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Κυριακή 2 Σεπτεμβρίου 2018

Poststroke Depression: A Long-Term Problem for Stroke Survivors Erratum

No abstract available

https://ift.tt/2wDnv8m

Changes in plasma interleukin-8 and tumor necrosis factor-α levels during the early treatment period as a predictor of the response to sorafenib in patients with unresectable hepatocellular carcinoma

Abstract

Purpose

This study aimed to identify a biomarker for predicting the response to sorafenib in patients with hepatocellular carcinoma (HCC).

Methods

Of 100 patients with unresectable HCC who received sorafenib treatment in our institute (Cohort A), 48 had stored plasma samples collected within 28 days before the start of treatment (Cohort B). Concentrations of 18 plasma cytokines were measured in plasma samples using a sandwich immunoassay with multiplexed fluorescent bead-based technology. Among 27 patients with follow-up plasma samples taken at 5–10 days of treatment (Cohort C), changes in the 18 cytokines were also evaluated.

Results

In Cohort A, progressive disease (PD) according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) was associated with poor overall survival by multivariate analysis (p = 0.024). In Cohort B, no significant differences in baseline concentrations of α-fetoprotein, des-γ-carboxy prothrombin, or the 18 cytokines were found between patients with PD and those with stable disease (SD) or partial response (PR). In Cohort C, the increase in interleukin-8 and tumor necrosis factor-α (TNF-α) was significant in the PD group (p = 0.0063 and p < 0.001, respectively) but not in the SD + PR group (p = 0.67 and p = 0.15, respectively). In addition, the fold changes in interleukin-8 and in TNF-α were correlated (p < 0.001, r = 0.67).

Conclusions

Changes in plasma interleukin-8 and TNF-α levels during the first few days could predict the response to sorafenib therapy in HCC patients.



https://ift.tt/2Ndv146

The Application of Biomaterials to Tissue Engineering Neural Retina and Retinal Pigment Epithelium

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2Q2N4sD

Architectural Effects of Star‐Shaped “Structurally Nanoengineered Antimicrobial Peptide Polymers” (SNAPPs) on Their Biological Activity

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2CkGqLw

Prevalence of BRCA1 and BRCA2 pathogenic variants in a large, unselected breast cancer cohort

International Journal of Cancer, Volume 0, Issue ja, -Not available-.


https://ift.tt/2CdcaC6

Cryopyrin-Associated Periodic Fever Syndrome and the Nervous System

Abstract

Purpose of review

The purpose of this review is to highlight the molecular and clinical characteristics of the cryopyrin-associated periodic fever syndrome (CAPS) and its management. CAPS is an autosomal dominantly inherited autoinflammatory disorder associated with mutations in the NLRP3 gene, which ultimately lead to excessive production of interleukin-1β (IL-1β) and systemic inflammation. Typical systemic features include fever, urticarial rash and arthralgia, and ultimately amyloidosis. There are also multiple neurological manifestations including, but not restricted to, headache, sensorineural hearing loss, aseptic meningitis, myalgia and optic nerve involvement.

Recent findings

Since the recognition of CAPS as a single disease entity and discovery of the underlying causative gene, there has been a major breakthrough in terms of its treatment by pharmacological IL-1β inhibition. Highly targeted therapies against IL-1 have been shown to be remarkably effective in the treatment of CAPS and make early diagnosis of this condition crucial. It is hoped that starting pharmacological intervention in a timely manner will prove neuroprotective. There are three drugs licensed for treatment of CAPS; canakinumab, anakinra and rilonacept. The former two are widely used: canakinumab is a fully humanised anti-IL-1β monoclonal antibody administered as a subcutaneous injection once every 8 weeks starting at a dose of 150 mg in patients weighing more than 40 kg. Anakinra is a recombinant form of the IL-1 receptor antagonist and the adult daily dose is 100 mg subcutaneously.

Summary

CAPS is a highly debilitating disorder characterised by unregulated IL-1β production driven by autosomal dominantly inherited mutations in the NLRP3 gene. Effective therapies targeted against IL-1 are now available and are vital to prevent long-term complications.



