Objective We investigated the relation between memory impairment and the fornix injury in patients with mild traumatic brain injury(TBI), using diffusion tensor tractography(DTT). Design Eighty six chronic patients with mild TBI and 50 normal control subjects were recruited. Fractional anisotropy(FA) and fiber volume were measured for each reconstructed fornix. The patients were classified according to three types; type A(47 patients) - intact integrity of both fornical crura, type B(27 patients) - showed a discontinuation in either fornical crus, and type C(12 patients) - discontinuations in both fornical crura.The Memory Assessment Scale(MAS) was used for evaluation of memory function. Results FA and fiber volume showed weak positive correlations with global memory of MAS, respectively(r=0.303, P=0.006, r=0.271, P=0.014). Significant difference in the global memory of MAS was observed between type A and B, and between type A and C without difference between type B and C(p
https://ift.tt/2L1y7qL
Τρίτη 10 Ιουλίου 2018
Mechanical In-Exsufflation–Expiratory Flows as Indication for Tracheostomy Tube Decannulation: Case Studies
Mechanical insufflation exsufflation–expiratory flows (MIE-EF) correlate with upper airway patency. Patients dependent on continuous noninvasive ventilatory support (CNVS) with severe spinal muscular atrophy type 1, now over 20 years old, have used MIE sufficiently effectively along with CNVS to avoid tracheotomy indefinitely. While MIE-EF can apparently decrease in amyotrophic lateral sclerosis to necessitate tracheotomy, they can increase over time and remain effective in all spinal muscular atrophy types. Two cases demonstrate an association between increasing MIE-EF and ultimately successful decannulation of a continuous tracheostomy mechanical ventilation dependent patient with spinal muscular atrophy type 2 and a patient with obesity hypoventilation syndrome. Only when MIE-EF increased to exceed 200 L/m did the decannulations succeed. Definitive noninvasive management (CNVS) of these patients may only be possible when MIE is effective and the greater the MIE-EF, the greater its effectiveness. Thus, increasing MIE-EF can signal resolution of upper airway obstruction sufficiently to permit decannulation whether a patient is ventilator dependent or not. Correspondence: John R. Bach, MD, Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen Street, Newark, NJ 07103, Phone: 1-973-9722085, Fax: 1-973-9725725, E-mail: bachjr@njms.rutgers.edu Author Disclosures: Financial disclosure statements have been obtained and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2L7WlMX
https://ift.tt/2L7WlMX
Efficacy of Compression Gloves in the Rehabilitation of Distal Radius Fractures: Randomized Controlled Study
Objective To examine the outcomes of wearing made-to-measure compression gloves following distal radius fracture. Design In a randomized controlled trial, adults who were about six weeks post-distal radius fracture were recruited and divided into a comparison control group (N=15), who received standard rehabilitation twice a week for half an hour, and an intervention group (N=17), who additionally used compression gloves. All treatments were conducted at a single rehabilitation clinic. Outcomes assessed were wrist and fingers range of motion; grip strength; swelling, pain, and activities of daily living (using the Patient Rating Wrist Evaluation). The intervention group underwent additional objective dynamic assessments of range of motion with and without the gloves. Results The intervention group demonstrated reduced swelling, pain, and analgesic use; increased wrist range of motion; better scores for specific hand functions, and greater participation in activities of daily living compared with the comparison group. Conclusion This randomized controlled trial shows that using compression gloves during the rehabilitation phase following distal radius fracture improves daily functioning and reduces adverse symptoms. These improvements, which are important in their own right, are also expected to aid in preventing the development of chronic conditions and disability. Evidence Level II: un-blinded prospective comparative study. Correspondence: Dr. Naomi Schreuer, Dept. of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, 31905 Israel, Phone: +972 5252 11119, Fax +972 4 8249753, Email nchreuer@univ.haifa.ac.il Disclosures: This research was partially supported by the donation of made-to-measure compression gloves by Uriel Meditex Ltd and by the provision of the MediTouch HandTutorTM system for use during the study. However, neither manufacturer employed or otherwise remunerated any of the authors. Researchers declare no competing interests. The paper is based on a thesis submitted as part of the requirements for the MSc. degree in Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel (In Hebrew). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2JbLIaf
https://ift.tt/2JbLIaf
Impacts of selenium and vitamin E supplementation on mRNA of heat shock proteins, selenoproteins and antioxidants in broilers exposed to high temperature
The study was carried out to investigate the effect of dietary selenium (Se) and vitamin E (VE) supplementation on mRNA level of heat shock proteins, selenoproteins, and antioxidant enzyme activities in the br...
https://ift.tt/2L0e38k
Characterization of two Pantoea strains isolated from extra-virgin olive oil
The olive oil is an unfavorable substrate for microbial survival and growth. Only few microorganisms use olive oil fatty acids as carbon and energy sources, and survive in the presence of olive oil anti-microb...
https://ift.tt/2JcRp7N
A comparative study of the enzymatic hydrolysis of batch organosolv-pretreated birch and spruce biomass
A shift towards a sustainable and green society is vital to reduce the negative effects of climate change associated with increased CO2 emissions. Lignocellulosic biomass is both renewable and abundant, but is re...
https://ift.tt/2L02pdM
Flavonoids of Rosa roxburghii Tratt offers protection against radiation induced apoptosis and inflammation in mouse thymus
Abstract
The present study evaluated the protective effect of the natural compound flavonoids of Rosa roxburghii Tratt (FRT) against γ-radiation-induced apoptosis and inflammation in mouse thymus cells in vivo and in vitro. Thymus cells and mice were exposed to 60Co γ-ray at a dose of 6 Gy. The radiation treatment induced significant cell apoptosis and inflammation. Radiation increased the expressions of cleaved caspase 3/8–10, AIF, and PARP-1, and FRT could mitigate their activation and inhibit subsequent apoptosis in the thymus both in vitro or in vivo. Irradiation increased the mRNA expression of ICAM-1/VCAM-1, IL-1α/IL-6 and TNF-α/NF-κB. Our results also indicated that FRT alleviated gene expression of some inflammatory factors such as ICAM-1/VCAM-1, TNF-α/NF-κB, but not IL-1α/IL-6. Irradiation increased the protein expression levels of ICAM-1/VCAM-1, IL-1α/IL-6 and TNF-α/NF-Κb, and our results also indicated that FRT alleviated protein level expression of certain inflammatory factors such as ICAM-1, IL-1α/IL-6, TNF-α/NF-κB, but not VCAM-1. Our results suggested that FRT enhanced radioprotection at least partially by regulating caspase 3/8–10, AIF, and PARP-1 to reduce apoptosis and by regulating ICAM-1, IL-1α/IL-6, TNF-α/NF-κB to reduce inflammation.
https://ift.tt/2ubSBU5
Motor neuron-derived microRNAs cause astrocyte dysfunction in amyotrophic lateral sclerosis
Abstract
We recently demonstrated that microRNA-218 (miR-218) is greatly enriched in motor neurons and is released extracellularly in amyotrophic lateral sclerosis model rats. To determine if the released, motor neuron-derived miR-218 may have a functional role in amyotrophic lateral sclerosis, we examined the effect of miR-218 on neighbouring astrocytes. Surprisingly, we found that extracellular, motor neuron-derived miR-218 can be taken up by astrocytes and is sufficient to downregulate an important glutamate transporter in astrocytes [excitatory amino acid transporter 2 (EAAT2)]. The effect of miR-218 on astrocytes extends beyond EAAT2 since miR-218 binding sites are enriched in mRNAs translationally downregulated in amyotrophic lateral sclerosis astrocytes. Inhibiting miR-218 with antisense oligonucleotides in amyotrophic lateral sclerosis model mice mitigates the loss of EAAT2 and other miR-218-mediated changes, providing an important in vivo demonstration of the relevance of microRNA-mediated communication between neurons and astrocytes. These data define a novel mechanism in neurodegeneration whereby microRNAs derived from dying neurons can directly modify the glial phenotype and cause astrocyte dysfunction.https://ift.tt/2JcDqi4
Brenda Milner on her 100th birthday: a lifetime of ‘good ideas’
Brenda Milner—the renowned neuroscientist who changed our understanding of brain and behaviour—celebrates her 100th birthday this year on St Swithun's Day: 15 July 2018. We have known Brenda for the past quarter of that century initially as postdocs at the Montreal Neurological Institute (the MNI or the 'Neuro') and latterly as colleagues and friends. In this article, we summarize the impact and legacy of Brenda's work.
https://ift.tt/2KXI4FJ
https://ift.tt/2KXI4FJ
Reorganization of cortical oscillatory dynamics underlying disinhibition in frontotemporal dementia
Abstract
The distribution of pathology in frontotemporal dementia is anatomically selective, to distinct cortical regions and with differential neurodegeneration across the cortical layers. The cytoarchitecture and connectivity of cortical laminae preferentially supports frequency-specific oscillations and hierarchical information transfer between brain regions. We therefore predicted that in frontotemporal dementia, core functional deficits such as disinhibition would be associated with differences in the frequency spectrum and altered cross-frequency coupling between frontal cortical regions. We examined this hypothesis using a 'Go-NoGo' response inhibition paradigm with 18 patients with behavioural variant frontotemporal dementia and 20 healthy aged-matched controls during magnetoencephalography. During Go and NoGo trials, beta desynchronization was severely attenuated in patients. Beta power was associated with increased impulsivity, as measured by the Cambridge Behavioural Inventory, a carer-based questionnaire of changes in everyday behaviour. To quantify the changes in cross-frequency coupling in the frontal lobe, we used dynamic causal modelling to test a family of hierarchical casual models, which included the inferior frontal gyrus, pre-supplementary motor area (preSMA) and primary motor cortex. This analysis revealed evidence for cross-frequency coupling in a fully connected network in both groups. However, in the patient group, we identified a significant loss of reciprocal connectivity of the inferior frontal gyrus, particularly for interactions in the gamma band and for theta to alpha coupling. Importantly, although prefrontal coupling was diminished, gamma connectivity between preSMA and motor cortex was enhanced in patients. We propose that the disruption of behavioural control arises from reduced frequency-specific connectivity of the prefrontal cortex, together with a hyper-synchronous reorganization of connectivity among preSMA and motor regions. These results are supported by preclinical evidence of the selectivity of frontotemporal lobar degeneration on oscillatory dynamics, and provide a clinically relevant yet precise neurophysiological signature of behavioural control as a potential pharmacological target for early phase experimental medicines studies.https://ift.tt/2L8vX5H
Stevia rebaudiana Bertoni and Its Effects in Human Disease: Emphasizing Its Role in Inflammation, Atherosclerosis and Metabolic Syndrome
Abstract
Purpose of Review
Stevia rebaudiana Bertoni is a perennial shrub with zero calorie content that has been increasing in popularity for its potential use as an adjuvant in the treatment of obesity. The level of evidence supporting general benefits to human health is insufficient. We conducted a review of the literature summarizing the current knowledge and role in human disease.
