Higher mean platelet volume is associated with paediatric chronic spontaneous urticaria and with a more severe disease in the affected children

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Higher mean platelet volume is associated with paediatric chronic spontaneous urticaria and with a more severe disease in the affected children

https://ift.tt/2GAZIxm

Melanoma-associated antigen-A and programmed death-ligand 1 expression are associated with advanced urothelial carcinoma

Abstract

Background

Melanoma-associated antigen-A (MAGE-A) and programmed-death ligand 1 (PD-L1) are present in urothelial carcinoma (UC). We assessed survival outcomes in patients with MAGE-A and PD-L1 expression.

Methods

MAGE-A and PD-L1 expression on neoplastic cells was analyzed using tissue microarrays from patients with UC. We compared differential expression between disease stage and grade. MAGE-A and PD-L1 co-expression was subcategorized. Fisher's exact test was done for categorical variables followed by univariable and multivariable analysis of recurrence-free survival (RFS) and progression-free survival (PFS).

Results

Co-expression of MAGE+/PD-L1+ was higher in advanced disease; however, only MAGE+/PD-L1− was associated with shorter RFS [hazard ratio (HR) 1.89; 95% confidence interval (CI) 1.19–2.99; p = .006]. MAGE+/PD-L1+ was associated with the worst PFS (HR 17.1; 95% CI 5.96–49.4; p ≤ .001). MAGE-A expression was more prevalent with high-grade (p = .015), and higher-stage ≥ pT2 (p = .001) disease. The 5-year RFS was 44% for MAGE+ versus 58% for MAGE− patients. On multivariable analysis, MAGE+ was also associated with shorter RFS (HR 1.55; 95% CI 1.05–2.30; p = .03). Similarly, MAGE+ was associated with shorter PFS (HR 3.12; 95% CI 1.12–8.68; p = .03).

Conclusion

MAGE-A and PD-L1 expression is increased in advanced disease and associated with shorter PFS. Furthermore, MAGE-A expression was significantly associated with higher-grade and -stage disease and associated with shorter RFS and PFS. The worse prognosis associated with MAGE-A+/PD-L1+ provides evidence that a combinatorial treatment strategy co-targeting MAGE/PD-L1 might be feasible. Further studies are needed to validate these findings.

https://ift.tt/2Ni7MUi

Diel-scale variation of dissolved inorganic carbon during a rainfall event in a small karst stream in southern China

Abstract

Metabolic processes of the submerged aquatic community (photosynthesis and respiration) play important roles in regulating diel cycles of dissolved inorganic carbon (DIC) and sequestering carbon in a karst stream. However, little is known of whether diel DIC cycling occurs during rainfall in a karst groundwater-fed stream, even though this question is critical for the accurate estimation of what may be a major terrestrial carbon sink. Here, we measured diel variations of water chemical composition in a small karst groundwater-fed stream in southwest China during a rainfall event to assess the influences of rainfall and rising discharge on DIC diel cycling and the potential carbon sink produced by in-stream metabolism. Our results show that water chemical composition at the source spring (CK site) is relatively stable due to chemostatic behavior during rising discharge after a rainfall period. This site lacked submerged aquatic vegetation and, thus, had no diel variations in water chemistry. However, diel cycles of all hydrochemical parameters occurred at a site 1.3 km downstream (LY site). Diel variations in pH, DO, and δ¹³C_DIC were inversely related to diel changes in SpC, DIC, Ca²⁺, and pCO₂. These results indicated that diel cycling of DIC due to in-stream metabolism of submerged aquatic community was still occurring during elevated discharge from rainfall. We estimate the carbon sink through the in-stream metabolism of the submerged aquatic community to be 5.6 kg C/day during the studied rainfall event. These results imply that submerged aquatic communities in a karst stream can significantly stabilize carbon originating from the carbonate rock weathering processes in karst areas.

https://ift.tt/2SfI1VB

A National Cancer Database Analysis of the effect of brachytherapy on overall survival in patients with base of tongue cancer

Abstract

Background

We performed an analysis of the National Cancer Database (NCDB) to evaluate overall survival (OS) in patients with base of tongue (BOT) cancer treated with external beam radiation therapy (EBRT) combined with brachytherapy (BT).

Methods

The tongue NCDB Participant User File was used to obtain demographic and clinical patient data. The Kaplan–Meier method was used to determine OS. Significance was determined using univariable and multivariable Cox proportional hazards models.

Results

At 3 years, OS was 69.6%, 77.1%, and 63.7% for patients treated with EBRT (n = 27 954), EBRT + BT (n = 209), or BT alone (n = 154), respectively (P = .01). On multivariable analysis, the instantaneous hazard of death for patients receiving EBRT + BT was 25% (Hazard ratio [HR] = 0.75, 95% CI: 0.58‐0.98) lower than patients receiving only EBRT (P = .03).

Conclusions

The addition of BT to EBRT in BOT cancer has an OS benefit.

https://ift.tt/2BNl7zc

Safety and Efficacy of Radiofrequency Ablation of the Medial Branch Nerves with Preexisting Spinal Hardware. A Case Series and Review of Literature

Abstract

Purpose of Review

To explore the efficacy of radio frequency ablation in treating pain in patients with hardware at site of the procedure.

Recent Findings

There is very limited data in literature about this topic. One study performed in 2016 indicated no complications when performing RFA close to hardware in patients with chronic pain conditions.

Summary

Radiofrequency ablation can be safely and effectively performed close to hardware. While heating of the hardware can happen which can theoretically lead to tissue injury or decreased heat going to target nerve, this does not seem to be of clinical significance. More studies are needed to confirm this finding.

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Unique Considerations for Special Populations in Episodic Migraine: the Underserved

Abstract

Purpose of Review

People with migraine disease face many challenges, and these challenges can be magnified when someone is part of an "underserved" population. We set out to examine various categories of "underserved" populations, consider the unique challenges faced by these groups, and discuss mechanisms to mitigate these challenges as much as possible.

Recent Findings

Very little research has been performed to specifically evaluate underserved populations related to people with migraine disease. Recent research has shown the overall limitations of limited numbers of physicians with specialty training in headache disorders, and the socioeconomic implications of migraine disease have long been reported.

Summary

Even the definition of "underserved" is not completely clear. We undertook to define this concept in the setting of migraine disease, breaking into different categories, including financial, geographic, and cultural/racial. Each underserved population has both shared and unique challenges, and in reality, given the paucity of medical expertise throughout the United States, one could make the argument that nearly all people with migraine disease are at risk for being underserved. In the future, epidemiologic as well as therapeutic research should incorporate analyses of these and any other underserved population to improve the application of study results across broad and varied populations whose commonality, in many cases, ends with sharing the same disease.

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