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Testicular morphology in hypogonadotropic hypogonadism after the abuse of anabolic steroids

Abstract

Hypogonadism in men results from the failure of the testes to produce physiological levels of testosterone and a normal number of spermatozoa due to a disruption of the hypothalamic-pituitary-testicular axis. An example of secondary hypogonadism as a result of anabolic steroid abuse is presented with the case report of a man who committed suicide after a history of aggressive behavior and physical abuse of his wife. The autopsy revealed shrunken testicles, with more than 30% of parenchymatous sclerosis, absent spermatogenesis, and very few Leydig cells detected only by immunohistochemistry. A low-specific immunochemical analysis revealed a very high level of total testosterone (serum 109.8 nmol/L; urine 81.2 nmol/L). A more accurate analysis confirmed an overdose of synthetic anabolic steroids. Doctors in different medical areas should be alerted to chronic abusers of synthetic anabolic steroids among the growing number of recreational athletes.



https://ift.tt/2N98aGT

Pityriasis Lichenoides et Varioliformis Acuta Associated With Human Herpesvirus 7

M. Costa-Silva, A. Calistru, J. Sobrinho-Simões, C. Lisboa, F. Azevedo
Actas Dermosifiliogr.2018;109:e6-e10

Abstract - Full text - PDF

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Management of Moderate to Severe Psoriasis in Routine Clinical Practice in Spanish Hospitals

J.L. López-Estebaranz, P. de la Cueva-Dobao, C. de la Torre Fraga, M. Galán Gutiérrez, E. González Guerra, J. Mollet Sánchez, I. Belinchón Romero
Actas Dermosifiliogr.2018;109:631-42

Abstract - Full text - PDF

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The First Year of the AEVD Primary Cutaneous Lymphoma Registry

Y. Peñate, O. Servitje, S. Machan, R. Fernández-de-Misa, M.T. Estrach, E. Acebo, J. Mitxelena, M.D. Ramón, A. Flórez, M. Blanes, M. Morillo, S. Medina, J. Bassas, A. Zayas, P. Espinosa, A. Pérez, N. Gónzalez-Romero, J.D. Domínguez, C. Muniesa, J. López Robles, A. Combalia, I. Yanguas, H. Suh, I. Polo-Rodríguez, I. Bielsa, A. Mateu, B. Ferrer, M.A. Descalzo, I. García-Doval, P.L. Ortiz-Romero
Actas Dermosifiliogr.2018;109:610-6

Abstract - Full text - PDF

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Agminated Dermal Melanocytosis in the Territory of Ota's Nevus

L. Diluvio, M. Mazzeo, L. Bianchi, E. Campione
Actas Dermosifiliogr.2018;109:653-5

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Biologic Therapy as a First-Line Treatment in Patients with Psoriasis: An Unstudied Population

O. Baniandrés Rodríguez
Actas Dermosifiliogr.2018;109:579

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Teledermatology Implementation: The Importance of a Clear Objective

I. García-Doval
Actas Dermosifiliogr.2018;109:580

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Role of Color Doppler Ultrasound in the Diagnosis of Idiopathic Facial Aseptic Granuloma

X. Wortsman
Actas Dermosifiliogr.2018;109:581

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Ertapenem for the treatment of Hidradenitis suppurativa: how much do we need it?

P. Mendes-Bastos, A. Martorell, S. Magina
Actas Dermosifiliogr.2018;109:582-3

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Prevention and treatment of tuberculosis infection in candidates for biologic therapy: A multidisciplinary consensus statement adapted to the dermatology patient

P. Rodríguez-Jiménez, I. Mir-Viladrich, P. Chicharro, G. Solano-López, F.J. López-Longo, C. Taxonera, P. Sánchez-Martínez, X. Martínez-Lacasa, M. García-Gasalla, J. Dorca, M. Arias-Guillén, J.M. García-García, E. Dauden
Actas Dermosifiliogr.2018;109:584-601

Abstract - Full text - PDF

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Allergic Contact Dermatitis Due to Paraphenylenediamine: An Update

B. Encabo Durán, D. Romero-Pérez, J.F. Silvestre Salvador
Actas Dermosifiliogr.2018;109:602-9

Abstract - Full text - PDF

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Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016

