No abstract available
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Πέμπτη 1 Νοεμβρίου 2018
What We Know About the Clinical Course of Nonsegmental Vitiligo: Experience of a Researcher and a Dermatologist
Algorithm for Treatment of Chronic Spontaneous Urticaria with Omalizumab
J. Spertino, L. Curto Barredo, E. Rozas Muñoz, I. Figueras Nart, E. Serra Baldrich, M. Bonfill-Ortí, V. Expósito-Serrano, A. Guilabert, G. Melé Ninot, M. Villar Buil, J. Garcias Ladaria, X. García Navarro, M. Vilavella, I. Bielsa Marsol, G. Aparicio Ortiz, C. Baliu Piqué, A. Álvarez Abella, N. Lamas Domenech, J.M. Mascaró, S. Gómez, J.I. Torné Gutiérrez, A. Vicente Villa, A. Gimenez Arnau
Actas Dermosifiliogr.2018;109:771-6
Abstract - Full Text - PDF
https://ift.tt/2P4JOzV
A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma
Paradoxical Reactions to Biologic Therapy in Psoriasis: A Review of the Literature
Subungual Melanoma: A Descriptive Study of 34 Patients
Evaluation of Structure Indicators for Assessing Skin Cancer Quality of Care in Dermatology Departments
Experience With Vismodegib in the Treatment of Advanced Basal Cell Carcinoma at a Cancer Center
Rapidly Growing Lesion on the Chest
A Flat Pink Plaque On The Right Anterior Forearm
Histologic Diagnosis of Melanocytic Lesions and Melanoma: Real Challenges
Necrobiotic Xanthogranuloma: A Cutaneous Manifestation of Monoclonal Gammopathy
Huge Squamous Cell Carcinoma Arising on Severe Hidradenitis Suppurativa
Dermatitis of the Face and Neck: Response to Itraconazole
Facial Papules in Frontal Fibrosing Alopecia: Good Response to Isotretinoin
Multiple Acral Syringomas
Ultrasound Assessment of a Subcutaneous Eumycetoma of the Eyebrow in an Immunocompromised Patient
Adult testicular granulosa cell tumour: an extremely rare entity
Adult granulosa cell tumours are extremely rare and usually benign but sometimes can assume an aggressive behaviour. A 31-year-old man presented with a 45 mm testicular mass. Radical orchiectomy was performed. Histological examination showed elongated cells, with hyperchromatic nuclei and Call-Exner bodies. Immunohistochemical analysis revealed positivity to vimentin, inhibin and negative PLAP and AE1/AE3 staining. The patient did not receive any adjuvant therapy and remained asymptomatic during 10 years. There are few cases of adult granulosa cell tumours and there is no consensus regarding malignancy criteria, treatment and follow-up. The description of these entities is crucial to allow a better management of these patients.
https://ift.tt/2QecTFE
Acute myeloid leukaemia relapse presenting as cardiac myeloid sarcoma
A 50-year-old woman previously diagnosed with acute myeloid leukaemia presented with a 3-month history of shortness of breath and a right-sided facial rash. A chest CT revealed an intracardiac mass in the right atrium extending into her superior and inferior vena cava. Surgery was performed to remove the mass and pathology was consistent with myeloid sarcoma. After surgery, adjuvant radiation therapy was directed to the residual disease. The patient eventually relapsed in other sites not including the right atrium and eventually succumbed to her disease.
https://ift.tt/2qnTdUr
Incidental discovery of Amyands hernia
Description
A 58-year-old woman was referred to Hospital Tuanku Ja'afar (Seremban, Malaysia) for contrast-enhanced CT abdomen and pelvis following discovery of a solid mass in the right adnexa on ultrasonography. CT findings revealed a well-defined, fat-containing mass with calcifications in the right adnexa measuring 4.5x7.8x4 cm, consistent with ovarian teratoma (figure 1). Incidentally, the vermiform appendix appeared to be elongated and extended into the right inguinal canal. It was not enlarged, and there was no surrounding fat streakiness (figures 1 and 2). A diagnosis of Amyand's hernia was made. She was advised for conservative (non-surgical) treatment as she was asymptomatic for both ovarian mass and Amyand's hernia. She was then given appointment for ultrasound follow-up.
Figure 1
Contrast-enhanced CT abdomen and pelvis in axial sections showing the appendix (arrows) extending into the right inguinal canal. Right ovarian teratoma is also visualised (asterisk).
https://ift.tt/2QecMtI
Congenital colonic stenosis with absent caecum and appendix: a rare association
Congenital colonic stenosis is a rare condition with less than 20 cases reported in the literature since 1966. We report an interesting case of a 7-month-old baby girl who presented with features suggestive of acute intestinal obstruction. On exploration, it was a case of ascending colon stenosis with absence of caecum and appendix. A double barrel ileocolostomy was performed. The histopathology confirmed the diagnosis of colonic stenosis and ruled out the presence of Hirschsprung's disease in the distal colon. The child underwent second stage surgery (stoma closure) after 9 months. In complex cases of congenital colonic stenosis, an early decompressive surgery followed by a delayed second stage closure is recommended in patients with poor general condition.
https://ift.tt/2qpjjX5
Central serous chorioretinopathy in a patient of juxtapapillary excavation misdiagnosed as optic disc pit maculopathy
A 29-year-old healthy man had blurring of vision in the left eye for the past 2 months and was referred for the surgical management of optic disc pit maculopathy. Colour fundus examination and optical coherence tomography (OCT) revealed a large deep retinochoroidal excavation close to the temporal edge of the optic disc with an isolated central neurosensory detachment at the macula with underlying multiple small pigment epithelium detachments in the absence of retinoschisis. Fundus fluorescein angiography (FFA) confirmed the presence of multi-focal leakage at the macula and pooling into subretinal space in the form of a 'smoke-stack'. A correct diagnosis of juxtapapillary excavation and central serous chorioretinopathy was made and lifestyle modifications were advised in view of the acute episode. The clinical signs, OCT and FFA feature helped in the differentiation and appropriate management of maculopathy in this case.
https://ift.tt/2QecTp8
Multifocal avascular osteonecrosis despite appropriate anticoagulation therapy in a patient with systemic lupus erythematosus and antiphospholipid syndrome
Multifocal avascular osteonecrosis (AON) is a serious manifestation of systemic lupus erythematosus (SLE). Prothrombotic factors, especially antiphospholipid antibodies (aPL), have been associated with the development of AON; therefore, attenuating the procoagulant state while balancing the haemorrhagic risks might have a rationale when managing this condition. We report a case of a 37-year-old patient with SLE, treated with low doses of corticosteroids and immunosuppressive therapy, who was started on vitamin K antagonist following an episode of deep vein thrombosis while having persistent positivity for aPL. After 2 years, he presented with multifocal AON, involving both femurs and shoulders. The patient underwent a bilateral hip replacement, but despite appropriate anticoagulation therapy after 2 years, he developed another episode of AON at both distal epiphyses of the femurs and proximal epiphyses of the tibias. Multifocal AON should be suspected, especially in the presence of aPL positivity. Its aetiology is still unknown and is most likely multifactorial. Its management is challenging and requires combined approaches.
https://ift.tt/2qqBiws
Challenges facing a woman wishing to report intimate partner violence in Belize
We present a case of a 29-year-old woman who presented to a volunteer-run primary care facility in Southern Belize. Her initial presentation was vaginal itching and white discharge; she also requested insertion of a sub-dermal contraceptive implant. During the insertion, marks suspicious for deliberate self-harm were noticed on the patient's arm, and on further exploration she revealed she was being physically and emotionally abused by her husband. With some encouragement, she requested help in taking further action to preserve her safety; however, in Belize clinicians have no power to assist in cases involving adults. Therefore, the victim should self-present to a police station, resulting in a significant potential barrier to reporting intimate partner violence (IPV). Here we discuss this barrier further, as well as other barriers that exist to reporting IPV, and discuss possible policy changes that may improve the situation in Belize.
https://ift.tt/2Qc0thn
Hypoglossal canal schwannoma causing isolated left 12th cranial nerve palsy
A 40-year-old woman presented with insidious onset, gradually progressive dysarthria and inability to manoeuvre bolus of food in her mouth while eating. The duration of her symptoms was 3 months. On evaluation, the left half of her tongue was wasted. The tongue deviated to the left on protrusion. There were no clinical features suggestive of involvement of the ipsilateral 9th, 10th or 11th cranial nerves. MRI of the brain showed a large, fusiform lesion in the left hypoglossal canal, extending into the jugular canal. The lesion was surgically excised and found to be a schwannoma.
https://ift.tt/2qnTaIf
Case of keratoacanthoma centrifugum marginatum treated with acitretin
Keratoacanthoma centrifugum marginatum (KCM) is a rare variant of keratoacanthoma (KA), characterised by a progressively expanding tumour with a lack of spontaneous remission and significant scarring. KCM has been reported previously in less than 50 cases worldwide. We present the case of a large solitary KCM on the right shin of a 71-year-old woman. This was treated successfully with oral acitretin for 16 months with sustained remission at 24 months. Our case provides further supporting evidence for acitretin as a useful treatment for KCM to induce remission, prevent extensive surgery and minimise destructive scarring.
https://ift.tt/2QcXsgR
Cryoablation: a potential treatment option for renal metastasis from lung cancer?
