Longitudinal Study of Pediatric Urticaria Pigmentosa

Abstract

Background/Objectives

Urticaria pigmentosa (UP) is the most common form of mastocytosis in children and is associated with systemic signs, symptoms, and triggers. To our knowledge, the effect of UP on children's quality of life has not been studied. The objective of the current study was to characterize the natural history, triggers, and complications of pediatric UP, identify prognostic indicators, and determine its effect on quality of life.

Methods

Between 2002 and 2007, children with three or more mastocytomas diagnosed by a pediatric dermatologist were recruited during visits at the Children's Hospital of Wisconsin Dermatology Clinic (Milwaukee, WI). Research visits were conducted every 3 years and telephone interviews yearly. The Children's Dermatology Life Quality Index was administered to subjects 4 years of age and older at enrollment. Laboratory test results were collected for subjects younger than 4 years at enrollment. Subjects were followed until UP resolution or study end in August 2015.

Results

The final cohort size was 43 subjects followed for a median of 8.1 years. Twenty-six subjects were followed through study completion. At age 12 years, 6 patients had disease resolution and 14 remained active. Patients who had disease resolution before age 12 years were more likely to be male and had fewer years of age and smaller lesions, fewer affected areas, and earlier onset. Common medications and anesthetics resulted in no serious reactions. Hymenoptera stings occurred in 51%, with no reports of anaphylaxis. No patient reported a severe effect on quality of life, with most indicating mild to no effect.

Conclusion

Severe complications are not common with historically identified triggers. Disease does not resolve before adolescence in most children. UP has a minimal effect on quality of life for most children.

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Use of Phototherapy in Children

Abstract

Background

Phototherapy is a well-recognized treatment in adults and children. Previous articles have reported success in treating recalcitrant skin disorders such as atopic dermatitis (AD), psoriasis, pityriasis lichenoides chronica, and vitiligo in children.

Methods

This was a retrospective review over an 18-month period from June 2012 to December 2013 of all children receiving phototherapy in a tertiary pediatric dermatology center.

Results

Seventy-five patients 3 to 17 years of age (mean 10.6 years; 35 male, 40 female) were included. Forty-eight (64%) patients had AD and 21 (28%) had psoriasis. Seventy received narrowband ultraviolet B (NBUVB) treatment and five received hand and foot psoralen and ultraviolet A (PUVA) treatment. All patients with AD were treated with NBUVB and four (8.3%) were also treated with hand PUVA. After phototherapy, 76% had documented clear to almost clear skin. At the 12-month follow-up, 52% of the patients with AD remained clear. All 21 patients with psoriasis underwent NBUVB phototherapy. The clearance rate after phototherapy was 86%. At the 12-month follow-up, 43% of the patients with psoriasis remained clear.

Conclusion

Phototherapy can reduce disease burden in individuals with severe AD and psoriasis and should be considered as a second-line therapy if standard topical regimens are unsuccessful.

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An MR-compatible gyroscope-based arm movement tracking system

Publication date: Available online 29 January 2017
Source:Journal of Neuroscience Methods
Author(s): S.Iman Shirinbayan, Jochem W. Rieger
BackgroundFunctional magnetic resonance imaging is well suited to link neural population activation with movement parameters of complex natural arm movements. However, currently existing MR-compatible arm tracking devices are not constructed to measure arm joint movement parameters of unrestricted movements. Therefore, to date most research focuses on simple arm movements or includes very little knowledge about the actual movement kinematics.New methodWe developed a low cost gyroscope-based arm movement tracking system (GAMTS) that features MR-compatibility. The system consists of dual-axis analogue gyroscopes that measure rotations of upper and lower arm joints. After MR artifact reduction, the rotation angles of the individual arm joints are calculated and used to animate a realistic arm model that is implemented in the OpenSim platform. The OpenSim platform can then provide the kinematics of any point on the arm model.ResultsIn order to demonstrate the capabilities of the system, we first assessed the quality of reconstructed wrist movements in a low-noise environment where typical MR-related problems are absent and finally, we validated the reconstruction in the MR environment.Comparison with existing methodsThe system provides the kinematics of the whole arm when natural unrestricted arm movements are performed inside the MR-scanner.ConclusionThe GAMTS is reliably capable of reconstructing the kinematics of trajectories and the reconstruction error is small in comparison with the movement induced variation of speed, displacement, and rotation. Moreover, the system can be used to probe brain areas for their correlation with movement kinematics.



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The Plastic Surgery Compass: Navigating the Reconstructive Ladder in the Personalized Health Care Era

Summary: The reconstructive ladder and the reconstructive elevator have withstood the test of time as didactic tools for resident education. Over time, many alternative models have been suggested to incorporate the technological advances in plastic surgery, but none of them have focused on the patient. Changes in practice and the trend toward personalized health care demand a 360-degree evaluation and solution of surgical problems incorporating patient-specific characteristics. We, therefore, suggest the concept of the plastic surgery compass to navigate the ladder.

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Prospects for applications of stem cells in vascular surgery

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Frequency and factors associated with high Ankle-Brachial Index in diabetic patients

Resumo Contexto O índice tornozelo-braquial (ITB) é um exame de rastreamento da doença arterial obstrutiva periférica, sendo também utilizado para avaliar o risco cardiovascular. Em diabéticos, a interpretação do exame é difícil pela possibilidade de índice aberrante devido à calcificação da camada média arterial. Objetivo Encontrar a frequência de ITB aberrante em diabéticos e verificar sua associação com variáveis sociodemográficas. Métodos Estudo descritivo com entrevista e aferição de ITB de 309 pacientes diabéticos tipo 2, acompanhados no centro de referência Centro de Diabetes e Endocrinologia da Bahia (CEDEBA), Salvador, BA, Brasil. Foi estudada a frequência e a relação entre o ITB aberrante e variáveis sociodemográficas, como sexo, idade e renda familiar. Utilizou-se um ponto de corte para ITB aberrante de 1,3. As variáveis contínuas foram dicotomizadas. Para a análise estatística, utilizou-se o teste do qui-quadrado, considerando significante um p ≤ 0,05. Resultados Entre os 309 pacientes entrevistados, 65% eram mulheres, 26% haviam cursado ensino médio completo e 77% tinham renda familiar igual ou menor que três salários mínimos. A frequência de ITB aberrante ≥ 1,3 foi 16,5%. Não foram encontradas correlações estatisticamente significantes nas análises bivariadas entre o ITB aberrante (≥ 1,3) e as variáveis sociodemográficas estudadas (sexo, idade, tempo de duração de diabetes melito, renda familiar e escolaridade). Conclusões A frequência de ITB aberrante entre diabéticos foi de 16,5%. Não encontramos correlação entre as variáveis sociodemográficas (sexo, idade, tempo de DM, escolaridade e renda familiar) e a ocorrência de ITB aberrante.

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Abstract Background The ankle-brachial index (ABI) is a screening test for peripheral arterial occlusive disease and it can also be used to assess cardiovascular risk. However, in diabetics it can be difficult to interpret because the index may be excessively high because of calcification of the arterial tunica media. Objective To determine the frequency of high ABI in diabetics and to test for associations with sociodemographic variables. Methods This was a descriptive study in which 309 type 2 diabetes patients were interviewed and had their ABI measured. The sample was recruited at a referral center for diabetes and endocrinology (CEDEBA) in Salvador, BA, Brazil. The frequency of excessively high ABI and its relationships with sociodemographic variables such as sex, age and family income were studied. The cutoff point chosen for excessively high ABI was 1.3. Continuous variables were dichotomized. The chi-square test was used for statistical analysis and results with p ≤ 0.05 were considered significant. Results A total of 309 patients were interviewed, 65% were women, 26% had graduated from secondary education and 77% had a family income equal to or less than three times the minimum salary. The frequency of excessively high ABI (≥ 1.3) was 16.5%. Bivariate analyses detected no statistically significant correlations between excessively high ABI (≥ 1.3) and the sociodemographic variables studied (sex, age, time since diagnosis of diabetes mellitus, family income and educational level). Conclusions The frequency of high ABI among this sample of diabetics was 16.5%. We did not detect correlations between the sociodemographic variables (sex, age, duration of DM, educational level and family income) and high ABI.

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Pharmacotherapeutic profile of obese patients during the postoperative period after bariatric surgery

Resumo Contexto A obesidade pode estar relacionada a doenças como diabetes, hipertensão arterial e dislipidemia. A cirurgia bariátrica é um dos tratamentos mais eficazes, levando à diminuição de peso e comorbidades. Objetivo Avaliar o perfil metabólico e farmacoterapêutico de pacientes obesos após cirurgia bariátrica. Métodos Trata-se de um estudo observacional transversal retrospectivo, realizado em um hospital localizado na cidade de Porto Alegre, RS, Brasil. Foram avaliados 70 prontuários de pacientes que realizaram cirurgia bariátrica, nos períodos de antes de 2 meses e mais de 6 meses após a cirurgia bariátrica. A análise estatística foi realizada no programa SPSS 17.0®. Resultados A pressão arterial inicial foi de 130/85 mmHg, passando para 120/80 mmHg (p < 0,01). Com relação ao perfil metabólico antes de dois meses, o HDL foi de 34 mg/dL, o colesterol total foi de 195,07 ± 40,17 mg/dL, o LDL foi de 118,22 ± 41,28 mg/dL, os triglicerídeos foram de 141,09 ± 43,39 mg/dL, e a glicemia de jejum foi de 90 mg/dL. Após 6 meses de cirurgia, os valores passaram para 43 mg/dL, 133,67 ± 28,14 mg/dL, 65,53 ± 24,3 mg/dL, 104,41 ± 29,6 mg/dL, e 77 mg/dL, respectivamente (p < 0,01). Com relação ao uso de medicamentos, 41% utilizaram anti-hipertensivos, 39% utilizaram hipolipemiantes, 10% utilizaram hipoglicemiantes orais e 97% utilizaram suplementos antes dos 2 meses de cirurgia. Após os 6 meses, os percentuais foram alterados para 21%, 19%, 9% e 99%, respectivamente. Conclusões O estudo mostra o sucesso da cirurgia bariátrica em pacientes obesos com comorbidades, revelando melhora no perfil metabólico e redução na utilização de medicamentos para tratamento de comorbidades.