G. Carretero Hernández, C. Ferrándiz, R. Rivera Díaz, E. Daudén Tello, P. de la Cueva-Dobao, F.J. Gómez-García, E. Herrera-Ceballos, I. Belinchón Romero, J.L. López-Estebaranz, M. Alsina Gibert, J.L. Sánchez-Carazo, M. Ferrán Farrés, A. González Quesada, J.M. Carrascosa Carrillo, M. Llamas-Velasco, M.V. Mendiola Fernández, D. Ruiz Genao, C. Muñoz Santos, I. García-Doval, M.A. Descalzo
Actas Dermosifiliogr.2018;109:617-23

Abstract - Full text - PDF

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Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014

G. Romero, D. de Argila, L. Ferrandiz, M.P. Sánchez, S. Vañó, R. Taberner, P. Pasquali, C. de la Torre, F. Alfageme, J. Malvehy, D. Moreno-Ramírez
Actas Dermosifiliogr.2018;109:624-30

Abstract - Full text - PDF

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Idiopathic Facial Aseptic Granuloma: Clinical and Ultrasound Findings in 3 Cases

A.I. Rodríguez-Bandera, M. Feito-Rodríguez, R. Maseda-Pedrero, R. de Lucas-Laguna
Actas Dermosifiliogr.2018;109:e1-5

Abstract - Full text - PDF

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Ulcerated Penile Lesion

E.R. Martínez Lorenzo, B. Moreno Torres, A.I. Sánchez Moya
Actas Dermosifiliogr.2018;109:643-4

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Máculas evanescentes en tronco y extremidades

M.Á. Flores-Terry, M. Franco-Muñóz, J.A. Garrido-Martín, N. Villasanti-Rivas
Actas Dermosifiliogr.2018;109:645-6

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Tumor Collision Over Sebaceous Nevus: Clues for Dermoscopic Diagnosis

A. Lobato-Berezo, P. Aguilera-Peiró, R.M. Pujol
Actas Dermosifiliogr.2018;109:647-8

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Quality of Life in Nonmelanoma Skin Cancer

P. García-Montero, M.V. de Gálvez-Aranda, M. de Troya Martín
Actas Dermosifiliogr.2018;109:649-50

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Rare Tongue Compromising of Mucocutaneous Leishmaniasis by Leishmania Subgenus Viannia

R. Bueno-Filho, S. Vernal, C.M. Gomes, A.M. Roselino
Actas Dermosifiliogr.2018;109:651

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Cervical Cellulitis of Odontogenic Origin

P. García-Montero, G. González-Pérez, N. Blázquez-Sánchez
Actas Dermosifiliogr.2018;109:652

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https://ift.tt/2NFck6t

Enfermedad de Rosai-Dorfman cutánea: una nueva presentación clínica

J.M. Conde, A.Y. Kim, R. de Miguel, C.H. Nousari
Actas Dermosifiliogr.2018;109:655-7

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Survival trends among non‐small‐cell lung cancer patients over a decade: impact of initial therapy at academic centers

Cancer Medicine, EarlyView.


https://ift.tt/2CdxR57

Patient choice for high‐volume center radiation impacts head and neck cancer outcome

Cancer Medicine, EarlyView.


https://ift.tt/2wyIslS

Trends and patterns of incidence of diffuse glioma in adults in the United States, 1973‐2014

Cancer Medicine, EarlyView.


https://ift.tt/2LTXOGa

The Role of BPIFA1 in Upper Airway Microbial Infections and Correlated Diseases

The mucosa is part of the first line of immune defense against pathogen exposure in humans and prevents viral and bacterial infection of the soft palate, lungs, uvula, and nasal cavity that comprise the ear-nose-throat (ENT) region. Bactericidal/permeability-increasing fold containing family A, member 1 (BPIFA1) is a secretory protein found in human upper aerodigestive tract mucosa. This innate material is secreted in mucosal fluid or found in submucosal tissue in the human soft palate, lung, uvula, and nasal cavity. BPIFA1 is a critical component of the innate immune response that prevents upper airway diseases. This review will provide a brief introduction of the roles of BPIFA1 in the upper airway (with a focus on the nasal cavity, sinus, and middle ear), specifically its history, identification, distribution in various human tissues, function, and diagnostic value in various upper airway infectious diseases.