Cryoablation is successfully performed as a treatment for small renal cancers. The occurrence of a solitary renal metastasis from lung cancer is an uncommon finding entailing a limited knowledge on the choice of its optimal treatment. We present two patients diagnosed with non-small cell lung cancer, who were initially treated with curatively intended chemoradiotherapy. In the follow-up period, a non-symptomatic solitary renal metastasis was found in both patients. Both received CT-guided cryoablation of their renal metastases. One patient was successfully treated with no relapse, whereas the other patient received re-cryoablation due to development of a new renal metastasis. In both patients, no residual tumour was found at the 3 months' follow-up examination. Whether the minimally invasive procedure of cryoablation is a feasible treatment in the management of solitary renal metastases from lung cancer is still undetermined. The recurrence and incomplete treatment are concerns requiring further research.
https://ift.tt/2qoazR9
Perioperative management of an anterior mediastinal teratoma in an infant: one more tool in the toolbox
Anterior mediastinal masses present a significant challenge in the perioperative period. Standard anaesthetic induction and airway management are often not feasible due to the risk of complete respiratory and/or cardiovascular collapse. Invasive manoeuvres, such as extracorporeal membrane oxygenation, cardiac bypass, or tracheal or bronchial stenting, are sometimes not applicable due to significant anatomic aberration. We present a case of anterior mediastinal mass in a 5-month-old infant where typical management techniques in the treatment algorithm were not possible.
https://ift.tt/2QfiYl1
Endodontic management of maxillary central incisor with pulp canal obliteration
Description
Traumatised teeth usually develop pulp canal obliterations and are characterised by radiographic loss of pulp space and yellowish discoloration of clinical crown.1 2 The American Association of Endodontists included teeth with radiographic indiscernible root canals requiring treatment in high difficulty criteria.3 Proper debridement, disinfection and obturation of root canal is difficult in such cases thus compromising root canal treatment. This article presents case of pulp canal obliteration of maxillary central incisor that was managed with usage of cone beam CT (CBCT), microscopes, periodic radiographs and small sized hand files which helped in achieving patency to the pulp chamber and root canal.
A 35 year old male patient reported with pain in upper front region of jaw since 3 months. The patient gave history of trauma 3 years ago when he met with an accident, thereafter he noticed gradual change in the transparency of the crown but...
https://ift.tt/2qpjhhV
An unusual presentation of gall bladder papillomatosis in association with metachromatic leukodystrophy
A 5-year-old boy with metachromatic leukodystrophy, debilitated by spastic quadriparesis presented to us with massive ascites and respiratory distress. A subtotal cholecystectomy was performed on him from another centre for a gall bladder mass a year before he came to us. Imaging revealed a polypoidal frond-like mass arising from the gall bladder fossa which was supplied by a hypertrophied branch of the right hepatic artery. A decision was made to offer surgical resection preceded by embolisation of the feeding vessel. At surgery, a polypoidal frond-like mass in communication with the peritoneal cavity was seen arising from the remnant gall bladder bed with over 4 L of mucoid ascites. The mass along with the remnant gall bladder was removed. Biopsy revealed villous papilloma of the gall bladder. The child is well and asymptomatic at 5-month follow-up.
https://ift.tt/2Qf9IO6
Age (autoimmunity) associated B cells (ABCs) and their relatives
Swati Phalke | Philippa Marrack
https://ift.tt/2qmkHcW
Psychometric properties of the Iranian version of mindful eating questionnaire in women who seeking weight reduction
Abstract
Background
The aim of the present study was to test the validity, reliability and factor structure of the original Mindful Eating Questionnaire (MEQ) for use in an Iranian population.
Methods
This was a cross-sectional study conducted on 150 women who attended four athletic gyms and met the inclusion criteria in Ahvaz city in July of 2015. After linguistic validation of the Iranian version of the MEQ, the content validity ratio (CVR) and content validity index (CVI) were assessed by an expert panel. Then, exploratory factor analysis (EFA) was performed on the scale constructs and scale reliability (internal consistency and test-retest reliability) was assessed with respect to the psychometric properties of the scale.
Results
The CVR and CVI scores for the MEQ were 0.89 and 0.93, respectively. EFA loaded all 28-items with a 5-factor solution ('awareness', 'distraction', 'disinhibition', 'emotional response' and 'external cues') that jointly accounted for 53.78% of the observed variance. The results of the EFA supported the item 'When a restaurant portion is too large, I stop eating when I'm full' being placed in the external cues rather than the disinhibition subscale. This displacement improved the reliability coefficient for this subscale.
The results of internal consistency analysis, including Cronbach's alpha (ranging from 0.73 to 0.81) and intraclass correlation coefficients (ranging from 0.73 to 0.91) were satisfactory.
Conclusions
The Persian version of the MEQ appears to be valid and reliable; therefore, it can be an effective tool in designing mindfulness-based interventions for the treatment of individuals with eating disorders, overweight and obesity in an Iranian population.
https://ift.tt/2Py9QLo
Medicare Plans to Phase in Changes for Office-Visit Payments
CMS delays the start of a controversial E&M payment change but remains committed to collapsing what's now a five-level coding system.
Medscape Medical News
https://ift.tt/2zmNPoL
Postoperative hemorrhage following tonsillectomy in adults: Analysis of population-based inpatient cohort in Taiwan
Because of the lack of population-based analyses, this study elucidated the epidemiology and 30-day postoperative complications of inpatient adult tonsillectomies in Taiwan.
https://ift.tt/2Rw0xsS
Assessment of oropharyngeal swallowing dysfunction in myasthenia gravis patients presenting with difficulty in swallowing
To examine the correlation between the results of a clinical neurological evaluation and swallowing dysfunction in myasthenia gravis (MG) patients who presented with difficulty in swallowing and underwent videofluorographic (VF) and fiber-optic endoscopic (FE) evaluation.
https://ift.tt/2PyKCwd
Characterization of the biomechanical properties of canine trachea using a customized 3D-printed apparatus
The canine trachea is considered to be an excellent preclinical model for tracheal research due to its similar mechanical and dimensional characteristics to the human trachea. However, normative biomechanical properties have yet to be defined and it is one of the main reasons tracheal reconstruction has not succeeded in animal models at large scale. Variation and inaccurate measurement due to a lack of proper apparatus for mechanical tests further prevent determination of normative mechanical data of the trachea.
https://ift.tt/2Rw0mOe
Single surgeon series of outcomes of 897 consecutive endoscopic carpal tunnel releases stratified by disease severity
The safety and efficacy of multiple endoscopic carpal tunnel (eCTR) techniques have been established in the literature.1-3 High rates of symptomatic relief and low risk of complications are reported, similar to those seen with open CTR.2 A stratification of postoperative results and relief of carpal tunnel syndrome (CTS) based on objective pre-operative disease severity has not been established. This information would allow more individualized preoperative counselling.
https://ift.tt/2CV8gMS
Effects of pedicle torsion on dynamic perforasome survival in a multi-territory perforator flap model: An experimental study
Necrosis of propeller flaps is a problem in clinical practice. This study was performed to investigate the effects of pedicle torsion on dynamic perforasome survival using a multi-territory perforator flap model in rats.
https://ift.tt/2P5cx7N
Microvascular Anastomotic Coupler Application Learning Curve: A curriculum supporting further deliberate practice in Ex-vivo Simulation models
Microvascular anastomosis with coupler devices revolutionized microsurgery practice. Couplers are considered easier to apply and offer improved operating time while maintaining success rates. This study aims to map the learning curve, skill acquisition and decay of novice microsurgeons in performing coupler anastomosis.
https://ift.tt/2CXGkYV
A retrospective study on surgical outcomes and patient satisfaction of EGIS® ADM in one-stage implant-based breast reconstruction
Implant-based breast reconstruction (IBBR) is the most performed breast reconstruction method. It is performed either as a one-stage (i.e. direct-to-implant) or two-stage (expander/implant) procedure. In both methods, an acellular dermal matrix (ADM) can be used. The ADM provides support of the implant and improves implant coverage, which facilitates a one-stage reconstruction and results in a more natural ptotic breast.1 Reported complication rates after IBBR with an ADM vary widely, from less than 5% up to 50%.
https://ift.tt/2P8nBBe
A Quantitative Analysis of Factors Influencing Lower Lid Retraction and Involutional Ectropion
Laxity of the eyelid can be evaluated by a subjective assessment during manipulation and distraction, using procedures such as the "pinch test" and "snap back test".1 To our knowledge, no study has objectively measured the force exerted to induce eyelid malposition during such testing. We conducted a quantitative analysis to record the minimum force that can induce lower eyelid ectropion and displacement in four different demographic groups (age, gender, race, and orbital vectors).
https://ift.tt/2CV7rDM
Biomechanical behavior of mandibles reconstructed with fibular grafts at different vertical positions using finite element method
For large mandibular defects, surgical reconstruction using microvascular fibular grafts has advantages over other alternatives in terms of blood supply and good quality of grafted bone. However, the fibular segment is usually lower in height than that of the original mandible, meaning that the vertical positioning of the fibular graft is variable, with different biomechanical consequences on the reconstructed mandible.
https://ift.tt/2OZNrae
A feasibility study of indocyanine green fluorescence mapping for sentinel lymph node detection in cutaneous melanoma
Sentinel lymph node biopsy (SLNB) is standard of care for staging regional LN in AJCC stage IB-IIC melanoma; using dual localization with radiolabelled colloid and blue dye. Combining these gives optimal accuracy; drawbacks include cumulative radiation exposure for healthcare workers, coordination between disciplines and anaphylaxis. An alternative tracer agent is indocyanine green (ICG); an optical enhancer that fluoresces in the near infrared range. This prospective cohort study assesses the feasibility of using ICG as a tracer agent to detect SLN in cutaneous melanoma.