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Abstract Background Obesity can be associated with diseases such as diabetes, arterial hypertension and dyslipidemia. Bariatric surgery is one of the most effective treatments available, reducing both weight and comorbidities. Objective To evaluate the metabolic and pharmacotherapeutic profile of obese patients after bariatric surgery. Methods This is a retrospective, cross-sectional, observational study conducted at a hospital located in the city of Porto Alegre, RS, Brazil, based on analysis of the medical records for 70 patients who underwent bariatric surgery covering periods spanning from 2 months prior to more than 6 months after their bariatric surgery. Statistical analysis was conducted using SPSS 17.0®. Results Initial arterial blood pressure was 130/85 mmHg, 6 months after surgery it was 120/80 mmHg (p < 0.01). The metabolic profile 2 months before surgery was as follows: HDL was 34 mg/dL, total cholesterol was 195.07 ± 40.17 mg/dL, LDL was 118.22 ± 41.28 mg/dL, triglycerides were 141.09 ± 43.39 mg/dL, and fasting glycemia was 90 mg/dL. The same figures 6 months after surgery were 43 mg/dL, 133.67 ± 28.14 mg/dL, 65.53 ± 24.3 mg/dL, 104.41 ± 29.6 mg/dL, and 77 mg/dL, respectively (p < 0.01). Use of medications 2 months before surgery was as follows: 41% were on antihypertensives, 39% on hypolipidemics, 10% on oral hypoglycemics, and 97% were on nutritional supplements. These percentages 6 months after surgery had changed to 21%, 19%, 9% and 99%, respectively. Conclusions This study illustrates that bariatric surgery for obese patients with comorbidities was successful, demonstrating improvements in their metabolic profile and reductions in use of medications used to treat comorbidities.

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How can prevention of venous thromboembolism be improved in a hospital with an oncological profile?

Resumo Contexto Complicações do tromboembolismo venoso são encontradas frequentemente em pacientes internados, tanto em condições clínicas quanto em pós-operatórios. Objetivo Verificar a quimioprofilaxia utilizada para tromboembolismo venoso em pacientes oncológicos internados, antes e após a realização de um programa de esclarecimento da sua importância. Métodos Estudo de corte transversal realizado em três momentos distintos: inicialmente antes do programa de conscientização da importância da profilaxia do tromboembolismo venoso, durante o período em que foi realizada e um ano após a etapa anterior. Para fins estatísticos, os pacientes foram divididos em alto risco e baixo risco, e estratificados quanto a erro na quimioprofilaxia em: precisavam, mas não fizeram profilaxia; não precisavam, mas fizeram profilaxia; fizeram profilaxia não padronizada; e não podiam, mas fizeram profilaxia. Resultados Foram avaliados 399 pacientes internados, sendo 56 pacientes antes do início do programa de conscientização, 255 durante o programa e 88 após um ano. Antes da realização da semana de conscientização, apenas 35,7% dos pacientes estavam recebendo a quimioprofilaxia adequada; após a semana de conscientização, houve um aumento do número de prescrições corretas, que passou para 63,9% (p < 0,001). Após um ano sem as aulas de conscientização, a manutenção da quimioprofilaxia não foi tão eficaz, com uma tendência ao aumento do número de profilaxias incorretas (p = 0,081). Conclusão A quimioprofilaxia é utilizada em uma porcentagem muito pequena nos pacientes internados, sendo necessários programas de esclarecimento de sua importância na prevenção do tromboembolismo venoso e a realização de monitoramento contínuo para auxiliar na sua prescrição.

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Abstract Background Complications of venous thromboembolism are common among both medical and surgical hospital patients. Objective To identify what, if any, pharmacological prophylaxis for venous thromboembolism was given to cancer patients in hospital before and after implementation of a program to raise awareness of its importance. Methods This was a cross-sectional study conducted in three phases at distinct times: before a program to raise awareness of the importance of prophylaxis against venous thromboembolism was implemented, during years when the program was being run, and 1 year after the end of the program. For statistical analysis, patients were classified as high risk or no risk and categorized on the basis of erroneous pharmacological prophylaxis, as follows: "needed prophylaxis, but were not given it"; "did not need prophylaxis, but were given it"; "were given nonstandard prophylaxis"; or "should not have been given prophylaxis, but were given it". Results A total of 399 hospital patients were assessed: 56 before the awareness-raising program, 255 during the program and 88 1 year after the program was last run. Before any awareness-raising weeks, just 35.7% of the patients were being given the correct pharmacological prophylaxis; after awareness-raising weeks, the proportion of correct prescriptions increased to 63.9% (p < 0.001). After one year with no awareness-raising efforts, maintenance of pharmacological prophylaxis was no longer as effective, and there was a trend for the proportion of incorrect prophylaxis to increase (p = 0.081). Conclusions Pharmacological prophylaxis is given to a very small percentage of patients in hospital and programs are needed to raise awareness of its importance in the prevention of venous thromboembolism and continuous monitoring is needed to facilitate prescriptions.

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A comparative analysis of transcranial Doppler parameters acquired during carotid stenting and semi-eversion carotid endarterectomy

Abstract Background Carotid endarterectomy (CEA) and carotid artery stenting (CAS) have both been proposed for treatment of critical atherosclerotic stenosis located at the carotid bifurcation. Monitoring of hyperintense microembolic signals (MES) by transcranial Doppler ultrasound (TCD) is considered a method of quality control, both in CEA and in CAS. Objective To analyze temporal distribution of MES throughout both semi-eversion CEA and CAS procedures and to evaluate changes in mean velocity of blood flow through the ipsilateral middle cerebral artery (MCA). Method Thirty-three procedures (17 CEA and 16 CAS) were prospectively monitored using TCD and the data were related to three different stages of surgery (pre-cerebral protection, during cerebral protection and post-cerebral protection). Chi-square, Mann-Whitney, ANOVA and contrast tests were used for statistical analysis. Results The MES were uniformly distributed in the CEA group, but not in the CAS group (p = 0.208). The number of MES was higher in the CAS group in all stages. The average flow in the MCA was similarly lower in both groups during the protection stage. Conclusion CEA provoked a lower incidence of MES per procedure than CAS in all stages. The behavior of the averages of the mean of blood flow through the MCA was similar in both groups.

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Resumo Contexto A endarterectomia carotídea (EC) e a angioplastia carotídea (AC) são propostas para o tratamento de estenoses críticas localizadas na bifurcação carotídea. O monitoramento dos sinais de microembolias (SMs) pela ultrassonografia Doppler transcraniana (UDT) é considerado um método de controle de qualidade para ambas as técnicas. Objetivos Analisar a distribuição temporal dos SMs ao longo de diferentes estágios da EC por semieversão e da AC, e avaliar o significado das mudanças nas médias das velocidades médias do fluxo na artéria cerebral média ipsilateral (ACM). Método Trinta e três procedimentos (17 ECs e 16 ACs) foram monitorados com UDT, e os dados foram coletados prospectivamente para diferenciar os diferentes estágios cirúrgicos (pré, durante e pós-proteção cerebral). Para análise estatística foram usados os testes qui-quadrado, Mann-Whitney, análise de variância (ANOVA) e contraste. Resultados Em ambos os grupos, os SMs foram distribuídos uniformemente (p = 0,208). Em todos os tempos, o número de SMs foi superior no grupo AC. A média das velocidades médias do fluxo na ACM foi menor durante o tempo de proteção em ambos os grupos. Conclusão A EC teve uma menor incidência de SMs que a AC em todos os estágios. A média das velocidades médias na ACM teve comportamento similar em ambos os grupos.

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Assessment of cardiac influence on peripheral vascular Doppler in the elderly

Resumo Contexto As cardiopatias podem causar alterações no formato das ondas da ultrassonografia vascular (UV) em vasos periféricos. Essas alterações, tipicamente bilaterais e sistêmicas, são pouco conhecidas e estudadas. Objetivo Avaliar as ondas periféricas da UV de pacientes idosos para identificar alterações decorrentes de cardiopatias. Métodos Foram estudados 183 pacientes idosos submetidos a UV periférica no ano de 2014. Resultados Foram avaliados 102 mulheres (55,7%) e 81 homens (44,3%) com idade entre 60 e 91 anos (média de 70,4±7,2 anos). Encontraram-se alterações pela UV em 84 pacientes (45,9%). Foram identificadas 138 alterações de oito dos 13 tipos descritos na literatura: arritmia, onda bisferiens de pico sistólico, baixa velocidade de pico sistólico, pulsatilidade em veias femorais, bradicardia, taquicardia, onda de pulso parvus tardus e onda de pulso alternans. Houve baixa concordância entre a presença e a não presença de alterações na UV e na avaliação cardiológica. Na análise específica das alterações, os exames tiveram uma concordância variável, que foi boa para o achado de taquicardia, moderada para arritmia e baixa para bradicardia. Não houve concordância entre a UV e os exames cardiológicos para as demais alterações. Conclusões É possível identificar determinadas alterações cardíacas em idosos por meio da análise do formato das ondas periféricas da UV. É importante reconhecer e relatar a presença dessas alterações, pela possibilidade de alertar para um diagnóstico ainda não identificado nesses pacientes. Entretanto, mais estudos são necessários para que seja definida a importância das alterações no formato das ondas Doppler periféricas no reconhecimento de cardiopatias.

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Abstract Background Heart diseases can cause changes to vascular ultrasonography (VUS) waveforms in peripheral vessels. These changes are typically bilateral and systemic, they have been little studied, and little is known about them. Objective To assess peripheral VUS waveforms in elderly patients in order to identify changes caused by heart diseases. Methods During 2014, a total of 183 elderly patients were examined with peripheral VUS and the results were analyzed. Results The sample comprised 102 women (55.7%) and 81 men (44.3%) with ages ranging from 60 to 91 years (mean of 70.4±7.2 years). Abnormalities were identified in VUS waveforms in 84 patients (45.9%). A total of 138 abnormalities were identified and classified into eight of the 13 categories described in the literature, as follows: arrhythmia, systolic pulsus bisferiens, low peak systolic velocity, pulsatile flow in femoral veins, bradycardia, tachycardia, pulsus tardus et parvus and pulsus alternans. There was low agreement between presence/absence of VUS abnormalities and cardiological assessments. Analysis of specific abnormalities revealed variable levels of agreement between VUS and cardiological assessments, ranging from good for tachycardia, moderate for arrhythmia, to low for bradycardia. There was no agreement between VUS and cardiological examinations for the remaining categories of abnormalities. Conclusions Certain cardiac abnormalities can be identified in elderly patients by analysis of peripheral VUS waveforms. It is important to recognize and report the presence of these abnormalities because there is a possibility that they may serve to signal hitherto unidentified diagnoses in these patients. However, further studies are needed to determine the importance of changes to peripheral Doppler waveforms to recognition of heart diseases.

