Gram-negative vertebral osteomyelitis infections are increasing due to rising intravenous drug use but overall remain uncommon. Here, we present a case of Burkholderia cepacia complex cervical osteomyelitis in an intravenous drug user. Burkholderia cepaciacomplex vertebral osteomyelitis has been infrequently described in the literature thus far with varied antibiotic treatment regimens. A 68-year-old male presented to the emergency department with neck pain after minor trauma. He endorsed active intravenous heroin and methamphetamine use. CT and MRI imaging of the cervical spine revealed destructive changes of C5-C6 vertebral bodies consistent with osteomyelitis. Neurological exam was stable and vital signs were within normal limits; so, antibiotics were held, and he was admitted for diagnostic evaluation. Five sets of blood cultures were drawn on admission and were ultimately negative. He subsequently underwent C5-C6 corpectomy, C4-C7 anterior fusion, and C3-T1 posterior fusion with allograft placement. Deep operative tissue cultures grew Burkholderia cepacia complex. He was treated with 6 weeks of intravenous ceftazidime followed by indefinite oral minocycline due to hardware placement. Burkholderia cepacia complex should be considered among pathogenic etiologies of pyogenic vertebral osteomyelitis, particularly among patients with intravenous drug use. Ceftazidime monotherapy was an effective treatment in this particular case.
https://ift.tt/2NXv1lW
Σάββατο 8 Σεπτεμβρίου 2018
Burkholderia cepacia complex Cervical Osteomyelitis in an Intravenous Drug User
A Risk Stratification Model for Cardiovascular Complications during the 3-Month Period after Major Elective Vascular Surgery
Introduction. The Revised Cardiac Risk Index (RCRI) is an extensively used simple risk stratification tool advocated by the European Society of Cardiology and European Society of Anesthesiology (ESC/ESA). Purpose. The aim of this study was to find the best model for predicting 3-month cardiovascular complications in elective major vascular surgical patients using preoperative clinical assessment, calculation of the RCRI and Vascular Physiological and Operative Severity Score for the enumeration of mortality and morbidity (V-POSSUM) scores, and the preoperative levels of N-terminal brain natriuretic peptide (NT pro-BNP), high-sensitivity troponin I (hs TnI), and high-sensitivity C-reactive protein (hs CRP). Materials and Methods. We included 122 participants in a prospective, single-center, observational study. The levels of NT pro-BNP, hs CRP, and hs TnI were measured 48 hours prior to surgery. During the perioperative period and 90 days after surgery the following adverse cardiac events were recorded: myocardial infarction, arrhythmias, pulmonary edema, acute decompensated heart failure, and cardiac arrest. Results. During the first 3 months after surgery 29 participants (23.8%) had 50 cardiac complications. There was a statistically significant difference in the RCRI score between participants with and without cardiac complications. ROC analysis showed that a combination of RCRI with hs TnI has good discriminatory power (AUC 0.909, p
https://ift.tt/2wRXaEw
Ocular torsion responses to electrical vestibular stimulation in Vestibular Schwannoma
Electrical Vestibular Stimulation (EVS) is a simple method for activating the vestibular nerve by directly applying cutaneous currents over the mastoid processes (Fitzpatrick et al., 2004). The resulting change in vestibular afferent firing rate produces a sensation of head roll (Reynolds et al., 2012). This, in turn, evokes a variety of motor outputs including sway (Lund et al., 1983) and orienting responses (Fitzpatrick et al., 2006). EVS also activates the vestibular-ocular reflex. The evoked eye movement is primarily torsional, with minimal lateral or vertical component (Schneider et al., 2002, Jahn et al., 2003a, Jahn et al., 2003b, Severac Cauquil et al., 2003, MacDougall et al., 2005, Mackenzie and Reynolds, 2018b).
https://ift.tt/2wXQGny
Prospective Immunophenotyping of CD8+ T-cells and Associated Clinical Outcomes of Patients with Oligometastatic Prostate Cancer Treated with Metastasis-Directed SBRT
It is unknown how changes in the Tumor-Reactive T-cell subpopulation (CD8+PD-1+CD11ahigh) correlate with clinical outcomes after metastasis-directed stereotactic body radiation therapy (mdSBRT) for patients with recurrent oligometastatic prostate cancer (OPCa). In this prospective trial of 37 patients with OPCa treated with mdSBRT, an increase in the Tumor-Reactive T-cell subpopulation after mdSBRT was protective against the risk of disease progression. These data have clinical implications for combining mdSBRT with anti-PD-1 therapy and/or adoptive cell transfer procedures.
https://ift.tt/2MayTP1
Influence of total body irradiation dose rate on idiopathic pneumonia syndrome in acute leukemia patients undergoing allogeneic hematopoietic cell transplantation
Idiopathic pneumonia syndrome (IPS) is a major cause of significant morbidity and mortality during allogeneic hematopoietic cell transplantation (HCT). Total body irradiation (TBI) dose rates have been implicated in the development of IPS, however there is no consensus regarding optimal dose rate. This single institution study includes 202 acute leukemia patients treated on a standard TBI-based myeloablative conditioning regimen for allogeneic HCT. Dose rates of >15 cGy/min were strongly associated with IPS.
https://ift.tt/2MYlNti
Is the Liberal Use of Oxygen Associated With Worse Outcomes Among Critically Ill Patients?
The search strategy identified 1,784 total records, of which 25 studies (16,037 patients) met the inclusion criteria. Studies included 3 trials of oxygen in critical illness, 1 trauma study, 2 sepsis studies, 7 stroke studies, 6 myocardial infarction studies, 2 cardiac arrest studies, and 4 emergency surgery studies. Twelve of 25 trials excluded patients with hypoxemia at baseline, whereas the remainder excluded only those with severe baseline hypoxemia (PaO2 to FiO2 ratio <100). Median follow-up duration was 3 months, with a range of 14 days to 12 months.
https://ift.tt/2wV4Chm
Synchronous pancreatic tumors in a patient with history of Wilms tumor: A case of pancreatic adenocarcinoma and lipid‐rich neuroendocrine tumor diagnosed by cytopathology
Diagnostic Cytopathology, EarlyView.
https://ift.tt/2wTTktW
Biomechanical Evaluation of Lumbar Lateral Interbody Fusion for the Treatment of Adjacent Segment Disease
Publication date: Available online 7 September 2018
Source: The Spine Journal
Author(s): Mark Shasti, Scott J. Koenig, Alysa B. Nash, Shahrzad Bahrami, Julio J. Jauregui, Nathan N. O'Hara, Ehsan Jazini, Daniel E. Gelb, Steven C. Ludwig
ABSTRACT
BACKGROUND CONTEXT
Adjacent segment disease (ASD) is a well-known complication after lumbar fusion. Lumbar lateral interbody fusion (LLIF) may provide an alternative method of treatment for ASD while avoiding the morbidity associated with revision surgery through a traditional posterior approach. This is the first biomechanical study to evaluate the stability of lateral-based constructs for treating ASD in existing multilevel fusion model.