https://ift.tt/2CZ1QMy
Novel technique of filler injection in the temple area using the vein detection device
The increasing popularity of soft tissue fillers will inevitably result in increasing incidence of vascular injury. The temple area consists of several layers such as the superficial subcutaneous layer, superficial temporal fascia, loose areolar tissue, deep temporal fascia, temporalis muscle, and temporal bone from the zygomatic arch to the superior temporal septum. Fillers can be injected into various layers: first, the superficial subcutaneous layer; second, between the superficial temporal fascia and deep temporal fascia; and third, above the periosteum of the temporal bone.
https://ift.tt/2P48qZB
Local safety of immediate reconstruction during primary treatment of breast cancer. Direct-to-implant versus expander-based surgery
After mastectomy, immediate breast reconstruction is paramount. With the growing number of nipple-sparing mastectomies, also the chances of successful one-stage reconstruction with implants are increasing. Local safety is one of the main issues. This study investigated which factors could lead to major or minor complications after expander-based versus direct-to-implant reconstruction.
https://ift.tt/2CZ1Mwi
Differential Visualization of Arterial and Venous Flow in Deep Inferior Epigastric Perforator Imaging with Vector-Flow Perforator Phase Contrast Angiography (pPCA)
Perforator flaps are commonly used in reconstructive surgery, with decreased donor site morbidity and increased flexibility in flap design cited as advantages over traditional techniques.1 Vascular imaging is often obtained preoperatively in order to facilitate flap design and execution.2-3 Computed tomographic angiography (CTA) is widely used in a variety of different perforator flaps, but possesses a number of drawbacks. CTA utilizes ionizing radiation, which is of particular concern to the patient population receiving perforator flap surgery as many of them are young and with greater than usual susceptibility to radiation induced neoplasia due to risk factors such as BRCA gene mutations and Li-Fraumeni Syndrome.
https://ift.tt/2P48qJ5
Individualized small-incision orbicularis-levator fixation blepharoplasty for unilateral single-eyelid Asians
Unilateral double-eyelid blepharoplasty is often required by people with unilateral single eyelid. The full incisional method may cause permanent skin scar formation, and the buried suture method may lead to early eyelid fold loosening, which could not reduce the eyelid's soft tissue thickness. A total of 85 patients (8 males, 77 females) with unilateral single eyelid were involved between January 2015 and January 2016, with a mean age of 25.57±6.5 years. Small-incision orbicularis-levator fixation blepharoplasty was performed on all patients on the single eyelid side.
https://ift.tt/2CZ1BkC
The Impact of Facial Expression on Facial Appearance of the Surgically Managed Unilateral Cleft Lip and Palate Patients (UCLP)
To evaluate the impact of facial expression on the asymmetry of surgically managed UCLP cases.
https://ift.tt/2P5FBfc
A Large-Volume Academic Center Retrospective Audit of The Temporal Evolution of Immediate Breast Reconstruction Protocols and the Effect on Breast Prosthetic Infection
Complications of tissue expanders (TE) in breast reconstruction are challenging. We sought to identify TE infection risks and acellular dermal matrix (ADM) and infection control protocol impacts on infection in a longitudinal study.
https://ift.tt/2CVcqnW
Sentinel node biopsy for melanoma: New Zealand indication guidelines in practice
Current New Zealand cutaneous melanoma management guidelines1 note thin melanomas (<1mm) can usually be cured by primary tumour removal, and while unnecessary in most cases, sentinel node biopsy (SNB) may be considered for patients with poor prognostic factors, such as ulceration or dermal mitoses (T1b2). For patients with intermediate thickness melanomas (1–4mm: T2 and T3), it is suggested SNB is useful for identifying small nodal metastases, allowing more accurate staging, better prognostication and improved regional tumour control.
https://ift.tt/2P4NxNN
Association of benign thyroid diseases with thyroid cancer risk: a meta-analysis of prospective observational studies
Abstract
Purpose
Evidence showed that benign thyroid disease was one of the risk factors for thyroid cancer. However, the results of some studies were inconsistent and were previously meta-analyses of case–control studies. Therefore, we performed a meta-analysis of prospective studies to investigate the relationship between benign thyroid diseases and thyroid cancer risk.
Methods
All eligible studies were identified via systematic searches of multiple literature databases. The combined RR (relative risk)/HR (hazard ratio) or SIR (standardized incidence ratio) with 95% confidence interval was calculated. Heterogeneity was assessed with the I2 test. Publication bias and subgroup analyses were also performed.
Results
Twelve studies were eligible for inclusion in the meta-analysis. The pooled RR/HR of thyroid carcinoma in benign thyroid diseases was 4.39 (95% CI 3.22–5.55). The pooled SIR of thyroid carcinoma in benign thyroid diseases was 5.98 (95% CI 4.09–7.86). Subgroup analysis was performed using the type of benign thyroid diseases. Effect value was RR/HR: hyperthyroidism (RR/HR = 3.89, 95% CI = 1.69–6.08), hypothyroidism (RR/HR = 2.72, 95% CI = 1.04–4.41), and goiter (RR/HR = 22.18, 95% CI = 12.09–32.28). Effect value was SIR: hyperthyroidism (RR/HR = 5.96, 95% CI = 1.88–10.03), goiter (RR/HR = 7.65, 95% CI = 6.94–8.37), and thyroiditis (RR/HR = 3.25, 95% CI = 1.62–4.89).
Conclusions
Our study has shown that benign thyroid diseases might be associated with increased risk of thyroid cancer, especially in hyperthyroidism, hypothyroidism, and goiter. However, further investigation is needed to better understand the underlying biological mechanisms.
https://ift.tt/2JvV2HG
Modulation of Premetastatic Niche by the Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitor Pazopanib in Localized High‐Risk Prostate Cancer Followed by Radical Prostatectomy: A Phase II Randomized Trial
Lessons Learned. Pazopanib was not effective in altering the premetastatic niche in the neoadjuvant setting.Pazopanib was safe and well tolerated without any new safety signals.Background.Vascular endothelial growth factor receptor 1 (VEGFR1) expressing myeloid‐derived suppressor cells (VEGFR1+ MDSCs) potentially foster metastases by establishing a premetastatic niche. In a preclinical study, VEGFR1+ clustering in lymph nodes (LNs) independently predicted time to biochemical recurrence (TTBR) in localized prostate cancer [1]. The hypothesis was that neoadjuvant pazopanib therapy will decrease VEGFR1+ clusters in pelvic lymph nodes and improve outcomes.Methods.This is a phase II trial (NCT01832259) of neoadjuvant pazopanib 800 mg versus placebo daily for 4 weeks in high‐risk localized prostate cancer. The primary endpoint was a decrease in VEGFR1+ MDSC clustering assessed by immunohistochemistry (IHC) analysis. Secondary endpoints were safety, feasibility, and TTBR.Results.Thirty patients were randomized to pazopanib versus placebo, with 15 patients randomized to each arm. Demographic and disease characteristics were similar in both arms. There was no difference in the VEGFR1+ clustering between the treatment arms (p = .345). Neoadjuvant therapy with pazopanib was well tolerated, and surgical complications were similar in both arms.Conclusion.Neoadjuvant pazopanib therapy did not alter the premetastatic niche; however, treatment targeting vascular endothelial growth factor (VEGF) in the preoperative period was safe and feasible, which may open up the avenue to investigate novel combinatorial regimens, including a VEGF inhibitor in combination with immune checkpoint inhibitor in this setting.
https://ift.tt/2DedO6h
A Destructive Sinonasal Process Leading to Sudden Blindness
A woman in her 70s with a history of pulmonary embolism presented with diplopia and blurry vision as well as 4 months of nasal congestion and progressive headaches despite multiple antibiotic courses. What is your diagnosis?
https://ift.tt/2yMIDLo
https://ift.tt/2yMIDLo
Defining Optimal Treatment Times in Head and Neck Cancer Care
Navigating patients with head and neck cancer (HNC) through their care is a challenge. Most patients will present with locoregionally advanced disease and, on average, a 5-year survival rate of 65%; this survival rate has increased slightly since the 1970s, but has remained stagnant for the last decade. Most patients will require multimodality treatment, including surgery, radiotherapy, and/or chemotherapy. This treatment regiment, itself, produces complications in 30% to 50% of patients.
https://ift.tt/2OkZB8D
https://ift.tt/2OkZB8D
Association of Treatment Delays With Survival for Patients With Head and Neck Cancer
This systematic review synthesizes information about the association between delays in the delivery of care for head and neck cancer and oncologic outcomes.
https://ift.tt/2yKZ8Yq
https://ift.tt/2yKZ8Yq
Iodine Deficiency and Hearing Impairment
To the Editor On June 7, 2018, Scinicariello et al published a study in JAMA Otolaryngology–Head & Neck Surgery in which they analyzed data from 1198 adolescents (aged 12-19 years) from NHANES 2007 to 2010, with urinary iodine, audiometric measurements, and demographic and related variables. The authors concluded that this is the first study in which it was demonstrated at a national level that a urinary iodine concentration (UIC) less than 100 μg/L was a predictive risk factor for having speech-frequency hearing loss (SFHL) among adolescents, and more specifically among those with UIC less than 50 μg/L.