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Assessment of the effects of bismuth subgallate on proliferation of myofibroblasts: an experimental study in rats

Resumo Contexto O subgalato de bismuto é um metal pesado e insolúvel, utilizado por suas propriedades adstringentes e hemostáticas. Objetivo Avaliar os efeitos do subgalato de bismuto na cicatrização mediante observação de miofibroblastos em pele de ratos. Métodos Foram utilizados 60 ratos da linhagem Wistar, que receberam uma ferida no dorso da pele. Os animais foram divididos em dois grupos: controle (aplicação diária de cloreto de sódio a 0,9%) e experimental (aplicação diária de 0,5 mg de subgalato de bismuto). Cada grupo foi subdividido em três subgrupos, que foram reoperados para retirada da ferida em 3, 7 e 14 dias. Foi realizada coloração de hematoxilina eosina, picrosirius e imuno-histoquímica para avaliar contagem de miofibroblastos, resposta inflamatória e síntese de colágeno. Resultados Não foi encontrada diferença entre os grupos controle e experimento com relação ao processo inflamatório – subgrupos 3 dias (p = 1), 7 dias (p = 0,474) e 14 dias (p = 303). A avaliação dos colágenos tipo I e III no grupo-controle não demonstrou benefícios de cicatrização – 3 dias (p = 0,436), 7 dias (p = 0,853) e 14 dias (p = 0,436); já no grupo experimental, houve aumento dos colágenos tipos I e III nos subgrupos 3 e 14 dias (p = 0,005). A imuno-histoquímica confirmou os resultados encontrados na coloração hematoxilina eosina, na qual a área de miofibroblastos entre os subgrupos, nos grupos experimental (p = 0,4) e controle (p = 0,336), foi indiferente. Conclusão A utilização do subgalato de bismuto em ferida de pele de ratos não evidenciou benefícios na cicatrização, ou seja, não houve diferença na fibroplasia quando comparados os grupos experimental e controle.

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Abstract Background Bismuth subgallate is an insoluble heavy metal that is used for its astringent and hemostatic properties. Objective To evaluate the effects of bismuth subgallate on the healing process by observation of myofibroblasts in the skin of rats. Methods A sample of 60 Wistar rats was used. Each rat was subjected to a dorsal skin wound and allocated to one of two groups: a control group, in which 0.9% sodium chloride was administered daily, or an experimental group, in which 0.5 mg of bismuth subgallate was administered daily. Each of these groups was further subdivided into three subsets, which were reoperated after 3, 7 and 14 days respectively for excision and collection of the skin wound specimens. Samples were treated with hematoxylin eosin, picrosirius, and immunohistochemical staining to enable assessment of myofibroblast counts, inflammatory response phase, and collagen synthesis. Results No inflammatory process differences were detected between the control and experimental groups at 3 days (p = 1), 7 days (p = 0.474), or 14 days (p = 303). Evaluation of types I and III collagen in the control group did not demonstrate healing benefits at 3 days (p = 0.436), 7 days (p = 0.853), or 14 days (p = 0.436); whereas in the experimental group there were increases in types I and III collagen at 3 and 14 days (p = 0.005). Immunohistochemical analysis confirmed the results of hematoxylin eosin staining, since there were no differences between subsets in terms of area of myofibroblasts, in the experimental (p = 0.4) or the control (p = 0.336) groups. Conclusions Administration of bismuth subgallate to skin wounds in rats did not result in any evidence of benefits to healing, i.e., no difference in fibroplasia was detected when experimental and control groups were compared.

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Comparative study of great saphenous vein ablation in the thigh, with and without tumescence

Resumo Contexto O tratamento com laser endovenoso das veias safenas oferece ao paciente um procedimento com baixos índices de complicações, proporcionando retorno precoce à atividade ocupacional. Objetivo Comparar a formação de hematoma, a presença de parestesia no trajeto da veia safena magna (VSM) e a sua taxa de obliteração em 30 dias após a termoablação ao nível da coxa, utilizando ou não a tumescência e dois tipos de fibras. Métodos Estudo prospectivo em que foram analisados três grupos de pacientes submetidos a termoablação da VSM em coxa, utilizando comprimento de onda 1470 nm. No grupo 1, utilizou-se fibra convencional e tumescência; no grupo 2, fibra convencional sem tumescência; e no grupo 3, fibra dupla radial sem tumescência. Foram comparados, no período de 30 dias, a taxa de obliteração ao eco-Doppler, a ocorrência de parestesias e hematomas. Resultados Ao se comparar 90 VSMs de coxa submetidas a termoablação, obteve-se taxas de obliterações similares entre os grupos, sem diferença estatística. Nos grupos sem tumescência, ocorreu maior número de parestesias no trajeto da VSM na coxa no sétimo dia do que no grupo com tumescência, mas somente com significância estatística na comparação com o grupo da fibra convencional. Ocorreram hematomas em todos os grupos, sendo mais frequentes no grupo 1 (73,33%). Conclusões A realização da tumescência mostrou-se útil na prevenção de lesões neurológicas menores, mas não influenciou a ocorrência de hematomas e a taxa de oclusão da VSM na coxa em até 30 dias de sua termoablação.

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Abstract Background Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities. Objective To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber. Methods This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared. Results Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%). Conclusions Tumescence proved useful for preventing minor neurological injuries, but didn't have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.

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Biomarkers of endothelial function in cardiovascular diseases: hypertension

Resumo A incidência de hipertensão arterial sistêmica está aumentando mundialmente. Sua prevenção baseia-se na identificação dos hipertensos. Atualmente, biomarcadores são utilizados com fins de diagnosticar, estratificar e prognosticar doenças. Neste estudo, objetivou-se revisar artigos dos últimos cinco anos relacionados a biomarcadores nas doenças cardiovasculares. Pesquisaram-se dados de PubMed, SciELO, Science Direct e MEDLINE, mediante as palavras-chave: hipertensão arterial, biomarcadores cardiovasculares, óxido nítrico, função endotelial e dimetilarginina assimétrica. Os estudos levantados mostram que as doenças cardiovasculares possuem uma etiologia complexa. Neste artigo, evidenciaram-se interações entre o óxido nítrico e a dimetilarginina assimétrica na regulação, no metabolismo e na determinação dos níveis intracelulares, e reviram-se outros biomarcadores relacionados à hipertensão. Alguns estudos indicam os biomarcadores como uma ferramenta útil na predição de eventos cardíacos, e outros reportam que eles contribuem pouco para a avaliação. A seleção e combinação desses pode ser uma alternativa para validar o uso dos biomarcadores devido à pouca especificidade existente para diagnosticar a hipertensão.

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Abstract The incidence of systemic arterial hypertension is increasing worldwide. The foundation of prevention is identification of people with hypertension. Nowadays, biomarkers are used to diagnose and stratify diseases and estimates prognosis. The objective of this study was to review articles published over the last 5 years on the subject of biomarkers of cardiovascular diseases. The PubMed, SciELO, Science Direct and MEDLINE databases were searched using the keywords: arterial hypertension, cardiovascular biomarkers, nitric oxide, endothelial function and asymmetric dimethylarginine. The studies reviewed show that cardiovascular diseases have complex etiologies. This article describes evidence demonstrating interactions between nitric oxide and asymmetric dimethylarginine that are involved in regulation, in metabolism, and in determination of intracellular levels, and also discusses other biomarkers related to hypertension. Some studies indicate that biomarkers are useful tools for prediction of cardiac events, whereas others state that they have little to contribute to assessments. Careful selection of tests and combinations of tests may be the key to validating use of biomarkers, in view of their low specificity for diagnosing hypertension.

http://ift.tt/2dVbTHw

Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries

Abstract The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual "X" format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

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Resumo A artéria tibial posterior e a artéria fibular se originam do tronco tibiofibular, na fossa poplítea. A trajetória clássica da artéria tibial posterior é correr entre o tríceps sural e os músculos do compartimento posterior da perna, e, então, seguir posteriormente ao maléolo medial. Já a artéria fibular corre na margem lateral da perna, seguindo profundamente aos músculos. O estudo dessas artérias é relevante para o campo da angiologia, cirurgia vascular e cirurgia plástica. O presente trabalho é o primeiro relato de caso de uma anastomose entre ambas artérias, na porção distal de suas trajetórias. Tais artérias se anastomosaram em formato de "X", antes da divisão da artéria tibial posterior em ramos plantares. Foi feita uma revisão de literatura das variações de tais artérias, dando ênfase ao aspecto clínico e embriológico, de modo a contribuir para novas investigações sobre esses vasos.

http://ift.tt/2ersAGz

Endovascular treatment of an aneurysm of the brachiocephalic trunk in a patient with Ehlers-Danlos syndrome type IV

Resumo A síndrome de Ehlers-Danlos é uma doença genética que acarreta alteração na síntese de colágeno, causando extrema fragilidade do tecido conjuntivo. Tal fragilidade predispõe a uma série de doenças vasculares, como dissecções, aneurismas e pseudoaneurismas. Os autores relatam o histórico de um indivíduo de 19 anos com aneurisma de tronco braquiocefálico que foi submetido ao tratamento endovascular com implante de stents revestidos. O caso evoluiu com complicação do sítio de punção, que também foi tratada em caráter de emergência pela técnica endovascular com o implante de stent revestido.

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Abstract Ehlers-Danlos syndrome is a genetic disease that results in abnormalities of collagen synthesis, causing extremely fragile connective tissue. This fragility predisposes patients to a series of vascular disorders, such as dissections, aneurysms and pseudoaneurysms. The authors describe the case of a 19-year-old patient with an aneurysm of the brachiocephalic trunk who was treated endovascularly by placement of covered stents. The case progressed with complications at the puncture site, which was also treated on an emergency basis, using endovascular techniques with a covered stent.

http://ift.tt/2dVeRvk

Basilic vein cystic adventitial disease: case report

Resumo A doença cística da adventícia é uma entidade rara que acomete principalmente a artéria poplítea. A ocorrência em veias é muito rara, e sua etiologia é desconhecida. Clinicamente, apresenta-se como isquemia, trombose ou dor a depender do território acometido. Apresentamos o caso de um paciente masculino jovem referindo nódulo no braço esquerdo. A angiorressonância magnética do membro mostrou lesão cística em contato com a veia basílica, com conteúdo homogêneo e sem realce pós-contraste. Foi realizada ressecção da lesão em bloco com o segmento venoso envolvido. O estudo anatomopatológico foi sugestivo de cisto de adventícia de veia basílica.

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Abstract Cystic adventitial disease is a rare entity that most often involves the popliteal artery. It rarely occurs in veins. Its etiology is unknown. Clinically, it presents with ischemia, thrombosis or pain, depending on the vessel affected. Here we present the case of a young male with a nodule in the left arm. Magnetic resonance angiography showed a cystic lesion in contact with the basilic vein, with homogenous content without post-contrast enhancement. The lesion was resected en bloc together with the venous segment involved. The results of microscopic analysis were suggestive of basilic vein cystic adventitial disease.

http://ift.tt/2ersizy

Rare origin of the obturator artery from the external iliac artery with two obturator veins

Abstract The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance.