Recent Findings
Despite stevia's minimal systemic absorption, studies have been promising regarding its potential benefits against inflammation, carcinogenesis, atherosclerosis glucose control, and hypertension. On the other hand, the growing popularity of artificial sweeteners does not correlate with improved trends in obesity. An increased intake of artificial non-caloric sweeteners may not be associated with decreased intake of traditional sugar-sweetened beverages and foods. The effects of Stevia on weight change have been linked to bacteria in the intestinal microbiome, mainly by affecting Clostridium and Bacteroides sp. populations. A growing body of evidence indicates that Stevia rebaudiana Bertoni is protective against malignant conversion by inhibition of DNA replication in human cancer cell growth in vitro.
Summary
Consumption of Stevia has demonstrated to be generally safe in most reports. Further clinical studies are warranted to determine if regular consumption brings sustained benefits for human health.
https://ift.tt/2unvLIu
EMS and grief: Understanding your emotions
For EMTs, grief is often a surprising reaction to every day interactions with patients and their loved ones
https://ift.tt/2JccqiR
Molecular Classification and Management of Rare Pediatric Embryonal Brain Tumors
Abstract
Purpose of Review
Malignant embryonal brain tumors (EBTs) of childhood span a wide clinical spectrum but can share remarkably similar morphologic features. This overlap presents significant diagnostic challenges, particularly for tumor entities that are rarely encountered in clinical practice and for which diagnostic criteria were poorly defined. This review will provide an update on the evolving characterization and treatment of rare EBTs.
Recent Findings
Rapid advances in genomic tools have led to the discovery of robust molecular markers, and identification of novel tumor types and subtypes for almost all major categories of pediatric brain tumors. These developments have had significant impact on improving the diagnostic classification of the rare EBTs, particularly for tumors with newly recognized C19MC alterations, central nervous system primitive neuroectodermal tumors (CNS-PNET), and pineoblastoma (PB).
Summary
These important developments in the clinical and molecular understanding of rare EBTs are paving the way for novel therapeutic strategies and improved clinical management.
https://ift.tt/2zuWZ5W
Unwarranted clinical variation in the care of children and young people hospitalised for injury: a population-based cohort study
Publication date: Available online 10 July 2018
Source: Injury
Author(s): Reidar P. Lystad, Mia Bierbaum, Kate Curtis, Jeffrey Braithwaite, Rebecca Mitchell
Abstract
Introduction
Injury is a leading cause of death and disability among children and young people. Recovery may be negatively affected by unwarranted clinical variation such as representation to an emergency department (ED), readmission to a hospital, and mortality. The aim of this study was to examine unwarranted clinical variation across providers of care of children and young people who were hospitalised for injury in New South Wales (NSW).
Materials and Methods
Retrospective population-based cohort study using linked ED, hospital, and mortality data of all children and young people aged ≤25 years who were injured and hospitalised during 1 January 2010 to 30 June 2014 in NSW. Unwarranted clinical variation across providers was examined using three indicators. That is, for each hospital that treated ≥100 cases per year, risk standardised ratios were calculated with 95% and 99.8% confidence limits using the number of observed and expected events of (1) representations to ED within 72 hours, (2) unplanned readmissions to hospital within 28 days, and (3) all-cause mortality within 30 days.
Results
There were 189,990 injury-related hospitalisations of children and young people. Of these, 4.4% represented to an ED, 8.7% were readmitted to hospital, and 0.2% died. Of the 45 public hospitals that treated ≥100 cases per year, higher than expected rates of ED representations, hospital readmissions, and mortality were observed in eleven, six, and two hospitals, respectively.
Conclusion
The rates of ED representations, hospital readmissions, and mortality among children and young people hospitalised for injury in NSW were similar to the rates reported in other countries. However, unwarranted clinical variation across public hospitals was observed for all three indicators. These findings suggest that by improving routine follow-up support services post-discharge for children and young people and their families, it may be possible to reduce unwarranted clinical variation and improve health outcomes.
https://ift.tt/2unuktF
Upregulation of long noncoding RNA MALAT1 in papillary thyroid cancer and its diagnostic value
Future Oncology, Ahead of Print.
https://ift.tt/2uah64g
Tubular carcinomas of the breast: an epidemiologic study
Future Oncology, Ahead of Print.
https://ift.tt/2zuNFis
Immunotherapy in non-small-cell lung cancer: a bridge between research and clinical practice
Future Oncology, Volume 14, Issue 13s, Page 41-60, June 2018.
https://ift.tt/2uaoegM
Emerging targets in advanced non-small-cell lung cancer
Future Oncology, Volume 14, Issue 13s, Page 61-72, June 2018.
https://ift.tt/2ulIsn5
Acquired resistance in oncogene-addicted non-small-cell lung cancer
Future Oncology, Volume 14, Issue 13s, Page 29-40, June 2018.
https://ift.tt/2u91U7o
Raising the bar in education: the Thoracic Academy experience
Future Oncology, Volume 14, Issue 13s, Page 1-2, June 2018.
https://ift.tt/2umyGRX
New options on the horizon for nononcogene addicted non-small-cell lung cancer
Future Oncology, Volume 14, Issue 13s, Page 19-28, June 2018.
https://ift.tt/2u91P3A
Oncogene addicted non-small-cell lung cancer: current standard and hot topics
Future Oncology, Volume 14, Issue 13s, Page 3-17, June 2018.
https://ift.tt/2zpdzUQ
The assessment of changes to the nontuberculous mycobacterial metabolome in response to anti-TB drugs
Abstract
Mycobacterium species can cause a range of nontuberculous infections of healthy and immunocompromised people as well as infected people during and after surgical procedures. The similarity of nontuberculous mycobacteria (NTM) to the tuberculosis bacilli (TB) could ultimately enable the use of anti-TB drugs for the genus. Hence, three NTM (Mycobacterium smegmatis, Mycobacterium phlei and Mycobacterium avium) were cultured under different lab conditions, causing two mycobacterial phenotypes (active and dormant), and treated with isoniazid (INH) and ethambutol (EMB) independently or in combination. Metabolite profiling was applied to facilitate the investigation and characterisation of intracellular targets affected by the antibiotics. Aliquots of the cell culture were taken over the treatment period and the metabolite profile of the cells analysed by gas chromatography mass spectrometry. Comparative analysis of the metabolite levels to untreated mycobacteria confirmed the successful action of the antibiotics on the metabolism of all three species. Furthermore, single metabolites and metabolite pathways affected by the antibiotics could be identified and included, besides the known target sites for INH and EMB on mycobacterial cells, changes in e.g. nucleotide and saccharide levels. The combined treatment highlighted the property of EMB to enhance the effects of INH even under hypoxic culture conditions.https://ift.tt/2uaofkQ
Shaping Escherichia coli for recombinant membrane protein production
Abstract
The bacterium Escherichia coli has been widely used for the production of both pro- and eukaryotic membrane proteins. Usually, a set of standard strains as well as different culture setups and induction regimes are screened for to enhance production yields. However, on a limited scale, E. coli strains have been isolated for recombinant helical bundle membrane protein production using both selection- and engineering-based approaches. Here, we discuss how such approaches have been used so far to shape E. coli for the production of these recombinant membrane proteins and may be used in the future to further enhance production yields.https://ift.tt/2zpdccU
SecA inhibitors as potential antimicrobial agents: differential actions on SecA-only and SecA-SecYEG protein-conducting channels
Abstract
Sec-dependent protein translocation is an essential process in bacteria. SecA is a key component of the translocation machinery and has multiple domains that interact with various ligands. SecA acts as an ATPase motor to drive the precursor protein/peptide through the SecYEG protein translocation channels. As SecA is unique to bacteria and there is no mammalian counterpart, it is an ideal target for the development of new antimicrobials. Several reviews detail the assays for ATPase and protein translocation, as well as the search for SecA inhibitors. Recent studies have shown that, in addition to the SecA-SecYEG translocation channels, there are SecA-only channels in the lipid bilayers, which function independently from the SecYEG machinery. This mini-review focuses on recent advances on the newly developed SecA inhibitors that allow the evaluation of their potential as antimicrobial agents, as well as a fundamental understanding of mechanisms of SecA function(s). These SecA inhibitors abrogate the effects of efflux pumps in both Gram-positive and Gram-negative bacteria. We also discuss recent findings that SecA binds to ribosomes and nascent peptides, which suggest other roles of SecA. A model for the multiple roles of SecA is presented.https://ift.tt/2uaodcI
Disruption of INOS, a Gene Encoding myo-Inositol Phosphate Synthase, Causes Male Sterility in Drosophila melanogaster
Inositol is a precursor for the phospholipid membrane component phosphatidylinositol (PI), involved in signal transduction pathways, endoplasmic reticulum stress, and osmoregulation. Alterations of inositol metabolism have been implicated in human reproductive issues, the therapeutic effects of drugs used to treat epilepsy and bipolar disorder, spinal cord defects, and diseases including diabetes and Alzheimer's. The sole known inositol synthetic enzyme is myo-inositol synthase (MIPS), and the homologue in D. melanogaster is encoded by the Inos gene. Three identical deletion strains (inosDF/CyO) were constructed, confirmed by PCR and sequencing, and homozygotes (inosDF/ inosDF) were shown to lack the transcript encoding the MIPS enzyme. Without inositol, homozygous inosDF deletion fertilized eggs develop only to the first-instar larval stage. When transferred as pupae to food without inositol, however, inosDF homozygotes die significantly sooner than wild-type flies. Even with dietary inositol the homozygous inosDF males are sterile. An inos allele, with a P-element inserted into the first intron, fails to complement this male sterile phenotype. An additional copy of the Inos gene inserted into another chromosome rescues all the phenotypes. These genetic and phenotypic analyses establish Drosophila melanogaster as an excellent model organism in which to examine the role of inositol synthesis in development and reproduction.
https://ift.tt/2zuG6Z2
The Sleep Inbred Panel, a Collection of Inbred Drosophila melanogaster with Extreme Long and Short Sleep Duration
Understanding how genomic variation causes differences in observable phenotypes remains a major challenge in biology. Specifically, tracing the sequence of events originating from genomic variants of interest, from changes in transcriptional responses to protein modifications, is difficult. Ideally, one would conduct experiments with individuals that are at either extreme of the trait of interest, but such resources are often not available. Additionally, advances in genome editing will enable testing of candidate polymorphisms individually and in combination. Here we have created a resource for the study of sleep with 39 inbred lines of Drosophila-the Sleep Inbred Panel (SIP). SIP lines have stable long- and short-sleeping phenotypes developed from naturally occurring polymorphisms. These lines are fully sequenced, enabling more accurate targeting for genome editing and transgenic constructs. This panel facilitates the study of intermediate transcriptional and proteomic correlates of sleep, and supports genome editing studies to verify polymorphisms associated with sleep duration.
