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Increasingly, patients affected by metabolic diseases affecting the central nervous system and neuroinflammatory disorders receive hematopoietic cell transplantation (HCT) in the attempt to slow the course of their disease, delay or attenuate symptoms, and improve pathologic findings. The possible replacement of brain-resident myeloid cells by the transplanted cell progeny contributes to clinical benefit. Genetic engineering of the cells to be transplanted (hematopoietic stem cell) may endow the brain myeloid progeny of these cells with enhanced or novel functions, contributing to therapeutic effects.
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Current American and European guidelines consider a pre-transplant BMI ≥40kg/m2 as a relative contraindication for liver transplantation but this recommendation is graded as uncertain and requires further research. Moreover, conflicting results are reported on the predictive value of BMI 30-39.9kg/m2 on post-transplant complication and mortality risk.
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to evaluate how Italian gastroenterologists use corticosteroids in clinical practice for the treatment of Crohn's disease (CD) and ulcerative colitis (UC).
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Family history of cancers at different sites except for colorectum has not been evaluated as a risk factor for colorectal neoplasia (CRN).
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Appropriate statistical data analyses and presentation of these results are critically important to many of the papers submitted to Clinical Neurophysiology. A well designed statistical approach allows readers to more clearly understand the significance of group differences in neurophysiological measures and, hence, the clinical and scientific implications of that data.
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With recent focus on minimizing radiation dose to the heart following adjuvant therapy for breast cancer, it is important to understand the current state of cardiac sparing and predictors of heart dose. In a large U.S. state-wide registry, we evaluated recent time trends in mean heart dose, adjusting for planned target dose and treatment technique. Our findings indicate mean heart dose decreased significantly for left-sided breast cancers over a 4-year period using ongoing monitoring of cardiac dose by institution.
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Pre-clinical studies showed that topical OTD70DERM®, a Regenerating Agent functional analogue of glycosaminoglycans could markedly reduce radiation-induced mucosal and cutaneous toxicities. This hypothesis was tested in a randomized, placebo-controlled trial performed in 76 HNC patients receiving radiotherapy plus cetuximab. No significant difference was observed concerning the incidence or duration of grade ≥2 radiodermatitis between the arms. Despite a good pre-clinical rationale, OTD70DERM® did not reduce the incidence and severity of radiodermatitis.
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A systematic review and meta-analysis was conducted to evaluate the therapeutic outcomes of conventional (CRT) and hypofractionated radiotherapy (HRT) in localized or locally advanced prostate cancers (LLPCa).
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Radiation therapy for pediatric optic pathway or hypothalamic low-grade glioma establishes long-term disease control in most patients, with 10-year event-free survival (EFS) of greater than 60% and 10-year overall survival (OS) of greater than 90%. The presence of NF-1 did not affect EFS or OS. No child older than 10 years developed vasculopathy after receiving RT. Radiation is thus an effective treatment for optic-hypothalamic LGG, and older children without NF-1 have a low risk of late toxicity.
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In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV into a serious chronic illness, warranting patient-provider discussion about advanced care planning (ACP). Evidence is needed to inform physicians on how to approach ACP for these patients. Chronic pain is common in PLWHA, particularly in those who have substance use disorders; although it is known this population is at risk for poorer patient-physician engagement, the effects on ACP are unknown.
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Advance care planning (ACP) is an important process that involves discussing and documenting one's values and preferences for medical care, particularly end-of-life treatments.
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Oxaliplatin-induced peripheral neuropathy (OIPN) is a dose limiting toxicity of oxaliplatin and affects most colorectal cancer (CRC) patients. OIPN is commonly evaluated by patient symptom report, using scales to reflect impairment. They do not discriminate between unique grouping of symptoms and signs, which impedes prompt identification of OIPN.
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To determine the effects of a home-based reflexology intervention delivered by a friend/family caregiver compared to attention control on health-related quality of life of women with advanced breast cancer undergoing chemotherapy, targeted and/or hormonal therapy.
