Background Cancer risk is elevated among adult transplant recipients, but there is limited data regarding long-term cancer risk and mortality in pediatric recipients. Methods We conducted a population-based retrospective cohort study in Ontario, Canada. We included pediatric recipients of solid organ transplants at the Hospital for Sick Children, Toronto from 1991 to 2014, and compared rates of new cancers and cancer-specific mortality to nontransplanted Ontario children born in the same year. We constructed standard and time-dependent Cox proportional hazards models accounting for competing risk of death. Results A total of 951 recipients (kidney n=400, liver n=283, heart n=218, lung n=36, multiorgan/small bowel n=14) were compared to 5.3 million general population children. Mean (SD) age was 8.2 (6.4) years; 50% were male. Over a mean (SD) follow-up of 10.8 (7.1) years, cumulative incidence of cancer was 20% in recipients and 1.2% in the general population (incidence rate ratio 32.9; 95% CI 26.6-40.8). Risk was highest in the first year posttransplant (aHR 176; 95% CI 117-264), but remained elevated beyond 10 years (aHR 10.8; 95% CI 6.3-18.6). Lymphoproliferative disorders were predominant (77%); however, solid cancers (renal, sarcomas, genital, thyroid) were seen. Recipients of lung or multiorgan transplants were at highest risk. Cancer-specific mortality was also higher among recipients (HR 93.1; 95% CI 59.6-145.2). Conclusions Childhood transplant recipients have a 30-times greater cancer incidence versus the general population. Further investigation is needed to guide screening strategies in this at-risk population. *Corresponding Author Contact Information: Rulan S. Parekh, MD, MS., FRCPC, Nephrologist, Division of Nephrology, Associate Chief, Clinical Research, Scientist, Child Health Evaluative Sciences, Research Institute, Professor, Faculty of Medicine, Institute of Medical Sciences and Dalla Lana School of Public Health, University of Toronto, Peter Gilgan Centre for Research & Learning, The Hospital for Sick Children (SickKids), 686 Bay Street, Child Health Evaluative Sciences, 11th floor, Toronto, ON, Canada, M5G 0A4, Phone: 416-813-7654 ext. 328042, Fax: 416-813-5979. Email: rulan.parekh@sickkids.ca AUTHORSHIP A.K., S.D., S.J.K., P.C.N., and R.S.P participated in the study design. A.K., S.D., S.G., and P.C.N. participated in the data analysis. A.K., S.D., J.S.D., P.C.N., and R.S.P drafted the manuscript. All authors read and approved the final manuscript. DISCLOSURES The authors declare no conflicts of interest. FUNDING Dr. Rulan S. Parekh received funding from the Transplant & Regenerative Medicine Centre (TRMC) Catalyst Grant at The Hospital for Sick Children, Ashley's Angels Catwalk and the Canadian Institutes of Health Research (CIHR) for the completion of this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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Πέμπτη 26 Ιουλίου 2018
Regional Variation in Utilization and Outcomes of Liver Allografts from Donors with High Body-Mass Index and Graft Macrosteatosis: A Role for Liver Biopsy
Background Obesity, defined as a body mass index ≥30 kg/m2 (hBMI), is a growing epidemic worldwide and is associated with multiple comorbidities. hBMI individuals account for an increasing portion of potential liver donors. Here we evaluate trends in the utilization and outcomes of hBMI donors on a national and regional level and the potential role of liver biopsy in donor evaluation. Methods UNOS STAR database was evaluated for deceased donor liver transplants between 2006 and 2016 across 11 OPTN regions. hBMI donors were compared to lower BMI counterparts and evaluated for biopsy rates, utilization rates and allograft outcomes. Univariate and multivariable analyses were performed. Results 77 050 potential donors were identified and 60 200 transplants were evaluated. Utilization rates for hBMI donors was 66.1% versus 78.1% for lower BMI donors (p
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https://ift.tt/2NNHTe0
Reduced Risk of BK Polyomavirus Infection in HLA-B51 Positive Kidney Transplant Recipients
Background Identification of specific HLA alleles and T cell epitopes that influence the course of BK polyomavirus (BKPyV) infection after kidney transplantation (KTx), including development of BKPyV-associated nephropathy (BKPyVAN), can be useful for patient risk stratification and possibly vaccine development. Methods In a retrospective cohort of 407 living kidney donor-recipient pairs, donor and recipient HLA class I and II status were correlated with the occurrence of recipient BKPyV viremia and BKPyVAN in the first year after KTx. Relevant HLA alleles were systematically analyzed for candidate peptide epitopes in silico. Results While none of the 78 HLA alleles analyzed increased the risk of BKPyV viremia and BKPyVAN, a considerable reduction of BKPyV viremia and BKPyVAN cases was observed in HLA-B51 positive KTx recipients. Multivariate analysis showed that HLA-B51-positivity, found in 36 recipients (9%), reduced the risk of viremia approximately five-fold (HR 0.18, 95% CI: 0.04 – 0.73, p = 0.017). Four HLA-B51-restricted putative cytotoxic T lymphocyte epitopes were identified, including a previously described HLA-B supermotif-containing peptide (LPLMRKAYL), encoded by 2 relevant T-antigens (Small T and Large T) and previously shown to be highly immunogenic. Conclusions In conclusion, HLA-B51-positive kidney transplant recipients were less susceptible to BKPyV infection, which might be explained by efficient presentation of a particular BKPyV-derived immunogenic peptide. Authorship The author's specific contributions are as follows: HFW and MCWF initiated the study. HFW, ACMK, JWdF, JIR, FHJC and MCWF designed the study. HFW, CSdB, GWH and JIR collected the samples and gathered the data. CSdB performed the serological tests and the PCR assays. HFW analysed the data. EWvZ and GWH provided statistical support. HFW, ACMK, JWdF, JIR, FHJC, and MCWF interpreted the data. HFW and MCWF drafted the manuscript, and designed the figures and tables. All authors reviewed and approved the final report. Disclosure The authors declare no conflicts of interest Funding This study was supported by the Dutch Kidney Foundation, grant 13A1D302. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2LTz4ih
The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients
Background In liver transplantation, both cold- and warm ischemia time are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known. Methods We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time and the donor risk index. Results Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score. (Coefficient 0.018, 95%CI 0.004 to 0.03, P = 0.012; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time and donor risk index had a significant effect on early graft function. Conclusions We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation. Correspondence information: Dieter Adelmann, MD, PhD, Department of Anesthesia & Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA, dieter.adelmann@ucsf.edu Authorship: D.A., G.R.R., and C.U.N. drafted the study protocol. C.U.N. obtained Institutional Review Board approval D.A., M.T. and R.P.K. collected patients' data D.A. performed the statistical analysis D.A., G.R.R., S.S., L.J.B, R.P.K. and C.U.N. prepared the manuscript. Disclosures: The authors declare no conflicts of interest Funding: This study was supported by departmental funds. (Department of Anesthesia and Perioperative Care San Francisco, University of California, San Francisco, CA) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2LImB4a
Cell Spray Transplantation of Adipose-Derived Mesenchymal Stem Cell Recovers Ischemic Cardiomyopathy in a Porcine Model
Background Allogeneic adipose-derived mesenchymal stem cells (ADSC) are promising cell sources for cell therapy to treat ischemic cardiomyopathy (ICM). We hypothesized that ADSC transplantation via the new cell spray method may be a feasible, safe, and effective treatment for ICM. Methods Human ADSCs were acquired from white adipose tissue. Porcine ICM models were established by constriction of the left anterior descending coronary artery. ADSCs were spread over the surface of the heart via cell spray in fibrinogen and thrombin solutions. The cardiac function was compared to that of the control group. Results ADSCs were successfully transplanted forming a graft-like gel film covering the infarct myocardium. Premature ventricular contractions were rarely detected in the first 3 days after transplantation. Echocardiography and magnetic resonance imaging revealed improved cardiac performance of the ADSC group at 4 and 8 weeks after transplantation. Systolic and diastolic parameters were significantly greater in the ADSC group at 8 weeks after transplantation. Histological examination showed significantly attenuated left ventricular remodeling and a greater vascular density in the infarct border area in the ADSC group. Moreover, the coronary flow reserve was maintained, and expression levels of angiogenesis-related factors in the infarct border and remote areas were significantly increased. Conclusion Spray method implantation of allogenic ADSCs can improve recovery of cardiac function in a porcine infarction model. This new allogenic cell delivery system may help to resolve current limitations of invasiveness and cost in stem cell therapy. Corresponding author: Yoshiki Sawa, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan, E-mail: sawa-p@surg1.med.osaka-u.ac.jp, TEL: +81-6-6879-3154/FAX: +81-6-6879-3163 Author contributions D.M. participated in research design performance of research, analyzed data, and wrote the article. S.Y., K.K., H.K., and H.N. performed research and analyzed data. K.I. and J.H. participated in performing PET.(helped with some experiments) S.S., S.F., T.U., and K.T. reviewed all data and article. S.M. and Y.S.participated in research design, writing of the article and reviewed all data and article. All authors have met the following criteria: drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Disclosure This study was supported by Rohto Pharmaceutical Co., Ltd. Dr. Sawa serves as an advisor for the sponsor. Dr. Sawa and Dr. Miyagawa received a speaking fee from the sponsor. Ms. Kawai, Mr. Kurata, and Mr. Nishida receive a salary from the sponsor where they are employees. The sponsor had no control over the interpretation, writing, or publication of this work. The terms of this arrangement have been reviewed and approved by Osaka University in accordance with its policy on objectivity in research. Funding This work was supported by the Department of Advanced Stem Cell Therapy (Rohto Pharmaceutical Co. Ltd.). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2LEMDoR
Vascularized Brachial Plexus Allotransplantation – An Experimental Study in Brown Norway and Lewis Rats