PURPOSE
We aimed to evaluate the biomechanical stability of anterior column reconstruction through the less invasive lateral-based interbody techniques compared to traditional posterior spinal fusion for the treatment of ASD in existing multilevel fusion.
STUDY DESIGN/SETTING
Cadaveric biomechanical study of laterally based interbody strategies for treating ASD.
METHODS
Eighteen fresh-frozen cadaveric specimens were non-destructively loaded in flexion, extension, and lateral bending. The specimens were randomized into three different groups according to planned posterior spinal instrumented-fusion (PSF): Group 1: L5-S1, Group 2: L4-S1, Group 3: L3- S1. In each group, ASD was considered the level cranial to the upper-instrumented vertebrae (UIV). After testing the intact spine, each specimen underwent PSF representing prior fusion in the ASD model. The adjacent segment for each specimen then underwent a) Stand-alone LLIF, b) LLIF + plate, c) LLIF + single screw-rod (SSR) anterior instrumentation, d) LLIF + traditional posterior extension of PSF. In all conditions, three-dimensional kinematics were tracked, and range of motion (ROM) was calculated for the comparisons.
RESULTS
ROM results were expressed as a percentage of the intact spine ROM. LLIF effectively reduces ROM in all planes of ROM. Supplementation of LLIF with plate or SSR provides further stability as compared to stand alone LLIF. Expansion of posterior instrumentation provides the most substantial stability in all planes of ROM (p<0.05). All constructs demonstrated a consistent trend of reduction in ROM between all the groups in all bending motions.
CONCLUSIONS
This biomechanical study suggests potential promise in exploring LLIF as an alternative treatment of ASD but reinforces previous studies' findings that traditional expansion of posterior instrumentation provides the most biomechanically stable construct.
https://ift.tt/2CBelzH
Molecular targeting of breast and colon cancer cells by PAR1 mediated apoptosis through a novel pro-apoptotic peptide
Abstract
A novel activating peptide was designed and synthesized from V. cholerae hemagglutinine protease (HAP) mediated cleavage site of mouse PAR1. The peptide "PFISED" interacts with PAR1 in a new site which is different from its thrombin mediated conventional activation site and induced a series of new downstream signaling pathways. The peptide showed apoptosis in human and mouse breast (MCF-7 and EAC) and colon (HT29 and CT26) cancer cells where as in the same peptide concentration in normal human breast epithelial cells (MCF-10A), normal human fibroblast cells (MRC-5), normal mouse peritoneal macrophage cells and normal mouse breast and colon tissues did not show any effect. Treatment with this peptide enhanced the survival kinetics of EAC induced mice. The peptide mediated apoptosis was inhibited in presence of PAR1 inhibitor and was significantly reduced in si-PAR1 treated cells that indicate the activating peptide "PFISED" induced PAR1 mediated apoptosis of colon and breast cancer cells. This peptide induced over expression and activation of PAR1 and its downstream MAP kinase and NFκB signaling pathways. These signaling pathways enhanced the cellular ROS level to kill malignant cells. We report a novel pro-apoptotic peptide which can selectively kill malignant cells via its specific target receptor PAR1 which is over expressed in the malignant cells and can be used as a molecular target therapy for cancer treatment.
https://ift.tt/2oR408M
Post-transplant CD4+ non-cytotoxic γδ T cell lymphoma with lymph node involvement
Abstract
Gamma delta T cells represent a minor subset of the normal lymphocyte component of the human immune system, largely inhabiting mucosal surfaces. Gamma delta T cell lymphomas (γδ TCLs) are thought to be derived from these cells and are rare, extremely aggressive lymphomas that typically exhibit a cytotoxic phenotype and often present in extranodal sites, most commonly as cutaneous or hepatosplenic subtypes. The immunophenotype usually lacks both CD4 and CD8 expression, but occasional cases express CD8. CD4 expression in γδ TCLs is exceedingly rare. The few reported cases tend to show a non-cytotoxic phenotype with preferential involvement of the lymph nodes. Cases showing cutaneous presentation or with an immunosuppressive clinical history, while relatively common among typical γδ TCLs, are even rarer among this unusual CD4+ subset. While this very small group appears to have an equally dismal prognosis to other types of γδ TCL, little else is known as to how they may differ biologically and whether they should be treated as a separate entity. We report a unique case of CD4-positive gamma delta T cell lymphoma with skin and systemic lymph node involvement in the post-transplant setting.
https://ift.tt/2oQIuB2
Epidemiology and incidence of tibia fractures in the Swedish Fracture Register
Publication date: Available online 7 September 2018
Source: Injury
Author(s): David Wennergren, Carl Bergdahl, Jan Ekelund, Hans Juto, Mikael Sundfeldt, Michael Möller
Abstract
Introduction
There is a lack of epidemiological studies of fractures in all segments of the tibia classified by orthopaedic surgeons according to the AO/OTA classification. Since 2011, the Swedish Fracture Register (SFR) has provided prospectively collected, population-based data on fractures of all types, treated both surgically and non-surgically. The aim of this study was to describe the epidemiology and incidence of fractures in all segments of the tibia in a cohort of consecutive tibia fractures over a period of five years at Sahlgrenska University Hospital, Gothenburg, Sweden.
Methods
Information on age, gender, date and mechanism of injury, fracture classification according to AO/OTA, affected side and high- or low-energy trauma was extracted from the SFR for all patients, aged 16 years and above, with tibia fractures treated at Sahlgrenska University Hospital, Gothenburg, during the five-year period 1 January 2011 to 31 December 2015.
Results
1,325 patients sustained 1,371 tibia fractures. There were 712 proximal tibia fractures, 417 tibial shaft fractures and 242 distal tibia fractures. Patients with proximal tibia fractures had a higher mean age (54.3) and 58% were women, whereas patients with shaft and distal fractures had a slightly lower mean age (47.0 and 48.7 respectively) and a dominance of men (59% and 54% respectively). The overall incidence of tibia fractures was 51.7 per 100,000 and year. The incidence of proximal, diaphyseal and distal tibia fractures was 26.9, 15.7 and 9.1 respectively per 100,000 and year. Among women, tibia fractures showed an increasing incidence with age in all segments, whereas men had a fairly flat incidence curve, except for tibial shaft fractures, which displayed a peak among young males. The incidence of tibia fractures and graphs for age-specific incidence for each segment of the tibia are presented.