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Publication date: Available online 21 July 2017
Source:The Spine Journal
Author(s): Jay M. Levin, Robert D. Winkelman, Gabriel A. Smith, Joseph E. Tanenbaum, Roy Xiao, Thomas E. Mroz, Michael P. Steinmetz
BackgroundHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are used to assess the quality of the patient experience following an inpatient stay. HCAHPS scores are used to determine reimbursement for hospital systems and incentivize spine surgeons nationwide. There are conflicting data detailing whether early readmission or other post-discharge complications are associated with patient responses on the HCAHPS survey. Currently, the association between post-discharge ED visits and HCAHPS scores following lumbar spine surgery is unknown.PurposeTo determine whether emergency department (ED) visits within 30 days of discharge are associated with HCAHPS scores for lumbar spine surgery patients.Study DesignRetrospective cohort study.Patient Sample453 lumbar spine surgery patients who completed the HCAHPS survey between 2013 and 2015 at a single tertiary care center.Outcome MeasuresThe HCAHPS survey - the Centers for Medicare and Medicaid Services' official measure of patient experience - results for each patient were analyzed as the primary outcome of this study.MethodsAll patients undergoing lumbar spine surgery between 2013 and 2015 who completed an HCAHPS survey were studied. Patients were excluded from the study if they had been diagnosed with spinal malignancy or scoliosis. Patients who had an ED visit at our institution within 30 days of discharge were included in the ED visit cohort. The primary outcomes of this study include 21 measures of patient experience on the HCAHPS survey. Statistical analysis included Pearson chi-square for categorical variables, student t-test for normally distributed continuous variables, and Mann Whitney U test for non-parametric variables. Additionally, log-binomial regression models were used to analyze the association between ED visits within 30 days after discharge and odds of top-box HCAHPS scores. No funds were received in support of this study and the authors report no conflict of interest-associated biases.ResultsAfter adjusting for patient-level covariates using log-binomial regression models, we found post-discharge ED visits were independently associated with lower likelihood of top-box score for several individual questions on HCAHPS. ED visits within 30 days of discharge were negatively associated with perceiving your doctor as "always" treating you with courtesy and respect (Risk Ratio (RR) 0.26, p<0.001) as well as perceiving your doctor as "always" listening carefully to you (RR 0.40, p=0.003). Also, patients with an ED visit were less likely to feel as if their preferences were taken into account when leaving the hospital (RR 0.61, p=0.008), less likely to recommend the hospital to family/friends (RR 0.46, p=0.020) and less likely to rate the hospital as a 9 or 10 out of 10, the top-box score (RR 0.43, p=0.005).ConclusionsOur results demonstrate a strong association between post-discharge ED visits and low HCAHPS scores for doctor communication, discharge information and global measures of hospital satisfaction in a lumbar spine surgery population.
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Publication date: Available online 21 July 2017
Source:The Spine Journal
Author(s): M Farshad, R Sutter, A Hoch
Background ContextNerve root compression causing symptomatic radiculopathy can occur within the intervertebral foramen. Sagittal MRI sequences are reliable in detection of nerve root contact to intraforaminal disc material, but a clinically relevant classification of degree of contact is lacking.PurposeTo investigate a potential relation of amount of contact between intraforaminal disc material and nerve root to clinical findings and response after periradicular corticosteroid infiltration.Study DesignPost hoc analysis of a prospective cohort.Patient SamplePatients who underwent CT-guided periradicular corticosteroid infiltration (L1 – L5) at our institution (01/2014 - 05/2016) were included.Outcome MeasuresThe medical records and radiographic imaging were reviewed.MethodsT2-weighted MR images of the lumbar spine of patients with single level symptomatic radiculopathy with (responders, n=28) or without (non-responders, n=14) pain relief after periradicular infiltration with corticosteroids were measured and compared by two independent readers to determine the amount of intraforaminal nerve root contact with the intervertebral disc ("melting" of the T2-hypointense signal). Pain relief was defined with a pain level decrease of >50% on a visual analogue scale and lack of pain relief with a pain level decrease of <25%, respectively. The amount of T2-hypointensity melting of disc and nerve root was categorized to 0%, 1-25%, and over 25%. Nothing to disclose.ResultsReader one identified 0% T2-melting in none of the responders, 1-25% melting in 13 (46.4%) patients, 26-50% in 15 (53.6%) of the 28 patients with pain relief after periradicular corticosteroid infiltration (responders) with a mean amount of T2-melting of 5.9±2.1mm. Whereas the non-responder group had 0% T2-melting in 2 (14.3%) patients, 1 – 25% T2-melting in 11 (78.6%) patients and 26 – 50% in 1 (7.1%) patient with a mean amount of T2-melting of 2.6±1.9mm (p<0.05).Reader two identified 0% T2-melting in none, 1-25% T2-melting in 15 (53.6%) patients and 26-50% in (46.4%) 13 of the 28 responders, with mean amount of 6.3±1.9mm. In the non-responder group 0% T2-melting was seen in 3 (21.4%) patients, 1 – 25% T2-melting in 10 (71.4%) patients and 26 – 50% in 1 (7.1%) patient with a mean amount of T2-melting of 2.7±1.9mm (p<0.05). None of the MR images showed T2-melting in over 50 percent of the circumference of the intraforaminal nerve root.A T2-melting of >25% had a high specificity of 93% but a sensitivity of 50%, thus a positive likelihood ratio of 7.5, to identify those with a pain relief of more than 50% after infiltration.ConclusionThe amount of T2-melting of disc material and nerve root on sagittal MRI (>25%) predicts the amount of pain relief by periradicular infiltration in patients with intraforaminal nerve root irritation.