Background Brachial plexus injuries are devastating. Current reconstructive treatments achieve limited partial functionality. Vascularized brachial plexus allotransplantation could offer the best nerve graft fulfilling the like-with-like principle. In this experimental study, we assessed the feasibility of rat brachial plexus allotransplantation and analyzed its functional outcomes. Methods A free vascularized brachial plexus with a chimeric compound skin paddle flap based on the subclavian vessels was transplanted from a Brown Norway rat to a Lewis rat. This study has 2 parts. Protocol I aimed to develop the vascularized brachial plexus allotransplantation-model (VBP-allo). Four groups are compared: no reconstruction, VBP-allo with and without Cyclosporine-A (CsA) immunosuppression, VBP autotransplantation (VBP-auto). Protocol II compared the recovery of the biceps muscle and forearm flexors when using all 5, 2 (C5+C6) or 1 (isolated C6) spinal nerve as the donor nerves. The assessment was performed on week 16 and included muscle weight, functionality (grooming tests, muscle strength), electrophysiology and histomorphology of the targeted muscles. Results Protocol I showed, the VBP-allo with CsA immunosuppression was electrophysiologically and functionally comparable to VBP-auto and significantly superior to negative controls and absent immunosuppression. In Protocol II, all groups had a comparable functional recovery in the biceps muscle. Only with 5 donor nerves did the forearm show good results compared with only 1 or 2 donor nerves. Conclusions This study demonstrated a useful vascularized complete brachial plexus allotransplantation rodent model with successful forelimb function restoration under immunosuppression. Only the allotransplantation including all 5 roots as donor nerves achieved a forearm recovery. Corresponding Author: David Chwei-Chin Chuang, M.D., Professor, Department of Plastic Surgery, Chang Gung Memorial Hospital, No.5, Fu-Shing St., Taoyuan, Taiwan, Tel.: 886-3-3281200, Ext 3355, Fax: 886-3-3972681, E-mail: dccchuang@gmail.com Authorship Author's specific contributions 1. Participated in research design: David Chwei-Chin Chuang 2. Participated in the writing of the paper: Tommy Nai-Jen Chang, Bassem W Daniel, Kuang-Te Chen, Johhny Chuieng-Yi Lu 3. Participated in the performance of the operation and the sample collection: Tommy Nai-Jen Chang, Kuang-Te Chen, Catherine Hernon 4. Contributed new reagents or analytic tools: Bassem W Daniel, David Chwei-Chin Chuang 5. Participated in data analysis: Tommy Nai-Jen Chang, Catherine Hernon, Mark Shafarenko, Yen-Lin Huang Disclosure The authors hereby declare that they have no conflict of interest in any products used/tested in this study and have nothing to declare. Financial Disclosure: This study was supported by a grant from the Ministry of Science and Technology Taiwan (NSC94-2314-B-182A-176) and the Chang Gung Memorial Hospital, Linkou, Taiwan (CMRPG3A0441-3). None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2LEMdih
A novel variant of SLC26A4 and first report of the c.716T>A variant in Iranian pedigrees with non-syndromic sensorineural hearing loss
Publication date: Available online 27 July 2018
Source: American Journal of Otolaryngology
Author(s): Fatemeh Azadegan-Dehkordi, Reza Ahmadi, Tayyeb Bahrami, Nasrin Yazdanpanahi, Effat Farrokhi, Mohammad Amin Tabatabaiefar, Morteza Hashemzadeh-Chaleshtori
Abstract
The autosomal recessive non-syndromic hearing loss (ARNSHL) can be associated with variants in solute carrier family 26, member 4 (SLC26A4) gene and is the second most common cause of ARNSHL worldwide. Therefore, this study aims to determine the contribution of the SLC26A4 genotype in the hearing loss (HL) of 40 ARNSHL pedigrees in Iran. A cohort of the 40 Iranian pedigrees with ARNSHL, having no mutation in the GJB2 gene, was selected. The linkage analysis with five short tandem repeat (STR) markers linked to SLC26A4 was performed for the 40 ARNSHL pedigrees. Then, two out of the 40 pedigrees with ARNSHL that linked to DFNB4 locus were further screened to determine the variants in all exons of SLC26A4 gene by direct DNA sequencing. The 21 exons of SCL26A4 were analyzed for the two pedigrees. A known variant (c.716T>A homozygote), it is the first reported incidence in Iran, a novel variant (c.493A>C homozygote) were detected in the two pedigrees and pathogenesis of c.493A>C confirmed in this study with review 100 hearing ethnically matched controls by PCR-RFLP analysis. The present study suggests that the SLC26A4 gene plays a crucial role in the HL occurring in Iranian pedigrees. Also, the results probably support the specificity and unique spectrum of SLC26A4 variants among Iranian HL patients. Molecular study of SLC26A4 gene may lead to elucidation of the profile of the population-specific variants which has importance in diagnostics of HL.
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Phenotypes, endotypes and biomarkers in anaphylaxis: current insights
Purpose of review The aim of the review is to describe the different clinical pictures of anaphylaxis (phenotypes), in relation to the underlying mechanisms and potential biomarkers, to describe anaphylaxis endotypes. This may aid in achieving a better understanding, management and outcomes of such severe reactions. Recent findings Different anaphylaxis phenotypes have been outlined, ranging from the classical type-I-like to those suggestive of cytokine-storm-like or complement-mediated reactions. Underlying mechanisms differ and biomarkers of cells and systems involved are being identified (tryptase, IL-6, bradykinin etc.) Summary Identifying specific phenotypes/endotypes will allow the application of precision medicine in patients with anaphylaxis, providing insights to the most appropriate approach in each case. Correspondence to Mar Guilarte, Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035 Barcelona, Spain. Tel: +34 932746169; e-mail: mguilarte@vhebron.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2vbfJ4L
https://ift.tt/2vbfJ4L
Reply to letter “Powered lymphaticovenular anastomosis for treatment of upper extremity lymphedema: deducing location of functional lymphatic vessels from pumping movement of the underlying muscles” related to “Noncontrast magnetic resonance lymphography for evaluation of lymph node transfer for secondary upper limb lymphedemas”.
Prevalence of an Intact Hyoid Bone at Revision Excision of a Thyroglossal Duct Remnant
Publication date: Available online 27 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Jonathan Huang, Beth Osterbauer, Jeffrey Koempel
Abstract
Objective
To determine the prevalence of an intact hyoid bone at the time of revision thyroglossal duct cyst (TGDC) surgery in a pediatric population.
Methods
The operative reports of 44 patients under 18 years of age who underwent a revision TGDC surgery from March 1997 to October 2015 at Children's Hospital Los Angeles were reviewed to determine finding of an intact hyoid bone at the time of the revision procedure.
Results
At the time of the revision surgery, 75% of the patients had an intact hyoid bone and 25% did not.
Conclusion
Patients who experience a recurrence of a TGDC are more likely than not to have an intact hyoid bone at revision surgery. These data indicate that some surgeons are not following the recommendation from Schlange and Sistrunk that removal of the mid-portion of the hyoid bone should be a routine part of any primary procedure for excision of a known or suspected TGDC in order to decrease the risk of recurrence. Despite the prevalent knowledge that the central portion of the hyoid bone be removed during a TGDC procedure, special attention should be given to the area of the midportion of the hyoid bone as a likely site of persistent disease in revision cases even if a previous operative report documents resection of a portion of the hyoid bone and/or cartilage.
https://ift.tt/2vbCtBN
A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study
Publication date: Available online 27 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Bronwyn Dixon, Juliet Gray, Nikki Elliot, Brett Shand, Adrienne Lynn
Abstract
Objectives
A programme was introduced in Canterbury, New Zealand to evaluate the diagnosis and treatment of frenulum releases in newborn infants with suspected tongue-tie (ankyloglossia). The primary goals were to support breastfeeding and ensure that unnecessary surgery was avoided.
Methods
Local healthcare professionals reached consensus on a pathway for improving management of infants with tongue-tie and breast-feeding difficulties. This embedded an expert breast-feeding review and assessment of lingual function used a validated method, the Bristol Tongue-tie Assessment Tool (BTAT). Infants with breastfeeding problems related to tongue-tie had a frenotomy at a hospital outpatient clinic. An education programme was developed to support introduction of the new clinical pathway and included seminars and online information for healthcare professionals and the general public.
Results
Frenotomy intervention rate reduced markedly from 11.3% in 2015 to 3.5% by mid-2017. Feeding methods were not different before or after surgery between infants who received a frenotomy and those who did not. Initially, the BTAT threshold for frenotomy was set at ≤5, however the final clinical pathway combined a breastfeeding assessment and a BTAT threshold of ≤4. The education programs assisted with the changes in practice, while increased use of the clinician guidance and public health information websites confirmed growing awareness of tongue-tie and community breastfeeding support.
Conclusions
Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.
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Shared processes resolve competition within and between episodic and semantic memory: Evidence from patients with LIFG lesions
Publication date: Available online 27 July 2018
Source: Cortex
Author(s): Sara Stampacchia, Hannah E. Thompson, Emily Ball, Upasana Nathaniel, Glyn Hallam, Jonathan Smallwood, Matthew A. Lambon Ralph, Elizabeth Jefferies
Abstract
Semantic cognition is supported by two interactive components: semantic representations and mechanisms that regulate retrieval (cf. 'semantic control'). Neuropsychological studies have revealed a clear dissociation between semantic and episodic memory. This study explores if the same dissociation holds for control processes that act on episodic and semantic memory, or whether both types of long-term memory are supported by the same executive mechanisms. We addressed this question in a case-series of semantic aphasic patients who had difficulty retrieving both verbal and non-verbal conceptual information in an appropriate fashion following infarcts to left inferior frontal gyrus (LIFG). We observed parallel deficits in semantic and episodic memory: (i) the patients' difficulties extended beyond verbal materials to include picture tasks in both domains; (ii) both types of retrieval benefitted from cues designed to reduce the need for internal constraint; (iii) there was little impairment of both semantic and episodic tasks when control demands were minimised; (iv) there were similar effects of distractors across tasks. Episodic retrieval was highly susceptible to false memories elicited by semantically-related distractors, and confidence was inappropriately high in these circumstances. Semantic judgements were also prone to contamination from recent events. These findings demonstrate that patients with deregulated semantic cognition have comparable deficits in episodic retrieval. The results are consistent with a role for LIFG in resolving competition within both episodic and semantic memory, and also in biasing cognition towards task-relevant memory stores when episodic and semantic representations do not promote the same response.
https://ift.tt/2v83OVC
Clinical management of quadriplegia in low and middle-income countries: a patients road to physiotherapy, prostheses and rehabilitation
Here we discuss the follow-up case of a 27-year-old male patient from rural Philippines, who was neglected by local health services after losing all four of his limbs as a result of a high-voltage electrical accident. The case follows the patient's road to accessing prostheses, rehabilitation health services and physiotherapy. Significant disparities were found between the government health services and the private sector with respect to quality, accessibility and affordability. Access to affordable healthcare is a basic human right that must be a priority for low-income and middle-income countries.