Conclusions
This study describes the epidemiology and incidence of fractures in the whole of the tibia classified by orthopaedic surgeons according to the AO/OTA classification.
https://ift.tt/2McM8id
Long-term survival in a patient with pulmonary spindle cell carcinoma treated with traditional Chinese medicine
Spindle cell carcinoma (SCC) is a rare pulmonary malignancy, accounting for only 0.2%–0.3% of all lung cancers. Therefore, the prognosis and treatment of pulmonary SCC is unclear. There are only 13 reported cases in literature, only three of which had a survival of more than 11 months. Here we reported a long-term survival of a patient with pulmonary SCC who underwent treatment with traditional Chinese medicine. At the most recent follow-up in July 2018, her survival after diagnosis is 48 months and she continues to do well. To our knowledge, this is the longest survival of late stage SCC with the largest tumour burden.
https://ift.tt/2M9gSR4
Recurrent giant cell tumour of the maxillary sinus and pterygoid process treated with denosumab
We report the case of a 74-year-old man with a giant cell tumour (GCT) of the right maxilla and pterygoid process. The patient presented to the maxillofacial and head and neck surgery clinic with an ulcerated lesion of the hard palate. Initial workup with CT revealed a mass within the right maxillary sinus and pterygoid process with associated bone expansion and erosion. Biopsy showed a GCT with mucosal ulceration. Two years after surgical resection, a follow-up CT revealed tumour recurrence involving the right pterygoid process and lateral pterygoid muscle. The patient was then proposed for therapy with denosumab. Under denosumab treatment, the lesion maintained stable dimensions and became sclerotic and heavily ossified.
https://ift.tt/2MXpQ9e
Septicaemia in an adolescent presenting with potentially fatal CA MRSA osteomyelitis
Description
A 14-year-old boy, with no prior medical history, presented with tenderness on the right knee after minor trauma while playing football the previous day. On physical examination, there were minor inflammatory signs, with no penetrating wound and he was sent home.
Two days later, due to worsening symptoms, MRI of the lower limb was performed and revealed multiple tibial lytic lesions, intraosseous abscesses and diffuse soft tissue oedema (figure 1).
Figure 1
Lower limb MRI imaging revealed multiple serpiginous lytic lesions in the proximal tibial metaphyseal region suggesting intraosseous abscesses.
Surgical debridement was performed and flucloxacillin and amikacin were initiated. The following day, his clinical status deteriorated with septic shock and respiratory failure. He was admitted in the paediatric intensive care unit.
Preoperatory blood cultures identified a methicillin-resistant Staphylococcus aureus (MRSA) Panton-Valentine leucocidin (PVL) positive and antimicrobial therapy was...
https://ift.tt/2NZ7Ibz
Venous thromboembolism leading to diagnosis of de novo malignancy in an organ transplant recipient
We report the case of a patient with remote orthotopic liver transplant who was ultimately diagnosed with Merkel cell carcinoma following admission for initial venous thromboembolism. Additionally, we review pertinent literature related to the risk of skin cancer in solid organ transplant recipients and discuss the importance of yearly skin exams in this patient population.
https://ift.tt/2oRxEeg
Goitre, lymphoma and the doughnut sign
Description
A 65-year-old woman, with a known case of Hashimoto's thyroiditis on eltroxin for 15 years, presented with progressive diffuse swelling neck for 2 months. She also gave a history of difficulty in swallowing and breathing for 1 week. On examination, she had respiratory distress, low oxygen saturation (85% on pulse oximeter) and cyanosed tongue. Systemic examination was unremarkable except for goitre (grade 2) and stridor. As the saturation was not improving with supplemental oxygen, she underwent an emergency tracheostomy. Subsequently, a contrast-enhanced CT scan of the neck showed large lobulated heterogeneously enhancing lesion in the region of thyroid gland encasing all major structure of neck including trachea (figure 1). Core biopsy and immunohistochemistry (CD45, CD20, CD10 and BCL6 positive) confirmed the diagnosis as diffuse large B cell lymphoma (DLBCL). The patient received R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone). After 1 month, she was asymptomatic with >50% decreased swelling,...
https://ift.tt/2Mc1Tpr
Recurrent gallstone ileus in a patient with ileostomy successfully treated by removal of impacted gallstone via the stoma
A 75-year-old man with a permanent ileostomy presented with recurrent gallstone ileus that was treated successfully with removal of the stones via the stoma.
https://ift.tt/2oPtAuP
Neuromyelitis optica spectrum disorder presenting in an octogenarian
This case describes an 81-year-old woman with a history of Sjögren's syndrome presenting with recurrent falls and poor balance. She subsequently developed new and rapidly evolving neurology including hyperaesthesia, spastic paraplegia and sphincteric dysfunction. Following serial clinical reviews and detailed investigations, MRI (brainstem and cervicothoracic spine) and a seropositive result for aquaporin 4 IgG, a diagnosis of neuromyelitis optica spectrum disorder (NMOSD) was made. This case describes the clinical course of this index patient with an unusual late age of onset. The report also includes a discussion on NMOSD. We review aspects of terminology, brief epidemiology, pathogenesis, notable autoimmune associations, variance in clinical presentation and current diagnostic criteria. We also review the importance of distinguishing NMOSD from multiple sclerosis in view of the significant implications for treatment and prognosis.
https://ift.tt/2NZ7eSN
Effect of halo-type frontal cockpit protection on overtaking
In 2018, the Fédération Internationale de l'Automobile introduced the halo frontal cockpit protection system into Formula 1. While extensive testing was conducted to confirm that the halo protects the driver from contact, the halo's effect on the driver during overtaking was not tested prior to its introduction. Here, we describe the effect of a halo-type structure on the neck muscle activity of one of the authors, a national-level amateur racing driver, during on-track simulations designed to practise overtaking. We found that the halo-type structure caused an increase in the rates of fatigue and workloads of sternocleidomastoid and cervical erector spinae. The results suggest that the driver adopted a forward and right laterally flexed head position, presumably to clear the central pillar from his visible field. This has the potential to increase compressive loading of the cervical spine and affect the ability to use visual cues during steering manoeuvres.
https://ift.tt/2N0Tnir
Adjuvant conundrum in central mucoepidermoid carcinoma of the mandible: case presentation and literature review
The cornerstone modality of treatment of central mucoepidermoid carcinoma (CMEC) of the mandible is surgery, optimally, an en bloc resection with/without segmental or hemimandibulectomy. Notwithstanding the documentation of a survival benefit in few case reports with the addition of postoperative radiotherapy in carefully selected high-risk patients, there does not exist a clearly defined consensus regarding the role of adjuvant radiotherapy. We report the case of a 49-year-old man who presented with right lower jaw swelling which on imaging was found to be a multiloculated lesion causing bony expansion and cortical destruction of the mandible and was diagnosed with CMEC after radiological and histopathological criteria were met. He underwent right hemimandibulectomy and histopathology showed squamous and mucinous cells with positive mucicarmine staining and characteristic immunohistochemistry markers confirming the diagnosis of CMEC. He subsequently underwent adjuvant radiotherapy and is disease free 5 years since treatment completion.
https://ift.tt/2O08aGC
Neuroblastoma with flat genomic profile: a question of representativity?