https://ift.tt/2m6MR9L
Organoaxial Volvulus
An elderly woman was seen in the Gastroenterology Clinic to evaluate 6 months of weekly episodic, left-sided, postprandial abdominal pain with nausea. Episodes typically lasted 30 minutes. The pain did not occur with every meal, and improved after emesis. Between episodes she was asymptomatic. Examination and laboratory results were unremarkable. She underwent small-bowel follow-through, which captured an episode of stomach herniation with organoaxial volvulus (Figure A). The stomach herniated into the thorax and rotated along the cardiopyloric axis of the stomach (Figure B, dashed line).
https://ift.tt/2NFFpix
In Regard to Yadav et al
We have read with great interest the article by Yadav et al (1), which was published in your estemeed journal. The aim of the study was to report results in terms of the feasibility and early toxicity of hypofractionated adjuvant whole breast–chest wall and regional nodal radiation therapy in patients with breast cancer. According to the authors, a two-week hypofractionated radiotherapy [34 Gy/10x (+ boost 10 Gy/5x)] appears to be feasible in patients with breast cancer and was associated with acute and late skin toxicity profiles that are similar to what has been observed during 3 weeks of treatment (35 Gy/15x).
https://ift.tt/2JcCz0Y
In Reply to Juretić and Suton
I appreciate the important question raised by Professor Juretić pertaining to selection of patients for adjuvant radiotherapy in our study (1, 2). The protocol has been developed to reduce the waiting period for the patients who need adjuvant radiation for breast cancer. At present, the boost is delivered with 8Gy/2#/2days.
https://ift.tt/2NDSnxg
The Radiation Safety of 5G Wi-Fi: Reassuring or Russian Roulette?
To the Editor: The impending rollout of fifth-generation (5G) Wi-Fi in mobile phones, augmenting the current fourth-generation (4G) technology toward making global interconnectivity between devices a reality, has been touted as a significant improvement of speed compared to current and previous wireless signaling (1). Less well explored are the potential consequences associated with this need for speed: namely, the substantial increase in biologic exposure to radiofrequency electromagnetic fields from the 1900-2100 MHz associated with 4G to the 3500 MHz estimated median bandwidth of 5G (2).
https://ift.tt/2L3Fg6O
The Long and Short of It: New Lessons on the Optimal Duration of Androgen Deprivation Therapy for High-Risk Prostate Cancer and Where We Need to Go From Here
Recently in the International Journal of Radiation Oncology, Biology, Physics, we have seen 3 articles providing updates or reanalyses from landmark trials testing the optimal duration of androgen deprivation therapy (ADT) with radiation in high-risk prostate cancer. Although it was started more than 25 years ago by Dr Gerald Hanks, the pioneering radiation oncology leader and former American Society for Radiation Oncology president who sadly passed away on December 20, 2017, the Radiation Therapy Oncology Group (RTOG) protocol 92-02 continues to provide valuable insights through its updates, as does the more recent DART 01/05 trial, and I will highlight them both in this month's Oncology Scan.
https://ift.tt/2NBfmcp
Consider Using Virtual Bolus
Vulvar cancers are traditionally treated with opposed anteroposterior/posteroanterior photon and en face electron beams, but intensity modulated radiation therapy (IMRT) provides better normal tissue sparing and faster delivery (1, 2, 3). However, IMRT planning can be challenging for a superficial clinical target volume (CTV) because the planning target volume (PTV) tends to extend into the air.
https://ift.tt/2JdeJCm
Consider Re-simulation or Evaluate With and Without Density Overrides
To start with, we would not have any portion of the gross tumor volume/clinical target volume in-air, although that will make little difference in this case (1). This is a complicated case; the best option maybe to re-simulate with wet gauze around the area, to reduce dosimetric uncertainties in the build-up region as well as to enable traditional handling of the planning target volume (PTV), without the computer needing to give dose to air. If this is not acceptable, the plan could be optimized with the PTV "as-is" and then recomputed, not reoptimitzed, with the PTV set to a density of tissue and the difference between the 2 plans evaluated.
https://ift.tt/2NDmSTY
Magnetic Resonance Imaging–Guided Radiation Therapy: A Short Strengths, Weaknesses, Opportunities, and Threats Analysis
A number of magnetic resonance (MR)-guided radiation therapy devices are under development, and the ViewRay system (ViewRay, Oakwood Village, OH), combining 3 multileaf collimated cobalt sources and 0.3 T MR imaging (MRI) with a split magnet system, has been in clinical use for some time, with a linear accelerator (linac) version announced (1). In contrast, the Elekta (AB, Sweden)/Philips (The Netherlands) Unity device consists of a 7-MV linac that rotates around a closed bore 1.5 T MR imager (2) and is expected to be European conformity marked later this year.
https://ift.tt/2LawjZG
In Regard to Ward et al
To the Editor: We read the study by Ward et al (1) with great interest and would like to congratulate the authors for their multi-institutional effort on this critically important subject in the era of intensity-modulated radiation therapy. The investigators of the Multi-Institution Reirradiation collaborative analyzed 412 patients with recurrent or second primary (RSP) head and neck cancers who had received at least 40 Gy during the initial radiation therapy and were treated with further ≥40 Gy reirradiation by utilizing the intensity-modulated radiation therapy technique.
https://ift.tt/2NE6dj7
The Air Out There: Treatment Planning When Target Volumes Extend Beyond the Skin
A patient presented with squamous cell carcinoma of the vulva, pT2pN2c, stage IIIC status post radical vulvectomy and bilateral groin dissection. The pathology report revealed close and positive margins and lymphovascular space invasion at the primary site, as well as multiple positive lymph nodes with extracapsular extension. The patient was simulated head-first supine in the frog-legged position, with the assistance of a custom immobilization device. Simulation also included 5 mm of water-equivalent bolus applied to the right groin, corresponding to a region suspicious for positive nodes and extracapsular extension.
https://ift.tt/2JcCg6k
In Reply to Yildirim and Topkan
We would like to thank Dr Yildirim et al for their interest in the Multi-Institution Reirradiation analysis addressing patient selection for reirradiation (1). The 2 questions are insightful and appropriate. First, how does tumor volume (GTV) factor into this conundrum and, second, what is the role of human papilloma virus (HPV) in outcomes after retreatment?
https://ift.tt/2NFFouZ
Erratum to: Sarria GJ, Saria GR, Pinillos LV. The Inca Trail to the Present: The Development of Radiation Therapy in Peru. Int J Radiat Oncol Biol Phys 2018;101:244-249.
In the above-referenced article, the name of the second author was misspelled. The correct spelling is "Gustavo R. Sarria."
https://ift.tt/2NFwE88
Red Journal Readers' Top Articles From 2017
Historically an individual paper's impact on science and on clinical practice has been measured through tracking the number of times it is cited in the literature. These citations go on to populate estimated calculations of "impact" through metrics such as the author's H-index and the journal's Impact Factor. However, published citations, although important, accumulate very slowly—over years—and reflect only the interest of other researchers in nations that themselves have a strong research focus.
https://ift.tt/2NFOHv2
Employ Piece-wise Optimization
Difficult planning scenarios like the vulva patient presented here are discussed at our daily physics, dosimetry, and therapy huddle, to encourage collaborative solutions (1).
https://ift.tt/2L5fSNU
Remission of spontaneous canine tumors after systemic cellular viroimmunotherapy
Dogs with spontaneous tumors treated in veterinary hospitals offer an excellent opportunity for studying immunotherapies, including oncolytic viruses. Oncolytic viruses have advanced into the clinic as an intratumorally administered therapeutic; however, intravenous delivery has been hindered by neutralization in the blood. To circumvent this hurdle, mesenchymal stem cells have been used as a "Trojan horse". Here we present the treatment of 27 canine cancer patients with canine mesenchymal stem cells infected with ICOCAV17, a canine oncolytic adenovirus. No significant adverse effects were found. The response rate was 74%, with 14.8% showing complete responses, including total remissions of lung metastasis. We detected virus infection, stromal degeneration, and immune cell infiltration in tumor biopsies after four weeks of treatment. The increased presence of anti-adenoviral antibodies in the peripheral blood of treated dogs did not appear to prevent the clinical benefit of this therapy. These data indicate that oncolytic viruses loaded in mesenchymal stem cells represent an effective cancer immunotherapy.
https://ift.tt/2N7TBj5
Discovery of Selective Estrogen Receptor Covalent Antagonists (SERCAs) for the treatment of ERa(WT) and ERa(MUT) breast cancer. [Research Articles]
Mutations in estrogen receptor alpha (ERa) that confer resistance to existing classes of endocrine therapies are detected in up to 30% of patients who have relapsed during endocrine treatments. Since a significant proportion of therapy-resistant breast cancer metastases continue to be dependent on ERa signaling, there remains a critical need to develop the next generation of ERa antagonists that can overcome aberrant ERa activity. Through our drug discovery efforts, we identified H3B-5942 which covalently inactivates both wild-type and mutant ERa by targeting Cys530 and enforcing a unique antagonist conformation. H3B-5942 belongs to a class of ERa antagonist referred to as Selective Estrogen Receptor Covalent Antagonists (SERCAs). In vitro comparisons of H3B-5942 with standard of care (SoC) and experimental agents confirmed increased antagonist activity across a panel of ERa(WT) and ERa(MUT) cell lines. In vivo, H3B-5942 demonstrated significant single-agent antitumor activity in xenograft models representing ERa(WT) and ERa(Y537S) breast cancer that was superior to fulvestrant. Lastly, H3B-5942 potency can be further improved in combination with CDK4/6 or mTOR inhibitors in both ERa(WT) and ERa(MUT) cell lines and/or tumor models. In summary, H3B-5942 belongs to a class of orally available ERa covalent antagonists with an improved profile over SoCs.
https://ift.tt/2KOCN4b
Immunotherapy Combinations and Sequences in Urothelial Cancer: Facts and Hopes
Immune checkpoint inhibitors (ICI) have emerged as a novel therapeutic strategy that achieves significant clinical benefit in several tumor types, including urothelial cancer (UC). Overall, these agents have shown objective response rates of around 20-23%, which indicates that a significant proportion of patient does not benefit from immunotherapy when given as monotherapy. Moreover, despite an initial response to therapy and an improvement on the median duration of response compared to chemotherapy, still only half of the patients develop long-term maintained remissions. Active research is ongoing in several fields, aiming to increase the number of patients that benefit from ICI, and this research is largely based on the development of biomarkers for personalized immunotherapy and novel combinations of ICI with other agents. This manuscript will review ongoing efforts to develop combinations of ICI with other therapeutic strategies in patients with urothelial cancer, including chemotherapy, targeted agents, other immunotherapy strategies and radiation therapy.