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Resumo A artéria obturatória é um ramo da artéria ilíaca interna, embora haja grande variabilidade a respeito de sua origem, pois tal vaso pode surgir de diversas artérias vizinhas, como a artéria ilíaca comum e a artéria ilíaca externa, assim de como qualquer ramo da artéria ilíaca interna. Normalmente, a artéria obturatória corre anteroinferiormente pela parede lateral da pelve até a porção superior do forame obturatório, ponto em que sai da pelve. No seu trajeto, a artéria é acompanhada pelo nervo e veia obturatórios. Ela supre os músculos do compartimento medial da coxa e possui anastomoses com ramos da artéria femoral na articulação do quadril e coxa. Este trabalho visa relatar e discutir os aspectos clínicos de uma variação incomum na artéria obturatória, na qual ela se origina da artéria ilíaca externa acompanhada de duas veias obturatórias com trajetos distintos.

http://ift.tt/2dVacda

Arteriovenous fistula after endovenous laser ablation with 1470 nm laser: case report

Resumo O tratamento tradicional da insuficiência da veia safena magna (VSM) inclui a ligadura alta na junção safeno-femoral combinada com a fleboextração. No entanto, a morbidade associada à insatisfação do paciente com esse tratamento tem conduzido ao desenvolvimento de técnicas alternativas, e a termoablação com laser endovenoso (EVLT) tornou-se uma alternativa minimamente invasiva à cirurgia. A formação de fístula arteriovenosa (FAV) durante o EVLT é extremamente rara. Neste estudo, relatamos um caso de identificação ecográfica de FAV entre um segmento da veia safena acessória lateral e a artéria femoral superficial. Optou-se inicialmente pela realização de duas tentativas de compressão com transdutor linear, sem sucesso, e alternativamente o procedimento cirúrgico foi realizado sem intercorrência e com resolução da FAV. Esse relato de caso evidencia a importância do seguimento de vigilância ecográfica após o EVLT tanto para o controle da efetividade do método como para o diagnóstico e tratamento precoce de suas complicações.

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Abstract Traditional treatment for great saphenous vein (GSV) insufficiency includes high ligation of the saphenofemoral junction and subsequent stripping of the GSV. However, the considerable morbidity and patient dissatisfaction associated with surgical treatment led to development of alternative techniques and intravenous laser treatment (EVLT) has emerged as a minimally invasive alternative to surgery. Formation of arteriovenous fistulas (AVF) during EVLT is extremely rare. In this study we report a case of AVF between a segment of the lateral accessory saphenous vein and the superficial femoral artery that was identified by ultrasound. Initially, two attempts were made at compression with a linear-array transducer without success, then alternatively surgery was performed without complications, leading to resolution of the AVF. This case report highlights the importance of ultrasound follow-up after EVLT, both for monitoring the effectiveness of the method and for diagnosis and early treatment of its complications.

http://ift.tt/2ertdQj

Absence of the celiac trunk and trifurcation of the common hepatic artery: a case report

Abstract Anatomical variations of the celiac trunk and its branches are particularly important from a surgical perspective due to their relationships with surrounding structures. We report here a particularly rare variant involving absence of the celiac trunk in association with trifurcation of the common hepatic artery. These variations were found in an adult male cadaver. We perform a review of the literature and discuss the clinical and embryological significance of these variations. Recognition of celiac trunk and hepatic artery variations is of utmost importance to surgeons and radiologists because multiple variations can lead to undue complications.

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Resumo As variações anatômicas do tronco celíaco e seus ramos são particularmente importantes do ponto de vista cirúrgico devido a sua relação com as estruturas adjacentes. Nós descrevemos aqui uma variante particularmente rara envolvendo ausência do tronco celíaco associada a trifurcação da artéria hepática comum. Essas variações foram observadas no cadáver de um adulto do sexo masculino. Neste artigo revisamos a literatura e discutimos a significância clínica e embriológica dessas variações. O reconhecimento das variações do tronco celíaco e da artéria hepática é extremamente importante para cirurgiões e radiologistas uma vez que variações múltiplas podem levar a complicações inesperadas.

http://ift.tt/2dVcEAh

Issue Information

http://ift.tt/2jtUmnC

Updates in wound healing: Mechanisms and translation

http://ift.tt/2kicC7M

6th Conference of the European Hidradenitis Suppurativa Foundation E.V.

http://ift.tt/2ju0uML

Clinical Snippets

http://ift.tt/2ki0UtM

Photodynamic therapy with intradermal application of 5-aminolevulinic acid successfully improved tumor lesions of mycosis fungoides

http://ift.tt/2jl7eBb

Dapsone and sulfasalazine combination therapy in dermatitis herpetiformis

http://ift.tt/2k7LZQk

Idiopathic Pulmonary Hemosiderosis in a Child with Recurrent Macrophage Activation Syndrome Secondary to Systemic Juvenile Idiopathic Arthritis

Macrophage activation syndrome, a severe complication of systemic juvenile idiopathic arthritis and other inflammatory diseases, represents one of the most important rheumatological emergencies. Delayed diagnosis could lead to life-threatening complications. Pulmonary hemosiderosis has been classically characterized by a triad of anemia, hemoptysis, and lung infiltrates on chest radiogram. Although the majority of patients of pulmonary hemosiderosis are considered idiopathic, secondary hemosiderosis associated with known diseases could be seen. In this case report, we aimed to present gradually increased pulmonary manifestations due to pulmonary hemosiderosis with recurrent macrophage activation syndrome attacks in a child with systemic juvenile idiopathic arthritis.

http://ift.tt/2jli7mz

Metallurgical-based prediction of stress-temperature induced rapid heating and cooling phase transformations for high speed machining Ti-6Al-4V alloy

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Qingqing Wang, Zhanqiang Liu, Dong Yang, Aziz Ul Hassan Mohsan
Local phase transformations of materials during mechanical machining influence the variation of surface integrity directly. The aim of this work is to investigate the relationship between cutting parameters and phase transformations during high speed machining (HSM) of Ti-6Al-4V. Rapid heating and cooling phase transformation models are firstly proposed based on phase transformation dynamics. Then, the proposed models are implemented into the Ti-6Al-4V cutting simulation model as a user subroutine of Abaqus/Explicit. The simulated results indicate that, in the chip formation process, β phase volume fraction increases from 8% to 90% in the serrated chips and the machined surface at the cutting speed range of 50–600m/min. In the rapid cooling process, the ratio of the transformed α" phase is about 4%. Finally, comparisons of the simulated results and high speed cutting experiments indicate that the developed models can precisely predict the phase transformations during HSM Ti-6Al-4V. The results help to get deeper insights into understanding the phase transformation mechanisms during HSM o Ti-6Al-4V. The research can also provide an instruction for optimizing the cutting parameters to control the surface integrity in machining of Ti-6Al-4V.

Graphical abstract

http://ift.tt/2kJejvC

The effects of hydroporation on melasma with anti-aging cocktail

Summary

Background

Jet-M is a device for epidermal peeling and is used to deliver substances by spraying air and microdroplets. Previously, a case was treated with a mixed solution of copper-GHK, oligo-hyaluronic acid, Rhodiola extract, tranexamic acid, and β-glucan. The results showed significant improvement of aged skin.

Aims

This study was conducted to evaluate the effects of hydroporation on melasma with the formulation in a small group of volunteers.

Methods

Clinical effects were evaluated by both subjective and objective methods including melanin index (MI) and erythema index (EI) measurement.

Results

Clinically, pigmentation and erythema were relieved and also both MI and EI decreased. Histopathologic observation revealed that type IV collagen and procollagen were increased in the upper dermis. Furthermore, the number of p63-positive cells is increased along the basement membrane. These results all suggest that hydroporation with GHR formulation induced anti-aging effects by reconstruction of extracellular matrix.

Conclusion

These findings suggest that the treatment may have depigmenting effects and erythema decreasing effects by enhancing the microenvironment of the skin.

http://ift.tt/2jIcVHS

Acne RA-1,2, a novel UV-selective face cream for patients with acne: Efficacy and tolerability results of a randomized, placebo-controlled clinical study

Summary

Background

General skincare measures such as the use of moisturisers and products containing adequate photoprotection are important components of acne patients' management to complement the pharmacological regimen. Acne RA-1,2 is a novel dermato-cosmetic product which contains selective photofilters and active ingredients against the multifactorial pathophysiology of acne.

Objectives

To evaluate the tolerability of Acne RA-1,2 and its effect on the clinical signs of acne.

Methods

This double-blind, placebo-controlled study randomized 40 adult patients with 10-25 comedones per half face to once-daily application of Acne RA-1,2 or placebo for 8 weeks. Evaluations after 4 and 8 weeks included the number of comedones, transepidermal water loss (TEWL), sebum production, and tolerability.

Results

In the Acne RA-1,2 group, there was a significant 35% decrease in the mean number of comedones from 26 at baseline to 17 at Week 8 (P<.001), a 7% significant reduction in TEWL (9.32 to 8.66 g/h/m²; P<.001), and a 24% significant reduction in sebum production (154.8 to 117.6 μg/cm²; P<.001). The reductions in TEWL and sebum production were significantly greater than those in the placebo group at Weeks 4 and 8 (P<0.05). There were no adverse events.

Conclusions

Acne RA-1,2 was well tolerated and effective at reducing comedones and sebum production and improving epidermal barrier function. These results suggest that Acne RA-1,2 is useful against acne-prone facial skin, particularly as it targets sebum production, which topical pharmacological acne therapies do not address.

http://ift.tt/2kK2ktH

The effects of hydroporation on melasma with anti-aging cocktail

Summary

Background

Jet-M is a device for epidermal peeling and is used to deliver substances by spraying air and microdroplets. Previously, a case was treated with a mixed solution of copper-GHK, oligo-hyaluronic acid, Rhodiola extract, tranexamic acid, and β-glucan. The results showed significant improvement of aged skin.

Aims

This study was conducted to evaluate the effects of hydroporation on melasma with the formulation in a small group of volunteers.

Methods

Clinical effects were evaluated by both subjective and objective methods including melanin index (MI) and erythema index (EI) measurement.

Results

Clinically, pigmentation and erythema were relieved and also both MI and EI decreased. Histopathologic observation revealed that type IV collagen and procollagen were increased in the upper dermis. Furthermore, the number of p63-positive cells is increased along the basement membrane. These results all suggest that hydroporation with GHR formulation induced anti-aging effects by reconstruction of extracellular matrix.

Conclusion

These findings suggest that the treatment may have depigmenting effects and erythema decreasing effects by enhancing the microenvironment of the skin.

http://ift.tt/2jIcVHS

Acne RA-1,2, a novel UV-selective face cream for patients with acne: Efficacy and tolerability results of a randomized, placebo-controlled clinical study

Summary

Background

General skincare measures such as the use of moisturisers and products containing adequate photoprotection are important components of acne patients' management to complement the pharmacological regimen. Acne RA-1,2 is a novel dermato-cosmetic product which contains selective photofilters and active ingredients against the multifactorial pathophysiology of acne.

Objectives

To evaluate the tolerability of Acne RA-1,2 and its effect on the clinical signs of acne.

Methods

This double-blind, placebo-controlled study randomized 40 adult patients with 10-25 comedones per half face to once-daily application of Acne RA-1,2 or placebo for 8 weeks. Evaluations after 4 and 8 weeks included the number of comedones, transepidermal water loss (TEWL), sebum production, and tolerability.