https://ift.tt/2OkZl9F
https://ift.tt/2OkZl9F
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis
This medical record review of 42 patients compares the use of peak expiratory flow, expiratory disproportion index, and total peak flow measures for monitoring disease progression in patients with idiopathic subglottic stenosis.
https://ift.tt/2yJBewo
https://ift.tt/2yJBewo
Iodine Deficiency and Hearing Impairment—Reply
In Reply We would like to thank Millon-Ramirez and coauthors for bringing our attention to their previous study on the association of iodine deficiency and hearing impairment among 150 children (aged 6-14 years). As we emphasized in our research letter, few studies have been conducted about this potential relationship, and among them we cited the study by Valeix et al. We agree with Millon-Ramirez and coauthors that in populations with adequate nutritional iodine levels there are individuals with less than adequate iodine intake, which could affect the thyroid system and thus auditory function. Moreover, the potential role of other chemical exposures, such as perchlorate, thiocyanate, and nitrate, which may disturb thyroid function should not be discarded. Alterations may occur either at the iodine uptake level in the thyroid cell by competing for the sodium iodine transporter, by inhibition of the deiodinase activity, or by other mechanisms (reviewed by Zoller).
https://ift.tt/2OhpvKk
https://ift.tt/2OhpvKk
Safety of intraperitoneal paclitaxel combined with conventional chemotherapy for colorectal cancer with peritoneal carcinomatosis: a phase I trial
Abstract
Purpose
Peritoneal carcinomatosis of colorectal cancer origin is associated with poor prognosis. With regard to ovarian, gastric, and pancreatic cancer, the safety and efficacy of intraperitoneal administration of paclitaxel (ip PTX) has been demonstrated. This drug can be administered easily and repeatedly through a catheter into the peritoneal cavity. In this phase I study, we evaluated the safety of ip PTX combined with 5-fluorouracil, folinic acid, oxaliplatin, and bevacizumab (mFOLFOX6-bevacizumab) or capecitabine, oxaliplatin, and bevacizumab (CapeOX-bevacizumab) for colorectal cancer with peritoneal metastasis.
Methods
Colorectal cancer patients with histologically confirmed peritoneal carcinomatosis were enrolled. After the implantation of a peritoneal access port, 20 mg/m2 of ip PTX was administered weekly, in combination with mFOLFOX6-bevacizumab or CapeOX-bevacizumab. Primary endpoint was the safety of the combination chemotherapy.
Results
Among the six patients enrolled, three received the mFOLFOX6-bevacizumab plus ip PTX regimen and three received the CapeOX-bevacizumab plus ip PTX regimen. Dose-limiting toxicity was not observed. Overall, grade 3 adverse events, such as leukopenia and neutropenia, were observed in two of three patients (66.7%) for each chemotherapeutic regimen, but no grade 4 adverse events were observed. Moreover, adverse events associated with the peritoneal access port, such as infection or occlusion of the catheter, were not observed.
Conclusions
The adverse events of mFOLFOX6-bevacizumab or CapeOX-bevacizumab in combination with ip PTX were considered similar to those described in previous studies of oxaliplatin-based treatment alone. 1 year after the start of chemotherapy, the efficacy of ip PTX will be evaluated as a secondary outcome.
https://ift.tt/2zg77vK
Nonclinical pharmacokinetics and in vitro metabolism of H3B-6545, a novel selective ERα covalent antagonist (SERCA)
Abstract
Purpose
H3B-6545, a novel selective estrogen receptor (ER)α covalent antagonist (SERCA) which inactivates both wild-type and mutant ERα, is in clinical development for the treatment of metastatic breast cancer. Preclinical studies were conducted to characterize the pharmacokinetics and metabolism of H3B-6545 in rat and monkeys.
Methods
The clearance and metabolic profiles of H3B-6545 were studied using rat, monkey and human hepatocytes, and reaction phenotyping was done using recombinant human cytochrome P450 enzymes. Blood stability, protein binding, and permeability were also determined in vitro. Pharmacokinetics of H3B-6545 was assessed after both intravenous and oral dosing. A nonclinical PBPK model was developed to assess in vitro–in vivo correlation of clearance.
Results
H3B-6545 had a terminal elimination half-life of 2.4 h in rats and 4.0 h in monkeys and showed low to moderate bioavailability, in line with the in vitro permeability assessment. Plasma protein binding was similar across species, at 99.5–99.8%. Nine metabolites of H3B-6545 were identified in hepatocyte incubations, none of which were unique to humans. Formation of glutathione-related conjugate of H3B-6545 was minimal in vitro. H3B-6545, a CYP3A substrate, is expected to be mostly cleared via hepatic phase 1 metabolism. Hepatocyte clearance values were used to adequately model the time-concentration profiles in rat and monkey.
Conclusions
We report on the absorption and metabolic fate and disposition of H3B-6545 in rats and dogs and illustrate that in vitro–in vivo correlation of clearance is possible for targeted covalent inhibitors, provided reactivity is not a predominant mechanism of clearance.
https://ift.tt/2DhnmNJ
Durvalumab Monotherapy and Combination Therapy in PD-L1–Low/Negative HNSCC
This phase 2 randomized clinical trial compare the efficacy and toxicity profiles of durvalumab monotherapy and tremelimumab monotherapy against a combination of both in patients with recurrent or metastatic head and neck squamous cell carcinoma with low or no expression of programmed death ligand 1.
https://ift.tt/2Px4C2u
https://ift.tt/2Px4C2u
Early Adoption of Biosimilar Growth Factors in Supportive Cancer Care
This retrospective observational analysis of health claims data compares the safety, effectiveness, and cost of biosimilar filgrastim and filgrastim.
https://ift.tt/2RwxpBH
https://ift.tt/2RwxpBH
Reporting of Research Biopsies in Clinical Trials in Oncology
This study searched ClinicalTrials.gov to examine the reporting rates of research biopsies conducted in oncology clinical trials amd investigates what factors correlate with research biopsy reporting.
https://ift.tt/2PByjzn
https://ift.tt/2PByjzn
Cancer Risk Estimates for Study of Multiple-Gene Testing After Diagnosis of Breast Cancer
To the Editor Kurian et al document the proportion of women among SEER breast cancer patients who had undergone genetic testing and had a preventive mastectomy of the contralateral breast, according to risk profile. Of those with a bona fide BRCA1/2 mutation, 79% had a bilateral mastectomy. Of those with a pathogenic variant in another gene, 38% had a bilateral mastectomy, and of those with a variant of unknown significance, 30% had a bilateral mastectomy. Of those with no mutation, 35% had a bilateral mastectomy. The data on BRCA1 and BRCA2 are useful, and genetic testing in this regard is warranted. However, on the basis of this analysis, Kurian et al conclude that the testing of genes other than BRCA1 and BRCA2 has clinical value by increasing the number of women with a mutation that places them at high risk. In my opinion, the article supports the opposite view. Among patients with a pathogenic variant in another gene, a variant of unknown significance, or no mutation, there appears to be no correlation between the objective inherent cancer risk and the action taken by patients. The operation was not recommended by the surgeon (except in rare cases), and I suspect the primary motives behind the surgery were fear and anxiety. It is unsettling that the rates of bilateral mastectomy are high in all categories; the fact that decisions regarding choice of surgery are made not with respect to the results of a formal risk assessment but as a consequence of the emotional state of the patient raises serious doubts about the basis of personalized medicine. This study confirms my research group's earlier work on preventive mastectomy. To look at the rationale for mastectomy more closely, it would be helpful to generate specific risk estimates for cancer and contralateral breast cancer for the entire study population and to determine whether any correlation exists between cancer risk and mastectomy that might be missed at the group level.
https://ift.tt/2Rt4ezd
https://ift.tt/2Rt4ezd
Hypofractionated Nodal Irradiation
This Viewpoint discusses the use of hypofractionation for regional nodal irradiation as part of radiotherapy for breast cancer and the importance of waiting for results of long-term prospective studies.
https://ift.tt/2PyaTLd
https://ift.tt/2PyaTLd
Focus on the Number of Radiation Oncology Trials or on Clinical Relevance?