https://ift.tt/2ozmNW2

A New Tridimensional Insight into Geometric and Kinematic Characteristics of Masticatory Cycles in Participants with Normal Occlusion

The aim of this study was to analyze the general, geometric, and kinematic characteristics of the masticatory cycle's movements in a tridimensional way, using a method developed by our study group to provide a new insight into the analysis of mandibular movements due to advancement in the potential of computational analysis. Ten individuals (20.1 ± 2.69 years), molar class I, without mandibular movement problems participated in this study. The movements of the masticatory cycles, frontal and sagittal mandibular border movements, were recorded using 3D electromagnetic articulography and processed with computational scripts developed by our research group. The number of chewing cycles, frequency (cycles/s), chewing cycle areas/mandibular border movements areas ratios, and the mouth opening and closing speeds on the 3D trajectory of the chewing cycle were compared. The cycles were divided and analyzed in thirds. The masticatory cycles showed high variation among the individuals (21.6 ± 9.4 cycles); the frequency (1.46 ± 0.21 cycles/s) revealed a moderate positive correlation (R = 0.52) with the number of cycles. The frontal area ratios between the cycle area and the mandibular border movement presented higher values in the first third (6.65%) of the masticatory cycles, and the ratios of sagittal areas were higher and more variable (first, 7.67%; second, 8.06%; and third, 10.04%) than the frontal view. The opening and closing mouth speeds were greater in the second third of the masticatory cycles (OS, 57.82 mm/s; CS, 58.34 mm/s) without a significant difference between the opening and closing movements when the same thirds were evaluated. Further studies are necessary to improve the understanding of the masticatory cycles regarding the standardization of parameters and their values.

https://ift.tt/2NJHKZA

MRI Findings of Early Myositis Ossificans without Calcification or Ossification

Purpose. To characterize and evaluate the MR imaging features of early myositis ossificans (MO) without calcification or ossification. Methods. The MRI manifestations of seven patients with pathologically proven early MO were retrospectively analyzed with regard to tumor location, size, margins, signal intensity, and enhancement appearance in MR images. Additionally, the surrounding soft-tissue edema and adjacent bone change were assessed. Results. All cases (n=7) had intramuscular tumor-like masses without calcifications. The lesions appeared as isointense in T1-weighted images (T1-WI) and inhomogeneous hyperintense in T2-weighted MR images (T2-WI). On T2-WI and postcontrast T1-WI, the heterogeneously high signal intensity in the expanded muscle interspersed with a few hypointense linear structures consistent with intact muscle fibers showed "striate pattern" in the plane parallel with muscle fibers. The relatively hypointense areas with geometrical pattern consistent with the bundles of intact muscle fibers are found within the lesion with diffuse high signal intensity, displaying the "checkerboard-like pattern" in the plane vertical to muscle fibers. A "striate pattern" (n = 7) and "checkerboard-like pattern" (n = 3) in the lesion appeared in T2-WI. In contrast-enhanced MRI images, all cases showed diffuse "striate pattern" enhancement. Among them, one case demonstrated "checkerboard-like pattern" enhancement. All cases had diffuse and prominent muscle edema that preserved the muscle fascicles. For two lesions located in the deep muscle group, the adjacent bone showed bone marrow edema. Conclusion. MR imaging has unique advantages for diagnosis of early MO without calcification or ossification: the "striate pattern" and "checkerboard-like pattern" appearance shown in T2-WI and contrast-enhanced MRI images can be helpful for differential diagnosis. MRI can delineate the extent of the tumor and provides accurate anatomical information, which is important in diagnosis, treatment, and follow-up.

https://ift.tt/2Nddqcw

A Wilms’ Tumor with Spinal Cord Compression: An Extrarenal Origin?