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Publication date: Available online 21 July 2017
Source:The Spine Journal
Author(s): Patrícia Parreira, Chris G. Maher, Rodrigo Z. Megale, Lyn March, Manuela L. Ferreira
Background ContextVertebral compression fractures are the most common type of osteoporotic fracture comprising approximately 1.4 million cases worldwide. Clinical practice guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision-making. However, currently available clinical guidelines and recommendations, established by different medical societies, are sometimes contradictory.PurposeThe aim of this study was to appraise the recommendations and methodological quality of international clinical guidelines for the management of VCFs.Study DesignThis is a systematic review of clinical guidelines for the management of vertebral compression fracture.MethodsGuidelines were selected by searching MEDLINE and PubMed, PEDro, CINAHL and EMBASE electronic databases between 2010 and 2016. We also searched clinical practice guideline databases, including the National Guideline Clearinghouse and the Canadian Medical Association InfoBase. The methodological quality of the guidelines was assessed by two authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument. We also classified the strength of each recommendation as either: strong (i.e. based on high quality studies with consistent findings for recommending for or against the intervention); weak (i.e based on lack of compelling evidence resulting in uncertainty for benefit or potential harm); or expert Consensus (i.e. based on expert opinion of the working group rather than scientific evidence). Guideline recommendations were grouped into diagnostic, conservative care, interventional care and osteoporosis treatment/prevention of future fractures. Our study was prospectively registered on PROSPERO. All authors have declared: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; any other relationships or activities that could appear to have influenced the submitted workResultsFour guidelines, from three countries, published in the period 2010 - 2013 were included. In general, the quality was not satisfactory (50% or less of the maximum possible score). The domains scoring 50% or less of the maximum possible score were rigor of development, clarity of presentation and applicability. Use of plain radiography or dual-energy x-ray absorptiometry for diagnosis was recommended in two of the four guidelines. Vertebroplasty or kyphoplasty were recommended in 3 of the 4 guidelines. The recommendation for bed rest, trunk orthoses, electrical stimulation and supervised or unsupervised exercise was inconsistent across included guidelines.ConclusionsThe comparison of clinical guidelines for the management of VCF showed that diagnostic and therapeutic recommendations were generally inconsistent. The evidence available to guideline developers was limited in quantity and quality. Greater efforts are needed to improve the quality of the majority of guidelines.