To the Editor We read with great attention the recent cross-sectional analysis published in JAMA Oncology that compared the characteristics of radiotherapy trials with those of other oncological trials. The authors detailed significant differences between these 2 types of trials, particularly in terms of industry sponsorship, and concluded that there is a need for more funding for radiotherapy research.
https://ift.tt/2RrHsIg
https://ift.tt/2RrHsIg
Five-Year Adjuvant Imatinib Treatment for Patients With Resected Primary Gastrointestinal Stromal Tumor
This phase 2, multi-institutional clinical trial assesses whether patients with resected primary gastrointestinal stromal tumor receiving 5 years of adjuvant imatinib mesylate therapy have improved recurrence-free survival and overall survival compared with patients receiving a shorter duration of therapy in previous studies.
https://ift.tt/2PEh40e
https://ift.tt/2PEh40e
Cancer Risk Estimates for Study of Multiple-Gene Testing After Diagnosis of Breast Cancer—Reply
In Reply Our results demonstrate that multiple-gene panel testing has largely replaced BRCA1/2-only testing in the United States. We agree that this marked surge in multiple-gene testing may be in advance of the evidence supporting the clinical use of more vs less comprehensive genetic testing, and we have commented on this problem in our prior work. Thus, there is need for studies that will address the consequences of this sea change on the evaluation and management of cancer risk. Our recent results addressed 1 aspect of potential harm from multiple-gene panel testing vs BRCA1/2-only testing: the possibility of unwarranted use of more extensive surgery (bilateral mastectomy) owing to finding more variants of uncertain significance or pathogenic variants in genes whose risks are less well characterized than those of BRCA1/2. We found that bilateral mastectomy rates in patients with variants of uncertain significance or with pathogenic variants in non-BRCA1/2 genes were no higher than those in patients with negative test results, which provides some reassurance. We and others have reported increasing use of bilateral mastectomy and that patient preference plays a role in this trend. However, our recent results offer no evidence that testing more vs fewer genes fuels patient preference for more extensive breast surgery. The suggested analysis (ie, generating specific risk estimates for contralateral breast cancer for the entire study population) is infeasible; validated breast cancer risk models, such as the Tyrer-Cuzick model, are indicated only for women who have never been previously diagnosed with breast cancer, and considerable uncertainty remains about the contralateral breast cancer risks associated with pathogenic variants in breast cancer susceptibility genes other than BRCA1/2.
https://ift.tt/2RwxlBX
https://ift.tt/2RwxlBX
White Noise
White and black coatsIn a biased random walkSpurting opinions across the rectangular room.Aromatase inhibitors get juxtaposed with organ-sparing IMRTAnd circulating lymphoma cells shake hands with neutropenic sepsis.
https://ift.tt/2PByivj
https://ift.tt/2PByivj
Focus on the Numbers of Radiation Oncology Trials or Clinical Relevance—Reply
In Reply We would like to thank Dr Chargari and colleagues for their insightful comments on our article. While we emphasized the limited number of radiotherapy trials and the lack of industry sponsorship for these studies, we did not imply that these issues should be the only areas for improvement. As Dr Chargari and colleagues point out, radiotherapy research is lagging behind that of medical oncology in terms of precision approaches. In recent years, targeted therapy, specifically therapy targeting activating mutations, has revolutionized systemic treatment for many cancers. However, none of these agents were approved to be combined with radiotherapy, except for cetuximab. Although the combination of immune checkpoint therapy with radiotherapy appears promising, validated biomarkers to select the appropriate patients for this combination of therapy are still lacking. Moreover, more preclinical and translational work are needed to better understand the interaction between immunotherapy and radiotherapy, the appropriate sequencing of the 2 treatments, and the optimal radiation regimen when combined with immunotherapy. With more knowledge, we will be able to design future trials that may change clinical practice, even with limited resources.
https://ift.tt/2Rw7Rol
https://ift.tt/2Rw7Rol
Analysis of the Strength of Legal Firearms Restrictions for Perpetrators of Domestic Violence and Their Associations With Intimate Partner Homicide
Abstract
In this research, we estimate the association of firearm restrictions for domestic violence offenders with intimate partner homicides (IPHs) on the basis of the strength of the policies. We posit that the association of firearm laws with IPHs depends on the following characteristics of the laws: 1) breadth of coverage of high-risk individuals and situations restricted; 2) power to compel firearm surrender or removal from persons prohibited from having firearms; and 3) systems of accountability that prevent those prohibited from doing so from obtaining guns. We conducted a quantitative policy evaluation using annual state-level data from 1980 through 2013 for 45 US states. Based on the results of a series of robust, negative binomial regression models with state fixed effects, domestic violence restraining order firearm-prohibition laws are associated with 10% reductions in IPH. Statistically significant protective associations were evident only when restraining order prohibitions covered dating partners (−13%) and ex parte orders (−13%) and included relinquishment provisions (−12%). Laws prohibiting access to those convicted of nonspecific violent misdemeanors were associated with a 23% reduction in IPH rates; there was no association when prohibitions were limited to domestic violence. These findings should inform policymakers considering laws to maximize protections against IPH.https://ift.tt/2yJCnDU
A primary germ cell tumour in the gastrointestinal tract: a caecal lesion of yolk-sac morphology in a young patient
Abstract
A 24-year-old man with a history of Crohns disease, whilst undergoing surveillance colonoscopy was found to have an ulcerated caecal lesion. The histopathology from the mucosal biopsy was suggestive of a yolk sac tumour. After thorough re-examination, the patient had no radiological evidence of malignancy in his testes or retroperitoneum. His alpha-fetoprotein levels returned as 2145, whilst his carcinoembryonic antigen was negligible. The patient was therefore consented for and underwent a laparoscopic right hemi-colectomy with an ileocolic anastomosis, without any complications. The formal histopathology confirmed the results from the biopsy, of a yolk sac non seminous germ cell tumour with positive lymph nodes and lymphovascular invasion. The patient was referred on to medical oncology for neoadjuvant chemotherapy. As the literature in his instance is scarce, the patient's overall prognosis remains unclear. To the best of our knowledge this is the first reported primary germ cell tumour of the gastrointestinal tract.https://ift.tt/2qlrsfc
Giant solitary fibrous tumor of the pleura
Abstract
Introduction: Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors representing <5% of all tumors of the pleura. Literature reveals only two case series and a few solitary reports. Case report: A 68-year-old male presented to our hospital after experiencing exertional dyspnea. A chest CT revealed a giant heterogeneous mass. CT-guided transthoracic core needle biopsy demonstrated SFTP. The well-circumscribed, encapsulated resected mass was measured to be 30 cm × 21 cm × 15 cm and weighed 6900 g. Discussion: SFTP are a rare pathology of the pleural cavity, which most of the time develop from submesothelial fibroblasts of the visceral pleura. Due to their non-characteristic clinical picture, SFTP are usually diagnosed in the later stages of the development. A significant issue in the management of giant SFTP is radical resection of the tumor to relieve compression of the lung parenchyma and other mediastinal structures. Conclusion: SFTP are rare neoplasms that fortunately are benign 80% of the time. Only a few cases of giant SFTP that cover almost the entire pleural space are described in the literature. This report represents one of the largest resected SFTP reports in the literature.https://ift.tt/2QbBPO9
Robotic Versus Thoracolaparoscopic Esophagectomy for Esophageal Cancer
Condition: Esophageal Cancer
Interventions: Procedure: Robotic esophagectomy; Procedure: Thoracolaparoscopic esophagectomy
Sponsor: GEM Hospital & Research Center
Not yet recruiting
https://ift.tt/2CSju4C
Interventions: Procedure: Robotic esophagectomy; Procedure: Thoracolaparoscopic esophagectomy
Sponsor: GEM Hospital & Research Center
Not yet recruiting
https://ift.tt/2CSju4C
Porfimer Sodium Interstitial Photodynamic Therapy With or Without Standard of Care Chemotherapy in Treating Patients With Locally Advanced or Recurrent Head and Neck Cancer
Conditions: Recurrent Head and Neck Carcinoma; Locally Advanced Head and Neck Carcinoma
Interventions: Biological: Nivolumab; Drug: Porfimer Sodium; Procedure: Interstitial Illumination Photodynamic Therapy; Biological: Pembrolizumab; Drug: Cisplatin; Drug: Carboplatin; Biological: Cetuximab; Other: Quality of Life Assessment; Drug: Fluorouracil
Sponsors: Roswell Park Cancer Institute; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2P1FbXj
Interventions: Biological: Nivolumab; Drug: Porfimer Sodium; Procedure: Interstitial Illumination Photodynamic Therapy; Biological: Pembrolizumab; Drug: Cisplatin; Drug: Carboplatin; Biological: Cetuximab; Other: Quality of Life Assessment; Drug: Fluorouracil
Sponsors: Roswell Park Cancer Institute; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2P1FbXj
Robotic Versus Thoracolaparoscopic Esophagectomy for Esophageal Cancer
Condition: Esophageal Cancer
Interventions: Procedure: Robotic esophagectomy; Procedure: Thoracolaparoscopic esophagectomy
Sponsor: GEM Hospital & Research Center
Not yet recruiting
https://ift.tt/2CSju4C
Interventions: Procedure: Robotic esophagectomy; Procedure: Thoracolaparoscopic esophagectomy
Sponsor: GEM Hospital & Research Center
Not yet recruiting
https://ift.tt/2CSju4C
Porfimer Sodium Interstitial Photodynamic Therapy With or Without Standard of Care Chemotherapy in Treating Patients With Locally Advanced or Recurrent Head and Neck Cancer
Conditions: Recurrent Head and Neck Carcinoma; Locally Advanced Head and Neck Carcinoma
Interventions: Biological: Nivolumab; Drug: Porfimer Sodium; Procedure: Interstitial Illumination Photodynamic Therapy; Biological: Pembrolizumab; Drug: Cisplatin; Drug: Carboplatin; Biological: Cetuximab; Other: Quality of Life Assessment; Drug: Fluorouracil
Sponsors: Roswell Park Cancer Institute; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2P1FbXj
Interventions: Biological: Nivolumab; Drug: Porfimer Sodium; Procedure: Interstitial Illumination Photodynamic Therapy; Biological: Pembrolizumab; Drug: Cisplatin; Drug: Carboplatin; Biological: Cetuximab; Other: Quality of Life Assessment; Drug: Fluorouracil
Sponsors: Roswell Park Cancer Institute; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2P1FbXj
Diagnostic usefulness of panoramic imaging of the pterygopalatine fossa: case of a schwannoma causing pterygopalatine fossa expansion
Abstract
The pterygopalatine fossa is a small area between the posterior wall of the maxillary sinus and the anterior surface of the pterygoid process of the sphenoid bone. The pterygopalatine fossa can be seen clearly on panoramic imaging. We present the case of a 57-year-old man who exhibited right pterygopalatine fossa expansion on panoramic imaging. Computed tomography (CT), magnetic resonance imaging (MRI), and panoramic imaging all showed a tumor at the right pterygopalatine fossa in this patient. CT indicated that the tumor replaced right retromaxillary fat and displaced the posterior wall of the maxillary sinus. On MRI, the tumor showed intermediate signal intensity at the paranasal area on T1-weighted images, and variable intermediate and high signal intensities on fat-suppressed T2-weighted images. It was eventually diagnosed as a schwannoma. Thus, panoramic imaging can be used for disease screening at the posterior border of the maxilla. Our conclusion is based on this report of a patient with a schwannoma at the posterior wall of the maxillary sinus, which panoramic imaging revealed to have pterygopalatine fossa expansion.