https://ift.tt/2N8UQPo
U.S. Surgeon General Urges More Americans to Carry Naloxone
TUESDAY, July 10, 2018 -- The U.S. Surgeon General released an advisory urging increased availability of the opioid overdose-reversing drug naloxone earlier this year, according to a report published by the U.S. Department of Health & Human...
https://ift.tt/2madLhg
TECH Parenting Can Limit Negative Impact of Media on Kids
TUESDAY, July 10, 2018 -- The talk, educate, co-view, and house rules (TECH) parenting framework can promote positive and specific media parenting behaviors that could help mitigate the potential negative impacts of media consumption for youth,...
https://ift.tt/2ulzPsM
Misleading Popular Videos Impact Attitudes About Tobacco
TUESDAY, July 10, 2018 -- Misleading portrayals of tobacco's health consequences in popular YouTube videos can increase positivity toward featured products including hookahs and electronic cigarettes (e-cigarettes), according to a study published in...
https://ift.tt/2madmeI
International Group Develops Best Practices for Drug Packaging
TUESDAY, July 10, 2018 -- Nine new drug labeling and packaging guidelines have been developed with an aim of reducing medication errors, according to a report published in Drug Topics. Medical safety organizations and advocates from over 20...
https://ift.tt/2zrETBH
AMA Calls for Inclusive Family, Medical Leave Policies
TUESDAY, July 10, 2018 -- The American Medical Association (AMA) calls for inclusive family and medical leave policies to support lesbian, gay, bisexual, transgender, and queer (LGBTQ) workers who care for relatives, spouses, and partners. As part...
https://ift.tt/2m6scCN
The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes
AJP Rep 2018; 08: e146-e157
DOI: 10.1055/s-0038-1661379
Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | open access Full text
https://ift.tt/2un7P7Z
Thyroid Autoantibodies do not Impair the Ovarian Reserve in Euthyroid Infertile Women: A Cross-Sectional Study
Horm Metab Res 2018; 50: 537-542
DOI: 10.1055/a-0637-9430
Patients with primary ovarian insufficiency (POI) have a high prevalence of thyroid autoimmune disorders. However, the extent of the contribution of thyroid autoantibodies or elevated thyroid-stimulating hormone (TSH) levels to decreased ovarian reserve is unclear. Therefore, we evaluated the serum levels of anti-Müllerian hormone (AMH) and thyroid autoantibodies [antithyroperoxidase antibody (TPOAb), and antithyroglobulin antibody (TgAb)] in euthyroid infertile women. One hundred and fifty-three women with normal menstrual cycles were recruited for this retrospective study. Serum levels of AMH were compared between patients with positive and negative thyroid autoantibodies. The correlation between serum levels of AMH and each thyroid autoantibody was also evaluated. Participants were observed to be either TPOAb or TgAb positive (n=27), only TPOAb positive (n=8), only TgAb positive (n=7), TPOAb and TgAb positive (double positive; n=12), and TPOAb and TgAb negative (double negative; n=126). No significant differences were found in serum AMH levels between the TPOAb- or TgAb-positive women and the antibody-double negative women. Serum AMH levels did not show a significant correlation with the concentration of TgAb or TPOAb. On the other hand, serum AMH levels negatively correlated with TSH levels in patients who were either positive for TPOAb or TgAb. Thyroid autoantibodies are not likely to influence ovarian reserve in euthyroid women whose TSH levels fall within the normal range although elevated TSH levels may be involved in the decline of serum AMH levels.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2JcJ5VL
Correlation Between Resistin Level and Metabolic Syndrome Component: A Review
Horm Metab Res 2018; 50: 521-536
DOI: 10.1055/a-0637-1975
Metabolic syndrome (MetS) has a collection of some abnormal and pathological conditions that cause many critical diseases. Resistin is one of the possible candidates for these pathologies but there are not enough data to prove if resistin has positive, neutral, or negative effects on one or some components of MetS. This review summarizes data about comparing the effects and contribution of resistin in initiation and progression of MetS components and also its different actions between human and other mammalians. This summarized data about the relationship of resistin and MetS components have been obtained from clinical researches and in some cases even animal studies. To find the relevant studies, the search in PubMed, Science Direct, and Scopus were performed. Human and animal studies on relationships between resistin and MetS (initiation and progression of components) were included in our search. In experiments reported among different human genetic groups as well as the patients with various disease such as diabetes, no significant correlation is shown between FBG and resistin level. Furthermore, this review shows that the results of correlation between resistin and TG, HDL, and central or abdominal obesity were inconsistent. These inconsistencies can arise from different sample size or genetic groups, gender, and also from experimental studies. Therefore, to obtain precise results systematic review and meta-analyses are required.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2L0TloH
Could Lipid Profile be Used as a Marker of Autonomous Cortisol Secretion in Patients with Adrenal Incidentalomas?
Horm Metab Res 2018; 50: 551-555
DOI: 10.1055/a-0630-1397
Adrenal incidentalomas (AIs) have been associated with an increased risk of metabolic syndrome and dyslipidemia, though evidence regarding the latter is limited. Lipid abnormalities in patients with AIs have been associated with subclinical hypercortisolism. The current study aims to test whether lipid profile in patients with AIs predicts "autonomous cortisol secretion" (ACS). Patients with AIs found on either computerized tomography (CT) or magnetic resonance imaging (MRI), were included in a prospective cohort study. All patients were followed up for at least three years. Alterations in their hormonal and lipid profiles were recorded. Ninety-four patients (69 women) harboring 111 AIs were included. There were no differences between patients with ACS and those without, with respect to their baseline lipid profile [total cholesterol, low-density-lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and non-HDL-C] and blood pressure (systolic and diastolic). Non-HDL-C concentrations decreased over time (Repeated Measures ANOVA, p=0.013), despite patients' body mass index (BMI) remaining unchanged. Logistic regression analysis revealed that the only predictor of ACS was the size of AIs, as calculated by CT or MRI. The current study demonstrated that lipid profile at baseline or during follow-up cannot predict ACS in patients with AIs. However, larger AIs may have a greater probability of ACS.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2JcJ2Jz
Association of Serum Leptin with All-Cause and Disease Specific Mortality: A Meta-Analysis of Prospective Observational Studies
Horm Metab Res 2018; 50: 509-520
DOI: 10.1055/a-0620-8671
Leptin levels may affect mortality through its link to inflammation and obesity. However, data are inconclusive. This meta-analysis was performed to investigate the association of leptin with mortality. The PubMed, Scopus, Google scholar, and reference lists of the included studies were searched for all published prospective observational studies that described the associations of serum leptin and mortality up to August 2017. Two reviewers independently assessed all potentially relevant studies for inclusion and methodological quality using standardized abstraction forms. Of 518 studies identified, 19 studies considered the association of leptin with all-cause mortality (16 208 subjects) and 12 studies evaluated the association of leptin with disease-specific mortality (13 680 subjects). In the overall analysis, no significant association was found between leptin and all-cause mortality (HR=1.028; 95% CI: 0.908–1.165; p=0.659), with a high between study heterogeneity (p˂0.001, I2=61). Subgroup analysis found that high leptin is associated with increased all-cause mortality in healthy people (HR=1.159 (95% CI, 1.032, 1.302), p=0.012), in men (HR=1.162; 95% CI: 1.036–1.302; p=0.010), and in subjects with ≥60 years old (HR=1.129; 95% CI: 1.030–1.238; p=0.010); whereas, increased leptin levels was related to the decreased cancer-specific mortality ((HR=0.550; 95% CI: 0.418–0.724), p˂0.001). Higher leptin levels in healthy people, old people, and males were associated with increased all-cause mortality, while increased leptin level was related to the reduced risk of death among patients with cancer.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2L0Tl8b
Diabetes Mellitus and Autoimmune Hepatitis: Demographical and Clinical Description of a Relatively Rare Phenotype
Horm Metab Res 2018; 50: 568-574
DOI: 10.1055/a-0631-2468
We studied demographic, metabolic, and clinical characteristics of patients with diabetes and autoimmune hepatitis (AIH) from the German/Austrian DPV registry. A total of 139 patients with diabetes and AIH were analyzed and compared to 437 728 patients with diabetes without AIH. The prevalence of AIH in patients with T1DM (44.8/100 000) seems higher than in the general population, the prevalence of AIH in patients with T2DM (23.6/100 000) does not seem to be increased. Patients with T2DM and AIH had a shorter duration of diabetes (p=0.007) and a higher proportion of females (p<0.001) compared to T2DM without AIH. Patients with diabetes (T1DM or T2DM) and AIH required higher insulin doses (p<0.001 and p=0.03, respectively) and showed increased liver enzymes (aspartate transaminase, alanine transaminase, gamma-glutamyltransferase) compared to diabetes patients without (all p<0.001). We detected a lower percentage of patients treated with oral antidiabetic drugs (p=0.01) and a higher percentage of patients treated by insulin in patients with T2DM and AIH (p<0.001) compared to patients with T2DM alone. We observed a higher incidence of autoimmune thyroid disease (AIT) in patients with diabetes (T1DM or T2DM) and AIH (p<0.001) compared to diabetes patients without AIH. AIH seems more frequent in patients with T1DM. Patients with diabetes and AIH require intensification of antidiabetic therapy and seem to have a higher prevalence of AIT.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2JcIXpf
Effect of Adjusting for Tanner Stage Age on Prevalence of Short and Tall Stature of Youths in the United States
To evaluate the extent to which pubertal timing alters the classification of extremes of attained stature across race-ethnicity groups of youths in the US.
https://ift.tt/2JdE7b5
Fluoroquinolone Antibiotics: FDA Requires Labeling Changes Due to Low Blood Sugar Levels and Mental Health Side Effects
Audience: Patient, Health Professional, Pharmacy ISSUE: FDA is strengthening the current warnings in the prescribing information that fluoroquinolone antibiotics may cause significant decreases in blood sugar and certain mental health side...
https://ift.tt/2L5FJJb
Radiotherapy Availability in Africa and Latin America: Two models of Low/ middle income countries
Significant correlations were demonstrated between population/MVM and each of gross domestic product (GDP) per capita, percentage of current health expenditure from GDP, life expectancy and cancer mortality incidence ratio (MIR). These findings indicate the detrimental impact of low radiotherapy coverage on life expectancy and cancer mortality in LMIC. On the other hand, no detected significant correlations were demonstrated between population/MVM and either capital expenditure, current health expenditure or current health expenditure per capita. It is noteworthy that in Latin America, a significant negative correlation was noted between population/MVM and GDP per capita as opposed to Africa.
https://ift.tt/2zyJCRY
P23. Does visual attentional performance determine working memory capacity?