https://ift.tt/2AkDAEW
Successful management of persistent distressing neuropsychiatric symptoms by clozapine in a patient suffering from dementia with Lewy bodies
Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia associated with poor prognosis and high carers' burden. Neuropsychiatric symptoms worsen this prognosis and are a high source of distress for service users and their carers. However, there is currently insufficient evidence to support the pharmacological and non-pharmacological management of these symptoms. Acetylcholinesterase inhibitors are the first-line pharmacological option, but challenging risky behaviours may persist despite their use. Antipsychotic medications are indicated in such clinical scenarios, but there is very limited evidence to support the efficacy and safety of these medications for managing neuropsychiatric symptoms in DLB. Hence, we report an individual with DLB with severe distressing persistent visual hallucinations and agitation. After multiple treatment options had failed, clozapine was successfully initiated with substantial improvement in both clinical and functional outcomes. Further studies are warranted for evaluating the efficacy of clozapine in managing neuropsychiatric symptoms in DLB.
https://ift.tt/2mNvgny
Linezolid-induced pancytopenia
Linezolid is a bacteriostatic antibiotic of the Oxazolidinone class; it works by inhibiting the initiation of protein synthesis on bacterial ribosomes. Due to its excellent bioavailability after oral dosing, it has become an important tool in combating multi-drug-resistant bacteria including glycopeptide-resistant enterococci and methicillin-resistant Staphylococcus aureus. Side effects are multiple and potentially serious. We report the case of an 87-year-old man who developed pancytopenia secondary to a 6-week course of linezolid. Withdrawal of the antibiotic was decided as the treatment and resolution of the pancytopenia was evident within 2 weeks. Clinicians should be aware of this side effect of linezolid therapy and that weekly full blood count monitoring is paramount.
https://ift.tt/2AeJSWV
Calvarial osteomyelitis and intracranial extension post-Mohs micrographic surgery
Mohs micrographic surgery (MMS) is a specialised micrographic technique used for the treatment of locally invasive skin cancers. Despite being a relatively low risk surgery, the overall complication rates range between 1.6% and 3%. Common complications include postoperative haemorrhage, haematoma formation, wound infection, wound dehiscence and flap/graft necrosis. Osteomyelitis after dermatological cancer surgery is exceedingly rare. There have only been two cases of osteomyelitis in association with Mohs surgery reported in the literature to date. Here, we describe an epidemiologically atypical patient who initially presented with fever and altered mental status and later found to have calvarial osteomyelitis, intracranial abscess (empyema) and meningoencephalitis as a result of Mohs surgery. Although rare, it is a predictable side effect postsurgery, and prevention of such complications are critical to decrease morbidity and mortality in patients undergoing MMS.
https://ift.tt/2OiA2pL
Neurogenic pulmonary oedema complicating a lateral medullary infarct
Neurogenic pulmonary oedema (NPO) is a rare clinical syndrome of pulmonary oedema occurring secondary to an insult of the central nervous system (CNS). The exact aetiology of this disorder is unknown. NPO can be fatal and poor awareness and identification of this entity, particularly in terms of misdiagnosis as primary pulmonary or cardiac disease, can result in suboptimal management and outcomes. We describe the presentation and management of a 68-year-old woman with an acute left lateral medullary stroke complicated by pulmonary oedema. The likely aetiology is discussed, and important learning points are highlighted.
https://ift.tt/2AeJMi1
Symptomatic pulmonary restriction secondary to diaphragmatic eventration and megacolon in adult
Description
A 70-year-old woman with a medical history significant for toxic megacolon secondary to Clostridium difficile infection treated 40 years prior with partial colectomy and known diaphragmatic eventration presents with a 3-day history of progressive shortness of breath and dyspnoea on exertion. The patient had never previously been symptomatic nor suffered blunt trauma and had a strong personal conviction to avoid surgery. CT imaging revealed a massive left diaphragmatic displacement containing spleen, stomach and colon with mediastinal shift, compression of the left lung and a pericardial effusion (figure 1). Due to persistent tachycardia and presence of pericardial effusion on CT, a transthoracic echocardiogram was obtained, which demonstrated a large pericardial effusion concerning for tamponade physiology. The patient developed supraventricular tachycardia for which cardiology was consulted and two doses of adenosine were administered with resolution. The patient was upgraded to surgical intensive care and taken to the operating...
https://ift.tt/2mLPZIw
Vessel wall enhancement by gadolinium-enhanced MRI in a patient with delayed stenosis after mechanical thrombectomy
Description
Delayed stenosis of targeted vessels is a reported complication of stent retriever-based mechanical thrombectomy.1 We report a case of delayed stenosis with MRI findings that may be related to the underlying stenotic mechanism.
A 46-year-old woman was brought to our hospital with sudden left hemiparesis and unilateral spatial neglect. MRI revealed occlusion of the right middle cerebral artery (MCA) and acute cerebral infarction (figure 1A,B). Emergent mechanical thrombectomy was performed with one stent retriever pass following two aspiration catheter passes, and a red thrombus was retrieved (figure 1C,D). We thought that an embolism had caused the vessel occlusion as no abnormalities were visualised at the occluded site on day 2 (figure 1E). Despite detailed examinations, we could not determine the embolic source during the patient's hospitalisation, so we administered low-dose aspirin. She was discharged on day 46.
https://ift.tt/2AeK0pn
Indapamide-induced bilateral choroidal effusion in pseudophakic patient.
We describe a case of indapamide-induced bilateral choroidal effusion, first time reported in pseudophakic patient, associated with no change in visual acuity and stable refraction.
A 70-year-old man was referred for ophthalmic assessment, with binasal visual field defect for 2 days. He had been started on treatment with indapamide 3 weeks earlier. His ophthalmic history included bilateral cataract surgery and intraocular lens implant. Fundal examination revealed bilateral choroidal effusions; B-scan ultrasonography was used to measure the extent of the choroidal detachment and the anterior chamber depth. Discontinuation of indapamide resulted in spontaneous resolution of choroidal effusion after 3 days. Our case is the first in the literature that describes bilateral choroidal effusion induced by indapamide in a pseudophakic patient. The lack of myopic shift likely resulted in a later presentation, enhancing the theory that lens thickening and/or accommodative spasm may play a crucial role in pathophysiology.
https://ift.tt/2OjKm0R
Spontaneous disenclavation of phakic intraocular iris claw lens
Description
A 35-year-old male patient came to the outpatient department with sudden onset painless diminution of vision and diplopia in RE since last 3 days. The vision was 20/200 in the RE and 20/20 in the LE. The patient was a known case of myopia with history of phakic eye iris claw intraocular lens (IOL) of both eyes done 12 years back. There was no history of trauma. His best-corrected visual acuity in the right eye was 20/20 with –3DS, –0.50DC x 90 in the OD. The intraocular pressure in the OD was 13 mm Hg and 15 mm Hg in the OS. On slit lamp examination nasal disenclavation of the iris claw lens was noted, the edge of which was bisecting the non-dilated pupillary plane. The IOL was hanging inferiorly with the optic touching the corneal endothelium inferiorly and with the other end fixed at the 9 o'clock position (figure 1). The cornea...
https://ift.tt/2AaHalb
POEMS syndrome: diagnostic delay and successful treatment with lenalidomide, cyclophosphamide and prednisone followed by autologous peripheral stem cell transplantation
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome is a rare systemic disease, often unrecognised in the primary care setting. POEMS syndrome is associated with plasma cell dyscrasias and upregulation of vascular endothelial growth factor leading to systemic oedema, papilloedema and pulmonary hypertension. A wide constellation of presenting symptoms often leads to late diagnosis. Unrecognised and untreated disease rapidly leads to death from neuropathic exhaustion or cardiopulmonary failure. Treatment is extrapolated from other plasma cell dyscrasias such as multiple myeloma. Autologous peripheral blood stem cell transplantation (PBSCT) is often an important component of treatment. There is no established standard of care for POEMS syndrome. Therapies include lenalidomide, bortezomib and targeted monoclonal antibodies. We present a patient with POEMS syndrome who achieved rapid complete response to triple therapy consisting of lenalidomide, cyclophosphamide and prednisone, followed by high-dose chemotherapy and PBSCT.
https://ift.tt/2OlMOnF
Predictors of Neck Reoperation and Mortality After Initial Total Thyroidectomy for Differentiated Thyroid Cancer
Thyroid, Ahead of Print.