Results

In the Acne RA-1,2 group, there was a significant 35% decrease in the mean number of comedones from 26 at baseline to 17 at Week 8 (P<.001), a 7% significant reduction in TEWL (9.32 to 8.66 g/h/m²; P<.001), and a 24% significant reduction in sebum production (154.8 to 117.6 μg/cm²; P<.001). The reductions in TEWL and sebum production were significantly greater than those in the placebo group at Weeks 4 and 8 (P<0.05). There were no adverse events.

Conclusions

Acne RA-1,2 was well tolerated and effective at reducing comedones and sebum production and improving epidermal barrier function. These results suggest that Acne RA-1,2 is useful against acne-prone facial skin, particularly as it targets sebum production, which topical pharmacological acne therapies do not address.

http://ift.tt/2kK2ktH

Eosinophilic Angiocentric Fibrosis as a Stenosing Lesion in the Subglottis

Subglottic Eosinophilic Angiocentric Fibrosis (EAF) is an extremely rare disease of an elusive aetiology. It is chronically progressive benign condition that causes narrowing of the subglottic region leading to dysphonia and airway compromise. The diagnosis is historical and imaging is nonspecific. We report a case xc of 56-year-old lady referred to our institution with globus sensation, hoarseness, and mild stridor. Incidental subglottic mass was found at time of diagnostic microlaryngoscopy and biopsy confirmed subglottic EAF. All laboratory investigations were unremarkable. Lesion was removed with laryngeal microdebrider and three courses of intravenous dexamethasone were administered. Patient's postoperative period was uneventful and had remained disease free for 1 year. To date, no consensus has been reached on the optimal treatment of subglottic EAF. We recommend regular follow-up to detect early recurrence.

http://ift.tt/2k7DbKi

Eosinophilic Angiocentric Fibrosis as a Stenosing Lesion in the Subglottis

Subglottic Eosinophilic Angiocentric Fibrosis (EAF) is an extremely rare disease of an elusive aetiology. It is chronically progressive benign condition that causes narrowing of the subglottic region leading to dysphonia and airway compromise. The diagnosis is historical and imaging is nonspecific. We report a case xc of 56-year-old lady referred to our institution with globus sensation, hoarseness, and mild stridor. Incidental subglottic mass was found at time of diagnostic microlaryngoscopy and biopsy confirmed subglottic EAF. All laboratory investigations were unremarkable. Lesion was removed with laryngeal microdebrider and three courses of intravenous dexamethasone were administered. Patient's postoperative period was uneventful and had remained disease free for 1 year. To date, no consensus has been reached on the optimal treatment of subglottic EAF. We recommend regular follow-up to detect early recurrence.

http://ift.tt/2k7DbKi

Glassy dynamics in polymers

Publication date: Available online 29 January 2017
Source:Materials Today
Author(s): David Bradley




http://ift.tt/2jIpRh5

Lichen myxedematosus: toward established classification and diagnostic criteria

http://ift.tt/2kE4ax9

The recent structure-based coarse graining of polymer melts using PRISM theory does not give thermodynamic consistency

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Qiang Wang, Delian Yang
The full thermodynamic consistency claimed by Guenza and co-workers in their recent papers (J. McCarty et al., Macromolecules 45 (2012) 8482; A. J. Clark et al., Phys. Rev. Lett. 109 (2012) 168301; and A. J. Clark et al., J. Chem. Phys. 139 (2013) 124906), where they performed structure-based coarse graining of homopolymer melts using the polymer reference interaction site model theory, directly contradicts the well-established and widely cited finding by several research groups. In this Communication, we clearly showed that (1) the full thermodynamic consistency claimed by Guenza and co-workers is simply due to the (incorrect) approximations used in their analytical derivation, (2) none of their criticisms on our work (D. Yang, Q. Wang, J. Chem. Phys. 142 (2015) 054905) given in their Comment (A. J. Clark et al., J. Chem. Phys. 143 (2015) 067101) is valid, and (3) the simulation-free coarse-graining strategy presented in our work is crucially different from the coarse-graining approach in their recent papers.

Graphical abstract

http://ift.tt/2jkQVEo

Hybrid peptides in the landscape of drug discovery

Publication date: Available online 29 January 2017
Source:Peptides
Author(s): Daniel Fourmy




http://ift.tt/2jHHX2M

Quantitative computed tomography imaging-based clustering differentiates asthmatic subgroups with distinctive clinical phenotypes

Publication date: Available online 29 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sanghun Choi, Eric A. Hoffman, Sally E. Wenzel, Mario Castro, Sean Fain, Nizar Jarjour, Mark L. Schiebler, Kun Chen, Ching-Long Lin
BackgroundImaging variables including airway diameter, wall thickness and air-trapping have been found to be important metrics when differentiating severe asthmatics from nonsevere asthmatics and healthy subjects.ObjectiveThe objective of this study was to identify imaging-based clusters and to explore the association of the clusters with existing clinical metrics.MethodsWe performed an imaging-based cluster analysis using quantitative computed tomography-based structural and functional variables extracted from the respective inspiration and expiration scans of 248 asthmatics. The imaging-based metrics included a broader-set of multiscale variables such as inspiratory airway dimension, expiratory air-trapping and registration-based lung deformation (inspiration vs. expiration). Asthma subgroups derived from a clustering method were associated with subject demography, questionnaire, medication history, and biomarker variables.ResultsCluster 1 patients were early-onset younger nonsevere asthmatics with reversible airflow obstruction, who showed normal airway structure; Cluster 2 patients were a mix of nonsevere and severe asthmatics with marginal inflammation, who exhibited airway luminal narrowing without wall thickening. Cluster 3 and 4 patients were dominated by severe asthmatics. Cluster 3 patients were obese females with reversible airflow obstruction who exhibited airway wall thickening without airway narrowing. Cluster 4 patients were late-onset older males with persistent airflow obstruction, exhibiting significant air-trapping and reduced regional deformation. Clusters 3 and 4 patients also showed decreased lymphocyte and increased neutrophils, respectively.ConclusionsFour image-based clusters were identified and shown to be correlated with clinical characteristics. Such clustering serves to differentiate asthma subgroups which may be used as a basis for the development of new therapies.

Teaser

We identified four asthma subgroups using a cluster analysis composed of imaging variables, which were associated with clinical metrics. Identifying imaging-based clusters could enable practical cluster-based therapeutic interventions.


http://ift.tt/2khBxsk

Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea

In the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA), there is no gold standard method to fine-tune the mandibular advancement. This study aimed to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea-hypopnea index (AHI).

http://ift.tt/2khwUhN

Maturation of auditory brainstem responses in young children with congenital monaural atresia

To date, the impact of conductive hearing loss on the auditory pathway at brainstem level has only been investigated in animal studies, which showed a species-specific delay of maturation. In this study, the functional maturation of auditory brainstem response (ABR) parameters in humans with unilateral atresia of the external auditory canal was investigated.

http://ift.tt/2jHfwlx

Parent educational materials regarding the newborn hearing screening process

Newborn hearing screening (NHS) procedures and implementation vary from state to state in the US. The purpose of this study was to evaluate the content and nature of information provided to parents about their infant's NHS across states to answer two questions: 1) what information is included in each state's parent information brochure? and 2) do the brochures include educational information requested by parents that may help reduce parental anxiety, improve satisfaction, and decrease the potential for misunderstandings?

http://ift.tt/2kILz23

Evaluation of cognitive performance in professional divers by means of event-related potentials and neuropsychology

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Mehmet Ergen, Atilla Uslu, Ozlem Caglar, Sukriye Akca-Kalem, Maide Cimsit, Hakan Gurvit
ObjectiveWe investigated whether professional air diving with no decompression illness causes any long-term changes in cognitive functions.MethodsThe all-male participants consisted of 18 healthy control (HC) volunteers and 32 divers. Divers were divided into two subgroups as moderate exposure group, Divers-I (DI) and extensive exposure group, Divers-II (DII). Participants were administered a comprehensive neuropsychological battery and event-related potentials (ERPs) were recorded while they performed auditory oddball task and visual continuous performance test (CPT).ResultsP3 waves in oddball and CPT were significantly attenuated and peak latencies were prolonged in both diver groups compared with HC. Amplitude decrements in CPT P3 were graded with respect to level of diving exposure. Neuropsychologically, DII group displayed significantly poorer performance than HC and DI groups in measures of visuo-constructional and visual long-term memory tests. DI group performed better than HC group in some measures of planning ability.ConclusionsMost of the changes in neurophysiological measures and poorer neuropsychological performance were found in DII group, and this might be interpreted as a red flag for the reflection of the slowly progressing deleterious effects of silent bubbles in brain function.SignificanceThis study reports impairments in certain neuropsychological measures and apparent neurophysiological markers pointing to slow cognitive decline referring to long-term effects of diving.



http://ift.tt/2jGNCG7

Corticokinematic coherence as a new marker for somatosensory afference in newborns

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Eero Smeds, Sampsa Vanhatalo, Harri Piitulainen, Mathieu Bourguignon, Veikko Jousmäki, Riitta Hari
ObjectiveSomatosensory evoked potentials have high prognostic value in neonatal intensive care, but their recording from infants is challenging. Here, we studied the possibility to elicit cortical responses in newborns by simple passive hand movements.MethodsWe examined 13 newborns (postnatal age 1–46 days) during clinically indicated 19-channel electroencephalography (EEG) recordings in the neonatal intensive care unit; EEG indications included birth asphyxia and suspected epileptic seizures. The experimenter moved the infant's wrist or fingers at 1 or 2 Hz for 5–10 min, separately on both sides. We measured movement kinematics with an accelerometer attached to the infant's hand, and computed coherence between the EEG and acceleration signals (corticokinematic coherence, CKC).ResultsStatistically significant CKC (amplitude 0.020–0.511) with characteristic scalp topography was observed in all infants at twice the movement frequency. CKC was contralaterally dominant on the central scalp (median laterality index 0.53 for right-hand and –0.63 for left-hand movements).ConclusionsPassive movements elicit cortical responses that can be readily observed in clinical EEG recordings from newborns in the intensive care environment.SignificanceCKC is a novel, noninvasive marker for the somatosensory system. Its robustness and practical ease make it attractive for bedside assessment of neurologically compromised newborns.



http://ift.tt/2jGDX2p

Sharpening a classic scalpel to face the growth of Alzheimer’s dementia

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Tarek K. Rajji




http://ift.tt/2jsRyaa

Status Epilepticus after Cardiac Arrest: Some Strides

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): G. Bryan Young




http://ift.tt/2jGDUUh

Peripheral nerve ultrasonography in patients with transthyretin amyloidosis

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Simon Podnar, Stayko Sarafov, Ivailo Tournev, Gregor Omejec, Janez Zidar
ObjectiveTo systematically study peripheral nerve morphology in patients with transthyretin (TTR) amyloidosis and TTR gene mutation carriers using high-resolution ultrasonography (US).MethodsIn this prospective cross-sectional study we took a structured history, performed neurological examination, and measured peripheral nerve cross-sectional areas (CSAs) bilaterally at 28 standard locations using US. Demographic and US findings were compared to controls.ResultsPeripheral nerve CSAs were significantly larger in 33 patients with familial amyloid polyneuropathy (FAP) compared to 50 controls, most dramatically at the common entrapment sites (median nerve at the wrist, ulnar nerve at the elbow), and in the proximal nerve segments (median nerve in the upper arm, sciatic nerve in the thigh). Findings in 21 asymptomatic TTR gene mutation carriers were less marked compared to controls, with CSAs being larger only in the median nerve in the upper arm. Nerve CSAs correlated with abnormalities on nerve conduction studies.ConclusionUsing US, we confirmed previous pathohistological and imaging reports in FAP of the most pronounced peripheral nerve thickening in the proximal limb segments.SignificanceSimilar to US findings in diabetic and vasculitic neuropathies these predominantly proximal locations of nerve thickening may be attributed to ischaemic nerve damage caused by poor perfusion in the watershed zones along proximal limb segments.