https://ift.tt/2qoPje8
Therapy with Ulipristal Acetate in a Hypertensive Patient
Ulipristal acetate (UPA) is a medical therapy for patients with symptomatic uterine fibroids. The drug has shown efficacy in the control of heavy menstrual bleeding and, as a consequence, in anaemia improvement. We report the case of a hypertensive patient treated with two courses of UPA. In addition to its observed benefits on hypermenorrhea caused by uterine fibroids, no exacerbation of the underlying disease was observed. No adverse effects were observed, and blood pressure levels were well controlled throughout.
https://ift.tt/2SFmmrl
Influence of foraminal enlargement on the healing of periapical lesions in rat molars
Abstract
Objectives
The aim of this study was to evaluate the influence of foraminal enlargement on the healing of induced apical periodontitis in a rat model.
Material and methods
Periapical lesions were bilaterally induced in mandibular first molars of 24 Wistar rats, through root canals exposure to the oral environment during 3 weeks. Endodontic treatment was performed in the mesial canal of right molars, which were separated into two experimental groups (n = 12/group). The foraminal enlargement group (FEG) received instrumentation in the entire root canal length, including the cemental canal, while in the non-foraminal enlargement group (NFEG), instrumentation was carried out 1 mm short of the apical foramen. Root canals were filled with gutta-percha and AH Plus sealer, in the same visit, 1 mm short of the apical foramen in both experimental groups. Left molars were not treated and served as a baseline control group. The animals were killed after 4 weeks, and their hemi-mandibles were prepared for radiographic and histological analysis. Data were analyzed by Student's t test and ANOVA.
Results
Only FEG presented lower areas of periapical radiolucency compared to the control (p < .05). Both FEG and NFEG allowed decreased inflammation intensity (p < .0001 and p < .01) and higher scores of cementum neoformation when compared to non-treated samples (p < .0001). FEG was more effective than NFEG in promoting biological seal, i.e., apical closure with cementum (p < .01). FEG, but not NFEG, showed lower scores of root resorption than the control.
Conclusions
Foraminal enlargement during root canal preparation improved periapical healing in rat molars.
Clinical significance
Foraminal enlargement has been suggested to improve disinfection at the apical portion of root canals. This procedure may favor the healing of chronic periapical lesions.
https://ift.tt/2yMfMXA
Cavity volume changes after surgery of a brain metastasis—consequences for stereotactic radiation therapy
Abstract
Purpose
For a large or symptomatic brain metastasis, resection and adjuvant radiotherapy are recommended. Hypofractionated stereotactic radiotherapy (HFSRT) is increasingly applied in patients with a limited number of lesions. Exact target volume definition is critical given the small safety margins. Whilst technical advances have minimized inaccuracy due to patient positioning and radiation targeting, little is known about changes in target volume. This study sought to evaluate potential changes in the resection cavity of a brain metastasis.
Methods
In all, 57 patients treated with HFSRT after surgical resection of one brain metastasis between 2008 and 2015 in our institution were included in this study. Gross tumor volume (GTV) of the initial metastasis and the volume of the resection cavity in the post-operative, planning, and follow-up MRIs were measured and compared.
Results
The mean cavity size decreased after surgery with the greatest change of −23.4% (±41.5%) occurring between post-operative MRI and planning MRI (p < 0.01). During this time period, the cavity volume decreased, remained stable, and increased in 79.1, 3.5, and 17.4%, respectively. A further decrease of −20.7% (±58.1%) was perceived between planning MRI and first follow-up (p < 0.01). No significant difference in pattern of change could be observed depending on the volume of initial GTV, size of the post-operative resection cavity, initial or post-resection FLAIR (fluid-attenuated inversion recovery) hyper-intensity, postsurgical ischemia, or primary tumor. The resection cavities of patients with post-operative ischemia were significantly larger than resection cavities of patients without ischemia.
Conclusion
The resection cavity seems to be very dynamic after surgery. Hence, it remains necessary to use very recent scans for treatment planning.
https://ift.tt/2qndaef
Editorial Board
Publication date: December 2018
Source: Archives of Oral Biology, Volume 96
Author(s):
https://ift.tt/2qmlniH
Synaptotagmin-1 overexpression under inflammatory conditions affects secretion in salivary glands from Sjögren's syndrome patients
Publication date: Available online 31 October 2018
Source: Journal of Autoimmunity
Author(s): Juan Cortés, Jorge Hidalgo, Sergio Aguilera, Isabel Castro, Mónica Brito, Hery Urra, Paola Pérez, María-José Barrera, Patricia Carvajal, Ulises Urzúa, Sergio González, Claudio Molina, Verónica Bahamondes, Marcela Hermoso, María-Julieta González
Abstract
Sjögren's syndrome (SS) is an autoimmune exocrinopathy associated with severe secretory alterations by disruption of the glandular architecture integrity, which is fundamental for a correct function and localization of the secretory machinery. Syt-1, PI(4,5)P2 and Ca2+ are significant factors controlling exocytosis in different secretory cells, the Ca2+ role being the most studied. Salivary acinar cells from SS-patients show a defective agonist-regulated intracellular Ca2+ release together with a decreased IP3R expression level, and this condition may explain a reduced water release. However, there are not reports where Syt-1, PI(4,5)P2 and Ca2+ in acinar cells of SS patients had been studied. In the present study, we analyzed the expression and/or localization of Syt-1 and PI(4,5)P2 in acinar cells of labial salivary gland biopsies from SS-patients and control individuals. Also, we evaluated whether the overexpression of Syt-1 and the loss of cell polarity induced by TNF-α or loss of interaction between acinar cell and basal lamina, alters directionality of the exocytosis process, Ca2+ signaling and α-amylase secretion in a 3D-acini model stimulated with cholinergic or β-adrenergic agonists. In addition, the correlation between Syt-1 protein levels and clinical parameters was evaluated. The results showed an increase of Syt-1 mRNA and protein levels, and a high number of co-localization points of Syt-1/STX4 and PI(4,5)P2/Ezrin in the acinar basolateral region of LSG from SS-patients. With regard to 3D-acini, Syt-1 overexpression increased exocytosis in the apical pole compared to control acini. TNF-α stimulation increased exocytic events in the basal pole, which was further enhanced by Syt-1 overexpression. Additionally, altered acinar cell polarity affected Ca2+ signaling and amylase secretion. Overexpression of Syt-1 was associated with salivary gland alterations revealing that the secretory dysfunction in SS-patients is linked to altered expression and/or localization of secretory machinery components together with impaired epithelial cell polarity. These findings provide a novel insight on the pathological mechanism implicated in ectopic secretory products to the extracellular matrix of LSG from SS-patients, which might initiate inflammation.
https://ift.tt/2DeSDkh
The utility of complement assays in clinical immunology: A comprehensive review
Publication date: Available online 31 October 2018
Source: Journal of Autoimmunity
Author(s): Thomas Lung, Lorenz Risch, Martin Risch, Benjamin Sakem, Reinhard Würzner, Urs Nydegger
Abstract
The multi-tasking organ liver, which is the major synthesis site of most serum proteins, supplies humoral components of the innate, – including proteins of the complement system; and, less intensely, also of the acquired immune system. In addition to hepatocyte origins, C1q, factor D, C3, C7 and other protein components of the complement system are produced at various body locations by monocytes/macrophages, lymphocytes, adipocytes, endometrium, enterocytes, keratinocytes and epithelial cells; but the contribution of these alternate sites to the total serum concentrations is slight. The two major exceptions are factor D, which cleaves factor B of the alternative pathway derived largely from adipocytes, and C7, derived largely from polymorphonuclear leukocytes and monocytes/macrophages. Whereas the functional meaning of the extrahepatic synthesis of factor D remains to be elucidated, the local contribution of C7 may up- or downregulate the complement attack. The liver, however, is not classified as part of the immune system but is rather seen as victim of autoimmune diseases, a point that needs apology. Recent histological and cell marker technologies now turn the hands to also conceive the liver as proactive autoimmune disease catalyst. Hosting non-hepatocytic cells, e.g. NK cells, macrophages, dendritic cells as well as T and B lymphocytes, the liver outreaches multiple sites of the immune system. Immunopharmacological follow up of liver transplant recipients teaches us on liver-based presence of ABH-glycan HLA phenotypes and complement mediated ischemia/regeneration processes. In clinical context, the adverse reactions of the complement system can now be curbed by specific drug therapy. This review extends on the involvement of the complement system in liver autoimmune diseases and should allow to direct therapeutic opportunities.