Neuroblastoma is one of the most common paediatric malignancies. Detection of somatic genetic alterations in this tumour is instrumental for its risk stratification and treatment. On the other hand, an absence of detected chromosomal imbalances in neuroblastoma biopsies is difficult to interpret because it is unclear whether this situation truly reflects the tumour genome or if it is due to suboptimal sampling. We here present a neuroblastoma in the left adrenal of a newborn. The tumour was subjected to single-nucleotide polymorphism array analysis of five tumour regions with >80% tumour cells in histological mirror sections. This revealed no aberrations compared with a normal reference sample from the patient. Whole exome sequencing identified two single-nucleotide variants present in most tumour regions, corroborating that the tumour resulted from monoclonal expansion. Our data provide proof-of-principle that rare cases of neuroblastoma can have a normal whole genome copy number and allelic profile.
https://ift.tt/2oPfBoY
Unusual cause for small bowel obstruction
Description
Foreign body ingestion is a common occurrence. Although over 80% of ingestions resolve spontaneously, approximately 1% of cases will require open surgical intervention. We present a rare case of foreign body ingestion in an 18-year-old man causing distal mechanical small bowel obstruction, requiring exploratory laparotomy and enterotomy.
An 18-year-old man with no significant medical history and no previous abdominal operations presented to a regional hospital with a 5-day history of persistent nausea, vomiting, absolute constipation and generalised abdominal pain. On clinical examination, he was tachycardic (116 beats/min) with a low-grade temperature (37.8°C), and had abdominal distension with central abdominal guarding. Plain films showed dilated loops of small bowel, consistent with small bowel obstruction. White cell count was 7.5x109/L and C reactive protein was 74 mg/L.
Subsequent evaluation with a CT scan demonstrated appearance of small bowel obstruction with at least one transition point in the left lower abdomen, with...
https://ift.tt/2Ma0YFW
Universal, school-based interventions to promote mental and emotional well-being: what is being done in the UK and does it work? A systematic review
Objectives
The present review aimed to assess the quality, content and evidence of efficacy of universally delivered (to all pupils aged 5–16 years), school-based, mental health interventions designed to promote mental health/well-being and resilience, using a validated outcome measure and provided within the UK in order to inform UK schools-based well-being implementation.
DesignA systematic review of published literature set within UK mainstream school settings.
Data sourcesEmbase, CINAHL, MEDLINE, PsycINFO, PsychArticles, ASSIA and Psychological and Behavioural Sciences published between 2000 and April 2016.
Eligibility criteriaPublished in English; universal interventions that aimed to improve mental health/emotional well-being in a mainstream school environment; school pupils were the direct recipients of the intervention; pre-post design utilised allowing comparison using a validated outcome measure.
Data extraction and synthesis12 studies were identified including RCTs and non-controlled pre-post designs (5 primary school based, 7 secondary school based). A narrative synthesis was applied with study quality check.1
ResultsEffectiveness of school-based universal interventions was found to be neutral or small with more positive effects found for poorer quality studies and those based in primary schools (pupils aged 9–12 years). Studies varied widely in their use of measures and study design. Only four studies were rated 'excellent' quality. Methodological issues such as small sample size, varying course fidelity and lack of randomisation reduced overall study quality. Where there were several positive outcomes, effect sizes were small, and methodological issues rendered many results to be interpreted with caution. Overall, results suggested a trend whereby higher quality studies reported less positive effects. The only study that conducted a health economic analysis suggested the intervention was not cost-effective.
ConclusionsThe current evidence suggests there are neutral to small effects of universal, school-based interventions in the UK that aim to promote emotional or mental well-being or the prevention of mental health difficulties. Robust, long-term methodologies need to be pursued ensuring adequate recording of fidelity, the use of validated measures sensitive to mechanisms of change, reporting of those lost to follow-up and any adverse effects. Further high-quality and large-scale research is required across the UK in order to robustly test any long-term benefits for pupils or on the wider educational or health system.
https://ift.tt/2wUqLNH
Systematic review of high-cost patients characteristics and healthcare utilisation
Objectives
To investigate the characteristics and healthcare utilisation of high-cost patients and to compare high-cost patients across payers and countries.
DesignSystematic review.
Data sourcesPubMed and Embase databases were searched until 30 October 2017.
Eligibility criteria and outcomesOur final search was built on three themes: 'high-cost', 'patients', and 'cost' and 'cost analysis'. We included articles that reported characteristics and utilisation of the top-X% (eg, top-5% and top-10%) patients of costs of a given population. Analyses were limited to studies that covered a broad range of services, across the continuum of care. Andersen's behavioural model was used to categorise characteristics and determinants into predisposing, enabling and need characteristics.
ResultsThe studies pointed to a high prevalence of multiple (chronic) conditions to explain high-cost patients' utilisation. Besides, we found a high prevalence of mental illness across all studies and a prevalence higher than 30% in US Medicaid and total population studies. Furthermore, we found that high costs were associated with increasing age but that still more than halve of high-cost patients were younger than 65 years. High costs were associated with higher incomes in the USA but with lower incomes elsewhere. Preventable spending was estimated at maximally 10% of spending. The top-10%, top-5% and top-1% high-cost patients accounted for respectively 68%, 55% and 24% of costs within a given year. Spending persistency varied between 24% and 48%. Finally, we found that no more than 30% of high-cost patients are in their last year of life.
ConclusionsHigh-cost patients make up the sickest and most complex populations, and their high utilisation is primarily explained by high levels of chronic and mental illness. High-cost patients are diverse populations and vary across payer types and countries. Tailored interventions are needed to meet the needs of high-cost patients and to avoid waste of scarce resources.
https://ift.tt/2CwV81J
Incidence and characteristics of ventilator-associated pneumonia in a regional non-tertiary Australian intensive care unit: protocol for a retrospective clinical audit study
Introduction
Ventilator-associated pneumonia (VAP) is a medical complication associated with prolonged mechanical ventilation. Most studies looking at VAP originate from major, tertiary intensive care units (ICUs). Our understanding of VAP in regional hospitals is limited. Given that patient characteristics often differ between metropolitan and regional centres, it is important to investigate VAP in a regional non-tertiary ICU. This project will establish and report the incidence, case characteristics and outcomes including mortality and length of stay related to VAP in a regional non-tertiary Australian ICU. Furthermore, it will compare the incidence of VAP in accordance with consultant diagnosed cases in the medical record, and by a post hoc screening of all cases against a list of previously published diagnostic criteria.
Methods and analysisThis retrospective clinical audit study will screen medical records from the period 1 January 2013 to 31 December 2016. All cases requiring mechanical ventilation for ≥72 hours will be screened against previously reported diagnostic criteria for VAP. At the same time, their medical records will be screened for a documented diagnosis of VAP.
Ethics and disseminationThis study has been granted ethical approval from the Central Queensland Hospital and Health Service (CQHHS) Human Research Ethics Committee (HREC/17/QCQ/11) and the Central Queensland University Human Research Ethics Committee (H17/05-102). This study will be submitted for publication in a peer-reviewed scientific journal and presented at internal workshops (within Queensland Health) and national and/or international scientific conferences.
https://ift.tt/2wSDnVC
Impact of levothyroxine therapy on obstetric, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials
Objective
To determine in women with subclinical hypothyroidism diagnosed in pregnancy whether levothyroxine treatment compared with control, impacts important obstetrical or childhood outcomes (specifically IQ) in randomised controlled trials.