Spinal cord compression in Wilms' tumor (WT) is an extremely rare event that can have a very poor prognosis if not taken care of rapidly. Most cases reported in the literature involve widely metastatic patient with bone or paraspinal metastases or occasionally intradural metastasis. Here, we present the case of a 3-year-old girl of WT confirmed by biopsy, with spinal cord compression due to the direct contiguous spread of a tumor through 2 vertebral foramina. Abdominal ultrasonography and magnetic resonance imaging performed for an abdominal mass revealed a large heterogeneous tumor near the upper pole of the left kidney. A nodular infiltration extended through the T11-L1 and L1-L2 neural foramina, forming an intraspinal mass that compressed the spinal cord. Major paresthesia subsequently occurred, requiring urgent treatment with corticosteroids and chemotherapy. The evolution was rapidly satisfying. After six courses of chemotherapy, a left nephrectomy was performed. Macroscopic examination identified a large tumor attached to the kidney without renal infiltration. Microscopical examination concluded to a nephroblastoma with regressive changes, of intermediate risk. Evolution at 6 months is satisfactory, with no neurological deficit. The histological aspect of the tumor and the clinical outcome suggest that she had an extrarenal WT that spread through the vertebral foramina and was secondarily attached to the kidney.

https://ift.tt/2PA5pfB

Fournier's gangrene: not as lethal as previously thought? A case series

ANZ Journal of Surgery, EarlyView.


https://ift.tt/2Q10NzM

Aqueous Extract of Semen Ziziphi Spinosae Exerts Anxiolytic Effects during Nicotine Withdrawal via Improvement of Amygdaloid CRF/CRF1R Signaling

Anxiety during nicotine withdrawal (NicW) is a key risk factor for smoking relapse. Semen Ziziphi Spinosae (SZS), which is a prototypical hypnotic-sedative herb in Oriental medicine, has been clinically used to treat insomnia and general anxiety disorders for thousands of years. Thus, the present study evaluated the effects of the aqueous extract of SZS (AESZS) on NicW-induced anxiety in male rats that received subcutaneous administrations of nicotine (Nic) (0.4 mg/kg, twice a day) for 7 d followed by 4 d of withdrawal. During NicW, the rats received four intragastric treatments of AESZS (60 mg/kg/d or 180 mg/kg/d). AESZS dose-dependently attenuated NicW-induced anxiety-like behaviors in the elevated plus maze (EPM) tests and 180 mg/kg/d AESZS inhibited NicW-induced increases in plasma corticosterone. Additionally, the protein and mRNA expressions of corticotropin-releasing factor (CRF) and CRF type 1 receptor (CRF1R) increased in the central nucleus of the amygdala (CeA) during NicW, but these changes were suppressed by 180 mg/kg/d AESZS. A post-AESZS infusion of CRF into the CeA abolished the attenuation of anxiety by AESZS and 180 mg/kg/d AESZS suppressed NicW-induced increases in norepinephrine and 3-methoxy-4-hydroxy-phenylglycol levels in the CeA. The present results suggest that AESZS ameliorated NicW-induced anxiety via improvements in CRF/CRF1R and noradrenergic signaling in the CeA.

https://ift.tt/2LRFUnz

A Case of Invasive Gastrointestinal Mycotypha Infection in a Patient with Neutropenia

Gastrointestinal mucormycosis is a rare life-threatening infection to which neutropenic patients are especially vulnerable. Mycotypha microspora is a mucormycete that has not been described as a human pathogen. We discuss the successful eradication of gastrointestinal Mycotypha microspora in a neutropenic patient with simultaneous pulmonary Aspergillus fumigatus infection.

https://ift.tt/2PuhcMm

Finite element modeling of near‐wall mass transport in cardiovascular flows

International Journal for Numerical Methods in Biomedical Engineering, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Pu7PMp

Highlighting Discrepancies in Walking Prediction Accuracy for Patients with Traumatic Spinal Cord Injury: an Evaluation of Validated Prediction Models using a Canadian Multi-centre Spinal Cord Injury Registry

Publication date: Available online 1 September 2018

Source: The Spine Journal

Author(s): Philippe Phan, Brandon Budhram, Qiong Zhang, Carly Rivers, Vanessa K. Noonan, Tova Plashkes, Eugene K. Wai, Jérôme Paquet, Darren M. Roffey, Eve Tsai, Nader Fallah, The RHSCIR Network

ABSTRACT
Background Context

Models for predicting recovery in traumatic spinal cord injury (tSCI) patients have been developed to optimize care. Several models predicting tSCI recovery have been previously validated, yet recent findings question their accuracy, particularly in patients whose prognoses are the least predictable.