In everyday life, working memory plays an important role. In the case of cognitive deficits, especially in old age, a diminishing working memory frequently causes increasing uncertainty and self-sufficiency among those affected. However, it is difficult to train the working memory to counter the effects of degeneration. Studies, in particular from the group around E.K. Vogel, suggest a link between individual working memory capacity (WMC) and selective attention. Subjects who are able to blend out irrelevant information had a higher individual WMC.
https://ift.tt/2uoDtlA
P24. Psychology of Monosynaptic T (tendon) and H (Hoffmann) Reflexes (MSR) – History, results and relevance
Soon after monosynaptic reflexes were discovered (Erb 1875, Westphal 1875) studies concerning supraspinal influences including psychophysiological effects were carried out. A survey of methods with some historical illustrations and results of experiments from nearly a century of research is given.Lombard (1887, AmJPsychol, vol. one) was the first to show tonic variations of the 'knee jerk' due to psychophysiological influences, whereas Bowditch and Warren (1890) showed phasic activation with sophisticated techniques, allowing short time registration within the range of 0 to about 2000 ms after different kinds of stimuli.
https://ift.tt/2uaw8H3
P21. Neural correlates of cognitive control in motor processes
The fronto-striato-subthalamic-pallidal network is involved in different aspects of motor and cognitive control (Jahanshahi et al., 2015), seeking as inhibition and conflict-induced slowing. Thus, in an automatic controlled mode of action. It has been proposed that this network 'communicates' in beta frequency oscillations (13–35 Hz) (Aron et al., 2016), which might reflect the cognitive control of motor processes.
https://ift.tt/2uuapth
P27. The fasting hormone FGF21-an alternative therapy for Alzheimer’s disease?
Lipolysis is regulated by PPAR and its target genes apoE and ABCA1, which not only control the transport of cholesterol but also the proteolytic degradation of A-peptide (A plaques, which are found to be deposited in increased number in Alzheimer's disease (AD). Accordingly, it was shown that PPAR-activation stimulates A-degradation, in an ABCA1- and apoE-dependent manner. Thus, it is reasonable to assume that increased lipolysis may be neuroprotective and could in part minimize the risk of developing dementia.
https://ift.tt/2ubj6sN
P28. The functional role of the anterior intraparietal sulcus for recovery of hand function in chronic stroke patients – A combined fMRI-TMS study
After stroke, neuroimaging studies frequently show increased activation of contralesional regions such as the primary motor cortex (M1) and the anterior intraparietal sulcus (aIPS) during movements of the impaired hand (Rehme et al., 2012). There is evidence that these areas may adopt either supportive or disturbing implications for motor control, depending on multiple factors, such as age, stroke severity, and lesion location (Di Pino et al., 2014). Importantly, previous research has mainly focused on investigating this question in the contralesional M1, while other areas involved in motor control, such as the aIPS have often been neglected despite considerable changes in post-stroke activity.
https://ift.tt/2zrD0oA
Severe endoscopic lesions are not associated with more infliximab fecal loss in acute severe ulcerative colitis
It has been observed that early infliximab (IFX) fecal excretion in patients with acute severe ulcerative colitis (ASUC) was associated with low treatment response.
https://ift.tt/2ztPLz0
FDA Updates Warnings for Fluoroquinolone Antibiotics on Risks of Mental Health and Low Blood Sugar Adverse Reactions
July 10, 2018 -- The U.S. Food and Drug Administration today is requiring safety labeling changes for a class of antibiotics called fluoroquinolones to strengthen the warnings about the risks of mental health side effects and serious blood sugar...
https://ift.tt/2KLsyh9
Impact of magnetic steering on gastric transit time of a capsule endoscopy (with video)
Delayed gastric transit of the capsule may lead to incomplete small bowel examination, reducing the diagnostic yield. Thus this study was designed to determine if magnetic steering could enhance capsule gastric emptying and mucosal visualization within the duodenum.
https://ift.tt/2m85fiv
Fluoroquinolone Antibiotics: FDA Requires Labeling Changes Due to Low Blood Sugar Levels and Mental Health Side Effects
[Posted 07/10/2018] AUDIENCE: Patient, Health Professional, Pharmacy ISSUE: FDA is strengthening the current warnings in the prescribing information that fluoroquinolone antibiotics may cause significant decreases in blood sugar and certain mental...
https://ift.tt/2L5FJJb
EMS Poem: ‘The Physicians Choice’
A volunteer firefighter/AEMT relates who is chosen to be guardian angels on Earth
https://ift.tt/2N2A0ky
A High-throughput Calcium-flux Assay to Study NMDA-receptors with Sensitivity to Glycine/D-serine and Glutamate
The goal of this protocol is to facilitate the study of NMDA-receptors (NMDAR) at a larger scale and allow the examination of modulatory effects of small molecules and their therapeutic applications.
https://ift.tt/2ukVdhW
High-resolution Patterning Using Two Modes of Electrohydrodynamic Jet: Drop on Demand and Near-field Electrospinning
https://ift.tt/2m7APgj
Corneal Epithelial Abrasion with Ocular Burr As a Model for Cornea Wound Healing
https://ift.tt/2zrx9zF
Preparation of Folic Acid-Targeted Temperature-Sensitive Magnetoliposomes and their Antitumor Effects In Vitro and In Vivo
Abstract
Background
Ovarian cancer is a common gynecologic malignancy with poor prognosis, requiring innovative new therapeutic strategies. Temperature-controlled drug delivery to cancer cells represents a novel, promising, targeted treatment approach.
Objective
We prepared folate receptor-targeted thermosensitive liposomes wrapped with the HSP90 inhibitor 17-AAG and superparamagnetic material (17-AAG/MTSLs-FA), and tested the efficacy of these targeted magnetoliposomes in vitro and in vivo.
Methods
Magnetic thermosensitive liposomes wrapped with 17-AAG were coprecipitated with Fe3O4 magnetic nanoparticles and prepared by a rotary evaporation method. Experiments were conducted with SKOV3 human ovarian cancer cells and MCF7 human breast carcinoma cells to evaluate the anti-tumor effects.
Results
17-AAG/MTSLs-FA prepared in this study met the basic requirements for therapeutic application. The preparation method is relatively simple and the raw materials are readily available. The product exhibited strong magnetism, high encapsulation efficiencies, and satisfactory performance. The liposomes combined with hyperthermia significantly inhibited the proliferation of SKOV3 cells and induced apoptosis. Experiments using a mouse subcutaneous model as well as an ascites tumor xenograft model indicated that 17-AAG/MTSLs-FA was stable in vivo and effectively targeted tumor tissues expressing the folate receptor.
Conclusions
Folic acid-conjugated 17-AAG magnetic thermosensitive liposomes in combination with an alternating magnetic field for heating can achieve a synergistic anti-tumor effect of chemotherapy and heat treatment, potentially offering a new method for ovarian cancer treatment. 
https://ift.tt/2ufSbLM
Any Opioid Use Tied to Involvement in Criminal Justice System
TUESDAY, July 10, 2018 -- Any opioid use is associated with involvement in the criminal justice system in the past year, according to a study published online July 6 in JAMA Network Open. Tyler N.A. Winkelman, M.D., from Hennepin Healthcare in...
https://ift.tt/2N0Clwn
Error Rate 7.4 Percent in Speech Recognition-Assisted Notes
TUESDAY, July 10, 2018 -- The error rate in speech recognition (SR)-assisted documentation is 7.4 percent, according to a study published online July 6 in JAMA Network Open. Li Zhou, M.D., Ph.D., from Brigham and Women's Hospital in Boston, and...
https://ift.tt/2N70r8v
High Financial Burden Up With ASCVD in Low-Income Families
TUESDAY, July 10, 2018 -- Low-income families that include a member with atherosclerotic cardiovascular disease (ASCVD) have increased odds of high financial burden and catastrophic financial burden, according to a study published online July 3 in...
https://ift.tt/2KLRJQC
Programs Can Lower Diabetes Distress in Adults With T1DM
TUESDAY, July 10, 2018 -- Both education/behavioral and emotion-focused approaches can effectively reduce diabetes distress (DD) among patients with type 1 diabetes (T1D) and elevated hemoglobin A1c (HbA1c), according to a study published online...
https://ift.tt/2N0ClMT
Pelvic Exam in ER Doesn't Help Predict STI for Young Females
TUESDAY, July 10, 2018 -- Pelvic examination does not increase the sensitivity or specificity for diagnosis of chlamydia, gonorrhea, or trichomonas over taking a history alone for young female patients presenting to the emergency department with...
https://ift.tt/2KJ2Cm2
HCV-Infected Kidney Transplant More Efficient in HCV-Infected
TUESDAY, July 10, 2018 -- For patients with hepatitis C virus (HCV) infection with end-stage renal disease, transplant of an HCV-infected kidney followed by treatment is more cost-effective than transplant of an HCV-uninfected kidney, according to a...
https://ift.tt/2KKWc6b
Transfeminine Persons Have Increased VTE Incidence
TUESDAY, July 10, 2018 -- Transfeminine individuals have increased rates of venous thromboembolism (VTE) compared with cisgender men and cisgender women, with more pronounced differences for those initiating hormone therapy, according to research...
https://ift.tt/2N0ClfR
Public Health Vaccine Opposition Growing in the United States
TUESDAY, July 10, 2018 -- Public health vaccine opposition has been growing in recent years in the United States, and has resulted in measles outbreaks, according to a policy forum article published online June 12 in PLOS Medicine. Jacqueline K....
https://ift.tt/2KKW2f5
Recent Years Have Seen U.S. Military Reinventing Trauma Care
TUESDAY, July 10, 2018 -- The U.S. military has reinvented trauma care, offering hope for changing approaches to health care, according to a blog post published online July 3 in Health Affairs. Arthur Kellermann, M.D., M.P.H., from the Uniformed...
https://ift.tt/2N5pQj4
Patient Interest Fairly High for Melanoma Genetic Risk Testing
TUESDAY, July 10, 2018 -- There is moderately high interest in genetic testing for melanoma risk among the general population, according to a study published in the June issue of JAMA Dermatology. Jennifer L. Hay, Ph.D., from the Memorial Sloan...
https://ift.tt/2KOnGru
Assessment of Respiratory Function in Conscious Mice by Double-chamber Plethysmography
https://ift.tt/2znVRAM
Experimental Protocol for Using Drosophila As an Invertebrate Model System for Toxicity Testing in the Laboratory
In this paper, we provide a detailed protocol for exposing species in the genus Drosophila to pollutants with the goal of studying the impact of exposure on a range of phenotypic outputs at different developmental stages and for more than one generation.
https://ift.tt/2mcEEBf
Long Noncoding RNA SNHG7 Promotes the Tumor Growth and Epithelial-to-Mesenchymal Transition via Regulation of miR-34a Signals in Osteosarcoma
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
https://ift.tt/2N72UQD
Salvage Radioimmunotherapy of Advanced Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen: Efficacy and Safety in Routine Practice
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
https://ift.tt/2KNOiZF
Cohort profile: prescriptions dispensed in the community linked to the national cancer registry in England
Purpose
The linked prescriptions cancer registry data resource was set up to extend our understanding of the pathway for patients with cancer past secondary care into the community, to ultimately improve patient outcomes.