DesignSystematic review and meta-analysis.
Study eligibility criteriaRandomised trials which met all the following were included: (1) reported original data of women with subclinical hypothyroidism diagnosed in pregnancy (by any prespecified study definition); (2) randomised to either levothyroxine or control (placebo or no treatment); (3) reported obstetrical outcomes and/or childhood neurodevelopmental outcomes and (4) published from 1980 to January 2018 in either English or French language.
Data sourcesMedline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.
Outcome measuresObstetrical, neonatal and childhood outcomes including: miscarriage, gestational hypertension, pre-eclampsia, preterm delivery, mode of delivery, neonatal intensive care unit admission, birth weight, gestational age at delivery, childhood IQ and neurodevelopmental scores.
Risk of bias assessment
Cochrane Risk of Bias Tool (Modified) for Quality Assessment of Randomised Controlled Trials
ResultsThree trials of low to unclear risk of bias with 1837 participants were included. Two studies were meta-analysed for maternal and neonatal outcomes and two studies for childhood IQ. No statistically significant differences were found for any clinical outcomes with levothyroxine therapy compared with control.
LimitationsOnly three trials were identified for inclusion.
ConclusionsThis review, based on three randomised trials in women with subclinical hypothyroidism diagnosed in pregnancy, found no evidence of benefit of levothyroxine therapy on obstetrical, neonatal, childhood IQ or neurodevelopmental outcomes. Current trial evidence does not support the treatment of subclinical hypothyroidism diagnosed in pregnancy.
PROSPERO registration numberCRD4201707980.
https://ift.tt/2CAbzL3
Protocol for a randomised controlled trial of interventions to promote adoption and maintenance of physical activity in adults with mental illness
Introduction
Physical activity (PA) has diverse benefits for physical and mental health and can reduce symptoms of mental illness. Adults with mental illness face practical, psychosocial and socioeconomic barriers to adopting and maintaining PA, and it is unclear how to effectively promote PA in this group. Supervised exercise interventions provide high support but may not promote autonomous motivation, which is important for PA maintenance. The aim of this study is to compare the effectiveness of two interventions to promote PA in adults with mental illness.
Methods and analysisThis is a randomised controlled trial of two interventions to promote PA: (1) supervised exercise and gym membership and (2) motivational discussions and self-monitoring of PA using fitness trackers. The intervention duration is 16 weeks, including 8 weeks of weekly supervised group sessions, and 8 weeks of access to the gym or fitness tracker unsupervised. Participants are community-dwelling adults recruited from outpatient clinics of public mental health services. The primary outcome is PA adoption assessed using GENEActiv accelerometers worn continuously over 8 weeks. Secondary outcomes measured at baseline, postintervention (8 weeks) and follow-up (16 weeks), include exercise motivation, psychological distress and self-reported PA assessed using self-administered questionnaires and indicators of physical health measured by a researcher blinded to allocation (blood pressure, weight, waist circumference, 6 min walk test). Participant experiences will be assessed using qualitative focus groups with analysis informed by a theoretical model of behaviour (COM-B).
Ethics and disseminationEthics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/17/QRBW/302). We plan to submit a manuscript on protocol development from pilot work, and a manuscript of the results to a peer-reviewed journal. Results will be presented at conferences, community and consumer forums and hospital grand rounds.
Trial registration numberACTRN12617001017314; Pre-results.
https://ift.tt/2wTEkNr
Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review
Objective
To determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations.
DesignEmbase and MEDLINE (1990–2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed.
SettingEuropean Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries.
ParticipantsHard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations.
Primary and secondary outcome measuresEffectiveness and cost-effectiveness of the interventions.
ResultsFrom the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community.
ConclusionsAlthough evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems.
PROSPERO registration numberCRD42015017865.
https://ift.tt/2CzigNn
Sacubitril/Valsartan (LCZ696): A Novel Treatment for Heart Failure and its Estimated Cost Effectiveness, Budget Impact, and Disease Burden Reduction in Germany
Abstract
Background
Heart failure affects over 1 million people in Germany and contributes to morbidity, mortality, and high healthcare costs. A recent large randomized controlled trial compared the novel compound sacubitril/valsartan (LCZ696) with the angiotensin-converting enzyme (ACE) inhibitor enalapril and found a 16% reduction in mortality hazard. In Germany, sacubitril/valsartan was launched at the beginning of 2016.
Objective
The purpose of this study was to conduct a post hoc analysis of the cost effectiveness, budget impact, and disease burden reduction of sacubitril/valsartan compared with ACE inhibitors for patients with heart failure from the perspective of the German social health insurance (SHI), based on the results of this trial.
Methods
A Markov (cohort) state transition model was constructed to simulate treatment over a remaining lifetime. Based on the Markov model, a dynamic population model was developed that projects the incidence, prevalence, mortality, and healthcare costs of heart failure in the SHI population from 2017 to 2060. The population model follows prevalent and incident cohorts over time. Each year a new cohort is added, while the existing cohorts age by 1 year or die. To test for sensitivity of results, a Monte Carlo simulation was run.
Results
Based on the price negotiated between manufacturer and representatives of the SHI, the base-case incremental cost-effectiveness ratio (ICER) of sacubitril/valsartan versus ACE inhibitors is €23,401 per life-year gained (in 2018 Euros). At a price of zero, the cost-effectiveness ratio is already €9594 per life-year gained due to high background costs of heart failure. Annual budget impact and reduction of disease burden reach a maximum at 4–8 years after launch (€221 million and 2.9%, respectively, in the base case).
Conclusions
The ICER of sacubitril/valsartan is projected to be at or below the level of other accepted interventions for the treatment of asymptomatic to severe heart failure in Germany. Projected budget impact leads to an increase in SHI expenditures by < 0.04% per year.
https://ift.tt/2oT3Yx7
Families’ and health care professionals’ attitudes towards Li‐Fraumeni Syndrome testing in children: a systematic review
Clinical Genetics, Volume 0, Issue ja, -Not available-.
https://ift.tt/2oQrriN
Clinical, radiographic, and genetic characteristics of hypohidrotic ectodermal dysplasia: A cross‐sectional study
Clinical Genetics, EarlyView.
https://ift.tt/2wWrtce
Androgen receptor mRNA analysis from whole blood: a low‐cost strategy for detection of androgen receptor gene splicing defects
Clinical Genetics, EarlyView.
https://ift.tt/2oPRcQ7
Effect of sodium triphosphate on particle size of heat‐induced whey protein concentrate aggregates
Food Science &Nutrition, EarlyView.
https://ift.tt/2NZ86GO
Postnatal deficiency of ADAMTS1 ameliorates thoracic aortic aneurysm and dissection in mice
Experimental Physiology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N0e3H9
Minocycline decreases Th2 chemokines from M2 macrophages: possible mechanisms for the suppression of bullous pemphigoid by traditional bullous disease drugs
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NWeXkA
The association between ST18 gene polymorphism and severe Pemphigus disease among Iranian population
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2wWqD00
Effects of 9-cis-retinoic acid on the proliferation and apoptosis of cutaneous T-cell lymphoma cells
https://ift.tt/2NXBtcK
Gastric obstruction secondary to a band adhesion post‐Nissen fundoplication: a rare entity
ANZ Journal of Surgery, EarlyView.