Purpose

To compare independent ambulatory outcomes in AIS (ASIA [American Spinal Injury Association] Impairment Scale) A, B, C, and D patients, as well as in AIS B+C and AIS A+D patients by applying two existing logistic regression prediction models.

Study Design

Prospective cohort study.

Participant Sample

Individuals with tSCI enrolled in the pan-Canadian Rick Hansen SCI Registry (RHSCIR) between 2004-2016with complete neurologic examination and Functional Independence Measure (FIM) outcome data.

Outcome Measures

The FIM locomotor score was used to assess independent walking ability at 1-year follow-up.

Methods

Two validated prediction models were evaluated for their ability to predict walking one-year post-injury. Relative prognostic performance was compared with the area under the receiver operating curve (AUC). This study and the RHSCIR are supported by funding from Health Canada, Western Economic Diversification Canada, and the Governments of Alberta, British Columbia, Manitoba, and Ontario. The funders had no role in the study or study reporting.

Results

In total, 675 tSCI patients were identified for analysis. In model 1, predictive accuracies for 675 AIS A, B, C, and D patients as measured by AUC were 0.730 (95% CI: 0.622-0.838), 0.691 (0.533-0.849), 0.850 (0.771-0.928) and 0.516 (0.320-0.711) respectively. In 160 AIS B+C patients, model 1 generated an AUC of 0.833 (95% CI 0.771–0.895), while model 2 generated an AUC of 0.821 (95% CI 0.754-0.887). The AUC for 515 AIS A+D patients was 0.954 (95% CI 0.933-0.975) with model 1 and 0.950 (0.928-0.971) with model 2. The difference in prediction accuracy between the AIS B+C cohort and the AIS A+D cohort was statistically significant using both models (p=0.00034;p=0.00038).The models were not statistically different in individual or subgroup analyses.

Conclusions

Previously tested prediction models demonstrated lower predictive accuracy for AIS B+C and AIS A+D patients. These models were unable to effectively prognosticate AIS A+D patients separately; a failure that was masked when amalgamating the two patient populations. This suggests that former prediction models achieved strong prognostic accuracy by combining AIS classifications coupled with a disproportionately high proportion of AIS A+D patients.



https://ift.tt/2oy3e0t

CYP3A4‐mediated effects of rifampicin on the pharmacokinetics of vilaprisan and its UGT1A1‐mediated effects on bilirubin glucuronidation in humans

British Journal of Clinical Pharmacology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2C66I3M

Effect of multiple‐dose osimertinib on the pharmacokinetics of simvastatin and rosuvastatin

British Journal of Clinical Pharmacology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2PZnWTx

Evaluation of postoperative pain intensity following occlusal reduction in teeth associated with symptomatic irreversible pulpitis and symptomatic apical periodontitis: a randomized clinical study

International Endodontic Journal, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N7vN2G

European Society of Endodontology Position Statement: External Cervical Resorption

International Endodontic Journal, Volume 0, Issue ja, -Not available-.


https://ift.tt/2NIzrgj

Cover Image

Chemical Biology &Drug Design, Volume 92, Issue 3, Page i-i, September 2018.


https://ift.tt/2wBgTYX

Issue Information

Chemical Biology &Drug Design, Volume 92, Issue 3, Page 1581-1584, September 2018.


https://ift.tt/2NG4w4n

Corrigendum

Chemical Biology &Drug Design, Volume 92, Issue 3, Page 1717-1717, September 2018.


https://ift.tt/2N7dQkM

Corrigendum

Chemical Biology &Drug Design, Volume 92, Issue 3, Page 1718-1718, September 2018.


https://ift.tt/2LOPpDO

COMBAT VASCULAR INJURY: INFLUENCE OF MECHANISM OF INJURY ON OUTCOME

Publication date: Available online 1 September 2018

Source: Injury

Author(s): A.E. Sharrock, K.N. Remick, M.J. Midwinter, R.F. Rickard

Abstract
Background

Haemorrhage is the leading cause of death on the battlefield. Seventy percent of injuries are due to explosive mechanisms. Anecdotally, these patients have had poorer outcomes when compared to those with penetrating mechanisms of injury (MOI). We wished to test the hypothesis that outcomes following vascular reconstruction were worse in blast-injured than non blast-injured patients.