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Effects of tDCS on motor learning and memory formation: a consensus and critical position paper

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Ethan R Buch, Emiliano Santarnecchi, Andrea Antal, Jan Born, Pablo A Celnik, Joseph lassen, Christian Gerloff, Mark Hallett, Friedhelm C Hummel, Michael A Nitsche, Alvaro Pascual-Leone, Walter J Paulus, Janine Reis, Edwin M Robertson, John C Rothwell, Marco Sandrini, Heidi M Schambra, Eric M Wassermann, Ulf Ziemann, Leonardo G Cohen
Motor skills are required for activities of daily living. Transcranial direct current stimulation (tDCS) applied in association with motor skill learning has been investigated as a tool for enhancing training effects in health and disease. Here, we review the published literature investigating whether tDCS can facilitate the acquisition, retention or adaptation of motor skills. Work in multiple laboratories is underway to develop a mechanistic understanding of tDCS effects on different forms of learning and to optimize stimulation protocols. Efforts are required to improve reproducibility and standardization. Overall, reproducibility remains to be fully tested, effect sizes with present techniques vary over a wide range, and the basis of observed inter-individual variability in tDCS effects is incompletely understood. It is recommended that future studies explicitly state in the Methods the exploratory (hypothesis-generating) or hypothesis-driven (confirmatory) nature of the experimental designs. General research practices could be improved with prospective pre-registration of hypothesis-based investigations, more emphasis on the detailed description of methods (including all pertinent details to enable future modeling of induced current and experimental replication), and use of post-publication open data repositories. A checklist is proposed for reporting tDCS investigations in a way that can improve efforts to assess reproducibility.



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Cyclic seizures in critically ill patients: clinical correlates, DC recordings and outcomes

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Lecio F Pinto, Emily J Gilmore, Ognen A Petroff, Adithya Sivaraju, Nishi Rampal, Lawrence J Hirsch, Nicolas Gaspard
ObjectiveTo describe EEG and clinical correlates, DC recordings and prognostic significance of cyclic seizures (CS).MethodsWe reviewed our prospective continuous EEG database to identify patients with CS, controls with non-cyclic status epilepticus (SE) and controls without seizure matched for age and etiology. EEG was reviewed with DC settings.Results39/260 (15%) patients with electrographic seizures presented with CS. These patients were older (62 vs 54 yrs.; p=0.04) and more often had acute or progressive brain injury (77% vs 52%; p=0.03) than patients with non-cyclic SE and had a lower level of consciousness, were more severely ill, than matched controls. CS almost always had focal onset, often from posterior regions. Patients with CS trended towards worse prognosis. When available (12 patients), DC recordings showed an infraslow cyclic oscillation of EEG baseline synchronized to the seizures in all cases.ConclusionsCS occur mostly in older patients with acute or progressive brain injury, are more likely to be associated with poor outcome than patients with other forms of nonconvulsive SE, and are accompanied by synchronous oscillations of the EEG baseline on DC recordings.SignificanceCS are a common form of non-convulsive status epilepticus in critically ill patients and provide further insights into the relationship between infraslow activity and seizures; further study on this relationship may shed light on the mechanisms of seizure initiation and termination.



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Event-related brain potential indices of cognitive function and brain resource reallocation during working memory in patients with Multiple Sclerosis

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Thomas J. Covey, Janet L. Shucard, David W. Shucard
ObjectiveTo examine event-related brain potentials (ERPs) in Multiple Sclerosis (MS) during a visual n-back working memory (WM) task, and test the hypothesis that compensatory brain function may be associated with variance in task performance in MS patients.MethodsMidline ERPs for 25 MS patients and 18 HCs were obtained for a visual n-back task that placed increasing demands on WM. N-back behavioral measures and neuropsychological performance measures of WM were also obtained.ResultsMS patients had slower reaction times (RTs) than HCs during the n-back task. Accuracy on the n-back and on neuropsychological tests did not differ between groups. P3 ERP amplitude decreased for both groups as WM demand increased. MS patients had lower overall P1 and P3 amplitudes compared to HCs. In MS, anteriorization of P3 amplitude was associated with better n-back performance. P1 and P3 amplitudes were also related to neuropsychological test performance in MS.ConclusionsMS patients had reduced ERP amplitude compared to HCs during the n-back, and changes in ERP anterior-posterior midline amplitude distribution in MS were associated with cognitive performance.SignificanceERPs, and in particular the P3 component obtained during a visual n-back task, are sensitive to subtle WM dysfunction in MS and may reflect compensatory reallocation of brain resources.



http://ift.tt/2kIEWgi

Diagnostic yield of ambulatory EEGs in the elderly

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Benjamin Tolchin, Jong Woo Lee, Milena Pavlova, Barbara A. Dworetzky, Rani A. Sarkis R
ObjectiveThe diagnostic yield of ambulatory EEG in the elderly is not known. We sought to determine diagnostic yield and identify factors predicting diagnostic findings in this elderly population.MethodsWe reviewed 156 consecutive 24-72 hour ambulatory EEGs performed on patients aged 60 or older.ResultsOf the 156 studies, 58 studies (37%) revealed potentially diagnostic findings: either epileptiform discharges, an epileptic seizure, or a typical nonepileptic event. Focal slowing on routine EEG predicted epileptiform abnormalities on ambulatory EEG with an odds ratio of 4.0 (95% CI 1.7 – 9.7, p=0.002). Age, the presence of a focal lesion on MRI, and duration of ambulatory EEG failed to predict epileptiform abnormalities on ambulatory EEG.Duration of ambulatory EEG predicted capture of a typical nonepileptic event with an odds ratio of 2.7 (95% CI 1.3 - 5.7, p=0.009) for every additional day of study duration.ConclusionsFocal slowing on routine EEGs may warrant an ambulatory EEG in the setting of diagnostic uncertainty.Longer ambulatory EEGs have a higher yield in capturing patients' typical non-epileptic events, and should be considered in patients where nonepileptic events are a likely diagnostic possibility.Signficance: These findings offer guidance in the use of ambulatory EEGs in the elderly.



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Epileptiform Abnormalities Predict Delayed Cerebral Ischemia in Subarachnoid Hemorrhage

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): J.A. Kim, E.S. Rosenthal, S. Biswal, S. Zafar, A.V. Shenoy, K.L. O'Connor, S.C. Bechek, J. Valdery Moura, M.M. Shafi, A.B. Patel, S.S. Cash, M.B. Westover
ObjectiveTo identify whether abnormal neural activity, in the form of epileptiform discharges and rhythmic or periodic activity, which we term here ictal-interictal continuum abnormalities (IICAs), are associated with delayed cerebral ischemia (DCI).MethodsRetrospective analysis of continuous electroencephalography (cEEG) reports and medical records from 124 patients with moderate to severe grade subarachnoid hemorrhage (SAH). We identified daily occurrence of seizures and IICAs. Using survival analysis methods, we estimated the cumulative probability of IICA onset time for patients with and without delayed cerebral ischemia (DCI).ResultsOur data suggest the presence of IICAs indeed increases the risk of developing DCI, especially when they begin several days after the onset of SAH. We found that all IICA types except generalized rhythmic delta activity occur more commonly in patients who develop DCI. In particular, IICAs that begin later in hospitalization correlate with increased risk of DCI.ConclusionsThus, IICAs represent a new marker for identifying early patients at increased risk for DCI. Moreover, IICAs might contribute mechanistically to DCI and therefore represent a new potential target for intervention to prevent secondary cerebral injury following SAH.SignificanceThese findings imply that IICAs may be a novel marker for predicting those at higher risk for DCI development.



http://ift.tt/2kICkiz

Guiding transcranial brain stimulation by EEG/MEG to interact with ongoing brain activity and associated functions: A position paper

Publication date: Available online 29 January 2017
Source:Clinical Neurophysiology
Author(s): Gregor Thut, Til Ole Bergmann, Flavio Fröhlich, Surjo R. Soekadar, John-Stuart Brittain, Antoni Valero-Cabré, Alexander Sack, Carlo Miniussi, Andrea Antal, Hartwig Roman Siebner, Ulf Ziemann, Christoph S. Herrmann
Non-invasive transcranial brain stimulation (NTBS) techniques have a wide range of applications but also suffer from a number of limitations mainly related to poor specificity of intervention and variable effect size. These limitations motivated recent efforts to focus on the temporal dimension of NTBS with respect to the ongoing brain activity. Temporal patterns of ongoing neuronal activity, in particular brain oscillations and their fluctuations, can be traced with electro- or magnetoencephalography (EEG/MEG), to guide the timing as well as the stimulation settings of NTBS. These novel, online and offline EEG/MEG-guided NTBS-approaches are tailored to specifically interact with the underlying brain activity. Online EEG/MEG has been used to guide the timing of NTBS (i.e., when to stimulate): by taking into account instantaneous phase or power of oscillatory brain activity, NTBS can be aligned to fluctuations in excitability states. Moreover, offline EEG/MEG recordings prior to interventions can inform researchers and clinicians how to stimulate: by frequency-tuning NTBS to the oscillation of interest, intrinsic brain oscillations can be up- or down-regulated. In this paper, we provide an overview of existing approaches and ideas of EEG/MEG-guided interventions, and their promises and caveats. We point out potential future lines of research to address challenges.



http://ift.tt/2jGAJMd

Role of high flow nasal oxygen in the management of a case of anaesthesia related aspiration pneumonia

Regurgitation and pulmonary aspiration of gastric contents is a feared complication of anaesthesia resulting in serious sequelae including acute hypoxemic respiratory failure (AHRF). Early application of non-invasive positive pressure ventilation (NIV) decreases the rate of endotracheal intubation and ICU mortality in AHRF. However, NIV is often complicated by high airway pressures predisposing to mask leaks, discomfort and device intolerance [1]. Recently high-flow oxygen delivered through nasal cannula (HFNO) has emerged as an alternative to NIV.