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Publication date: Available online 21 July 2017
Source:The Spine Journal
Author(s): Todd J. Blumberg, Erik Woelber, Carlo Bellabarba, Richard Bransford, Nicholas Spina
Background ContextWhile many risk factors are known to contribute to development of a post-operative surgical site infection (SSI) following spinal surgery, little is known regarding the costs associated management of this complication, or predictors for which patients that will require increased resources for management of SSI.PurposeThe aim of this study is to identify specific risk factors for increased treatment costs and length of stay in the management of a postoperative SSI.Study Design/SettingRetrospective cohort study of all patients undergoing spine surgery at a single institution over three consecutive years.Patient Sample90 patients that required return to the operating room following spine surgery for post-operative surgical site infection.Outcome MeasuresThe primary outcome measure was length of stay and hospital costs for patients with post-operative SSI following spine surgery at a single institution.MethodsA retrospective review of all patients undergoing spine surgery at a single institution between over three consecutive years was performed to identify patients requiring secondary surgical intervention for SSI. Demographic and financial data from both the index admission as well as all subsequent readmissions within two years of index procedure were reviewed. Independent variables abstracted from patient records were analyzed to determine the nature and extent of their associations with total direct hospital costs and length of stay.Results90 patients were identified that resulted in 110 readmissions and cumulatively underwent 138 I&Ds for management of postoperative spine SSI. Average length of stay for the index operation and secondary readmissions were 6.9 days and 9.6 days, respectively. Mean direct cost of treatment for SSI was $16,242. Length of stay, number of levels fused, MRSA, decreased serum albumin on readmission, and number of I&Ds required were significantly associated with increased treatment costs.ConclusionsPre-operative nutritional status assessment and MRSA colonization screening with targeted prophylaxis represent potentially modifiable risk factors in the treatment of SSI. Further study is needed to investigate the relationship between poor nutrition status and increased length of stay and total costs in the treatment of SSI following spine surgery.
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In a preclinical drug screen, mithramycin was identified as a potent inhibitor of the Ewing sarcoma EWS–FLI1 transcription factor. We conducted a phase I/II trial to determine the dose-limiting toxicities (DLT), maximum tolerated dose (MTD), and pharmacokinetics (PK) of mithramycin in children with refractory solid tumors, and the activity in children and adults with refractory Ewing sarcoma.
Mithramycin was administered intravenously over 6 h once daily for 7 days for 28 day cycles. Adult patients (phase II) initially received mithramycin at the previously determined recommended dose of 25 µg/kg/dose. The planned starting dose for children (phase I) was 17.5 µg/kg/dose. Plasma samples were obtained for mithramycin PK analysis.
The first two adult patients experienced reversible grade 4 alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation exceeding the MTD. Subsequent adult patients received mithramycin at 17.5 µg/kg/dose, and children at 13 µg/kg/dose with dexamethasone pretreatment. None of the four subsequent adult and two pediatric patients experienced cycle 1 DLT. No clinical responses were observed. The average maximal mithramycin plasma concentration in four patients was 17.8 ± 4.6 ng/mL. This is substantially below the sustained mithramycin concentrations ≥50 nmol/L required to suppress EWS–FLI1 transcriptional activity in preclinical studies. Due to inability to safely achieve the desired mithramycin exposure, the trial was closed to enrollment.
Hepatotoxicity precluded the administration of a mithramycin at a dose required to inhibit EWS–FLI1. Evaluation of mithramycin in patients selected for decreased susceptibility to elevated transaminases may allow for improved drug exposure.
Cancers, Vol. 9, Pages 94: Targeting Platelets for the Treatment of Cancer
Cancers doi: 10.3390/cancers9070094
Authors: Omar Elaskalani Michael Berndt Marco Falasca Pat Metharom
The majority of cancer-associated mortality results from the ability of tumour cells to metastasise leading to multifunctional organ failure and death. Disseminated tumour cells in the blood circulation are faced with major challenges such as rheological shear stresses and cell-mediated cytotoxicity mediated by natural killer cells. Nevertheless, circulating tumour cells with metastatic ability appear equipped to exploit host cells to aid their survival. Despite the long interest in targeting tumour-associated host cells such as platelets for cancer treatment, the clinical benefit of this strategy is still under question. In this review, we provide a summary of the latest mechanistic and clinical evidence to evaluate the validity of targeting platelets in cancer.
Adenosine receptors (ARs) subtypes are involved in several physiological and pharmacological processes. Ligands able to selectively modulate one receptor subtype can delay or slow down the progression of diverse diseases. In this context, our research group focused its investigation into the discovery and development of novel, potent and selective ARs ligands based on coumarin scaffold. Therefore, a series 3-phenylcarboxamidocoumarins were synthesised and their affinity for the human ARs subtypes was screened by radioligand binding assays for A1, A2A and A3 receptors and for A2B by adenylyl cyclase assay. Compound 26 was found to be the most remarkable, with a hA1/hA3 and hA2A/hA3 selectivity of 42, for the A3 AR (Ki = 2.4 μM). Receptor-driven molecular modelling studies have provided valuable information on the binding/selectivity data of compound 26 and for the following optimization process. Moreover, compound 26 present drug-like properties according to the general guidelines linked to the concept.