https://ift.tt/2M4pCb7
Utility of magnetic resonance imaging in differentiating renal infection from tumour: a not uncommon clinical conundrum
ANZ Journal of Surgery, EarlyView.
https://ift.tt/2QdyZIP
Video‐assisted thorascopic lobectomy for pulmonary arteriovenous malformations to prevent cerebral abscess
ANZ Journal of Surgery, EarlyView.
https://ift.tt/2Ma6ecw
Bilateral chylothorax and pericardial effusion following subtotal gastrectomy in a patient with situs inversus totalis
ANZ Journal of Surgery, EarlyView.
https://ift.tt/2Q8H6q5
The influence of heart failure on the pharmacokinetics of cardiovascular and non‐cardiovascular drugs: a critical appraisal of the evidence
British Journal of Clinical Pharmacology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2oRDaxe
Side effects of drugs for osteoporosis and metastatic bone disease
British Journal of Clinical Pharmacology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2MbHxwn
Rivaroxaban and macitentan can be co‐administered without dose adjustment but the combination of rivaroxaban and St. John´s Wort should be avoided
British Journal of Clinical Pharmacology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2oQQYIr
Statins after intracranial haemorrhage: seizing a new opportunity?
British Journal of Clinical Pharmacology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NYBInW
Flow Immunophenotyping of Benign Lymph Nodes Sampled by FNA: Representative With Diagnostic Pitfalls
Cancer Cytopathology, EarlyView.
https://ift.tt/2MXCvZN
The genetic landscape of gliomas arising after therapeutic radiation
Abstract
Radiotherapy improves survival for common childhood cancers such as medulloblastoma, leukemia, and germ cell tumors. Unfortunately, long-term survivors suffer sequelae that can include secondary neoplasia. Gliomas are common secondary neoplasms after cranial or craniospinal radiation, most often manifesting as high-grade astrocytomas with poor clinical outcomes. Here, we performed genetic profiling on a cohort of 12 gliomas arising after therapeutic radiation to determine their molecular pathogenesis and assess for differences in genomic signature compared to their spontaneous counterparts. We identified a high frequency of TP53 mutations, CDK4 amplification or CDKN2A homozygous deletion, and amplifications or rearrangements involving receptor tyrosine kinase and Ras–Raf–MAP kinase pathway genes including PDGFRA, MET, BRAF, and RRAS2. Notably, all tumors lacked alterations in IDH1, IDH2, H3F3A, HIST1H3B, HIST1H3C, TERT (including promoter region), and PTEN, which genetically define the major subtypes of diffuse gliomas in children and adults. All gliomas in this cohort had very low somatic mutation burden (less than three somatic single nucleotide variants or small indels per Mb). The ten high-grade gliomas demonstrated markedly aneuploid genomes, with significantly increased quantity of intrachromosomal copy number breakpoints and focal amplifications/homozygous deletions compared to spontaneous high-grade gliomas, likely as a result of DNA double-strand breaks induced by gamma radiation. Together, these findings demonstrate a distinct molecular pathogenesis of secondary gliomas arising after radiation therapy and identify a genomic signature that may aid in differentiating these tumors from their spontaneous counterparts.
https://ift.tt/2oOSVoT
Performance of Multitarget Stool DNA Testing in African American Patients
Cancer, EarlyView.
https://ift.tt/2N1shI4
Irrational Fear of Whole‐Brain Radiotherapy: Are We Doing Our Patients a Disservice?
Cancer, EarlyView.
https://ift.tt/2x29hhN
Castration Remains Despite Decreasing Definitive Treatment of Localized Prostate Cancer in the Elderly: A Case for De‐Implementation
Cancer, EarlyView.
https://ift.tt/2x29fXd
Predicting the Risk for Aberrant Opioid Use Behavior in Patients Receiving Outpatient Supportive Care Consultation at a Comprehensive Cancer Center
Cancer, EarlyView.
https://ift.tt/2oNidno
The evolutionary significance of hippocampal neurogenesis
European Journal of Neuroscience, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NYHAxp
THE EFFECT OF STATIC STRETCHING OF PERONEAL AND TIBIAL MUSCLES ON THE REACTION TIME: A RANDOMIZED CONTROLLED STUDY
https://ift.tt/2Nq0Ir6
Glucose metabolism in the brain in LMNB1‐related autosomal dominant leukodystrophy
Acta Neurologica Scandinavica, Volume 0, Issue ja, -Not available-.
https://ift.tt/2wXNuYy
Endoscopic purse‐string suture technique: An effective remedy for a large iatrogenic rectal perforation
Digestive Endoscopy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2M8WUG6
Novel CSF biomarkers to discriminate FTLD and its pathological subtypes
Annals of Clinical and Translational Neurology, EarlyView.
https://ift.tt/2wSaOa4
Aging and APOE‐ε4 are determinative factors of plasma Aβ42 levels
Annals of Clinical and Translational Neurology, EarlyView.
https://ift.tt/2NtUzKq
Review article: an analysis of safety profiles of the treatments for diarrhoea‐predominant irritable bowel syndrome
Alimentary Pharmacology &Therapeutics, EarlyView.
https://ift.tt/2MafA8r
Review article: drug‐induced liver injury in the context of nonalcoholic fatty liver disease – a physiopathological and clinical integrated view
Alimentary Pharmacology &Therapeutics, EarlyView.
https://ift.tt/2oRyVBO
Anti‐TNF therapy for genital fistulas in female patients with Crohn's disease: a nationwide study from the Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif (GETAID)
Alimentary Pharmacology &Therapeutics, EarlyView.