Graphical abstract
https://ift.tt/2DdmnOJ
TARBP2 negatively regulates IFN-β production and innate antiviral response by targeting MAVS
Publication date: December 2018
Source: Molecular Immunology, Volume 104
Author(s): Ting Ling, Sheng-Na Li, Guang-Xiu Weng, Weiying Wang, Changsheng Li, Lingzhen Cao, Hua Rao, Hong-Bing Shu, Liang-Guo Xu
Abstract
MAVS as an essential receptor protein for anti-virus innate immunity plays an important role in the production of virus-induced typeⅠ interferon and regulation of interferon regulatory factor 3/7. Understanding the MAVS-mediated antiviral signaling pathway can provide detailed insights. In this study, we identify transactivation response element RNA-binding protein (TARBP2), as an inhibitor of the cellular protein kinase PKR, negatively regulates virus -induced IFN-β production by targets MAVS. Overexpression of TARBP2 inhibits virus-induced IFN-β production as well as cellular antiviral response. Then knockdown of TARBP2 inhibited virus-induced IFN-β signaling. Further studies demonstrated that TARBP2 interacted with MAVS and targeted MAVS to abrogate MAVS-RIG-I and MAVS-TRAF3 association. Our findings suggest that TARBP2 is an important non-redundant virus-mediated negative regulator of typeⅠ interferon.
https://ift.tt/2JvMv7y
Editorial Board
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s):
https://ift.tt/2DeY9DD
Two Synchronous Congenital Neck Masses with Facial Nerve Weakness
Publication date: Available online 31 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Elise Lippmann, Taher Valika, John Maddalozzo
Abstract
Objective
To describe a case of a complex neck mass with final pathology significant for two synchronous lesions, a type 1 branchial cleft cyst and an enteric duplication cyst, and to discuss its management given the unique presentation.
https://ift.tt/2CXOi4j
Prism adaptation changes resting-state functional connectivity in the dorsal stream of visual attention networks in healthy adults: a fMRI study
Publication date: Available online 31 October 2018
Source: Cortex
Author(s): Kengo Tsujimoto, Katsuhiro Mizuno, Daisuke Nishida, Masatoshi Tahara, Emi Yamada, Shiori Shindo, Shoko Kasuga, Meigen Liu
Abstract
Unilateral spatial neglect (USN) can be defined as a failure to orient to contra-lesional stimuli in the absence of either sensory or motor defects. Although the behavioral and clinical effects of prism adaptation (PA) are widely accepted, its underlying mechanisms are still controversial. However, recent neuroimaging and neurophysiological studies support the idea that PA affects the visual attention and sensorimotor networks including in the parietal cortex and cerebellum. We investigate the effect of PA on functional connectivity (FC) in attention and sensorimotor networks, evaluating changes of resting-state FC before and after PA in healthy individuals using functional magnetic resonance imaging (fMRI). MR sessions were conducted before PA, after PA (Post1), and 1 h after PA (Post2). The FC between the right frontal eye (FEF) field and the right intraparietal sulcus was significantly decreased at Post1 and that between the right FEF and the right anterior cingulate cortex was significantly increased after PA and recovered within 1 h. This is the first study to demonstrate transient changes of resting-state FC in the right dorsal attention network (DAN) by PA in healthy adults using fMRI. These results will contribute to the elucidation of the underling mechanism of PA therapy and to devising new therapies for USN and/or other higher cortical dysfunctions.
https://ift.tt/2Ohdp3R
Clinical presentation, immunologic features, and hematopoietic stem cell transplant outcomes for IKBKB immune deficiency
Publication date: Available online 31 October 2018
Source: Clinical Immunology
Author(s): Geoffrey D.E. Cuvelier, Tamar S. Rubin, Anne Junker, Roona Sinha, Alan M. Rosenberg, Donna A. Wall, Marlis L. Schroeder
Abstract
IKBKB deficiency is a rare but life-threatening primary immunodeficiency disorder, involving activation defects in adaptive and innate immunity. We present sixteen cases of a homozygous IKBKB mutation (c.1292dupG) in infants characterized by early-onset bacterial, viral, fungal and Mycobacterial infections. In most cases, T- and B-cells were quantitatively normal, but phenotypically naïve, with severe hypogammaglobulinemia. T-cell receptor excision circles were normal, meaning newborn screening by TREC analysis would miss IKBKB cases. Although IKBKB deficiency does not meet traditional laboratory based definitions for SCID, this combined immune deficiency appears to be at least as profound. Urgent HSCT, performed in eight patients, remains the only known curative therapy, although only three patients are survivors. Ongoing infections after transplant remain a concern, and may be due to combinations of poor social determinants of health, secondary graft failure, and failure of HSCT to replace non-hematopoietic cells important in immune function and dependent upon IKK/NF-κB pathways.
https://ift.tt/2SBNBms
Efficacy and safety of rupatadine in Japanese patients with seasonal allergic rhinitis: A double-blind, randomized, multicenter, placebo-controlled clinical trial
Publication date: Available online 31 October 2018
Source: Allergology International
Author(s): Kimihiro Okubo, Takamasa Suzuki, Ayaka Tanaka, Hiroshi Aoki
Abstract
Background
Rupatadine is a novel non-sedating second-generation H1-antihistamine with antiplatelet-activating factor activity, first marketed in Spain in 2003. It is used for treating allergic rhinitis in more than 80 countries. This study investigated its efficacy and safety in Japanese patients with seasonal allergic rhinitis (SAR).
Methods
This was a randomized, placebo-controlled, double-blind study conducted at 4 medical institutions in Japan (JapicCTI-152785). Adolescent and adult SAR outpatients aged 12–64 years entered a 1-week placebo run-in period. After eligibility was confirmed, patients orally received placebo, rupatadine 10 mg, or 20 mg once daily for 2 weeks. The primary endpoint was a change from baseline to second week of treatment in total 4 nasal symptom score (T4NSS).
Results
Nine hundred patients were randomly assigned to placebo, rupatadine 10 mg, or rupatadine 20 mg (302, 298, and 300 patients, respectively). The least squares mean difference in the primary endpoint between rupatadine and placebo was −1.085 for 10 mg, and −1.415 for 20 mg (analysis of covariance, both P < 0.001). The rates of adverse events were 6.6%, 14.1%, and 15.0% for placebo, rupatadine 10 mg, and rupatadine 20 mg, respectively. Somnolence was most frequently reported: 7.0% for rupatadine 10 mg and 7.3% for rupatadine 20 mg. No serious adverse drug reactions were observed, and no adverse events resulted in premature discontinuation.
Conclusions
Rupatadine 10 and 20 mg were significantly superior to placebo in improving nasal and ocular symptoms of SAR, and were well tolerated.
https://ift.tt/2PB5cMs
The application of artificial intelligence in the IMRT planning process for head and neck cancer
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Vasant Kearney, Jason W. Chan, Gilmer Valdes, Timothy D. Solberg, Sue S. Yom
Abstract
Artificial intelligence (AI) is beginning to transform IMRT treatment planning for head and neck patients. However, the complexity and novelty of AI algorithms make them susceptible to misuse by researchers and clinicians. Understanding nuances of new technologies could serve to mitigate potential clinical implementation pitfalls. This article is intended to facilitate integration of AI into the radiotherapy clinic by providing an overview of AI algorithms, including support vector machines (SVMs), random forests (RF), gradient boosting (GB), and several variations of deep learning. This document describes current AI algorithms that have been applied to head and neck IMRT planning and identifies rapidly growing branches of AI in industry that have potential applications to head and neck cancer patients receiving IMRT. AI algorithms have great clinical potential if used correctly but can also cause harm if misused, so it is important to raise the level of AI competence within radiation oncology so that the benefits can be realized in a controlled and safe manner.
https://ift.tt/2SwP8Kq
Are gingival cells more sensitive to genotoxic effects caused by dental radiography?
Publication date: Available online 31 October 2018
Source: Oral Oncology
Author(s): Mahesh Shivaji Chavan, Priti Mahesh Chavan, Digamber Sable, Suhas Pande, Harshada Inamdar, Girija Kunjir, Pallavi Channe
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Genetic Loci Determining Total Immunoglobulin E Levels from Birth through Adulthood
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OgDLmJ
Overexpression of FOXQ1 Correlates With Poor Prognosis in Papillary Thyroid Carcinoma
Clinical Endocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CUL4hN
Relationship Between Midface Volume Deficits and the Appearance of Tear Troughs and Nasolabial Folds
BACKGROUND Understanding interrelationships among aging facial features is important in facial aesthetics as a global treatment approach becomes standard. OBJECTIVE Examine empirical relationships between midface volume deficit and severity of tear troughs (TTs) and nasolabial folds (NLFs) in women and men of different racial/ethnic groups. METHODS A web-based study was administered to health panel members (aged 18–75 years). Participants compared their midface volume, TTs, and NLFs against photonumeric scales depicting degrees of severity. Linear regressions were conducted to assess the relationship of midface volume on severity of TTs and NLFs, controlling for demographic factors. RESULTS Of 4,086 participants (80.0% female), 3,553 had complete data. Increasing severity of midface volume deficit was associated with increasing severity of TTs and NLFs in both sexes (all p
https://ift.tt/2qmWlzP
https://ift.tt/2qmWlzP
Multidrug-resistant Aeromonas hydrophila causing fatal bilateral necrotizing fasciitis in an immunocompromised patient: a case report
Aeromonas hydrophila is a water-dwelling, gram-negative rod-shaped bacterium, associated with diarrheal illness and, less commonly, necrotizing skin and soft tissue infections, especially among immunocompromised ...