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A series 3-phenylcarboxamidocoumarins were synthesised and their affinity for the human ARs subtypes was screened for A1, A2A and A3 and A2B receptors Compound 26 was found to be the most remarkable, with a hA1/hA3 and hA2A/hA3 selectivity of 42, for the A3 AR (Ki = 2.4 µM). Receptor-driven molecular modelling studies have provided valuable information on the binding/selectivity data of compound 26 and for the following optimization process.
Antagonists of the adenosine receptors (A1 and A2A) are thought to be beneficial in neurological disorders, such as Alzheimer's and Parkinson's disease. The aim of this study was to explore 2-benzylidene-1-tetralone derivatives as antagonists of A1 and/or A2A adenosine receptors. In general, the test compounds were found to be selective for the A1 adenosine receptor, with only three test compounds possessing affinity for both the A1 and A2A adenosine receptor. The 2-benzylidene-1-tetralones bearing a hydroxyl substituent at either position C5, C6 or C7 of ring A displayed favorable adenosine A1 receptor binding, while C5 hydroxy substitution led to favorable A2A adenosine receptor affinity. Interestingly, para-hydroxy substitution on ring B in combination with ring A bearing a hydroxy at position C6 or C7 provided the 2-benzylidene-1-tetralones with both A1 and A2A adenosine receptor affinity. Compounds 4 and 8 displayed the highest A1 and A2A adenosine receptor affinity with values below 7μM. Both these compounds behaved as A1 adenosine receptor antagonists in the performed GTP shift assays. In conclusion, the 2-benzylidene-1-tetralone derivatives can be considered as lead compounds to design a new class of dual acting adenosine A1/A2A receptor antagonists that may have potential in treating both dementia and locomotor deficits in Parkinson's disease.
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Substitution of 2-benzylidene-1-tetralone with a hydroxy group on ring A and/or B played a key role in modulating the binding affinity and selectivity for the adenosine A1 and A2A receptors. Generally, C5-hydroxy substitution on ring A favored A1 affinity, while C4′-hydroxy substitution on ring B governed both A1 and A2A affinity. Adenosine A1 and A2A receptor antagonists are deemed therapeutically beneficial in Parkinson's disease; thus, 2-benzylidene-1-tetralones represent a new class of dual acting adenosine A1 and A2A receptor antagonists.
A series of novel menadione based triazole hybrids were designed and synthesized by employing copper catalyzed azide-alkyne cycloaddition (CuAAC). All the synthesized hybrids were characterized by their spectral data (1H NMR, 13C NMR, IR and HRMS). The synthesized compounds were evaluated for their anticancer activity against five selected cancer cell lines including lung (A549), prostate (DU-145), cervical (Hela), breast (MCF-7) and mouse melanoma (B-16) by using MTT assay. The screening results showed that majority of the synthesized compounds displayed significant anticancer activity. Among the tested compounds, the triazoles 5 and 6 exhibited potent activity against all cell lines. In particular, compound 6 showed higher potency than the standard tamoxifen and parent menadione against MCF-7 cell line. Flow cytometric analysis revealed that compound 6 arrested cell cycle at G0/G1 phase and induced apoptotic cell death which was further confirmed by Hoechst staining, measurement of mitochondrial membrane potential (ΔΨm) and Annexin V-FITC assay. Thus, compound 6 can be considered as lead molecule for further development as potent anticancer therapeutic agent.
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Menadione based triazole hybrids were synthesized by employing copper catalyzed azide-alkyne cycloaddition (CuAAC). The synthesized compounds were evaluated for their anticancer activity against five selected cancer cell lines. Compound 6 showed higher potency than the standard tamoxifen and parent menadione against MCF-7 cell line, arrested cell cycle at G0/G1 phase and induced apoptotic cell death.
Recent advances in the treatment of eyelid tumors have centered on the excision, evaluation of margins, role of sentinel lymph node biopsy, and adjunctive/adjuvant systemic and radiation therapy. The purpose of this review is to elaborate on these advances.