https://ift.tt/2uUN8Bz
Methylphenidate Attenuates the Cognitive and Mood Alterations Observed in Mbnl2 Knockout Mice and Reduces Microglia Overexpression
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystem disorder affecting muscle and central nervous system (CNS) function. The cellular mechanisms underlying CNS alterations are poorly understood and no useful treatments exist for the neuropsychological deficits observed in DM1 patients. We investigated the progression of behavioral deficits present in male and female muscleblind-like 2 (Mbnl2) knockout (KO) mice, a rodent model of CNS alterations in DM1, and determined the biochemical and electrophysiological correlates in medial prefrontal cortex (mPFC), striatum and hippocampus (HPC). Male KO exhibited more cognitive impairment and depressive-like behavior than female KO mice. In the mPFC, KO mice showed an overexpression of proinflammatory microglia, increased transcriptional levels of Dat, Drd1, and Drd2, exacerbated dopamine levels, and abnormal neural spiking and oscillatory activities in the mPFC and HPC. Chronic treatment with methylphenidate (MPH) (1 and 3 mg/kg) reversed the behavioral deficits, reduced proinflammatory microglia in the mPFC, normalized prefrontal Dat and Drd2 gene expression, and increased Bdnf and Nrf2 mRNA levels. These findings unravel the mechanisms underlying the beneficial effects of MPH on cognitive deficits and depressive-like behaviors observed in Mbnl2 KO mice, and suggest that MPH could be a potential candidate to treat the CNS deficiencies in DM1 patients.https://ift.tt/2vcy5T0
PTPN11 Gain-of-Function Mutations Affect the Developing Human Brain, Memory, and Attention
Abstract
The Ras-MAPK pathway has an established role in neural development and synaptic signaling. Mutations in this pathway are associated with a collection of neurodevelopmental syndromes, Rasopathies; among these, Noonan syndrome (NS) is the most common (1:2000). Prior research has focused on identifying genetic mutations and cellular mechanisms of the disorder, however, effects of NS on the human brain remain unknown. Here, imaging and cognitive data were collected from 12 children with PTPN11-related NS, ages 4.0–11.0 years (8.98 ± 2.33) and 12 age- and sex-matched typically developing controls (8.79 ± 2.17). We observe reduced gray matter volume in bilateral corpus striatum (Cohen's d = −1.0:−1.3), reduced surface area in temporal regions (d = −1.8:−2.2), increased cortical thickness in frontal regions (d = 1.2–1.3), and reduced cortical thickness in limbic regions (d = −1.6), including limbic structures integral to the circuitry of the hippocampus. Further, we find high levels of inattention, hyperactivity, and memory deficits in children with NS. Taken together, these results identify effects of NS on specific brain regions associated with ADHD and learning in children. While our research lays the groundwork for elucidating the neural and behavioral mechanisms of NS, it also adds an essential tier to understanding the Ras-MAPK pathway's role in human brain development.https://ift.tt/2Okuawc
Mental Imagery Follows Similar Cortical Reorganization as Perception: Intra-Modal and Cross-Modal Plasticity in Congenitally Blind
Abstract
Cortical plasticity in congenitally blind individuals leads to cross-modal activation of the visual cortex and may lead to superior perceptual processing in the intact sensory domains. Although mental imagery is often defined as a quasi-perceptual experience, it is unknown whether it follows similar cortical reorganization as perception in blind individuals. In this study, we show that auditory versus tactile perception evokes similar intra-modal discriminative patterns in congenitally blind compared with sighted participants. These results indicate that cortical plasticity following visual deprivation does not influence broad intra-modal organization of auditory and tactile perception as measured by our task. Furthermore, not only the blind, but also the sighted participants showed cross-modal discriminative patterns for perception modality in the visual cortex. During mental imagery, both groups showed similar decoding accuracies for imagery modality in the intra-modal primary sensory cortices. However, no cross-modal discriminative information for imagery modality was found in early visual cortex of blind participants, in contrast to the sighted participants. We did find evidence of cross-modal activation of higher visual areas in blind participants, including the representation of specific-imagined auditory features in visual area V4.https://ift.tt/2v8XrRY
Evidence for a Posterior Parietal Cortex Contribution to Spatial but not Temporal Numerosity Perception
Abstract
Posterior parietal cortex (PPC) is thought to encode and represent the number of objects in a visual scene (i.e., numerosity). Whether this representation is shared for simultaneous and sequential stimuli (i.e., mode independency) is debated. We tested the existence of a common neural substrate for the encoding of these modes using fMRI. While both modes elicited overlapping BOLD response in occipital areas, only simultaneous numerosities significantly activated PPC. Unique activation for sequential numerosities was found in bilateral temporal areas. Multivoxel pattern analysis revealed numerosity selectivity in PPC only for simultaneous numerosities and revealed differential encoding of presentation modes. Voxel-wise numerosity tuning functions for simultaneous numerosities in occipital and parietal ROIs revealed increasing numerosity selectivity along an occipito-to-parietal gradient. Our results suggest that the parietal cortex is involved in the extraction of spatial but not temporal numerosity and question the idea of commonly used cortical circuits for a mode-independent numerosity representation.https://ift.tt/2LuVXfW
A Quantitative Study on the Distribution of Mitochondria in the Neuropil of the Juvenile Rat Somatosensory Cortex
Abstract
Mitochondria play a key role in energy production and calcium buffering, among many other functions. They provide most of the energy required by neurons, and they are transported along axons and dendrites to the regions of higher energy demands. We have used focused ion beam milling and scanning electron microscopy (FIB/SEM) to obtain stacks of serial sections from the somatosensory cortex of the juvenile rat. We have estimated the volume fraction occupied by mitochondria and their distribution between dendritic, axonal, and nonsynaptic processes. The volume fraction of mitochondria increased from layer I (4.59%) to reach its maximum in layer IV (7.74%) and decreased to its minimum in layer VI (4.03%). On average, 44% of mitochondrial volume was located in dendrites, 15% in axons and 41% in nonsynaptic elements. Given that dendrites, axons, and nonsynaptic elements occupied 38%, 23%, and 39% of the neuropil, respectively, it can be concluded that dendrites are proportionally richer in mitochondria with respect to axons, supporting the notion that most energy consumption takes place at the postsynaptic side. We also found a positive correlation between the volume fraction of mitochondria located in neuronal processes and the density of synapses.https://ift.tt/2v8X21U
Target Interneuron Preference in Thalamocortical Pathways Determines the Temporal Structure of Cortical Responses
Abstract
Sensory processing relies on fast detection of changes in environment, as well as integration of contextual cues over time. The mechanisms by which local circuits of the cerebral cortex simultaneously perform these opposite processes remain obscure. Thalamic "specific" nuclei relay sensory information, whereas "nonspecific" nuclei convey information on the environmental and behavioral contexts. We expressed channelrhodopsin in the ventrobasal specific (sensory) or the rhomboid nonspecific (contextual) thalamic nuclei. By selectively activating each thalamic pathway, we found that nonspecific inputs powerfully activate adapting (slow-responding) interneurons but weakly connect fast-spiking interneurons, whereas specific inputs exhibit opposite interneuron preference. Specific inputs thereby induce rapid feedforward inhibition that limits response duration, whereas, in the same cortical area, nonspecific inputs elicit delayed feedforward inhibition that enables lasting recurrent excitation. Using a mean field model, we confirm that cortical response dynamics depends on the type of interneuron targeted by thalamocortical inputs and show that efficient recruitment of adapting interneurons prolongs the cortical response and allows the summation of sensory and contextual inputs. Hence, target choice between slow- and fast-responding inhibitory neurons endows cortical networks with a simple computational solution to perform both sensory detection and integration.https://ift.tt/2Ltd01y
Stress Impairs Episodic Retrieval by Disrupting Hippocampal and Cortical Mechanisms of Remembering
Abstract
Despite decades of science investigating the neural underpinnings of episodic memory retrieval, a critical question remains: how does stress influence remembering and the neural mechanisms of recollection in humans? Here, we used functional magnetic resonance imaging and multivariate pattern analyses to examine the effects of acute stress during retrieval. We report that stress reduced the probability of recollecting the details of past experience, and that this impairment was driven, in part, by a disruption of the relationship between hippocampal activation, cortical reinstatement, and memory performance. Moreover, even memories expressed with high confidence were less accurate under stress, and this stress-induced decline in accuracy was explained by reduced posterior hippocampal engagement despite similar levels of category-level cortical reinstatement. Finally, stress degraded the relationship between the engagement of frontoparietal control networks and retrieval decision uncertainty. Collectively, these findings demonstrate the widespread consequences of acute stress on the neural systems of remembering.https://ift.tt/2v4HYC8
Risk and Relevance of Insulin Pump Therapy in the Aetiology of Ketoacidosis in People with Type 1 Diabetes
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0654-5134
Objective The aim of this systematic data analysis was to determine the prevalence of diabetic ketoacidosis (DKA) as well as hypoglycemic and hyperglycemic disorders during insulin pump therapy (CSII) in patients with type 1 diabetes. The main focus was to investigate whether CSII patients have more DKA than the general type 1 diabetes population. Subjects and Methods This retrospective study with patients who were treated in our treatment center from 2003 to 2016 includes data from 229 patients (52.4% male, 47.6% female, 37.2±16.3 years; DKA: 93, hypoglycemia: 66, hyperglycemia: 70). Results Intensified insulin therapy was the most common treatment regimen in the study cohort (73.4%), followed by CSII (24%). However, 32.3% of the patients with DKA were on CSII. This number of DKA cases among the insulin pump users in our study cohort was higher than the prevalence reported in a previously published study by Reichel et al. (2013; p<0.05) and in a customer database (p<0.005). Most common causes of DKA in our study cohort were patient errors (43.3%) or insulin resistance induced by an underlying infection (29.8%). Device malfunction caused 13.5% of all DKA cases with an overwhelming majority on insulin pump treatment (93%). Overall, patient errors caused more DKA cases than device malfunctions. Conclusions Our findings suggest that despite development of more sophisticated insulin pump devices, DKA is still more frequent with CSII than with other kinds of insulin treatment.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Fangchinoline Protects Against Renal Injury in Diabetic Nephropathy by Modulating the MAPK Signaling Pathway
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0636-3883
In this study, we evaluated the nephroprotective effects of fangchinoline in rats with diabetic nephropathy (DN). DN was induced by feeding a high-fat diet for 4 weeks and administering a single dose of streptozotocin (STZ) (30 mg/kg) intraperitoneally. The rats were split into groups; one group received oral fangchinoline (3 mg/kg) per day for 8 weeks. After completion of the 8-week study period, biomedical and inflammatory markers were evaluated in serum and urine, and oxidative stress was estimated in kidney tissues. In addition, Western blot assays, reverse transcription-polymerase chain reaction, and immunohistochemical analyses were performed in the kidney tissues of DN rats. The results suggest that treatment with fangchinoline attenuated the biochemical marker changes induced by DN in blood and urine. Moreover, a significant (p<0.01) reduction in inflammatory markers in serum was found in the fangchinoline group compared to the controls. Immunohistochemical analyses also revealed that treatment with fangchinoline significantly reduced the expression of collagen IV and CD31 in the kidneys compared to the control group. The expression of p38 MAPK, TNF-α, COX-2, and MMP-9 was also attenuated by fangchinoline treatment in the kidney tissues of DN rats. Together, the results of this study suggest that fangchinoline protects against nephron damage by attenuating alterations in the p38 MAPK pathway, thereby reducing oxidative stress and inflammation in DN rats.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2mLugQY
Estimating tomato tolerance to heavy metal toxicity: cadmium as study case
Abstract
This work aimed to develop a reliable and fast approach to estimate the plant tolerance degree to heavy metal (HM) phytotoxicity. Two independent experiments were carried out using tomato accessions, with contrasting morphological features, that were grown in a hydroponic solution containing different CdCl2 concentrations for 7 days. Plant dry weight and chlorophyll content (SPAD units) were evaluated, and tolerance degree to Cd toxicity was estimated according to the tolerance index (TI), which is a new mathematical formula based on plant biomass proposed in this study. Although with different magnitudes, tomato exhibited reductions in their dry weight concurrently with the increasing CdCl2 concentration. By contrast, chlorophyll content presented no standard response, decreasing and even increasing according to CdCl2 concentrations, indicating that only under certain conditions (particularly, at CdCl2 50 μM), this parameter can be used to estimate plant tolerance to Cd toxicity. TI was efficiently able to segregate tomato cultivars with similar performance (based on the total dry weight of plants), and such segregation was optimized when the hydroponic solution contained from 25 to 50 μM CdCl2. Within this range, data pointed at 35 μM CdCl2 as the best concentration to be employed in studies related to the tomato tolerance/sensitivity to Cd toxicity. In conclusion, TI proved to be a reliable estimator of tolerance degree to Cd exposure in genetically distinct tomato accessions. Moreover, TI can be used for this same purpose in plants under other HM-induced stresses.
