignancy in the United States and is more prevalent in older populations. OBJECTIVE The aim of this study was to investigate BCC risk factors in male patients younger than 40 years. MATERIALS AND METHODS A consecutive series of male patients with pathology-proven BCC and younger than 40 years at time of diagnosis were retrospectively identified along with matched controls. Phone interviews were conducted using a structured questionnaire, and differences between patients with and without BCC were investigated. RESULTS A total of 50 patients with BCC and 27 controls were included in this study. Compared with controls, patients with BCC worked outdoor jobs for longer lengths of time (43.2 vs 15.6 months; p = .04), were more likely to have a family history of skin cancer (66% vs 44%; p = .02), and were more likely to use sunscreen heavily after biopsy (p = .02). Patients with multiple BCCs (n = 20) were more likely to have a history of substantial recreational sun exposure (p = .01) than patients with solitary lesions (n = 30). CONCLUSION The authors conclude that outdoor sun exposure in patients with underlying genetic susceptibility is the most likely mechanism of BCC formation in young male patients.

https://ift.tt/2z7jSJ2

Reduction of Submental Fat Continues Beyond 28 Days After ATX-101 Treatment: Results From a Post hoc Analysis

imageNo abstract available

https://ift.tt/2SkBsSU

Commentary on Risk Factors for Basal Cell Carcinoma in Men Younger Than 40 Years of Age

No abstract available

https://ift.tt/2z1CqKQ

Hypertrophic Lichen Planus and Well-Differentiated Squamous Cell Carcinoma: A Diagnostic Conundrum

imageNo abstract available

https://ift.tt/2SkBieg

Patients' Body Image Improves After Mohs Micrographic Surgery for Nonmelanoma Head and Neck Skin Cancer

imageBACKGROUND Most skin cancers occur on the head and neck, areas of the body that are significant to an individual's body image (BI) perception. Poor BI is a robust risk factor for depression and decreased quality of life. Thus, patients with nonmelanoma head and neck skin cancer (NMHNSC) may be more vulnerable to BI disturbance and the negative sequelae of poor BI. OBJECTIVE Describe the nature of BI concerns in patients diagnosed with NMHNSC and assess how BI changes with treatment. METHODS AND MATERIALS Patients undergoing Mohs micrographic surgery (MMS) for NMHNSC completed assessments of BI and well-being before (N = 239) and 6 months after (N = 80) treatment with MMS. Demographic and tumor data were gathered through retrospective chart review. RESULTS Body image improved significantly 6 months after MMS, and the magnitude of this change was large (η2 = 0.18). Repair length (length of final scar irrespective of repair type) >4 cm predicted poorer BI at 6-month follow-up. CONCLUSION Patients' BI improves after treatment with MMS for NMHNSC.

https://ift.tt/2z7jF8I

Commentary on a Retrospective Case-Matched Cost Comparison of Surgical Treatment of Melanoma and Nonmelanoma Skin Cancer in the Outpatient Versus Operating Room Setting

imageNo abstract available

https://ift.tt/2SkBaeM

Commentary on Patients' Body Image Improves After Mohs Micrographic Surgery for Nonmelanoma Head and Neck Skin Cancer

No abstract available

https://ift.tt/2z2rBrN

Pseudohalo Basal Cell Carcinoma

imageNo abstract available

https://ift.tt/2SkB32Q

Hidradenitis Suppurativa–Like Condition Occurring After Microwave Sweat Gland Ablation

imageNo abstract available

https://ift.tt/2Sl4RvW

Do Patterns of Reconstruction Choices After Mohs Surgery Vary by Specialty? A Pilot Study of Mohs Surgeons and Facial Plastic Surgeons

imageBACKGROUND Differences in approach to repair a specified defect after Mohs micrographic surgery (MMS) between specialties have not been previously examined. OBJECTIVE To assess the difference in frequency of which reconstruction repairs are selected after MMS, among Mohs surgeons and facial plastic surgeons (FPS), and evaluate whether the level of satisfaction with the final repair outcome differed between specialties. MATERIALS AND METHODS The study was approved by the Saint Louis University Institutional Review Board. A link to the survey was distributed to members of American College of Mohs Surgery (ACMS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), between January and May 2016. RESULTS The reconstructive procedure selected most often ("top choice") was not significantly different between Mohs surgeons and FPS for the majority of the images. There was no material difference in how dermatologists and FPS rate the aesthetic outcome of the 3 presented closure types, with the exception of one closure type—nose with graft. CONCLUSION Mohs surgeons were found to more likely cluster around a single preference for their reconstruction technique compared with FPS, in which a higher percentage of surgeons also selected other options.

https://ift.tt/2z4MrHf

Comprehensive Review of Tissue Adhesives

imageBACKGROUND Cyanoacrylates, also known as tissue adhesives or skin glues, are commonly used as sealants for lacerations and incisions and have found utility in excisional and cosmetic surgeries in both outpatient and operating room settings. OBJECTIVE To review the surgical literature on the utilities, advantages, disadvantages, and special uses of cyanoacrylates applicable to dermatology. MATERIALS AND METHODS PubMed was reviewed for relevant articles related to cyanoacrylates and their use in skin closures. Articles unrelated to cutaneous closures were excluded. RESULTS Tissue adhesives polymerize to a water resistant, pliable film after application to approximated wound edges and have antibacterial properties. Adhesives slowly slough off as the wound heals, typically after 5 days. Compared with 5-0 nonabsorbable suture, adhesives provide similar tensile strength and similar patient and surgeon satisfaction. Although slightly more expensive than sutures, tissue adhesives obviate the need for wound dressings and suture removal. They do not perform as well as sutures for wounds under higher tension or in the setting of moisture and inadequate hemostasis. CONCLUSION Cyanoacrylates serve as a safe and effective suture alternative in appropriate dermatologic surgeries and procedures.

https://ift.tt/2Shuazj

Sustained Benefit After Treatment of Acne Vulgaris Using Only a Novel Combination of Long-Pulsed and Q-Switched 1064-nm Nd: YAG Lasers

imageBACKGROUND Acne vulgaris remains a challenging disease to treat in many patients. Traditional therapies may have limited successes with potential side effects. Laser and light energy devices may offer a desirable alternative. OBJECTIVE To evaluate the effectiveness and safety in using a combination laser approach with both long-pulsed (LP) and Q-switched (QS) Nd:YAG lasers in the treatment of active acne. METHODS Twenty patients with moderate to severe inflammatory acne were treated with LP YAG laser followed immediately with QS YAG laser. Patients received at least 8 treatments. Follow-up evaluation occurred at a minimum of 12 months. Pre- and post-treatment photographs were graded by blinded physicians. All topical acne medications and oral antibiotics were discontinued throughout the therapy and follow-up period. RESULTS There was a 81% reduction in acne lesions, with 60% of patients having 90% or greater reduction. Overall appearance was graded at 84% improvement at follow-up. Follow-up occurred at a mean of 22.7 months after completion of therapy. Aside from transient erythema, there were no other adverse effects. CONCLUSION Active acne can be treated successfully with a combination of LP and QS YAG lasers with patients remaining off acne medications throughout laser therapy and the follow-up period.

https://ift.tt/2z4MrqJ

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