Mohs excision of basal cell carcinoma and squamous cell carcinoma continues to provide the greatest success in complete excision of the cancer, especially in those cases of high-risk disease including medial canthal location and recurrent disease. Sentinel lymph node biopsy has proven useful in the assessment of early regional metastasis in sebaceous cell carcinoma, melanoma, and Merkel cell carcinoma. The pathologic finding of perineural invasion is a high-risk feature in all periocular cancers, and adjuvant therapy should be considered. Targeted therapy shows great potential in situations that are not amenable to complete excision without sacrificing the globe.
Identification of high- and low-risk features in eyelid cancers allows a stratified approach to treatment. While high-risk features may require adjuvant therapy, larger margins, and sentinel lymph node biopsy, low-risk features may allow topical therapy to adequately address the condition. Monoclonal antibodies and small molecule inhibitors show great promise in the treatment of extensive disease.
Glioblastoma (GBM) is the most common and lethal primary brain tumor in adults, with a median survival of less than 2 years despite the standard of care treatment of 6 weeks of chemoradiotherapy. We review the data investigating hypofractionated radiotherapy (HFRT) in the treatment of newly diagnosed GBM.
Investigators have explored alternative radiotherapy strategies that shorten treatment duration with the goal of similar or improved survival while minimizing toxicity. HFRT over 1–3 weeks is already a standard of care for patients with advanced age or poor performance status. For young patients with good performance status, HFRT holds the promise of radiobiologically escalating the dose and potentially improving local control while maintaining quality of life.
Through the use of shorter radiotherapy fractionation regimens coupled with novel systemic agents, improved outcomes for patients with GBM may be achieved.
Neuroendocrine tumours are uncommon or rare at all sites in the female genital tract. The 2014 World Health Organisation (WHO) Classification of neuroendocrine tumours of the endometrium, cervix, vagina and vulva has been updated with adoption of the terms low-grade neuroendocrine tumour and high-grade neuroendocrine carcinoma. In the endometrium and cervix, high-grade neoplasms are much more prevalent than low-grade and are more common in the cervix than the corpus. In the ovary, low-grade tumours are more common than high-grade carcinomas and the term carcinoid tumour is still used in WHO 2014. The term ovarian small-cell carcinoma of pulmonary type is included in WHO 2014 for a tumour which in other organs is termed high small-cell neuroendocrine carcinoma. Neuroendocrine tumours at various sites within the female genital tract often occur in association with other neoplasms and more uncommonly in pure form.
The vast majority (86% or 453,000 cases) of the global burden of cervical cancer occurs in Africa, Latin America and the Caribbean, and Asia, where one in nine new cancer cases are of the cervix. Although the disease has become rare in high-resource settings (e.g. in North America, parts of Europe, Japan) that have historically invested in effective screening programmes, the patterns and trends are variable elsewhere. While favourable incidence trends have been recorded in many populations in Asia and Latin America and the Caribbean in the past decades, rising rates have been observed in sub-Saharan African countries, where high quality incidence series are available. The challenge for countries heavily affected by the disease in these regions is to ensure resource-dependent programmes of screening and vaccination are implemented to transform the situation, so that accelerated declines in cervical cancer are not the preserve of high-income countries, but become the norm in all populations worldwide. This article is protected by copyright. All rights reserved.
MiR-21, the only miRNA found to be overexpressed in any type of solid tumor, its guide stand, miR-21-5p, has been studied a lot in colorectal cancer (CRC), however, few researchers focused on its passenger strand, miR-21-3p. In this study, based on The Cancer Genome Atlas (TCGA) data, we found that there were more variety and quantity of miR-21-3p isoforms in microsatellite instability (MSI)-type CRC. We further examined the role of miR-21-3p by in vitro and in vivo studies. MiR-21-3p may be an oncogene in CRC by promoting cellular mobility through epithelial-mesenchymal transition (EMT). However, different isoforms, especially miR-21-3p 0|2, may be a favorable prognostic marker for CRC survival probably due to increased complementary effect of miR-21-5p and/or target genes. Further study investigating the underlying mechanism of miRNA isoforms is needed. This article is protected by copyright. All rights reserved.
An 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14 h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC?
Idarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs.
In this article, we review currently available NOACs, their laboratory monitoring, and reversal agents.
OBJECTIVE: To investigate clinical effects of Rosuvastatin on blood lipid levels, hemorheological profiles, vascular endothelial function, pentraxin 3 (PTX-3) level, the number of granule membrane glycoprotein (GMP-140) molecules and platelet aggregation rate in elderly patients with acute myocardial infarction (AMI) undergoing elective percutaneous coronary intervention (PCI).