https://ift.tt/2v5XzSf
Serum periostin levels following small bone fractures, long bone fractures and joint replacements: an observational study
In asthma, serum periostin may potentially be used as a biomarker in the management of patients with Type-2 eosinophilic airway inflammation. However, serum periostin may be influenced by factors other than Ty...
https://ift.tt/2OjiDgN
Comparison of aural rehabilitation outcomes in presence and absence of back ground noise in hearing impaired children with and without attention deficit hyperactivity disorder (ADHD)
Publication date: Available online 26 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Fariba Noori, Saeed Farahani, Hermin Mokrian, Mastoore Asadi, Helnaz Mokrian
https://ift.tt/2AnU5Av
The bacterial community and local lymphocyte response are markedly different in patients with recurrent tonsillitis compared to obstructive sleep apnoea
Publication date: Available online 26 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): James Johnston, Michael Hoggard, Kristi Biswas, Carmen Astudillo‐García, Sharon Waldvogel-Thurlow, Fiona J. Radcliff, Murali Mahadevan, Richard G. Douglas
Abstract
Introduction
Obstructive sleep apnea (OSA) is now a more common indication for tonsillectomy than recurrent tonsillitis (RT) [1,2]. Few studies have addressed possible differences in pathogenesis between these two conditions. Children with RT and OSA are often being treated in the community with multiple courses of antibiotics before surgery. Current understanding of the role of bacteria in disorders of the tonsils is mainly based on the culture of tonsil swabs. Swab cultures reflect only a very small fraction of the bacteria present on the mucosal surface and may not represent the bacterial communities within the tonsil crypts [3,4]. This study aimed to evaluate the local lymphocyte response and associations with bacterial community composition using molecular techniques of the tonsils removed from children for RT or OSA.
Method
The palatine tonsils were removed by extracapsular dissection from 24 patients with age range one to ten years, 14 of whom had RT and 10 had OSA. The fixed tonsil tissues were evaluated for bacteria by Gram-staining and presence of connective tissue by safranin staining. B lymphocytes and T lymphocytes were also measured immunohistochemically. Finally, previously published bacterial community data for this cohort were reassessed for associations with RT and OSA, and with the observed lymphocyte patterns.
Results
In tonsils from patients with RT, large micro-colonies of bacteria were observed in the tonsil crypts, and a large number of B and T lymphocytes were noted immediately adjacent to the tonsil crypt itself. In marked contrast, the tonsils from patients with OSA had no bacteria identified, and no significant skewing of lymphocytes based on site (such as follicles or crypts). We observed that the majority of lymphocytes surrounding the bacterial micro-colonies were B lymphocytes with a mean ratio of 109:55 (B lymphocytes: T lymphocytes). Bacterial community diversity was not different between the two cohorts; however, there were significant differences in bacterial community composition. Children with RT had a higher relative abundance of members from the genera Parvimonas, Prevotella, and Treponema. While children with OSA had a higher relative abundance of Haemophilus, and Capnocytophaga.
Conclusion
These results demonstrate significant differences in the local lymphocyte response and bacterial community composition in tonsil tissue between RT and OSA patients. It suggests that the response to antibiotics used in the treatment of these two conditions may be different. Furthermore, the presence of lymphocytes in RT within the tonsil crypt outside the tonsil epithelium is a unique observation of the location of these cells.
https://ift.tt/2mMWRFM
Geographic Health Disparities in the Los Angeles Pediatric Neck Abscess Population
Publication date: Available online 26 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Varun Angajala, Kevin Hur, Lia Jacobson, Christian Hochstim
Abstract
Objective
To assess geographical sociodemographic differences in neck abscesses that require surgical drainage in Los Angeles.
Study Design: retrospective review
Methods
We reviewed the medical records of 119 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014-2017 with a diagnosis of a neck abscess requiring incision and drainage. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariate logistic regression.
Results
The average age of patients with a neck abscess in this study was 3.4 years old, 53.8% were female, 54.6% were Hispanic, and 82.5% had public health insurance. 79% of patients had an abscess located in the superficial neck, and 10.1% had an abscess located in the retropharyngeal space. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus those that lived farther than 10 miles. On multivariate analysis, zip codes with a high volume of neck abscesses were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not associated with zip codes with a high volume of neck abscesses.
Conclusion
Geographic areas in the greater Los Angeles community with a high volume of neck abscesses requiring incision and drainage at our institution were associated with lower income neighborhoods.
https://ift.tt/2AffKKQ
Tribute to Glyn W. Humphreys, 1954 – 2016
Publication date: Available online 26 July 2018
Source: Cortex
Author(s): Martin Edwards, Monika Harvey, Julie Snowden
https://ift.tt/2OkS9LH
Toll-like receptor 9 ligands increase type I interferon induced B-cell activating factor expression in chronic rhinosinusitis with nasal polyposis
Publication date: Available online 26 July 2018
Source: Clinical Immunology
Author(s): Jun Xu, Jin-Woo Lee, Soo-Kyoung Park, Sung-Bok Lee, Young-Hoon Yoon, Sun-Hee Yeon, Ki-Sang Rha, Ji-Ae Choi, Chang-Hwa Song, Yong Min Kim
Abstract
B-cell activating factor (BAFF) has been proposed to play a crucial role in the pathogenesis of chronic rhinosinusitis with nasal polyp (CRSwNP). The aim of this study was to evaluate the role of toll-like receptor (TLR) 9-mediated BAFF activation on the pathogenesis of CRSwNP. NP and uncinate tissue (UT) were obtained from patients with CRSwNP or CRS without NP, and control subjects. The expression of TLR9, high mobility group box-1 protein (HMGB1), type I interferon (IFN), BAFF, and anti-double stranded DNA (dsDNA) antibody were examined in the tissues and the cultured dispersed NP cells (DNPCs). The expression of TLR9, HMGB1, type I IFN, BAFF, and anti-dsDNA antibody were elevated in NP tissue compared to the UTs. Exposure to TLR9 agonist increased the type I IFN expression in vitro, which further increased BAFF production. In conclusion, we provided a novel therapeutic potential of TLR9 agonist in CRSwNP.
https://ift.tt/2LHJ954
The allergic allergist behaves like a patient
Publication date: Available online 26 July 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Jean Bousquet, Ruth Murray, David Price, David Somekh, Lars Münter, Jim Phillips, Wienia Czarlewski
https://ift.tt/2NIwuMk
Combination Inhaled Glucocorticoid/Long-Acting Beta-Agonist Safety: The Long and Winding Road
Publication date: Available online 26 July 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Joseph D. Spahn
https://ift.tt/2LEf4mQ
A tough pill to swallow: Medicolegal liability and dysphagia
Publication date: Available online 26 July 2018
Source: American Journal of Otolaryngology
Author(s): Christopher Badger, Sunil P. Verma
Abstract
Level of evidence
Level 4 (Case Series).
Objective
Dysphagia is a debilitating condition that is associated with many etiologies. It can have a devastating effect on a patient's quality of life with long-term sequelae that make it a source of medical malpractice litigation. This study analyzed medical malpractice cases involving dysphagia and looked for factors determining legal liability.
Methods
The Westlaw Next legal database (Thomson Reuters, New York, NY) was searched for relevant malpractice cases and assessed for several factors including if the dysphagia was iatrogenic, the amount paid by the defendant, and the medical specialty of the defendants.
Results
A total of 45 cases of dysphagia were included. The majority of these cases were jury verdicts for the defendant (73.3%). Iatrogenic dysphagia was alleged in 55.5% of cases. Settlements and verdicts favoring the plaintiff resulted in awards ranging between $25,000 and $5,003,000 with a mean of $1,014,015. The most frequent physician specialists named were general surgeons (24.1), internists (11.1%), anesthesiologists (9.3%), gastroenterologists (7.4%), and otolaryngologists (5.6%). Iatrogenic dysphagia (OR 8.89 CI 1.02–77.32), medication-related iatrogenesis (OR 18.86 CI 1.82–195.41), and cases naming multiple specialties as a defendant (OR 5.90, CI 1.07–32.55) were factors associated with a verdict for the plaintiff or a settlement.
Conclusion
Dysphagia is a condition with medicolegal consequences for many specialties. While the majority of these cases are decided in favor of the defendant the cost of a negative outcome is considerable. Iatrogenic dysphagia and naming more than one defendant specialty were associated with increased odds of a plaintiff verdict or settlement.
https://ift.tt/2LOXIRa
Office-based retrograde transtracheal application of mitomycin C
Publication date: Available online 26 July 2018
Source: American Journal of Otolaryngology
Author(s): Valeria Silva Merea, Paul C. Bryson
Abstract
Objectives
The utility of topical mitomycin C (MMC) as an adjuvant treatment in the management of laryngeal and tracheal stenosis has been studied; however, the ideal timing of MMC application has not been fully elucidated. There is a paucity of studies evaluating the timing of MMC application after surgical airway intervention for stenosis. The purpose of this study is to describe a novel technique for MMC application that allows for delayed application in the unsedated, office-based setting, approximately one week following endoscopic airway dilation.
Methods
A technique for retrograde transtracheal application of MMC was developed and utilized in 3 tracheostomy-dependent patients with subglottic stenosis and glottic stenosis with bilateral vocal fold immobility. After administration of topical anesthesia, a MMC (0.4 mg/mL) coated pledget was advanced via a transtracheal approach and directed to the area of stenosis in retrograde fashion using endoscopic frontal sinus instruments. Appropriate positioning of the pledget was confirmed via transnasal flexible fiberoptic laryngoscopy.
Results
All 3 patients underwent successful in-office retrograde application of MMC onto the area of laryngeal stenosis 7–9 days after their preceding surgery. There were no complications. Two patients achieved decannulation while the third patient's management was interrupted due to cancer treatment.