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Cervical plexus block for perioperative analgesia during otoplasty

To the Editor:

http://ift.tt/2kCAYq2

Pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery with two hemodilution methods

To investigate the pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery under acute normovolemic hemodilution (ANH) and acute hypervolemic hemodilution (AHH).

http://ift.tt/2jGtX9n

Effects of stylet use during tracheal intubation on postoperative pharyngeal pain in anesthetized patients: A prospective randomized controlled trial

This study aimed to compare the impact of stylet application for tracheal intubation for postoperative pharyngeal pain or hoarseness in patients undergoing elective surgery.

http://ift.tt/2kCATTD

Reversible brain atrophy in glutaric aciduria type 1

Publication date: Available online 29 January 2017
Source:Brain and Development
Author(s): Yurika Numata-Uematsu, Osamu Sakamoto, Yosuke Kakisaka, Yukimune Okubo, Yoshitsugu Oikawa, Natsuko Arai-Ichinoi, Shigeo Kure, Mitsugu Uematsu
Glutaric aciduria type 1 (GA1) is a rare metabolic disorder caused by a deficiency of glutaryl-CoA dehydrogenase. The typical clinical onset features an acute encephalopathic crisis developed in early childhood, causing irreversible striatal injury. Recently, tandem mass spectrometry of spots of dried blood has allowed pre-symptomatic detection of GA1 in newborns. Early treatment can prevent irreversible neurological injury. We report the case of a girl with GA1 who exhibited a characteristic reversible change upon brain magnetic resonance imaging (MRI). She was diagnosed with GA1 as a newborn. She commenced dietary carnitine and her intake of lysine and tryptophan were reduced at the age of 4weeks. After treatment commenced, her mean glutarylcarnitine level was lower than that in the previous reports. The plasma lysine and tryptophan levels were maintained below the normal ranges. At 4months, brain MRI revealed a widened operculum with dilatation of the subarachnoid spaces surrounding the atrophic bilateral frontotemporal lobes; this is typical of GA1 patients. However, at 17months, MRI revealed that the atrophic lesion had disappeared and she subsequently underwent normal maturation. She has never suffered a metabolic decompensation episode. At 26months, her development and brain MRI were normal. The present reversible brain atrophy in a patient with GA1 indicates that early dietary modifications with a lower level of glutarylcarnitine and administration of carnitine can lead to normal development.



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The role of dietary polyphenols in the management of erectile dysfunction–Mechanisms of action

Publication date: April 2017
Source:Biomedicine & Pharmacotherapy, Volume 88
Author(s): Chinedum Eleazu, Nwite Obianuju, Kate Eleazu, Winner Kalu
The incidence of erectile dysfunction (ED) is on the increase and it is estimated that it will affect about 322 million men globally by the year 2025 if adequate measures are not taken to curb it. Natural polyphenols in plant based diets have gained public interest in recent times due to their roles in the prevention of various disease that implicate free radicals/reactive oxygen species and recently on ED. However, the role of polyphenols in the management of ED has not been explored due perhaps to limited data available. Hence this study which reviewed the role of dietary polyphenols in the management of ED and their mechanisms of action. Literature search was carried out in several electronic data bases such as Pubmed, Google Scholar, Medline, Agora and Hinari from1972 to 2016 to identify the current status of knowledge on the role of polyphenols in the management of erectile dysfunction. Progress made so far in this direction suggests inhibition of arginase, acetylcholinesterase, angiotensin converting enzyme, rho-kinase II; activation of endothelial and neuronal NO synthase; decreased synthesis of luteinizing hormone and testosterone reduction; activation of silent information regulator 2-related enzymes (sirtuin1) as well as free radical/reactive oxygen species inhibition as the mechanisms through which the polyphenols identified in this review exert beneficial roles in the management of ED.



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Timing of Initiation of Adjuvant Chemotherapy for Gastric Cancer: A Case-Matched Comparison Study of Laparoscopic vs. Open Surgery

Publication date: Available online 29 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Akio Kaito, Takahiro Kinoshita, Kouhei Shitara, Hidehito Shibasaki, Toshirou Nishida
BackgroundLaparoscopic gastrectomy (LG) is reported to be associated with faster recovery than open gastrectomy (OG); however, the influence of the surgical approach on initiation timing of adjuvant chemotherapy (AC) remains unclear.MethodsThis was a single-institutional retrospective observational study. Patients with pathological stage II/III gastric cancer undergoing LG with D2 lymphadenectomy (LG group: n=74) were matched 1:1 with patients selected from 214 similar patients undergoing OG (OG group: n=74), identically matching gender, age, pathological stage, and type of gastrectomy, and comparing AC initiation timing between the two groups. Factors associated with delayed initiation of AC were investigated in a multivariable analysis.ResultsAC was performed in 86.5% (LG) and 83.8% (OG) of patients (p=0.64). The median time interval before AC was significantly shorter in the LG vs. OG group (5.7 vs. 6.6 weeks, respectively, p<0.001), and significantly more patients received AC within 6 weeks (60.8% vs. 27.0%, p<0.001). Independent factors associated with delayed initiation of AC (>6 weeks) were: morbidity (≥grade 3a; odds ratio (OR): 16.1, 95% confidence interval (CI): 1.86–143), open surgery (OR: 5.17, 95% CI: 2.50–13.1), and postoperative weight loss ≥ 8% (OR: 2.47, 95% CI: 1.07–5.71).ConclusionsLG may be associated with shorter intervals before AC. Postoperative morbidity should be reduced as much as possible.



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Embryonic Origin of Primary Colon Cancer Predicts Survival in Patients Undergoing Ablation for Colorectal Liver Metastases

Publication date: Available online 29 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Suguru Yamashita, Bruno C. Odisio, Steven Y. Huang, Scott E. Kopetz, Kamran Ahrar, Yun Shin Chun, Claudius Conrad, Thomas A. Aloia, Sanjay Gupta, Samer Harmoush, Marshall E. Hicks, Jean-Nicolas Vauthey
BackgroundIn patients with primary colorectal cancer (CRC) or unresectable metastatic CRC, midgut embryonic origin of the tumor is associated with worse prognosis. The impact of embryonic origin on survival after ablation of colorectal liver metastases (CLM) is unclear.MethodsWe identified 74 patients with CLM who underwent image-guided percutaneous liver ablation during 2004-2015. Survival and recurrence after ablation of CLM from midgut origin (n=18) and hindgut origin tumors (n=56) were analyzed. Prognostic value of embryonic origin was evaluated by multivariable analysis.ResultsRecurrence-free survival (RFS) and overall survival (OS) after hepatic resection were worse in patients with CLM from midgut origin tumors (3-year RFS rate: 5.6% vs. 24%, P=0.004; 3-year OS rate: 25% vs. 70%, P<0.001). In Cox proportional hazards regression analysis, factors associated with worse OS were midgut embryonic origin (hazard ratio [HR] 4.87, 95% CI 2.14-10.9, P<0.001), multiple CLM (HR 2.35, 95% CI 1.02-5.39, P=0.044), and RAS mutation (HR 2.78, 95% CI 1.25-6.36, P=0.013). At a median follow-up of 25 months, 56 patients (76%) had developed a recurrence, 16 (89%) with midgut origin and 40 (71%) with hindgut origin tumors (P=0.133). Recurrent disease was treated with local therapy in 20 patients (36%), 2 (13%) with midgut origin and 18 (45%) with hindgut origin tumors (P=0.022).ConclusionCompared to CLM from hindgut origin tumors, CLM from midgut origin tumors were associated with worse survival after ablation, which was partly attributable to the fact that patients with hindgut origin tumors were more frequently candidates for local therapy at recurrence.



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Long-term regional chemotherapy for patients with epithelial malignant peritoneal mesothelioma results in improved survival

Publication date: Available online 29 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Paul H. Sugarbaker, David Chang
PurposeMalignant peritoneal mesothelioma (MPM) is a rare disease with about 300 new cases per year in the USA. Its natural history is described as local progression within the peritoneal space in the absence of liver metastases or systemic disease.MethodsCytoreductive surgery (CRS) is a series of peritonectomy procedures and visceral resections with a goal of complete removal of all visible disease from the abdomen and pelvis. Over 20 years, three protocols investigating increasing efficacy of additional chemotherapy treatments added to CRS have been initiated. Initially, hyperthermic perioperative chemotherapy (HIPEC) with doxorubicin and cisplatin was used in the operating room. Then, early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel was added for the first 5 days after CRS. The third protocol employed HIPEC, then EPIC, and then long-term intraperitoneal (IP) paclitaxel or IP pemetrexed plus intravenous (IV) cisplatin as a adjuvant normothermic intraperitoneal chemotherapy (NIPEC).ResultThe median survival of 42 patients treated with CRS and HIPEC was 44%, for 58 patients treated with EPIC and HIPEC was 52% and 29 patients who received HIPEC, EPIC, and NIPEC was 75% (p=0.0374). Prognostic variables of age, gender, treatment administered, peritoneal cancer index (PCI) and completeness of cytoreduction were significant by univariate analysis and treatments administered and completeness of cytoreduction significant by multivariate analysis.ConclusionsLong-term regional chemotherapy was associated with improved survival in patients with MPM. In this rare disease, additional phase 2 investigations are suggested.

Teaser

Synopsis: Malignant peritoneal mesothelioma was treated over a 20 year time period with a consistent surgical procedure followed by an escalation of regional chemotherapy treatments. When regional chemotherapy long term was added to the treatment plan survival improved significantly (p=0.0108).


http://ift.tt/2k67Dok

Circulating tumor cells and circulating tumor DNA: what surgical oncologists need to know?