ParticipantsThe linked prescriptions cancer registry data resource is currently available for April to July 2015, for all patients diagnosed with cancer in England with a dispensed prescription in that time frame.
The dispensed prescriptions data are collected by National Health Service (NHS) Prescription Services, and the cancer registry data are processed by Public Health England. All data are routine healthcare data, used for secondary purposes, linked using a pseudonymised version of the patient's NHS number and date of birth.
Detailed demographic and clinical information on the type of cancer diagnosed and treatment is collected by the cancer registry. The dispensed prescriptions data contain basic demographic information, geography measures of the dispensed prescription, drug information (quantity, strength and presentation), cost of the drug and the date that the dispensed prescription was submitted to NHS Business Services Authority.
Findings to dateFindings include a study of end of life prescribing in the community among patients with cancer, an investigation of repeat prescriptions to derive measures of prior morbidity status in patients with cancer and studies of prescription activity surrounding the date of cancer diagnosis.
Future plansThis English linked resource could be used for cancer epidemiological studies of diagnostic pathways, health outcomes and inequalities; to establish primary care comorbidity indices and for guideline concordance studies of treatment, particularly hormonal therapy, as a major treatment modality for breast and prostate cancer which has been largely delivered in the community setting for a number of years.
https://ift.tt/2unhtHR
Severe obesity and gut microbiota: does bariatric surgery really reset the system?
The gut microbiota is considered as one of the relevant contributors involved in the complex causes of obesity and related metabolic disorders. Indeed, a plethora of publications describing the composition of the microbiota in subjects suffering from overweight or obesity as well as type 2 diabetes and cardiometabolic diseases are available (for review1 2). Conversely, the characteristics of the microbiome in extreme forms of obesity (ie, severe and morbid Body Mass Index >35–40 kg/m2) has been barely described.
Bariatric surgery has dramatically increased worldwide and is now appearing as a solution to reduce cardiovascular risks and diabetes, thereby leading to consider this surgical procedure as a 'metabolic surgery'.3 4 Interestingly, one of the key features of the microbiome characterising obesity is the so-called low microbial gene richness, which strongly correlates with metabolic disorders such as low-grade inflammation, insulin resistance, adipocyte size but also chance of...
https://ift.tt/2m56XRT
Evolutionary history of human colitis-associated colorectal cancer
Objective
IBD confers an increased lifetime risk of developing colorectal cancer (CRC), and colitis-associated CRC (CA-CRC) is molecularly distinct from sporadic CRC (S-CRC). Here we have dissected the evolutionary history of CA-CRC using multiregion sequencing.
DesignExome sequencing was performed on fresh-frozen multiple regions of carcinoma, adjacent non-cancerous mucosa and blood from 12 patients with CA-CRC (n=55 exomes), and key variants were validated with orthogonal methods. Genome-wide copy number profiling was performed using single nucleotide polymorphism arrays and low-pass whole genome sequencing on archival non-dysplastic mucosa (n=9), low-grade dysplasia (LGD; n=30), high-grade dysplasia (HGD; n=13), mixed LGD/HGD (n=7) and CA-CRC (n=19). Phylogenetic trees were reconstructed, and evolutionary analysis used to reveal the temporal sequence of events leading to CA-CRC.
Results10/12 tumours were microsatellite stable with a median mutation burden of 3.0 single nucleotide alterations (SNA) per Mb, ~20% higher than S-CRC (2.5 SNAs/Mb), and consistent with elevated ageing-associated mutational processes. Non-dysplastic mucosa had considerable mutation burden (median 47 SNAs), including mutations shared with the neighbouring CA-CRC, indicating a precancer mutational field. CA-CRCs were often near triploid (40%) or near tetraploid (20%) and phylogenetic analysis revealed that copy number alterations (CNAs) began to accrue in non-dysplastic bowel, but the LGD/HGD transition often involved a punctuated 'catastrophic' CNA increase.
ConclusionsEvolutionary genomic analysis revealed precancer clones bearing extensive SNAs and CNAs, with progression to cancer involving a dramatic accrual of CNAs at HGD. Detection of the cancerised field is an encouraging prospect for surveillance, but punctuated evolution may limit the window for early detection.
https://ift.tt/2zpfqsx
Stereotaxic Surgery for Genetic Manipulation in Striatal Cells of Neonatal Mouse Brains
https://ift.tt/2m8nIvD
Multiparametric MRI for prostate cancer: a national survey of patterns of practice among radiation oncologists in Spain
Abstract
Purpose
To investigate patterns of practice among Spanish radiation oncologists in the use of multiparametric magnetic resonance imaging (mpMRI) for the treatment of prostate cancer (PCa). We evaluated (1) access to mpMRI, (2) current clinical practices, and (3) physician expectations of mpMRI.
Methods
Cross-sectional survey of 118 radiation oncologists at 75 Radiation Oncology (RO) departments in Spain.
Results
A total of 55 radiation oncologists from 52 RO departments (52/75; 69%) completed the survey. Prostate mpMRI is performed at 94.5% of the centres that provided data. The most common indications for mpMRI in routine clinical practice were: (1) detection/localization of the tumour prior to second biopsy (82.7%), (2) cancer staging (80.8%), and (3) detection of recurrence after definitive treatment (80.8%). Most respondents (72.7%) reported modifying the primary radiotherapy treatment when mpMRI findings indicate a more advanced T stage with a resultant change in the risk group. Most respondents (90.5%) treat macroscopic local recurrence after prostatectomy with high doses, ranging from 71 to 83 Gy; in 37.7% of cases, the full dose is delivered to the entire prostate bed. In pelvic nodal recurrence, more than half (59.3%) of the respondents reported performing elective pelvic radiotherapy, including the prostate bed, with a boost to the involved nodes.
Conclusions
This survey shows that prostate mpMRI is routinely used by radiation oncologists in Spain in a wide range of clinical scenarios. The findings reported here underscore the need to standardize treatment protocols for definitive and salvage radiotherapy in patients evaluated with mpMRI.
https://ift.tt/2zBdZHR
UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study
Objectives
To compare the likelihood of success at selection into specialty training for doctors who were UK nationals but obtained their primary medical qualification (PMQ) from outside the UK ('UK overseas graduates') with other graduate groups based on their nationality and where they gained their PMQ. We also compared subsequent educational performance during postgraduate training between the graduate groups.
DesignObservational study linking UK medical specialty recruitment data with postgraduate educational performance (Annual Review of Competence Progression (ARCP) ratings).
SettingDoctors recruited into national programmes of postgraduate specialist training in the UK from 2012 to 2016.
Participants34 755 UK-based trainee doctors recruited into national specialty training programmes with at least one subsequent ARCP outcome reported during the study period, including 1108 UK overseas graduates.
Main outcome measuresOdds of being deemed appointable at specialty selection and subsequent odds of obtaining a less versus more satisfactory category of ARCP outcome.
ResultsUK overseas graduates were more likely to be deemed appointable compared with non-EU medical graduates who were not UK citizens (OR 1.29, 95% CI 1.16 to 1.42), although less so than UK (OR 0.25, 95% CI 0.23 to 0.27) or European graduates (OR 0.66, 95% CI 0.58 to 0.75). However, UK overseas graduates were subsequently more likely to receive a less satisfactory outcome at ARCP than other graduate groups. Adjusting for age, sex, experience and the economic disparity between country of nationality and place of qualification reduced intergroup differences.
ConclusionsThe failure of recruitment patterns to mirror the ARCP data raises issues regarding consistency in selection and the deaneries' subsequent annual reviews. Excessive weight is possibly given to interview performance at specialty recruitment. Regulators and selectors should continue to develop robust processes for selection and assessment of doctors in training. Further support could be considered for UK overseas graduates returning to practice in the UK.
https://ift.tt/2KKQK30
Deceleration Capacity of Heart Rate After Acute Altitude Exposure
High Altitude Medicine &Biology, Ahead of Print.
https://ift.tt/2m6p4qA
Teen couple urges public to learn CPR after lightning strike incident
Isaiah Cormier said he is "very grateful" that his girlfriend, Juliette Moore, saved him by performing CPR after he was struck by lightning
https://ift.tt/2L4wNjK
Selective BH3-mimetics targeting BCL-2, BCL-XL or MCL-1 induce severe mitochondrial perturbations
Journal Name: Biological Chemistry
Issue: Ahead of print
https://ift.tt/2KIyFm6
Down-regulated paxillin suppresses cell proliferation and invasion by inhibiting M2 macrophage polarization in colon cancer
Journal Name: Biological Chemistry
Issue: Ahead of print
https://ift.tt/2N51B4y
LAG-3 Inhibitory Receptor Expression Identifies Immunosuppressive Natural Regulatory Plasma Cells
Plasma cells secrete antibodies and play a key role in host defense against infection. Lino et al. identify a novel subset of natural regulatory plasma cells characterized by the expression of LAG-3 that develops at steady state independently of microbiota, and respond to innate stimulation by producing immunosuppressive IL-10.
https://ift.tt/2mcbxOt
Factors That Predict the Growth of Residual Nonfunctional Pituitary Adenomas: Correlations between Relapse and Cell Cycle Markers
Introduction. Nonfunctional pituitary adenomas are treated surgically, and even partial resection can improve or eliminate clinical symptoms. Notably, progression requires further intervention, which presents an increased risk, especially in older patients. This study investigated whether the histopathological characteristics of nonfunctional adenomas could predict recurrence. Materials and Methods. Data were obtained retrospectively from 30 patients who underwent surgery for the partial resection of pituitary adenomas. Remnant tumor growth was observed in 17 patients, while the residual tumor was unchanged more than 7 years after surgery in 13 patients. Statistical analysis was performed to investigate correlations between remnant tumor progression and tumor histopathological findings, including protein expression of p21, p27, p53, and Ki-67. Results and Discussion. Remnant tumors that demonstrated regrowth showed significantly higher protein expression of p21 and Ki-67. Expression of the p53 tumor suppressor was also higher in this group, but the difference was at the limit of statistical significance. Conclusion. Tumors with high expression of p21 and p53 and with a high Ki-67 index were more likely to show residual pituitary adenoma progression. Such cases should undergo frequent radiological examination and timely reoperation, and radiosurgery should be considered.
https://ift.tt/2unte0S
Addressing leadership and caregiver bias in EMS
The EMS leader's task is to recognize and reduce negative impacts of bias as much as possible
https://ift.tt/2N4RSey
Use of age-specific hospital catchment populations to investigate geographical variation in inpatient admissions for children and young people in England: retrospective, cross-sectional study
Objectives
To develop a method for calculating age-specific hospital catchment populations (HCPs) for children and young people (CYP) in England. To show how these methods allow geographical variation in hospital activity to be investigated and addressed more effectively.