Methods

Retrospective cohort study. British and American combat casualties with arterial injuries sustained in Iraq or Afghanistan (2003-2014) were identified from the UK Joint Theatre Trauma Registry (JTTR). Eligibility included explosive or penetrating MOI, with follow-up to UK hospital discharge, or death. Outcomes were mortality, amputation, graft thrombosis, haemorrhage, and infection. Statistical analysis was performed using Pearson Chi-Square test, t-tests, ANOVA or non-parametric equivalent, and survival analyses.

Results

One hundred and fifteen patients were included, 80 injured by explosive and 35 by penetrating mechanisms. Evacuation time, ISS, number of arterial injuries, age and gender were comparable between groups. Seventy percent of arterial injuries resulted from an explosive MOI. The explosive injuries group received more blood products (p = 0.008) and suffered more regions injured (p < 0.0001). Early surgical interventions in both were ligation (n = 36, 31%), vein graft (n = 33, 29%) and shunting (n = 9, 8%). Mortality (n = 12, 10%) was similar between groups. Differences in limb salvage rates following explosive (n = 17, 53%)vs penetrating (n = 13, 76.47%) mechanisms approached statistical significance (p = 0.056). Nine (28%) vein grafted patients developed complications. No evidence of a difference in the incidence of vein graft thrombosis was found when comparing explosive with non-explosive cohorts (p = 0.154).

Conclusions

The recorded numbers of vein grafts following combat arterial trauma in are small in the JTTR. No statistically-significant differences in complications, including vein graft thrombosis, were found between cohorts injured by explosive and non-explosive mechanisms.



https://ift.tt/2LNOQdI

Sentinel Amenable Mortality: A New Way to Assess the Quality of Healthcare by Examining Causes of Premature Death for Which Highly Efficacious Medical Interventions Are Available

Background. Amenable mortality, or premature deaths that could be prevented with medical care, is a proven indicator for assessing healthcare quality when adapted to a country or region's specific healthcare context. This concept is currently used to evaluate the performance of national and international healthcare systems. However, the levels of efficacy and effectiveness determined using this indicator can vary greatly depending on the causes of death that are included. We introduce a new approach by identifying a subgroup of causes for which there are available treatments with a high level of efficacy. These causes should be considered sentinel events to help identify limitations in the effectiveness and quality of health provision. Methods. We conducted an extensive literature review using a list of amenable causes of death compiled by Spanish researchers. We complemented this approach by assessing the time trends of amenable mortality in two high-income countries that have a similar quality of healthcare but very different systems of provision, namely, Spain and the United States. This enabled us to identify different levels of efficacy of medical interventions (high, medium, and low). We consulted a group of medical experts and combined this information to help make the final classification of sentinel amenable causes of death. Results. Sentinel amenable mortality includes causes such as surgical conditions, thyroid diseases, and asthma. The remaining amenable causes of death either have a higher complexity in terms of the disease or need more effective medical interventions or preventative measures to guarantee early detection and adherence to treatment. These included cardiovascular diseases, diabetes, hypertension, all amenable cancers, and some infectious diseases such as pneumonia, influenza, and tuberculosis. Conclusions. Sentinel amenable mortality could act as a good sentinel indicator to identify major deficiencies in healthcare quality and provision and detect inequalities across populations.

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Effects of Kudiezi Injection on Serum Inflammatory Biomarkers in Patients with Acute Cerebral Infarction