PATIENTS AND METHODS: Total of 120 elderly patients admitted with AMI undergoing elective PCI from July 2014 to January 2016 were selected. The patients were divided into the control group and the experimental group based on the rule of random number generation and double-blind controlled trial, 60 cases in each group. All of 120 patients were treated with routine medications; the experimental group was orally administered with Rosuvastatin 1 week before PCI. Blood lipid levels, hemorheological profiles, vascular endothelial function, PTX-3, the number of GMP-140 molecules and platelet aggregation rate were compared between two groups before treatment with Rosuvastatin and 10d after elective PCI.
RESULTS: Triglycerides, plasma total cholesterol, and low-density lipoprotein levels were significantly lower (p<0.05) in the experimental group when compared with the control group; plasma viscosity, fibrinogen, the viscosity of blood in the high shear rates and in the low shear rates in the experimental group were significantly lower than those of the control group (p<0.05); FMD and NMD in the experimental group were significantly higher than those of the control group (p<0.05); ET-1, TXA2 levels in the experimental group were lower, however, PGI2, NO as well as NOS in the experimental group were higher, when compared the control group , the differences were statistically significant (p<0.05); PTX-3, the number of GMP-140 molecules and platelet aggregation rate in the experimental group were significantly lower than those of the control group (p<0.05).
CONCLUSIONS: Oral administration of Rosuvastatin 1 week before PCI can significantly improve the blood lipid levels and hemorheological profiles, enhance endothelial function, reduce the PTX-3 level and the number of GMP-140 molecules, decrease the platelet aggregation rate, therefore improving prognosis in elderly patients with AMI undergoing PCI.
L'articolo Effects of Rosuvastatin on pentraxin 3 level and platelet aggregation rate in elderly patients with acute myocardial infarction undergoing elective interventional therapy: a double-blind controlled study sembra essere il primo su European Review.
American Journal of Roentgenology, Volume 209, Issue 2, Page W112-W113, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W118-W118, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W117-W117, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W114-W114, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page 243-247, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page 472-472, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W109-W109, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W116-W116, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page 289-303, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page 248-254, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W115-W115, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W111-W111, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page 241-242, August 2017.
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American Journal of Roentgenology, Volume 209, Issue 2, Page W110-W110, August 2017.
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Throughout the field of oncology, immunotherapy is moving further towards the first-line setting, and there is encouraging data for the use of these novel therapies in the management of lymphomas, utilizing treatments approved for both solid and hematologic malignancies. Herein, we review promising advances in this rapidly moving field from the past year.
In the last year, we have seen promising clinical data on engineered antibody therapies for the treatment of lymphomas, as well as further optimization of engineered antibody fragments fused onto linkers or chimeric T cell receptors, both of the modalities capable of transforming non-specific T cells into tumor-specific, serial killer cells.
Here we will review the promising data on these advances in antibody-based therapies, as well as some of the immunomodulators and checkpoint-blocking therapies that shown to have promising results in the treatment of lymphomas within the past year.
The aims of this study are to synthesize the findings of systematic reviews to (1) determine whether centre-based childcare interventions are effective in improving child physical activity and diet and (2) identify promising modifiable centre policies and practices to improve child physical activity and diet. Four electronic databases were searched. The methodological quality of included reviews was assessed using the AMSTAR tool. For intervention effectiveness, reviews were categorized as 'generally effective' if more than two-thirds of primary studies demonstrated positive effects.
Database searches yielded 1164 unique citations of which 22 reviews were included. Three of 16 physical activity reviews, including one of the two higher quality reviews, and the largest and most recent review to date, reported that the interventions were generally effective in improving physical activity. One of nine nutrition reviews reported that interventions were generally effective at improving dietary intake. This review was of moderate quality and was the largest and most recent review of dietary outcomes in children in this setting. The most consistently reported policies and practices associated with improved child physical activity included those targeting the physical environment (playground markings, equipment, space), educator qualifications and training, and structured physical activities. Policies and practices associated with improved child diet included food availability and menu modification, positive peer modelling, and including parents.
There is increasing evidence from high-quality, recent systematic reviews that childcare-based interventions can be effective at improving child physical activity. Systematic review evidence regarding the effects of intervention on child diet is more equivocal.