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MicroRNAs regulating mucin type O‐glycan biosynthesis and transforming growth factor β signaling pathways in nasal mucosa of patients with chronic rhinosinusitis with nasal polyps in Northern China
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2PwD0ul
Guidelines of care for the management of primary cutaneous melanoma
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer–related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy).
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The increase of interfollicular epidermal stem cells and regulation of aryl hydrocarbon receptor and its repressors in the skin through hydroporation with anti‐aging cocktail
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2EWt0GA
Appearance of aging signs in differently pigmented facial skin by a novel imaging system
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2AFvN2P
The increase of interfollicular epidermal stem cells and regulation of aryl hydrocarbon receptor and its repressors in the skin through hydroporation with anti‐aging cocktail
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2EWt0GA
Appearance of aging signs in differently pigmented facial skin by a novel imaging system
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2AFvN2P
IL‐17‐positive mast cell infiltration in the lesional skin of lichen planopilaris: possible role of mast cells in inducing inflammation and dermal fibrosis in cicatricial alopecia
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
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Fevipiprant, a DP2 Receptor Antagonist, Inhibits Eosinophil Migration Towards Mast Cells
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
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National Partnership for Maternal Safety Recommended Maternal Early Warning Criteria Are Associated With Maternal Morbidity
BACKGROUND: Many cases of maternal mortality and morbidity are preventable. A delayed response to clinical warning signs contributes to preventability. Therefore, the National Partnership for Maternal Safety devised maternal early warning criteria (MEWC), composed of abnormal vital signs that trigger bedside evaluation by a provider with the capacity to escalate care. The relationship of the MEWC to maternal morbidity has not been studied. We evaluated the correlation between the MEWC and maternal morbidity. METHODS: We retrospectively reviewed the first 400 deliveries at the University of Chicago in 2016. We analyzed the electronic medical record to determine whether vital signs triggered the MEWC during the admission to labor and delivery and whether patients experienced morbidity during their delivery hospitalization. The association between MEWC and morbidity was tested using χ2 analysis. We calculated the sensitivity, specificity, and positive and negative predictive values of the MEWC. RESULTS: Two hundred eighty-one (70%) of 400 patients triggered the MEWC at least once, and 198 (50%) of 400 patients had multiple or recurrent triggers. Ninety-nine (25%) of 400 patients experienced morbidity. The most common causes of morbidity were hemorrhage, suspected infection, and preeclampsia with severe features. The relative risk of maternal morbidity with at least a single trigger was 13.55 (95% confidence interval [CI], 4.38–41.91) and with recurrent or multiple triggers was 5.29 (95% CI, 3.22–8.71). The sensitivity of the MEWC in predicting morbidity was 0.97 (95% CI, 0.92–0.99) and the specificity was 0.39 (95% CI, 0.33–0.44) when patients with at least a single trigger were included. When including only patients with multiple or recurrent triggers, the sensitivity was 0.84 (95% CI, 0.75–0.90) and the specificity was 0.62 (95% CI, 0.56–0.67). The positive predictive value of the MEWC in our population was 0.34 (95% CI, 0.29–0.40), and the negative predictive value was 0.97 (95% CI, 0.93–0.99). When considering only patients with multiple or recurrent triggers, the positive predictive value was 0.42 (95% CI, 0.38–0.46) and the negative predictive value was 0.92 (95% CI, 0.88–0.95). CONCLUSIONS: The MEWC are associated with maternal morbidity. As a screening tool, they appropriately prioritize sensitivity and have an excellent negative predictive value. The criteria demonstrate low specificity, which is slightly improved by considering only patients with recurrent or multiple triggers. Additional efforts to improve the specificity of MEWC, with a focus on identifying sustained or recurrent patterns of abnormal vital signs, may be necessary before their widespread implementation. Accepted for publication September 26, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Barbara M. Scavone, MD, Departments of Anesthesia and Critical Care and Obstetrics and Gynecology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637. Address e-mail to bscavone@dacc.uchicago.edu. © 2018 International Anesthesia Research Society
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https://ift.tt/2CTGS1H
Psychometrics: Trust, but Verify
There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals—both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results—in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test–retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings. Accepted for publication September 10, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2P6PwBy
https://ift.tt/2P6PwBy
Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa
BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries. METHODS: Accordingly, with input from East African health care professionals, we created a context-relevant obstetric anesthesia checklist for cesarean delivery. Second, clinical observations were performed to assess in a real-world setting. Third, a pilot testing of the cognitive aid was undertaken. RESULTS: Clinical observation data highlighted significant deficiencies in the management of obstetric emergencies. The use of the cesarean delivery checklist during simulations of peripartum hemorrhage and preeclampsia showed significant improvement in the percentage of completed actions (pretraining 23% ± 6% for preeclampsia and 22% ± 13% for peripartum hemorrhage, posttraining 75% ± 9% for preeclampsia, and 69% ± 9% for peripartum hemorrhage [P
https://ift.tt/2CSNKfY
https://ift.tt/2CSNKfY
Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery: A Retrospective Cohort Study Using a Nationwide Database
BACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures. METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission. RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83–1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72–1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses. CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications. Accepted for publication September 25, 2018. Funding: Institutional/departmental. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). The authors have no conflicts of interest directly relevant to the content of this article within 36 months before submission. Reprints will not be available from the authors. Address correspondence to Koji Kawakami, MD, PhD, Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto 6068501, Japan. Address e-mail to kawakami.koji.4e@kyoto-u.ac.jp. © 2018 International Anesthesia Research Society
https://ift.tt/2OZYkJg
https://ift.tt/2OZYkJg
Is Activity Tracker–Measured Ambulation an Accurate and Reliable Determinant of Postoperative Quality of Recovery? A Prospective Cohort Validation Study
BACKGROUND: Quality of recovery (QOR) instruments measure patients' ability to return to baseline health status after surgery. Whether, and the extent to which, postoperative ambulation contributes to QOR is unclear, in part due to the lack of valid tools to measure ambulation in clinical settings. This cohort study of the cesarean delivery surgical model examines the accuracy and reliability of activity trackers in quantifying early postoperative ambulation and investigates the correlation between ambulation and QOR. METHODS: A prospective cohort of 200 parturients undergoing cesarean delivery between July 2015 and June 2017 was fitted with wrist-worn activity trackers immediately postpartum. The trackers were collected 24 hours later, along with QOR assessments (QoR-15 scale). The relationship between QOR and various covariates, including ambulation, was explored using multivariable linear regression and Spearman correlation (ρ). Forty-eight parturients fitted with 2 trackers also completed a walk exercise accompanied by a step-counting assessor, to evaluate accuracy, inter-, and intradevice reliability using interclass correlation (ICC). RESULTS: Compared to step counting, activity trackers had high accuracy (ICC = 0.93) and excellent inter- and intradevice reliability (ICC = 0.98 and 0.96, respectively). Correlation analysis suggested that early ambulation is moderately correlated with postcesarean QoR-15 scores, with a ρ (95% confidence interval) equivalent to 0.56 (0.328–0.728). Regression analysis suggested that ambulation is a determinant of postcesarean QoR-15 scores, with an effect estimate (95% confidence interval) equivalent to 0.002 (0.001–0.003). Ambulation was also associated with all QoR-15 domains, except psychological support. The patient's acceptable symptom state (subjective threshold for good ambulation) in the first 24 hours was 287 steps. CONCLUSIONS: This study demonstrated the accuracy and reliability of activity trackers in measuring ambulation in clinical settings and suggested that postoperative ambulation is a determinant of postoperative QOR. A hypothetical implication of our findings is that interventions that improve ambulation may also help to enhance QOR, but further research is needed to establish a causal relationship. Accepted for publication October 5, 2018. Funding: This work was supported by departmental funding. J.G.L., D.N.W., and F.W.A. were supported by the Merit Award Program, Department of Anesthesia, University of Toronto. F.W.A. also receives research time support from the Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa. D.N.W. is also supported by a New Investigator Award from the Canadian Institutes of Health Research. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society
https://ift.tt/2P5ZTVZ
https://ift.tt/2P5ZTVZ
Four cases of paradoxical cephalocervical pyogenic granuloma during treatment with paclitaxel and ramucirumab
The Journal of Dermatology, EarlyView.
https://ift.tt/2RvBrKD
High‐grade trichoblastic carcinoma arising through malignant transformation of trichoblastoma: Immunohistochemical analysis and the expression of p53 and phosphorylated AKT
The Journal of Dermatology, EarlyView.
https://ift.tt/2PtAVzt
Autophagy in malnutrition‐associated dermatoses
The Journal of Dermatology, EarlyView.
https://ift.tt/2RsYbur
Sézary syndrome without erythroderma: A case report and review of published work
The Journal of Dermatology, EarlyView.
https://ift.tt/2Pu9aqr
Association between rosacea severity and relative muscle mass: A cross‐sectional study
The Journal of Dermatology, EarlyView.
https://ift.tt/2RvBhTx
Two cases of chronic oral ulcers effectively treated with systemic corticosteroid therapy: Circumorificial plasmacytosis and traumatic ulcerative granuloma with stromal eosinophilia
The Journal of Dermatology, EarlyView.
https://ift.tt/2PBaKXA
Effectiveness of weekly paclitaxel for edema and pain in classic Kaposi sarcoma with widespread eruption in the lower legs
The Journal of Dermatology, EarlyView.
https://ift.tt/2RsIbsp
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