Publication date: Available online 29 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Luc Cabel, Charlotte Proudhon, Pascale Mariani, Dimitri Tzanis, Guillaume Beinse, Ivan Bieche, Jean-Yves Pierga, François-Clément Bidard
As a result of recent progress in detection techniques, circulating tumor DNA (ctDNA) and circulating tumor cells (CTC) can now be accurately detected in the blood of most cancer patients. While these new biomarkers can provide a better understanding of key biological mechanisms underlying cancer growth and dissemination, they also open up a wide range of possible clinical applications in medical oncology, radiation oncology and surgical oncology.In this review, we summarize the results obtained with ctDNA and CTC together with their potential future clinical applications in the field of surgical oncology, with particular focus on the perioperative setting of various types of cancer. These applications include, but are not limited to, cancer screening, early diagnosis, prognostic assessment, evaluation and management of preoperative systemic or local therapies, post-surgical detection of minimal residual disease and early detection of cancer relapse.



http://ift.tt/2jFE6mC

Subclinical atherosclerosis in Systemic Lupus Erythematosus: Comparable risk with Diabetes Mellitus and Rheumatoid arthritis

Publication date: Available online 29 January 2017
Source:Autoimmunity Reviews
Author(s): Maria G. Tektonidou, Evrydiki Kravvariti, George Konstantonis, Nicholas Tentolouris, Petros P. Sfikakis, Athanasios Protogerou
ObjectiveAlthough a high risk of clinical and subclinical atherosclerosis has been reported in systemic lupus erythematosus (SLE), it is not directly compared with that observed in other rheumatic and non-rheumatic high-cardiovascular (CVD) risk diseases, such as Rheumatoid Arthritis (RA) and Diabetes Mellitus (DM). Our objective was to evaluate the relative risk (RR) of subclinical atherosclerosis in SLE, RA and DM patients compared to healthy controls, and examine potential associations with traditional and disease-related CVD risk factors in SLE.MethodsWe examined for atherosclerotic plaques 460 individuals (92% female) without CVD history, using carotid and femoral artery ultrasound: 115 SLE patients and matched 1:1 for age and gender RA, DM, and control subjects. Multivariate models were used to determine relative risk estimates for the number of atherosclerotic plaques in patient groups versus controls, and associations of plaques with traditional CVD and disease-related factors in SLE.ResultsA nearly two-fold higher number of atherosclerotic plaques in the carotid and femoral arteries was detected in each of SLE, RA and DM groups compared to controls, after adjusting for the effect of traditional CVD risk factors (RR=1.80, 95% CI 1.05–3.08, p=0.033, RR=1.90 (1.11–3.26), p=0.019, RR=1.93 (1.14–3.28), p=0.015, respectively). In SLE patients, the number of atherosclerotic plaques was associated with age (p<0.001), smoking (p=0.016), hypertension (p=0.029), and cumulative corticosteroid dose (p=0.007).ConclusionThe relative risk of subclinical atherosclerosis in SLE was comparable to that found in RA and DM, indicating that SLE patients merit a similar diligence in CVD risk assessment and management measures.



http://ift.tt/2k677Xo

Efficacy of belimumab on renal outcomes in patients with systemic lupus erythematosus: A systematic review

Publication date: Available online 29 January 2017
Source:Autoimmunity Reviews
Author(s): S Sciascia, M Radin, J Yazdany, RA Levy, D Roccatello, M Dall'Era, Maria J Cuadrado
Both BLISS-52 and BLISS-76 international phase III trials in Systemic Lupus Erythematosus (SLE) met their primary outcomes; however, they were not designed to assess the efficacy of belimumab for the treatment of lupus nephritis (LN). LN is a frequent cause of SLE-associated morbidity and mortality, and emerging evidence suggests a potential therapeutic role for agents that target B lymphocyte stimulator (BLyS).We conducted a systematic review to identify data on the effect of belimumab on LN.A total of 2004 patients with SLE were identified from 11 studies. Three hundred and twenty-six patients had LN at baseline and 234 (71.8%) of those received belimumab. Thirteen patients out of 234 (5.5%) received belimumab for active LN. Due to the heterogeneous definitions of treatment response, clinical presentation and renal involvement, it was not possible to compare results using a single outcome parameter. However, the majority of these studies defined clinical response in terms of rates of renal flare, renal remission, and/or renal organ disease improvement. One hundred twenty-nine (55.1%) of the 234 patients with LN at baseline showed an improvement in renal parameters after treatment with belimumab. In patients with baseline proteinuria >0.2g/24h, (n=687), those receiving belimumab had a median reduction in proteinuria during follow-up as high as 38%. When focusing on patients with proteinuria ≥1g/24h (n=228), 70.7% of those treated with belimumab (n=157) achieved a renal response.In the pooled population of patients receiving belimumab, we found an overall annual renal flare rate of 1.7% [24/1448, mean observation time 1,1years (0,5–3)].Despite the limitations of the studies included in this analysis, available data are promising and provide preliminary support for targeting BlyS to induce or maintain a renal response. Further trials should examine whether belimumab (alone or following rituximab) represents an additional therapeutic option in the treatment of LN.



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Clinical follow-up predictors of disease pattern change in anti-Jo1 positive anti-synthetase syndrome: Results from a multicenter, international and retrospective study

Publication date: Available online 29 January 2017
Source:Autoimmunity Reviews
Author(s): Elena Bartoloni, Miguel A. Gonzalez-Gay, Carlo Scirè, Santos Castaneda, Roberto Gerli, Francisco Javier Lopez-Longo, Julia Martinez-Barrio, Marcello Govoni, Federica Furini, Trinitario Pina, Florenzo Iannone, Margherita Giannini, Laura Nuño, Luca Quartuccio, Norberto Ortego-Centeno, Alessia Alunno, Christopher Specker, Carlomaurizio Montecucco, Konstantinos Triantafyllias, Silvia Balduzzi, Walter Alberto Sifuentes-Giraldo, Giuseppe Paolazzi, Elena Bravi, Andreas Schwarting, Raffaele Pellerito, Alessandra Russo, Carlo Selmi, Lesley-Ann Saketkoo, Enrico Fusaro, Simone Parisi, Nicolò Pipitone, Franco Franceschini, Ilaria Cavazzana, Rossella Neri, Simone Barsotti, Veronica Codullo, Lorenzo Cavagna
ObjectiveArthritis, myositis and interstitial lung disease (ILD) constitute the classic clinical triad of anti-synthetase syndrome (ASSD). These patients experience other accompanying features, such as Raynaud's phenomenon, fever or mechanic's hands. Most ASSD patients develop the complete triad during the follow-up. In the present study we aimed to determine whether the subsequent appearance of accompanying features may suggest the development of triad findings lacking at the onset in anti-Jo1 positive ASSD patients.MethodsAnti-Jo1 positive patients presenting with incomplete ASSD (no >2 classic triad features) were assessed. Clinical characteristics and clusters of disease manifestations were retrospectively collected and analyzed in a large international multicenter cohort of ASSD patients.Results165 patients (123 women) with incomplete ASSD were identified. Ninety-five patients (57.5%) developed new classic triad manifestations after 15months median (IQR 9–51) and 40 (24%) developed new accompanying features after 19months median (IQR 6–56) from disease onset. During the follow-up, the ex-novo occurrence of triad features was observed in 32 out of 40 patients (80%) with new accompanying findings and in 63 out of 125 patients (50.5%) without new accompanying findings (p=0.002). In patients with at least one new accompanying feature the odds ratio for the occurrence of new triad manifestations was 3.94 with respect to patients not developing ex-novo accompanying findings (95% CI 1.68–9.21, p=0.002).ConclusionAnti-Jo1 ASSD patients with incomplete forms at disease onset are at high risk for the subsequent occurrence of lacking classic triad findings. Although all ASSD patients should be carefully assessed for the occurrence of new triad features, a closer follow-up should be considered in the subgroup of patients developing ex novo accompanying findings. These patients, indeed, have near four-fold increased risk for new classic triad manifestation occurrence with respect to patients not presenting ex novo accompanying findings.



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Subclinical atherosclerosis in Systemic Lupus Erythematosus: Comparable risk with Diabetes Mellitus and Rheumatoid arthritis

Publication date: Available online 29 January 2017
Source:Autoimmunity Reviews
Author(s): Maria G. Tektonidou, Evrydiki Kravvariti, George Konstantonis, Nicholas Tentolouris, Petros P. Sfikakis, Athanasios Protogerou
ObjectiveAlthough a high risk of clinical and subclinical atherosclerosis has been reported in systemic lupus erythematosus (SLE), it is not directly compared with that observed in other rheumatic and non-rheumatic high-cardiovascular (CVD) risk diseases, such as Rheumatoid Arthritis (RA) and Diabetes Mellitus (DM). Our objective was to evaluate the relative risk (RR) of subclinical atherosclerosis in SLE, RA and DM patients compared to healthy controls, and examine potential associations with traditional and disease-related CVD risk factors in SLE.MethodsWe examined for atherosclerotic plaques 460 individuals (92% female) without CVD history, using carotid and femoral artery ultrasound: 115 SLE patients and matched 1:1 for age and gender RA, DM, and control subjects. Multivariate models were used to determine relative risk estimates for the number of atherosclerotic plaques in patient groups versus controls, and associations of plaques with traditional CVD and disease-related factors in SLE.ResultsA nearly two-fold higher number of atherosclerotic plaques in the carotid and femoral arteries was detected in each of SLE, RA and DM groups compared to controls, after adjusting for the effect of traditional CVD risk factors (RR=1.80, 95% CI 1.05–3.08, p=0.033, RR=1.90 (1.11–3.26), p=0.019, RR=1.93 (1.14–3.28), p=0.015, respectively). In SLE patients, the number of atherosclerotic plaques was associated with age (p<0.001), smoking (p=0.016), hypertension (p=0.029), and cumulative corticosteroid dose (p=0.007).ConclusionThe relative risk of subclinical atherosclerosis in SLE was comparable to that found in RA and DM, indicating that SLE patients merit a similar diligence in CVD risk assessment and management measures.



http://ift.tt/2k677Xo

Efficacy of belimumab on renal outcomes in patients with systemic lupus erythematosus: A systematic review

Publication date: Available online 29 January 2017
Source:Autoimmunity Reviews
Author(s): S Sciascia, M Radin, J Yazdany, RA Levy, D Roccatello, M Dall'Era, Maria J Cuadrado
Both BLISS-52 and BLISS-76 international phase III trials in Systemic Lupus Erythematosus (SLE) met their primary outcomes; however, they were not designed to assess the efficacy of belimumab for the treatment of lupus nephritis (LN). LN is a frequent cause of SLE-associated morbidity and mortality, and emerging evidence suggests a potential therapeutic role for agents that target B lymphocyte stimulator (BLyS).We conducted a systematic review to identify data on the effect of belimumab on LN.A total of 2004 patients with SLE were identified from 11 studies. Three hundred and twenty-six patients had LN at baseline and 234 (71.8%) of those received belimumab. Thirteen patients out of 234 (5.5%) received belimumab for active LN. Due to the heterogeneous definitions of treatment response, clinical presentation and renal involvement, it was not possible to compare results using a single outcome parameter. However, the majority of these studies defined clinical response in terms of rates of renal flare, renal remission, and/or renal organ disease improvement. One hundred twenty-nine (55.1%) of the 234 patients with LN at baseline showed an improvement in renal parameters after treatment with belimumab. In patients with baseline proteinuria >0.2g/24h, (n=687), those receiving belimumab had a median reduction in proteinuria during follow-up as high as 38%. When focusing on patients with proteinuria ≥1g/24h (n=228), 70.7% of those treated with belimumab (n=157) achieved a renal response.In the pooled population of patients receiving belimumab, we found an overall annual renal flare rate of 1.7% [24/1448, mean observation time 1,1years (0,5–3)].Despite the limitations of the studies included in this analysis, available data are promising and provide preliminary support for targeting BlyS to induce or maintain a renal response. Further trials should examine whether belimumab (alone or following rituximab) represents an additional therapeutic option in the treatment of LN.



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