Conclusions
We present a novel and well tolerated technique for delayed in-office application of MMC in tracheostomy-dependent patients with laryngeal stenosis. This approach can facilitate the study of the ideal timing of topical MMC use in airway stenosis.
https://ift.tt/2LBuk3Z
Combination Inhaled Glucocorticoid/Long-Acting Beta-Agonist Safety: The Long and Winding Road
This perspective seeks to address one of the major controversies that had plagued asthma management for over a decade. This controversy involves long-acting beta-agonist (LABA) safety, as it pertains to its use when combined with an inhaled glucocorticoid (GC). Unlike many controversies in medicine, this one can finally be put to rest. LABA's when used in combination with an inhaled GC are safe 1-4. On December 20, 2017 the FDA removed the black box warning in a Drug Safety Communication stating that there was no significant increase in risk of serious asthma outcomes with LABA's used in combination with inhaled GC's 5.
https://ift.tt/2JZvm4H
The allergic allergist behaves like a patient
There is a complete disconnection between physician's prescription and patient's behavior for the treatment of pollen-induced allergic rhinitis. The vast majority of allergists prescribe medications for the entire season recommending the patient to use them regularly even during days with few symptoms. On the other hand, the vast majority of patients use their medications on-demand when their AR is not well controlled and do not follow guidelines 1,2.
https://ift.tt/2mJNypP
Selecting the Right Biologic for Your Patients with Severe Asthma
Severe asthma affects 5-10% of the adult asthma population and is associated with increased morbidity, mortality, and consumption of health care resources. Recently, several biologic medications have been approved for use in severe asthma. These medications target the type-2 inflammatory pathway, which is characterized by activation of cytokines including interleukin (IL)-4, IL-5 and IL-13, which results in eosinophilia, high fractional exhaled nitric oxide (FeNO) and atopic features. The objective of this review is to provide clinicians with key points to assist in selecting the best biologic medication for each patient.
https://ift.tt/2K0e47H
Severe Asthma With Eosinophilic Gastroenteritis Effectively Managed by Mepolizumab and Omalizumab
Eosinophilic gastroenteritis and asthma are typically treated with systemic corticosteroids in the severe cases but chronic corticosteroid use often leads to serious long-term adverse effects.1 We herein report a unique case where eosinophilic gastroenteritis, esophagitis, and severe asthma refractory to systemic corticosteroids was and is being effectively managed by mepolizumab and omalizumab.
https://ift.tt/2Lr7TiJ
Long-Term Prophylaxis Therapy in Patients with Hereditary Angioedema with C1 Inhibitor Deficiency
Hereditary angioedema with C1 inhibitor (C1-INH) deficiency (C1-INH-HAE) is a rare condition that may have a profound effect on patients' lives, both physically and emotionally.1, 2 Swelling can occur in the abdomen, face, throat, genitalia, or extremities and may cause pain and disability. Abdominal swelling can cause severe pain and potentially intestinal obstruction, incapacitating the patient during the attack. Swelling of the extremities can impede patients from walking or using their hands, and swelling with airway involvement is potentially life-threatening.
https://ift.tt/2K0dUND
MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass
Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.
https://ift.tt/2AaYbvF
A randomised, open-label, parallel group phase 2 study of antisense oligonucleotide therapy in acromegaly
Objective
ATL1103 is a second-generation antisense oligomer targeting the human growth hormone (GH) receptor. This phase 2 randomised, open-label, parallel-group study assessed the potential of ATL1103 as a treatment for acromegaly.
DesignTwenty-six patients with active acromegaly (IGF-I >130% upper limit of normal) were randomised to subcutaneous ATL1103 200 mg either once or twice weekly for 13 weeks and monitored for a further 8-week washout period.
MethodsThe primary efficacy measures were change in IGF-I at week 14, compared to baseline and between cohorts. For secondary endpoints (IGFBP3, acid labile subunit (ALS), GH, growth hormone-binding protein (GHBP)), comparison was between baseline and week 14. Safety was assessed by reported adverse events.
Results and conclusionsBaseline median IGF-I was 447 and 649 ng/mL in the once- and twice-weekly groups respectively. Compared to baseline, at week 14, twice-weekly ATL1103 resulted in a median fall in IGF-I of 27.8% (P = 0.0002). Between cohort comparison at week 14 demonstrated the median fall in IGF-I to be 25.8% (P = 0.0012) greater with twice-weekly dosing. In the twice-weekly cohort, IGF-I was still declining at week 14, and remained lower at week 21 than at baseline by a median of 18.7% (P = 0.0005). Compared to baseline, by week 14, IGFBP3 and ALS had declined by a median of 8.9% (P = 0.027) and 16.7% (P = 0.017) with twice-weekly ATL1103; GH had increased by a median of 46% at week 14 (P = 0.001). IGFBP3, ALS and GH did not change with weekly ATL1103. GHBP fell by a median of 23.6% and 48.8% in the once- and twice-weekly cohorts (P = 0.027 and P = 0.005) respectively. ATL1103 was well tolerated, although 84.6% of patients experienced mild-to-moderate injection-site reactions. This study provides proof of concept that ATL1103 is able to significantly lower IGF-I in patients with acromegaly.
https://ift.tt/2mR1NcN
Reduction of arrhythmias in primary hyperparathyroidism, by parathyroidectomy, evaluated with 24-h ECG monitoring
Objective
Hypercalcemia may induce arrhythmias. There are no data on the prevalence of arrhythmias in primary hyperparathyroidism (PHPT) in daily life. Aim of the study was to investigate both the prevalence of arrhythmias in patients with PHPT compared to controls and the impact of parathyroidectomy, evaluated by 24-h electrocardiogram (ECG) monitoring.
DesignThis is a randomized study.
MethodsTwenty-six postmenopausal women with PHPT and 26 controls were enrolled. PHPT patients were randomized to two groups: 13 underwent parathyroidectomy (Group A) and 13 were followed up conservatively (Group B). After 6 months, patients were studied again. Each patient underwent mineral metabolism biochemical evaluation, bone mineral density measurement, standard ECG and 24-h ECG monitoring.
ResultsPHPT patients showed higher calcium and parathyroid hormone compared to controls and a higher prevalence of both supraventricular (SVBPs) and ventricular premature beats (VPBs) during 24-h ECG monitoring. Groups A and B showed no differences in mean baseline biochemical values and ECG parameters. Mean value of QTc in PHPT groups was in the normal range at baseline, but significantly shorter than controls. A negative correlation was found between QTc and ionized calcium levels (r = –0.48, P < 0.05). After parathyroidectomy, Group A had a significant reduction in SVPBs and VPBs compared to baseline and restored normal QTc. Group B showed no significant changes after a 6-month period.
ConclusionsThe increased prevalence of SVPBs and VPBs is significantly reduced by parathyroidectomy, and it is mainly related to the short QTc caused by hypercalcemia.
https://ift.tt/2AaY7fp
Insulin Resistance and Metabolic Syndrome: Clinical and Laboratory Associations in African Americans Without Diabetes in the Hemochromatosis and Iron Overload Screening Study
Metabolic Syndrome and Related Disorders, Volume 16, Issue 6, Page 267-273, August 2018.
https://ift.tt/2OkTkuU
Optimizing irrigation and nitrogen requirements for maize through empirical modeling in semi-arid environment
Abstract
Uncertainty in future availability of irrigation water and regulation of nutrient amount, management strategies for irrigation and nitrogen (N) are essential to maximize the crop productivity. To study the response of irrigation and N on water productivity and economic return of maize (Zea mays L.) grain yield, an experiment was conducted at Water Management Research Center, University of Agriculture Faisalabad, Pakistan in 2015 and 2016. Treatments included of full and three reduced levels of irrigation, with four rates of N fertilization. An empirical model was developed using observed grain yield for irrigation and N levels. Results from model and economic analysis showed that the N rates of 235, 229, 233, and 210 kg ha−1 were the most economical optimum N rates to achieve the economic yield of 9321, 8937, 5748, and 3493 kg ha−1 at 100%, 80%, 60%, and 40% irrigation levels, respectively. Economic optimum N rates were further explored to find out the optimum level of irrigation as a function of the total water applied using a quadratic equation. The results showed that 520 mm is the optimum level of irrigation for the entire growing season in 2015 and 2016. Results also revealed that yield is not significantly affected by reducing the irrigation from full irrigation to 80% of full irrigation. It is concluded from the study that the relationship between irrigation and N can be used for efficient management of irrigation and N and to reduce the losses of N to avoid the economic loss and environmental hazards. The empirical equation can help farmers to optimize irrigation and N to obtain maximum economic return in semi-arid regions with sandy loam soils.
https://ift.tt/2uPr3Ei
Daily Application of an Aqueous, Acidifying, Peelable Nail Polish versus Weekly Amorolfine for Topical Onychomycosis Treatment: A Prospective, Randomized, Blinded Trial
Abstract
Introduction
Onychomycosis is a fungal nail infection, frequently caused by dermatophytes, which occurs in 2–14% of Western adults. The present study was set up to evaluate the efficacy and safety of a water-based, peelable nail polish (daily application), which acidifies the nail environment, versus a 5% amorolfine nail lacquer (weekly application) for topical treatment of mild-to-moderate onychomycosis.
Methods
One hundred two adults were randomized in this open, prospective, blinded trial. Clinical efficacy was evaluated at baseline and days 30, 60, 120, and 180, respectively. All patients underwent microbiological testing (at baseline and study end). The primary objective of this trial was the change in the percentage of healthy nail surface at day 180.
Results
The percentage of healthy surface between baseline and day 180 increased with 11.8% in the test product group and 13.2% in the amorolfine group, which were statistically comparable. Other onychomycosis-related parameters (dystrophy, discolouration, thickening, and healthy aspect, respectively) showed significant (p < 0.05) improvement after 180 days (versus baseline) with both treatments. Clinical performance was further confirmed by the frequency of patients showing onychomycosis improvement or success at the end of the study: 96.0% (test product) versus 79.6% (amorolfine). Microbiological results and improved quality of life confirmed clinical performance. Both treatments were well tolerated and appreciated for their properties and efficacy.
Conclusion
The present trial confirmed the clinical performance of daily acidification of the nail, as reflected by (1) a comparable increase of percentage of healthy nail surface following treatment with the test product versus amorolfine, (2) the overall improvement of other onychomycosis-related parameters, (3) user convenience, and (4) absence of side effects. These data indicate that daily application of an aqueous, acetic acid-based, peelable solution can be a convenient, safe, and equally effective alternative for the topical management of onychomycosis.
Trial Registration
ClinicalTrials.gov identifier; NCT03382717
Funding
Oystershell Laboratories.
https://ift.tt/2A9Gn44
Topical Application of 5-Fluorouracil Associated with Distant Seborrheic Dermatitis-like Eruption: Case Report and Review of Seborrheic Dermatitis Cutaneous Reactions after Systemic or Topical Treatment with 5-Fluorouracil
Abstract
Introduction
5-Fluorouracil is a fluoropyrimidine antineoplastic medication that is used to topically treat actinic keratoses. Although local adverse effects to the drug are common and anticipated, distant skin reactions are rare and unexpected. In this case report, we describe a patient who developed seborrheic dermatitis-like eruption at a distant site after topical application of 5-fluorouracil to his arms.
Case report
A 63-year-old man with actinic keratoses on his arms developed a facial seborrheic dermatitis-like reaction after topically applying 5-fluorouracil 5% cream twice daily to actinic keratoses on his forearms for 7 days. The facial dermatosis resolved shortly after discontinuation of the 5-fluorouracil; upon rechallenge of topical 5-fluorouracil on his arms, the facial seborrheic dermatitis recurred.