DesignRetrospective, secondary analysis of existing national datasets.
SettingInpatient care of CYP (0-18 years) in England.
ParticipantsHospital Episode Statistics (HES) data were accessed for all inpatient admissions (elective and emergency) for CYP from birth to 18 years, 364 days, for 2011/2012–2014/2015. In 2014/2015, 857 112 admissions were analysed, from an eligible population of approximately 11.9 million CYP.
Outcome measuresFor each hospital Trust, the catchment population of CYP was calculated; Trust-level admission rates per thousand per year were then calculated for admissions due to (1) any diagnostic code, (2) primary diagnosis of epilepsy and (3) epilepsy listed as primary diagnosis or comorbidity.
ResultsEstimated 2014/2015 HCPs for CYP ranged from 268 558 for Barts Health NHS Trust to around 30 000 for the smallest acute general paediatric services and below 10 000 for many Trusts providing specialist services. As expected, the composition of HCPs was fairly consistent for age breakdown but levels of deprivation varied widely. After standardising for population characteristics, admission rates with a primary diagnosis of epilepsy ranged from 14.3 to 157.7 per 100 000 per year (11.0-fold variation) for Trusts providing acute general paediatric services. All-cause admission rates showed less variation, ranging from 4033 to 11 681 per 100 000 per year (2.9-fold variation).
ConclusionsUse of age-specific catchment populations allows variation in hospital activity to be linked to specific teams and care pathways. This provides an evidence base for initiatives to tackle unwarranted variation in healthcare activity and health outcomes.
https://ift.tt/2umzyG9
Clinical and ultrasonographic predictors for achieving minimal disease activity in patients with psoriatic arthritis: the UPSTREAM (Ultrasound in PSoriatic arthritis TREAtMent) prospective observational study protocol
Introduction
Psoriatic arthritis (PsA) occurs in 10%–15% of people with psoriasis and accounts for 10%–20% of early arthritis clinics referral. Only a few prognostic factors of therapeutic response in patients with PsA have been identified. In the last years, the role of imaging has grown up and the European League Against Rheumatism recognised that ultrasound (US) has higher sensitivity than clinical examination to detect inflammatory disease activity. The aims of the Ultrasound in PSoriatic arthritis TREAtMent (UPSTREAM) study are to integrate clinic and US in order to inform whether US has provide an added prognostic value in PsA.
Methods and analysisUPSTREAM is an observational prospective cohort study enrolling patients with PsA having clinically active joint disease and starting a new course of therapy. The primary objective is to evaluate the additional value of US over clinical examination in detecting patients achieving minimal disease activity after 6 months. Data will be obtained at baseline and at standard clinical follow-up visits. Patient's clinical assessment will be performed according to the core set proposed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology. Sonographic evaluations will be performed by expert sonographers in 42 joints, 36 tendons, 12 entheses and 2 bursae, according to a score that will be purposely developed for PsA by the US Study Group of the Italian Society for Rheumatology. The UPSTREAM study will identify clinical and US predictors of response to treatment in patients with PsA and active peripheral arthritis starting a new course of therapy.
Ethics and disseminationEthic approval for this study has been obtained from the institutional review board (IRB)/independent ethics committee (IEC) Comitato Etico Lazio 1 (Prot. N 198 02-02-2017) and then locally from the IRB/IEC of each participating centre. Results will be published in relevant scientific journals and be disseminated in international conferences. Fully anonymised data will be accessible from authors upon request.
Trial registration numberhttps://ift.tt/2m7Xutb
Detecting concurrent mood in daily contact networks: an online participatory cohort study with a diary approach
Objectives
This paper examines how people express personal mood concurrently with those connected with them by one or two degrees of separation.
DesignParticipatory cohort study.
SettingOnline contact diary.
Participants133 participants kept online diaries for 7 months in 2014, which included 127 455 contacts with 12 070 persons.
Main outcome measuresDiary keepers rated a contacted person's mood during each specific contact, as well as the strength of ties between any pairs of such contacted persons. Such rich information about ties and contacts enable us to construct a complete contact network for each diary keeper, along with the network members' mood and tie strength. We calculate one's overall mood by that person's average mood score during the study period and take the shortest path between any given pair of contacted persons as the degree of separation. We further assume that two connecting persons in a contact network have made contact with each other during the study period, which allows us to examine whether and how personal moods occur concurrently within these contact networks.
ResultsUsing mixed-effects models while controlling for covariates at individual, tie and contact levels, we show that personal mood score positively and significantly correlates with the average mood among those directly tied to the person. The same effect remains positive and significant for those connected to the person by two degrees, although the effect size is reduced by about one-half. The mood of anyone separated by more than two degrees is statistically irrelevant.
ConclusionsApplying network perspectives and rich data at both tie and contact levels to inquiries about subjective well-being, the current study sheds new light on how an improved diary approach can help explain the sophisticated ways in which individuals express their personal moods concurrently during social interactions in everyday life, contact by contact.
https://ift.tt/2znEDUs
Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study
Objective
The study aims to explore the association between serum proprotein convertase subtilisin/kexin type 9 (PCSK9) level and saphenous vein grafts disease (SVGD) after coronary artery bypass grafting (CABG).
DesignA cross-sectional study.
SettingA secondary hospital in Tianjin City, China.
ParticipantsA total of 231 participants were included in the study. Inclusion criteria were as follows: age ≥18 years, previous CABG surgery at least 12 months ago, at least one SVG for bypass during CABG, abnormal non-invasive test results or recurrent stable angina pectoris by coronary angiography indications, and willing to participate and sign informed consent. Participants with any of the following were excluded from the study: congenital valvular disease, decompensated heart failure, anaemia defined as a haemoglobin level of <12 g/dL in women or <13 g/dL in men, malignant neoplasms, renal failure, severe hepatic disease, thyroid disease, acute or chronic inflammatory disease and chronic obstructive lung disease.
Primary outcome measureSVGD was defined as at least one SVG with significant stenosis (≥50%). Circulating PCSK9 levels were measured using commercial ELISA kits according to the manufacturer's instructions.
ResultsThe mean PCSK9 level in the SVGD group was significantly higher than that in the patent group (275.2±38.6 vs 249.3±37.7, p<0.01). The multivariate logistic regression model revealed a significant association between serum PCSK9 and SVGD (OR 2.08, 95% CI 1.46–2.95) per 1 SD increase in serum PCSK9.
ConclusionsThe present study is the first to identify an independent association between PCSK9 and late SVGD after adjustment for established cardiovascular risk factors. A multicentre prospective cohort study with large sample size should be conducted in the future to further research this relationship.
https://ift.tt/2m4og5E
Endovascular treatment for symptomatic intracranial artery stenosis: protocol for a systematic review and network meta-analysis
Introduction
Atherosclerotic intracranial artery stenosis (ICAS) is one of most common causes of stroke, which is the second-leading cause of death worldwide. Medical, surgical and endovascular therapy are three major treatments for ICAS. Currently, medical therapy is considered as the standard of care for most patients with ICAS, while extracranial to intracranial bypass is only used in rare situations. Balloon angioplasty alone, balloon-mounted stent and self-expanding stent, collectively called endovascular treatment, have shown promising potentials in treating specific subgroups of patients with symptomatic ICAS; however, their comparative safety and efficacy is still unclear. Therefore, a systematic review with network meta-analysis is needed to establish a hierarchy of these endovascular treatments.
Methods and analysisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was followed to establish this protocol. The search will be limited to studies published from 1 January 2000 to the formal search date. Major databases including Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, conference proceedings and grey literature database will be searched for clinical studies comparing at least two interventions for patients with symptomatic ICAS. Primary outcomes include short-term and long-term mortality or stroke rate. Random effects pairwise and network meta-analyses of included studies will be performed on STATA (V.14, StataCorp, 2015). The surface under the cumulative ranking curve and mean rank will be calculated in order to establish a hierarchy of the endovascular treatments. Evaluation of the risk of bias, heterogeneity, consistency, transitivity and quality of evidence will follow the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.
Ethics and disseminationEthics approval is not needed as systematic review is based on published studies. Study findings will be presented at international conferences and published on a peer-reviewed journal.
PROSPERO registration numberCRD42018084055; Pre-results.
https://ift.tt/2m8tcXh
Role of personality traits in reporting the development of adverse drug reactions: a prospective cohort study of the Estonian general population
Objective
To examine the role of the Five Factor Model (FFM) personality traits in reporting the development of adverse drug reactions (ADRs) when controlling for sociodemographic variables and health status.
DesignProspective cohort study.
SettingThe Estonian Biobank of the Estonian Genome Centre, University of Tartu.
Participants814 women and 543 men (mean age=47.9 years; SD=15.2) who after the initial enrolment in the Estonian Biobank were re-contacted for follow-up purposes about 5.3 years after the enrolment and for whom both self- and informant-reported personality data were available.
Main outcome measureParticipants who did not report having any ADRs at baseline but who reported ADRs at the follow-up about 5.3 years later versus participants who did not report any ADRs at either time point. The reports of developing ADRs were predicted from the FFM personality traits after statistically controlling for sociodemographic variables (age, gender and education), baseline indicators of health status (number of diagnoses and medicines taken, body mass index and blood pressure), and the change in health status between the two measurements.
ResultsThe results of a hierarchical binary logistic regression analysis showed that participants who reported the development of ADRs between the two measurements had higher levels of conscientiousness, were more likely to be women, were taking more medicines at baseline and had a higher increase in the number of medicines taken during the study period than participants who did not report any ADRs at either time point (all p values <0.05). Higher neuroticism (p=0.067) and a higher number of diagnosed diseases at baseline (p=0.053) also made marginal contributions to predicting the development of ADRs.