https://ift.tt/2Mafyxl
The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature
https://ift.tt/2wPlA0C
Autism spectrum disorder
https://ift.tt/2MXVoMl
Mental illness and the provision of mental health services in prisons
https://ift.tt/2wU2vu9
An Incidental Finding of Subcutaneous Hemangioma During 99mTcO4 Salivary Gland Scintigraphy
A 43-year-old woman with papillary thyroid cancer prepared for 131I ablation after total thyroidectomy. With a history of type 2 diabetes for 10 years, she recently presented with periodontitis, candidiasis, and mouth dryness. 99mTcO4 scintigraphy was ordered to evaluate function of the salivary glands. The scintigraphy incidentally found a focal 99mTcO4 uptake in the left supraclavicular region. The subsequent neck ultrasonography showed a hypoechoic soft tissue mass with heterogeneous hypervascularity, suggestive of hemangioma.https://ift.tt/2oRiOVe
Hepatic Metastases From Prostatic Adenocarcinoma Without Elevated 18F-Choline Activity
We report the case of a 69-year-old man referred for 18F-fluorocholine (FCH) PET/CT for a biochemical recurrence of prostate cancer. FCH PET/CT demonstrated 2 hypodense hepatic lesions with no uptake but progressing in size compared with a previous assessment. MRI showed a suspicious peripheral contrast enhancement, raising the question of a liver metastasis. Histopathologic examination concluded to a prostate adenocarcinoma metastasis. This case highlights an unusual pitfall in FCH PET/CT: the lack of uptake in prostatic liver metastasis is presumably due to the partial volume effect induced by the necrotic center and the high uptake of the liver.https://ift.tt/2wXM7sS
Impact of DAT-SPECT on Management of Patients Suspected of Parkinsonism
Objective To evaluate the value of 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT) to change management strategies of patients suspected of parkinsonism. Method This was an institutional review board–approved, retrospective study. DAT-SPECT scans ordered by movement disorder specialist and neurologists from 2011–2014 were reviewed. Clinical data and radiological reports of 173 patients suspected of parkinsonism were reviewed. The DAT-SPECT scan results were correlated with clinical assessment and treatment changes. Results A total of 173 patients (104 male and 69 female subjects; age, 64.4 ± 12.6 years) suspected of parkinsonism were included. Median duration of symptoms was 36 months (range, 1–480 months). Scans were most often requested when there was diagnostic uncertainty in clinical features (59.6%, 103/173) or to differentiate one other disease from parkinsonism such as Parkinson disease (PD) versus essential tremor (23.7%, 41/173), PD versus drug-induced parkinsonism (8.7%, 15/173), or PD versus psychogenic (6.4%, 11/173) or vascular (1.7%, 3/173) disorders. Patients were classified, according to the DAT-SPECT scanning results, as those with abnormal DAT-SPECT findings (59%, 102/173) and those with normal DAT-SPECT findings (41%, 71/173). In patients with normal DAT-SPECT findings, follow-up management data were available in 76.1% (54/71). The management changed in 39.4% (28/54) after DAT scan with starting a new appropriate medications or supportive therapy in 4.2% (3/28), withholding inappropriate dopaminergic treatment in 11.3% (8/28), or continuing observation in 23.9% (17/28). In patients with abnormal DAT-SPECT findings, follow-up management data were available in 78.4% (80/102). There was change in management of 37.3% (38/80), a new PD treatment was started in 89.5% (34/38). The dose of medication was adjusted in 5.3% (2/38), although the original treatment was not changed. Parkinson disease treatment was stopped in 2.6% (1/38) and discontinued in 2.6% (1/38) based on clinical decision of neurologists despite abnormal DAT-SPECT findings. Conclusions DAT-SPECT findings impacted treatment decisions in 44.7% of patients suspected of Parkinsonism.https://ift.tt/2MYJz8z
Pan-Costochondritis Caused by Aspergillus Diagnosed by 18F-FDG PET/CT
Thoracic pain is an entity that can be difficult to diagnose etiologically. Once the cardiac origin has been ruled out, the rheumatologic, neoplastic, and infectious causes have to be taken into account. We present the case of a patient with atypical chest pain after triple-bypass surgery in whom 18F-FDG PET/CT scan showed an important uptake of the radiopharmaceutical in costal cartilages, in relation to pan-costochondritis due to Aspergillus.https://ift.tt/2wSGfAP
Prediction of Occult Lymph Node Metastasis Using Tumor-to-Blood Standardized Uptake Ratio and Metabolic Parameters in Clinical N0 Lung Adenocarcinoma
Purpose We aimed to investigate whether the tumor-to-blood SUV ratio (SUR) and metabolic parameters of 18F-FDG uptake could predict occult lymph node metastasis (OLM) in clinically node-negative (cN0) lung adenocarcinoma. Materials and Methods We retrospectively reviewed 157 patients with cN0 lung adenocarcinoma who underwent both preoperative 18F-FDG PET/CT and surgical resection with the systematic lymph node dissection. The SUVmax, SUVmean, MTV, and total lesion glycolysis (TLG) of the primary tumor was measured on the PET/CT workstation. SURmax, SURmean, and TLGsur were derived from each of them divided by descending aorta SUVmean. These PET parameters and clinicopathological variables were analyzed for OLM. Results In our study, OLM was detected in 31 (19.7%) of 157 patients. Significantly higher values of tumor size, SUVmax, SUVmean, MTV, TLGsuv, SURmax, SURmean, and TLGsur were found in patients with OLM. In receiver operating characteristic curve analysis, the optimal cutoff values of the above parameters were 29.50, 4.38, 2.45, 6.37, 44.13, 5.30, 1.86, and 28.24, respectively. The multivariate analysis showed that TLGsur (odds ratio, 1.024; P = 0.002) was the most potent associated factor for the prediction of OLM in cN0 lung adenocarcinoma. Conclusions TLGsur showed the most powerful predictive performance than the other PET parameters for the prediction of OLM in cN0 lung adenocarcinoma. This normalized volumetric parameter would be helpful in selection of sublobar resection or aggressive tailored treatments in patients with cN0 lung adenocarcinoma.https://ift.tt/2MVoqMk
177Lu-DOTATATE Therapy in Radioiodine-refractory Differentiated Thyroid Cancer: A Single Center Experience
Introduction Patients with radioiodine-refractory differentiated thyroid cancer (RrDTC) have a rather poor prognosis and are in need of novel treatments. As RrDTCs can in some cases express somatostatin receptors (SSRT), targeting of these receptors by 68Ga/177Lu-DOTATATE could evolve as a novel theranostic option. Methods Five RrDTC patients with limited further therapeutic options and documented expression of SSRT using 68Ga-DOTATATE-PET/CT received 2 to 4 cycles of PRRT with 177Lu-DOTATATE. Response to therapy was assessed by thyroglobulin (Tg) and morphological and metabolic criteria based on interim and follow-up 68Ga-DOTATATE-PET/CTs. Analysis was performed on a per-patient basis. Results In the post-therapy evaluation, only one out of five patients showed a partial response, whereas three patients had a progressive disease. One patient had discordant findings between stable imaging results albeit rising Tg levels. Conclusion In this case study of five patients, 177Lu-DOTATATE therapy showed only heterogeneous response and efficacy in RrDTC patients despite good lesional uptake in pre-therapeutic PET.https://ift.tt/2wS12oh
Scintigraphic Findings Beyond Ejection Fraction on Hepatobiliary Scintigraphy: Are They Correlated With Chronic Gallbladder Disease?