Discussion
Several case reports have been published which describe exacerbations of preexisting seborrheic dermatitis with local topical 5-fluorouracil. Additionally, one case series describes the development of scrotal dermatitis in two patients after distant treatment with 5-fluorouracil. The pathogenesis that causes this distant reaction is unclear.
Conclusion
We describe a patient with a seborrheic dermatitis eruption after topical application of 5-fluorouracil at a distant site. The etiologic association between the drug and adverse effect was confirmed with multiple cycles of application and discontinuation of the offending agent.
https://ift.tt/2OlKoVV
Mature dendritic cell density is affected by smoking habit, lesion size, and epithelial dysplasia in oral leukoplakia samples
Publication date: November 2018
Source: Archives of Oral Biology, Volume 95
Author(s): Giovanna Ribeiro Souto, Michelle Danielle Porto Matias, Laiz Fernandes Mendes Nunes, Raquel Conceição Ferreira, Ricardo Alves Mesquita
Abstract
Objective
To compare the densities of CD1a + immature and CD83+ mature dendritic cells, and inflammatory infiltrate cells between smokers and non-smokers with oral leukoplakia. Parameters associated with malignant transformation were also evaluated.
Design
21 smokers and 23 non-smokers diagnosed with oral leukoplakia were obtained. Densities of inflammatory infiltrate cells were calculated in H&E sections. Immunohistochemistry using anti-CD1a and anti-CD83 was performed and densities were calculated. Comparisons and statistical analyses were performed among the groups and parameters as gender, lesion size, site, and presence of cell dysplasia were analyzed.
Results
A lower density of CD83+ cells was observed in smokers compared to non-smokers (P < 0.05). For samples of smokers, a lower density of CD1a + cells, CD83+ cells, and inflammatory infiltrate cells was observed in samples with <10 mm compared to samples ≥10 mm of diameter (P < 0.05), and a lower density of CD83+ cells was also observed between samples without dysplasia compared to samples with dysplasia (P < 0.05).
Conclusion
In oral leukoplakia samples, dendritic cell density decreases in the presence of smoking habit, and increases in larger lesions and with epithelial dysplasia. Smoking habit is an external factor that contribute to alteration of the anti-tumoral immune defense system in lesions of oral leucoplakia, reinforcing that smoking elimination is important to control the development of this disease.
https://ift.tt/2NKqvXA
Pleomorphic Adenoma of the Nasolacrimal Duct
This study describes the case of a man in his 60s with a 2-year medical history of right epiphora with recent 6-week onset of hemolacrima who presented with an incidental soft tissue lesion along the left inferior turbinate with associated nasolacrimal duct dilatation above the mass.
https://ift.tt/2LtQRAA
https://ift.tt/2LtQRAA
Nodular Mass in the Upper Lip
A man presents with a firm, painless, slow-growing mass in his upper lip. What is your diagnosis?
https://ift.tt/2v7nB7v
https://ift.tt/2v7nB7v
Management of Hoarseness
This guideline summary presents American Academy of Otolaryngology–Head and Neck Surgery recommendations for assessing and treating patients with hoarseness (dysphonia).
https://ift.tt/2Ln04ul
https://ift.tt/2Ln04ul
Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity
This laboroatory analysis of synthetic femurs investigates the association of anterolateral thigh osteomyocutaneous flap harvest, with and without prophylactic fixation, with femur structural integrity as measured by 4-point bend and torsional biomechanical testing.
https://ift.tt/2vfHBVN
https://ift.tt/2vfHBVN
Positive Initial Margins and Survival Among Patients With SCC Treated With Total Laryngectomy
This cohort study investigates the association between positive initial margins and survival among patients with squamous cell carcinoma who underwent total laryngectomy and had negative final margins.
https://ift.tt/2LrhqWX
https://ift.tt/2LrhqWX
Quoi de neuf dans les malformations capillaires ?
Publication date: Available online 26 July 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): A. Dompmartin
https://ift.tt/2LBUcwp
The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014
Publication date: Available online 26 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Jean-Phillip Okhovat, Derek Beaulieu, Hensin Tsao, Allan C. Halpern, Dominique S. Michaud, Shimon Shaykevich, Alan C. Geller
Background
The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985.
Objective
We aimed to assess the American Academy of Dermatology's national skin cancer screening program from 1986 to 2014 by analyzing the risk factor profile, access to dermatologic services, and examination results.
Methods
We conducted several detailed statistical analyses of the screening population.
Results
From 1986 to 2014, records were available for 2,046,531 screenings, 1,963,141 (96%) of which were subjected to detailed analysis. Men comprised 38% of all participants. The number of annual screenings reached approximately 100,000 in 1990 and remained relatively stable thereafter. From 1991 to 2014 (data for 1995, 1996 and 2000 were unavailable), clinical diagnoses were rendered for 20,628 melanomas, 156,087 dysplastic nevi, 32,893 squamous cell carcinomas, and 129,848 basal cell carcinomas. Only 21% of screenees had a regular dermatologist. Those with a clinical diagnosis of skin cancer were more likely than the general screening population to be uninsured.
Limitations
Inability to verify clinical diagnoses histopathologically.
Conclusion
Our findings suggest that the SPOTme program has detected thousands of skin cancers that may have gone undetected or experienced a delay in detection.
https://ift.tt/2LUii2j
Late Mortality Risk After Allogeneic Blood or Marrow Transplantation Performed in Childhood
This cohort study examines cause-specific late mortality among individuals who have lived 2 years or more after allogeneic blood or marrow transplantation performed in childhood and whether rates of late mortality have changed over time.
https://ift.tt/2uQrONA
https://ift.tt/2uQrONA
Understanding the Limitations of Cancer Registry Insurance Data
To the Editor Ellis et al report widening survival disparities for California patients with cancer who have public, primarily Medicaid, insurance relative to the privately insured. However, without an understanding of cancer registry data nuances and policy context, the study's implications for policy are easily misunderstood. The timing of insurance is not recorded in cancer registry data, and we cannot know whether insurance status changes during the course of treatment or whether patients were insured prior to their diagnosis (the insurance status reflected in the registry). The California Cancer Registry data presented by Ellis et al reflect the last known insurance status of multiple reports for a given tumor diagnosis, which may not accurately reflect insurance status immediately prior to diagnosis or even at first treatment. Many Medicaid beneficiaries gain coverage subsequent to diagnosis. Research from Michigan, a state that linked registry data with Medicaid enrollment records, found that more than 40% of patients with cancer who have Medicaid coverage enrolled after diagnosis. Ellis et al state that California Cancer Registry insurance data have been independently verified relative to other data sources, but it is unclear whether those sources contain information on the timing of insurance either (no reference is provided).
https://ift.tt/2NJ76Gv
https://ift.tt/2NJ76Gv
Risk of Breast Implant–Associated Anaplastic Large Cell Lymphoma—Reply
In Reply We appreciate the comments on our article. Although relative cancer risk estimates are important for the understanding of oncogenetic processes, it is the excess absolute risk that should be the basis for health care decisions for patients and clinicians alike. Robust epidemiological studies to reliably determine the risk for breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) are required to place the high relative risk in perspective. These studies fully depend on unbiased identification of BIA-ALCL and reference disease cases as can be retrieved from population-based, preferably national, comprehensive disease registries and on valid assessment of exposure. In the Netherlands, all these preconditions are available, permitting reliable epidemiological studies on the long-term effects of certain medical exposures on rare diseases, including breast-ALCL in women with breast implants. Various other published studies on risk assessment in BIA-ALCL are limited by bias from case registrations in nonmandatory (national) registries and international collaborative efforts based on poorly defined populations, dual entries in registries, and lack of central pathology review. Because implant registries have only been operational in the past few years and in few countries, reliable estimates of implant carrier prevalence, as well as the use of specific implant types over the past years, is largely lacking. These limitations lead to unpredictable overestimation and underestimation of absolute risks. Also, observed associations of BIA-ALCL with certain implant types should be approached with caution because not only is the use of textured vs smooth implants variable around the world and over time, also implant history in individual patients is often unknown. Considering that the interval between BIA-ALCL diagnosis and time of first implant is more than 10 years (mean, 13 years; range, 1-39 years) these aspects preclude strong statements and the issue should be considered unsettled for now.
https://ift.tt/2uTY7uY
https://ift.tt/2uTY7uY
Risk of Breast Implant–Associated Anaplastic Large Cell Lymphoma
To the Editor De Boer et al calculate a 1:6920 lifetime risk of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) in Dutch patients. The authors report that 82% of affected patients had macrotextured implants and 45% of all implants sold in the Netherlands from 2010 through 2015 were macrotextured (P < .001). Despite this significant comparison, de Boer et al do not find an association between implant type and BIA-ALCL risk. The authors recognize that their study is limited by the fact that almost no smooth implants are inserted in the Netherlands.
https://ift.tt/2NN2jDR
https://ift.tt/2NN2jDR
Follow-up Recommendations for Completely Resected Gastroenteropancreatic Neuroendocrine Tumors
This Special Communication discusses consensus recommendations regarding follow-up of fully resected, well-differentiated, or moderately differentiated gastroenteropancreatic neuroendocrine tumors.
https://ift.tt/2LAeAyd
https://ift.tt/2LAeAyd
Risk of Breast Implant–Associated Anaplastic Large Cell Lymphoma
To the Editor I applaud de Boer and colleagues for their excellent work in further unraveling the mystery of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL).
https://ift.tt/2mN49t2
https://ift.tt/2mN49t2
Lay Health Worker Intervention and Documentation of Cancer Patients’ Goals of Care
This randomized clinical trial tests the effect of consultation with a lay health worker on documentation of goals of care and health care use, costs, and satisfaction among patients with advanced-stage or recurrent cancer at a Veterans Affairs medical center.
https://ift.tt/2AdctvC
https://ift.tt/2AdctvC
Understanding the Limitations of Cancer Registry Insurance Data—Reply
In Reply We thank Sabik and Bradley for raising these important points about our study. The lack of information on timing of and change in health insurance coverage is a limitation inherent to cancer registry data and, as discussed, has the potential to result in misclassification of patient insurance status. However, we reaffirm that the impact of any such misclassification on our results is likely to be minimal and would not alter the study's conclusions.
https://ift.tt/2OkaGIc
https://ift.tt/2OkaGIc
Circulating Tumor Cells and Late Recurrence of Estrogen Receptor–Positive Breast Cancer
This secondary analysis of a randomized clinical trial investigates the association of circulating tumor cells with recurrence of breast cancer 5 or more years after diagnosis among patients with hormone receptor–positive breast cancer.
https://ift.tt/2A8PEJs
https://ift.tt/2A8PEJs
Use of Intravenous Bisphosphonates in Early Breast Cancer
This Viewpoint assesses the use of low-dose bisphosphonates to reduce the risks of bone metastases and mortality in postmenopausal patients with early breast cancer.
https://ift.tt/2mJeOoz
https://ift.tt/2mJeOoz
Definitive Pelvic Radiation Therapy and Survival Among Patients With Newly Diagnosed Cervical Cancer
This cohort study investigates overall survival among patients with newly diagnosed metastatic cervical cancer who received chemotherapy alone compared with those who received chemotherapy and pelvic radiation therapy.
https://ift.tt/2AdUuFi
https://ift.tt/2AdUuFi
Supportive Therapieansätze beim hepatozellulären Karzinom
Zusammenfassung
Hintergrund
Die Therapieoptionen bei Patienten mit hepatozellulärem Karzinom (HCC) nach Versagen einer Therapie mit Sorafenib sind derzeit weiterhin eingeschränkt. Insbesondere bei Verschlechterung der Leberfunktion, der häufigsten HCC-bedingten Todesursache, erfolgt eine supportive Behandlung als akzeptierter Standard.