ConclusionsThis study shows for the first time that higher levels of conscientiousness and neuroticism are associated with reporting the development of ADRs.
https://ift.tt/2zr7IhI
Danggui Sini Decoction Protected Islet Endothelial Cell Survival from Hypoxic Damage via PI3K/Akt/eNOS Pathway
Danggui Sini decoction (DSD) is a traditional Chinese decoction, which is wildly applied and showed to be effective in ameliorating ischemia-related symptoms. However, the mechanisms of DSD action in ischemic damage remain to be fully clarified. Pancreatic islet endothelial cells are pivotal constituent of islet microvasculature, with high vulnerability to hypoxic injuries. Here, using MST1 cell, a pancreatic islet endothelial cell-line, as a model, we investigated the effects of DSD on hypoxia-stimulated endothelial cell lesions and its underlying mechanisms. We found that DSD-Containing Serum (DSD-CS), collected from DSD-treated rats, could efficiently protect MST1 survival and proliferation from Cobalt chloride (CoCl2) induced damage, including cell viability, proliferation, and tube formation. Furthermore, DSD-CS restored the activity of PI3K/Akt/eNOS signaling inhibited by CoCl2 in MST1 cells. The protective effect of DSD-CS could be blocked by the specific PI3K/Akt/eNOS inhibitor LY294002, suggesting that DSD-CS protection of MST1 cell survival from hypoxia was mediated by PI3K/Akt/eNOS pathway. In conclusion, DSD treatment protected MST1 survival from hypoxic injuries via PI3K/Akt/eNOS pathway, indicating its role in protecting microvascular endothelial cells.
https://ift.tt/2zn5OyB
Vasorelaxant and Hypotensive Effects of Cheonwangbosimdan in SD and SHR Rats
Historically, traditional herbal medicines (THMs) have been the conventional treatment strategy in the Korean medical system for treating many diseases. However, THMs have rarely been used to treat hypertension, and moreover few studies have investigated the interaction of blood pressure with the coadministration of synthetic antihypertensives. We aimed to evaluate the vasorelaxant and hypotensive effects of the traditional herbal prescription Cheonwangbosimdan (CWBSD; "Tianwangbuxindan" in Chinese) and the combination of CWBSD with amlodipine. CWBSD was extracted with distilled water at 100°C for 2 h. To investigate vasorelaxant activities, CWBSD with amlodipine (10 μg/ml) was added cumulatively (10–1,000 μg/ml) to isolated rat aortic rings precontracted using phenylephrine or potassium chloride in organ chambers. To investigate hypotensive effects, CWBSD (2,476 mg/kg) was orally administered with or without amlodipine (5 mg/kg) to spontaneously hypertensive rats (SHRs). CWBSD increased the relaxation of rat aortic rings induced by amlodipine (P
https://ift.tt/2m5iDnD
Empirical treatment of tuberculosis: TB or not TB?
Of the 8.6 million new cases of tuberculosis (TB) that occur globally each year, a quarter occur in India. We describe the case of a 38-year-old Indian woman who presented with symptoms of hepatitis after being treated empirically with anti-TB therapy for five months. The patient was suspected to have TB after having recurrent episodes of coughing which would improve briefly before her respiratory symptoms returned, which led to her being treated at various healthcare clinics and hospitals. We highlight the challenges the patient faced due to the lack of centralised medical records which would have prevented unnecessary investigations and treatment.
https://ift.tt/2u6fdFQ
Multisystem amyloidosis as the unifying diagnosis for constipation, collapse and cardiomyopathy
Amyloidosis a rare disorder characterised by the deposition of amyloid protein aggregates in different organ systems throughout the body with resulting functional impairment of affected organs. It can present with localised or multisystemic deposits. Diagnosis is often delayed due to the non-specific nature of the symptoms. We present the case of a 59-year-old man with a 12-month history of non-specific symptoms. Investigations revealed Helicobacter pylori positive gastritis. Blood tests showed only a normocytic anaemia and thrombocytopaenia. CT scan showed proximal sigmoid thickening. Biopsies were unremarkable. Echocardiogram and cardiac MRI scan showed restrictive cardiomyopathy. Congo red staining of gastric biopsies showed amyloid deposition. The patient had elevated serum kappa light chains and a bone marrow biopsy confirmed multiple myeloma and he was subsequently diagnosed with systemic light chain (AL) amyloidosis secondary to this. He was started on chemotherapy and parenteral nutrition; however, he deteriorated rapidly and so was started on palliative treatment and discharged home.
https://ift.tt/2ufg4Dc
Bilateral serpentine radio-opaque shadows near the urinary bladder: nothing but calcified vas deferens!
Description
A 77-year-old man presented with voiding lower urinary tract symptoms with history of terminal haematuria. His ultrasonography (USG) was suggestive of a 58 g prostate with thickened urinary bladder walls along with two vesical calculi. A plain X-ray was taken that showed two radio-opaque shadows in the urinary bladder corresponding to vesical calculi reported on the USG. Along with that there were two serpentine radio-opaque shadows on each side of the urinary bladder (figure 1). The primary care physician thought these shadows to be ureteric calculi/calcification and referred the patient to our centre for further workup and management. On carefully reviewing the X-ray we immediately recognised that the serpentine radio-opaque shadows were nothing but bilaterally calcified vas deferens. The shadow on the left also had a characteristic pattern of loop that the vas makes during its course towards the inguinal canal. The patient was non-diabetic and...
https://ift.tt/2ualRup
Gluten-free diet: a possible treatment for chronic diarrhoea in common variable immunodeficiency
Gastrointestinal disorders are frequent in common variable immunodeficiency (CVID). Clinical symptoms and histological alterations in CIVD can resemble celiac disease. Usually, patients with chronic diarrhoea associated with CVID do not improve with a gluten-free diet. The authors present a case of a male patient who was diagnosed with CVID at age 33 and had chronic diarrhoea which resolved after initiating a gluten-free diet. Clinical relapse occurred after gluten reintroduction. The main objective of this case report is to alert clinicians to implement a gluten-free diet in patients with CVID with chronic diarrhoea.
https://ift.tt/2u7o3TC
A novel cause of postmenopausal bleeding in an immunosuppressed patient
Malakoplakia is a rare histiocytic disease first described in 1902 by Michaelis and Gutmann. It is associated with host immunocompromise including chronic inflammatory conditions, infectious conditions or malnutrition. Here, we report the case of uterine malakoplakia as a rare cause of postmenopausal bleeding in an immunocompromised patient.
https://ift.tt/2u7LlZl
A novel mutation in Wiskott-Aldrich gene manifesting as macrothrombocytopenia and neutropenia
Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder, described as a clinical triad of microthrombocytopenia, eczema and recurrent infections. Different mutations in WAS gene have been identified, resulting in various phenotypes and a broad range of disease severity, ranging from classic WAS to X-linked thrombocytopenia and X-linked neutropenia. WAS in some cases can be fatal without haematopoietic stem cell transplantation early in life. In this particular case, we present a novel mutation with a unique presentation. An 18-year-old man incidentally found to have macrothrombocytopenia and neutropenia at 16 years of age later found to be hemizygous for c. 869T>C (p.Ile290Thr) mutation in WAS gene. The late presentation, absence of other manifestations of WAS and presence of macrothrombocytopenia, rather than microthrombocytopenia, which is usually a characteristic finding in WAS, misled the initial diagnosis. On review of literature, this mutation has not been reported as causing WAS.
https://ift.tt/2zpBKSO
Rectus sheath haematoma causing ureteric obstruction
Rectus sheath haematoma is an uncommon condition. However, its incidence is increasing, attributed to greater use of anticoagulant therapy. We present the case of an 83-year-old woman on therapeutic enoxaparin for a prior pulmonary embolus who underwent elective right hemicolectomy and developed a rectus sheath haematoma 13 days postoperatively. Her extensive haematoma compressed retroperitoneal structures including the right ureter. She was successfully managed conservatively.
https://ift.tt/2u7o220
Rare but life-threatening complication of fecalith
Description
A 78-year-old woman with history of Addison's disease, hypothyroidism, hypertension and recent hospital admission for asthma exacerbation requiring hospitalisation for steroid pulse presented to the emergency department with 1 day of significant epigastric and right lower quadrant pain. Her pain steadily worsened and was associated with nausea and clear emesis. She was on a steroid taper for her recent asthma exacerbation, and she is normally on baseline low-dose steroids for her Addison's disease.
On evaluation in the emergency department, the patient was noted to be tachycardic in the 100s but otherwise haemodynamically stable. Her abdomen was distended, and she endorsed moderate to severe tenderness over her right lower quadrant with guarding but no rebound. Her labs were notable for white cell count of 31.6x109/L and a lactate of 4.5 mmol/L.
The patient was promptly fluid resuscitated, given intravenous antibiotics and analgesics. Given concern for bowel ischaemia, an abdominopelvic CT angiogram was...
https://ift.tt/2zoiRjp
Giant abdominal metastasis from cardiac liposarcoma
Description
The patient was a 58-year-old man. His history began 6 years before the admission to our hospital because of a syncopal episode. MRI showed a 2 cm lesion at the confluence of the left pulmonary veins. It was surgically removed and the histopathological diagnosis was of 'pleomorphic liposarcoma'. The postoperative course was regular.
Since the patient lived in a rural area, he was not treated in a high-volume reference centre for sarcoma and follow-up was not managed by a dedicated multidisciplinary team. Three years later, for the onset of an intestinal occlusion, he underwent emergency laparotomy. An ileo-ileal invagination due to a little ileal lesion was treated with a 30 cm intestinal resection. The histopathological response was again of liposarcoma. Chemotherapy was not performed.
One year later, a thoracoabdominal CT scan showed a heart recurrence and an enormous abdominal mass involving many ileal loops with intestinal subocclusion. The patient...
https://ift.tt/2u6feJU
When a patient with depression is feeling sleepy, be aware of sleep apnoea
A 67-year-old man was referred to an outpatient clinic of geriatric psychiatry because of persistent symptoms of depression and anxiety, accompanied by sleepiness. The latter had been evaluated multiple times in the general practice over several years; each time it was considered to be a symptom of depression. After referral, the patient was diagnosed with severe obstructive sleep apnoea (OSA), comorbid to a depressive and anxiety disorder. Retrospectively, we conclude that affective symptoms accompanying OSA and sleepiness were wrongfully interpreted as depression, but after having led to problems at work, they have triggered psychiatric comorbidity. Treatment of OSA in addition to the psychiatric disorders resulted in a full recovery over time. The delayed diagnosis of OSA has certainly diminished the patient's quality of life and might have precipitated the depressive disorder. Moreover, OSA poses patients at an increased risk of cardiovascular disease, hypertension, stroke and traffic accidents.
https://ift.tt/2uffEg6
Mixed extragonadal germ cell tumour of the prostate
Extragonadal germ cell tumours (EGGCTs) originated in prostate are extremely rare, with <20 cases described in the literature. We report a case of a patient with a primary prostatic mixed EGGCT. A 47-year-old man presenting severe low urinary tract symptoms and signs of prostatic enlargement, with no malignancy suspicion, underwent transurethral resection of the prostate. The histopathological evaluation suggested the diagnosis of a retroperitoneal sarcoma. The patient underwent neoadjuvant chemotherapy and then was submitted to radical cystoprostatectomy. Histology revealed a mixed EGGCT of the prostate with yolk sac tumour and seminoma components. No testicular abnormalities were identified on the postoperative scrotal ultrasound. The patient went through four cycles of chemotherapy with bleomycin, etoposide and cisplatin. After 12 months of follow-up, the patient is alive and free of recurrence.
https://ift.tt/2u6dEYs
Εγγραφή σε:
Αναρτήσεις (Atom)
-
Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
-
Alimentary Pharmacology &Therapeutics, EarlyView. https://ift.tt/2qECBIJ
-
heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