Background. Kudiezi injection is a traditional Chinese medicine for acute cerebral infarction, but the exact mechanisms are poorly understood. Objective. To investigate the mechanisms of Kudiezi injection on the inflammatory response in the treatment of acute cerebral infarction. Methods. This was a prospective study of patients with acute cerebral infarction within 48 h of onset and treated between July 2012 and July 2016 at three hospitals in China. The patients were randomized to routine treatments (control group) versus routine treatments and Kudiezi injection (Kudiezi group). The National Institutes of Health Stroke Score was assessed on days 1, 3, 5, 7, and 14. The patients were tested for serum levels of pro- and anti-inflammatory cytokines (S100 calcium-binding protein B, neuron-specific enolase, interleukin-6, interleukin-10, interleukin-18, and matrix metaloproteinase-9; by enzyme-linked immunosorbent assay) immediately after admission and on days 3, 5, and 14. Results. Stroke scores were improved in both groups from days 1 to 14. On days 5 and 7, stroke scores in the Kudiezi group were lower than in the control group (). Compared with controls, the Kudiezi group had lower serum S100 calcium-binding protein B on day 14; higher interleukin-6 and interleukin-10 on day 3; lower interleukin-6 and interleukin-18 on day 5; and lower interleukin-18 and matrix metaloproteinase-9 on day 14. Conclusion. Kudiezi injection could lead to early reduction of interleukin-6, interleukin-18, matrix metaloproteinase-9, neuron-specific enolase, and S100 calcium-binding protein B levels and increases of interleukin-10 levels in patients with acute ischemic stroke. This trial is registered with ClinicalTrials.gov NCT01636154.

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Proposal for the creation of an international day of tribute to body donors

Clinical Anatomy, Volume 0, Issue ja, -Not available-.


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Analysis of Gender-based Differences in Surgery Faculty Compensation, Promotion, and Retention: Establishing Equity

imageObjectives: The objectives of this study were to evaluate gender-based differences in faculty salaries before and after implementation of a university-wide objective compensation plan, Faculty First (FF), in alignment with Association of American Medical Colleges regional median salary (AAMC-WRMS). Gender-based differences in promotion and retention were also assessed. Summary Background Data: Previous studies demonstrate that female faculty within surgery are compensated less than male counterparts are and have decreased representation in higher academic ranks and leadership positions. Methods: At a single institution, surgery faculty salaries and work relative value units (wRVUs) were reviewed from 2009 to 2017, and time to promotion and retention were reviewed from 1998 to 2007. In 2015, FF supplanted specialty-specific compensation plans. Salaries and wRVUs relative to AAMC-WRMS, time to promotion, and retention were compared between genders. Results: Female faculty (N = 24) were compensated significantly less than males were (N = 62) before FF (P = 0.004). Female faculty compensation significantly increased after FF (P

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New Contributions to Asarum Powder on Immunology Related Toxicity Effects in Lung

Objective. Asarum is widely used in clinical practice of Chinese medicine in the treatment of respiratory diseases. Many toxic ingredients (safrole, etc.) had been found in Asarum that show multiple visceral toxicities. In this study, we performed systematic investigation of expression profiles of genes to take a new insight into unclear mechanism of Asarum toxicities in lung. Methods. mRNAs were extracted from lungs of rats after intragastric administration with/without Asarum powders, and microarray assays were applied to investigate gene expression profiles. Differentially expressed genes with significance were selected to carry out GO analysis. Subsequently, quantitative PCRs were performed to verify the differential expression of Tmprss6, Prkag3, Nptx2, Antxr11, Klk11, Rag2, Olr77, Cd7, Il20, LOC69, C6, Ccl20, LOC68, and Cd163 in lung. Changes of Ampk, Bcl2, Caspase 3, Il1, Il20, Matriptase2, Nfκb, Nptx2, and Rag2 in the lung on protein level were verified by western blotting and immunohistochemistry. Results. Compared with control group, the estimated organ coefficients were relatively increased in Asarum group. Results of GO analysis showed that a group of immune related genes in lung were expressed abnormally. The result of PCRs showed that Ccl20 was downregulated rather than other upregulated genes in the Asarum group. Western blotting and immunohistochemistry images showed that Asarum can upregulate the expression of Ampk, Caspase 3, Il1, Il20, Matriptase2, Nfκb, and Rag2 and downregulate the expression of Bcl2 in lung. Conclusion. Our data suggest that expressions of immune related genes in lung were selectively altered by Asarum. Therefore, inflammatory response was active, by regulating Caspase 3, Il1, Il20, Matriptase2, Nfκb, Rag2, Tmprss6, Prkag3, Nptx2, Antxr1, Klk11, Olr77, Cd7, LOC69, C6, LOC68, Cd163, Ampk, Bcl2, and Ccl20. Our study indicated that inflammatory factors take effect in lung toxicity caused by Asarum, which provides a new insight into molecular mechanism of Asarum toxicities in lung.

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