Methoden
Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema supportive Behandlung bei HCC.
Ergebnisse
Was genau eine supportive Behandlung bei HCC beinhaltet, ist in aktuellen Leitlinien und der Literatur jedoch unzureichend definiert. Außer zum Pruritus liegen kaum validierte Daten vor. Die meisten Patienten entwickeln im weiteren Krankheitsverlauf Symptome der Leberinsuffizienz (Aszites, Syntheseeinbruch mit Gerinnungsstörungen und Blutungen, Ödeme, u. a.). Klassische tumorassoziierte Beschwerden wie Schmerzen und Mangelernährung treten im weiteren Krankheitsverlauf auf. Eine Schmerztherapie erfolgt bevorzugt mit Paracetamol, ggf. mit Opiaten. Eine typische HCC-assoziierte Komplikation ist die maligne Pfortaderthrombose, über deren Therapie Uneinigkeit besteht. Als relativ seltene Komplikationen treten Cholestase/Cholangitis sowie symptomatische Knochen- und Lungenmetastasen auf.
Schlussfolgerung
Die vorliegende Übersicht fasst die derzeitige Datenlage zur supportiven Therapie inkl. der aktuellen Leitlinienempfehlungen zusammen.
https://ift.tt/2uP40tE
The effects of motor adaptation on ankle isokinetic assessments in older drivers
OBJECTIVES: This study sought to analyze the extent of motor adaptation in ankle plantar flexors and dorsiflexors among older drivers during clinical isokinetic testing. METHODS: One hundred older adults (70.4±5.7 years) participated in two bilateral ankle plantar flexor and dorsiflexor isokinetic assessments at 30°/sec. Peak torque (PTQ), PTQ adjusted for body weight (PTQ/BW), and total work (TW) were analyzed. RESULTS: On the dominant side, PTQ/BW and TW were significantly greater for the second plantar flexion test than were those for the first such test (p<0.001), whereas PTQ, PTQ/BW, and TW (p<0.001) were significantly greater for the second dorsiflexion test than were those for the first such test. On the non-dominant side, plantar flexion PTQ and TW were significantly lower for the second test than were those for the first test (p<0.001). CONCLUSION: Older drivers demonstrated better performance with the dominant limb on the second test. The low variability in test execution showed the existence of a motor adaptation effect for the tested movements, despite the short recovery period between the assessments.
https://ift.tt/2Admr03
The ROPScore as a Screening Algorithm for Predicting Retinopathy of Prematurity in a Brazilian Population
OBJECTIVES: To evaluate the accuracy of the ROPScore algorithm as a predictor of retinopathy of prematurity (ROP). METHODS: A prospective cohort of 220 preterm infants with a birth weight ≤1500 g and/or gestational age ≤32 weeks was included. The ROPScore was determined in the sixth week of life in 181 infants who then survived until a corrected gestational age of 45 weeks. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the algorithm were analyzed. RESULTS: ROP was found in 17.6% of the preterm infants. The sensitivity of this test for any stage of ROP was 87.5%, while that for severe ROP was 95.4% (21/22 cases). The PPV and NPV were 59.6% and 97%, respectively, for any stage of ROP and 44.7% and 99.25%, respectively, for severe ROP. The ROPScore could therefore hypothetically reduce the number of ophthalmologic examinations required to detect ROP by 71.8%. CONCLUSION: The ROPScore is a useful screening tool for ROP and may optimize examinations and especially the identification of severe ROP.
https://ift.tt/2mLyQin
Applicability of a novel mathematical model for the prediction of adult height and age at menarche in girls with idiopathic central precocious puberty
OBJECTIVES: Unfavorable predicted adult height and psychosocial inadequacy represent parameters used to guide therapeutic intervention in girls with central precocious puberty. Gonadotropin-releasing hormone analog is the first-line treatment. The aim of this study was to compare two methods used to predict adult height and assess a validated tool for predicting the age at menarche in girls with central precocious puberty. METHODS: The predicted adult height of 48 girls with central precocious puberty was calculated at diagnosis using the Bayley-Pinneau method based on average and advanced bone age tables and compared with the predicted adult height calculated using a mathematical model. In addition, the age at spontaneous menarche was predicted using the new formulae. After Gonadotropin-releasing hormone analog treatment, the predicted adult height was calculated using only the Bayley-Pinneau tables. RESULTS: The achieved adult height was within the target height range in all treated girls with central precocious puberty. At diagnosis, the predicted adult height using the Bayley-Pinneau tables was lower than that using the mathematical model. After the Gonadotropin-releasing hormone analog treatment, the predicted adult height using the Bayley-Pinneau method with the average bone age tables was the closest to the achieved adult height. Using the formulae, the predicted age at spontaneous menarche was 10.1±0.5 yr. The Gonadotropin-releasing hormone analog treatment significantly postponed this event until 11.9±0.7 yr in these "idiopathic" central precocious puberty girls, highlighting the beneficial effect of this treatment. CONCLUSION: Both initial adult height prediction methods are limited and must be used with caution. The prediction of the age at spontaneous menarche represents an innovative tool that can help in clinical decisions regarding pubertal suppression.
https://ift.tt/2Ad66s3
Removing Unwanted Background Phase with a Reference Phantom for Applications in Susceptibility Quantification
Publication date: Available online 26 July 2018
Source: Magnetic Resonance Imaging
Author(s): He Xie, Yu-Chung Norman Cheng, Saifeng Liu, Paul Kokeny
Abstract
Purpose
A method of removing the background phase with a reference phantom but without overcorrecting the induced phase from objects of interest is proposed. Several factors during the imaging procedure and post processing are investigated for their accuracies.
Methods
A method using a reference phantom to remove eddy currents as well as using the least squares fit to quantify susceptibility and to remove the background phase is proposed. Phase induced from simulated spheroids was fitted and compared to their true magnetic moments, an important concept for the proposed method. A cylindrical phantom and its simulation, a phantom with straws filled with Gd-DTPA, and a simulated head model were used to study systematic errors due to some confounding factors. The feasibility for in vivo applications was demonstrated from an actual human head. Susceptibility and remaining phase after removing the background phase were measured in all cases.
Results
Simulations show that magnetic moments of various spheroids and phantoms can be accurately quantified from images, regardless of the partial volume effect. All measured susceptibility values are within ± 0.16 ppm of −9.4 ppm for agarose and 0.05 ppm of 1 ppm for Gd-DTPA. Most residual phase is within ± 0.1 rad from the phantom center. Susceptibilities close to −9.4 ppm are also obtained for the simulated and actual head. Correspondently, the remaining phase has a mean value less than two standard deviations.
Conclusion
The proposed method from phantom studies can reliably remove the background phase without overcorrections. The in vivo example demonstrates the feasibility of the method.
https://ift.tt/2NNhDAi
Randomized Phase II Trial of CapOX plus Bevacizumab and CapIRI plus Bevacizumab as First‐Line Treatment for Japanese Patients with Metastatic Colorectal Cancer (CCOG‐1201 Study)
AbstractPurpose.The aim of this randomized, multicenter, noncomparative, phase II trial was to investigate the efficacy and safety of two potential first‐line treatments, capecitabine and oxaliplatin (CapOX) plus bevacizumab (BEV) and capecitabine and irinotecan (CapIRI) plus bevacizumab, in Japanese patients with metastatic colorectal cancer (mCRC).Patients and Methods.Patients with untreated mCRC were randomly assigned to receive either CapOX plus bevacizumab (CapOX/BEV arm: bevacizumab 7.5 mg/kg and oxaliplatin 130 mg/m2 on day 1 and oral capecitabine 2,000 mg/m2 on days 1–14, every 3 weeks) or CapIRI plus bevacizumab (CapIRI/BEV arm: bevacizumab 7.5 mg/kg and irinotecan 200 mg/m2 on day 1 and capecitabine 1,600 mg/m2 on days 1–14, every 3 weeks). The primary endpoint was overall response rate (ORR), and the secondary endpoints included progression‐free survival (PFS), overall survival (OS), and safety.Results.A total of 107 patients were enrolled. The intent‐to‐treat population comprised 54 patients in the CapOX/BEV arm and 53 patients in the CapIRI/BEV arm. The median follow‐up period was 35.5 months. ORR was 56% in the CapOX/BEV arm and 55% in the CapIRI/BEV arm. Median PFS and OS were 12.4 and 26.7 months in the CapOX/BEV arm and 11.5 and 28.7 months in the CapIRI/BEV arm, respectively. The frequencies of hematological and nonhematological adverse events above grade 3 were 13% and 30% in the CapOX/BEV arm and 25% and 23% in the CapIRI/BEV arm, respectively.Conclusion.CapOX plus bevacizumab and CapIRI plus bevacizumab are equally effective and feasible as the first‐line treatments in Japanese patients with mCRC.Implications for Practice.The CCOG‐1201 study was designed to evaluate the efficacy and safety of capecitabine and oxaliplatin plus bevacizumab and capecitabine and irinotecan plus bevacizumab as a first‐line treatment in Japanese patients with metastatic colorectal cancer. This article reports on the trial and efforts to define the role of these regimens, including the effect of KRAS status and UGT1A1 polymorphisms in metastatic colorectal cancer.
https://ift.tt/2AdAwun
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