Objective To determine if classically reported findings associated with chronic cholecystitis on hepatobiliary scintigraphy (HBS), such as delayed small bowel (SB) transit, slow gallbladder (GB) filling, and reversal of the normal GB and SB transit, are associated with a depressed GB ejection fraction (GBEF). The secondary objectives were to determine whether GBEF is correlated with the time of GB filling, time of SB transit, or reversal of normal GB/SB filling sequence. We hypothesize that an association between a depressed GBEF and these classical HBS findings could validate them as surrogate markers for chronic GB disease. Patients and Methods We reviewed all HBS exams over a retrospective 16-month period. Data from 221 patients (mean age, 45.3 ± 15.2 years; 152 female and 69 male subjects) who underwent HBS with GBEF determination for evaluation of chronic symptoms concerning for biliary etiology met inclusion criteria. Classically reported findings for cholecystitis were recorded for each patient. Comparisons were made using t test and Fisher test analysis. Results Comparing exams with normal and abnormal GBEF values, there were no significant differences based on age, sex, GB fill time, normal versus delayed SB transit, and reversal of normal GB/SB filling sequence. Additionally, we did not see a correlation between the measured GBEF and GB fill time, SB transit time, or reversal of normal GB/SB filling sequence. Conclusions Delayed SB transit, slow GB filling time, and reversal of the normal GB and SB filling sequence on HBS imaging are not associated with the measured GBEF and not predictive of chronic GB disease.https://ift.tt/2oOPQVR
Central Nervous System Myelomatosis Delineated by High-Resolution Brain Images From Fully Digital 18F-FDG PET
Central nervous system myelomatosis is uncommon and is associated with a particularly poor prognosis. PET images, from a 53-year-old man referred to a fully digital 18F-FDG PET for relapsed multiple myeloma, revealed high 18F-FDG uptakes located in the cortex and sulci of the right central area and within the meningeal envelopes of the cerebellum, the trigeminal nerves, and on the spinal canal. These particular uptakes gave evidence of a central nervous system myelomatosis subsequently confirmed by plasma cells documented in cerebrospinal fluid. Such interesting images could be obtained owing to the potential of high-resolution images provided by fully digital 18F-FDG PET.https://ift.tt/2wT8f7u
Therapeutic Responses and Survival Effects of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castrate-Resistant Prostate Cancer: A Meta-analysis
Purpose We performed a meta-analysis on the therapeutic effects of prostate-specific membrane antigen (PSMA)–617 labeled with lutetium-177 (177Lu-PSMA-617) in patients with metastatic castration-resistant prostate cancer (mCRPC). Patients and Methods The primary outcome was the therapeutic responses after the first cycle of 177Lu-PSMA-617 radioligand therapy. The parameters studied were the pooled proportions of any prostate-specific antigen (PSA) decline and a greater than 50% PSA decline. The secondary outcome was the survival effects after 177Lu-PSMA-617 radioligand therapy. Studied parameters were pooled hazard ratios of the overall survival according to any PSA decline and a greater than 50% PSA decline after the first cycle of 177Lu-PSMA-617 radioligand therapy. Results In total, 10 eligible studies with 455 patients were finally included in this meta-analysis. The pooled proportions of any PSA decline was 68.00% (95% confidence interval [CI], 63.55%–72.22%], and those with a greater than 50% PSA decline was 34.45% (95% CI, 30.14%–38.97%). The pooled hazard ratios for the overall survival of any PSA decline was 0.29 (95% CI, 0.21–0.40) with significance (Phttps://ift.tt/2N0jNkk
Elevated 68Ga-DOTATATE Activity in IgG4-Related Lymphadenopathy
68Ga-DOTATATE PET/CT was performed in a 60-year-old man to detect culprit tumor responsible for tumor-induced osteomalacia (TIO). The images revealed multiple foci of abnormal activity in soft tissue lesion, which were not typical of tumor causing TIO in 68Ga-DOTATATE PET/CT. Considering other neoplastic processes, FDG PET/CT were subsequently performed, which showed all same lesions, although the lesions with highest activity were different between the scans. Pathological examination demonstrated that the patient experienced TIO caused by 1 lesion, but other lesions were due to IgG4-related lymphadenopathy.https://ift.tt/2wUTT6G
The Prognostic Value of 18F-FDG PET/CT in Monitoring Chemotherapy in Ovarian Cancer Both at Initial Diagnosis and at Recurrent Disease
https://ift.tt/2oQqUgP
Re: False Positive Uptake in Bilateral Gynecomastia on 68Ga-PSMA PET/CT Scan
No abstract availablehttps://ift.tt/2wUkKjn
Quality and Safety in Health Care, Part XL: Stents and Unusual Indications for a PCI
https://ift.tt/2oRxkMG
Increased 18F-FDG Uptake in Lhermitte-Duclos Disease With Cowden Syndrome Revealed by PET-MRI
A 62-year-old woman, with the history of breast and colorectal cancer, presented intermittent diplopia. A cerebellar lesion was revealed by 18F-FDG PET-MRI without post-gadolinium enhancement, but with increased perfusion and strong 18F-FDG uptake. The diagnosis of Cowden syndrome with PTEN gene mutation, linked to higher risk of neoplasia and occurrence of hamartomatous lesions characteristic of the Lhermitte-Duclos disease (LDD), was confirmed by genetic investigation.https://ift.tt/2wTpINg
18F-FDG PET/CT in a Patient With Pregnancy and Lactation-Associated Osteoporosis
A 33-year-old woman in the 6th month postpartum and breast-feeding period suffered from acute thoracolumbar pain for 1 month. She presented with slightly decreased serum calcium level. Other laboratory assessments were unremarkable. Considering the worsening symptom and her strong demand to exclude potential malignancy, 18F-FDG PET/CT was performed. Multiple FDG-avid foci in the thoracic and lumbar vertebra were detected on FDG PET, corresponding to vertebral compression fractures on CT, and diffuse FDG uptake was seen within bilateral breast, and dual-X ray absorptiometry showed markedly decreased bone mineral density, all of which supported the diagnosis of pregnancy and lactation-associated osteoporosis.https://ift.tt/2oPDkoZ
Bone Scintigraphy in Poststreptococcal Periostitis With Dysproteinemia
A 39-year-old man presented with severe bone pain in the tibiae and forearms in the wake of a poststreptococcal sepsis complicated with pneumonia and erysipelas 4 months earlier. Bone scintigraphy was indicative of periostitis of the tibia, ulna, and radius bilaterally, and in combination with the increased inflammatory parameters and dysproteinemia, the diagnosis of Goldbloom syndrome was made. Goldbloom syndrome is an idiopathic periosteal hyperostosis associated with dysproteinemia and elevated inflammatory parameters. Although it has only been described in children/adolescents, this case illustrates that, in the specific clinical and biochemical setting, it should also be considered in adults.https://ift.tt/2wU2tm1
The addition of pretreatment plasma Epstein‐Barr virus DNA into the 8th edition of nasopharyngeal cancer TNM stage classification
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NtSX3k
Genome‐wide microRNA analysis of HPV‐positive self‐samples yields novel triage markers for early detection of cervical cancer
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2wUmedm
Circulating insulin‐like growth factor I in relation to melanoma risk in the European Prospective Investigation into Cancer and Nutrition
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NsVTxh
The IL‐1/IL‐1R axis induces greater fibroblast‐derived chemokine release in human papillomavirus‐negative compared to positive oropharyngeal cancer
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2wWd8wJ
A novel SOCS5/miR‐18/miR‐25 axis promotes tumorigenesis in liver cancer
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NtSHRU
Aberrant expression of SETD1A promotes survival and migration of estrogen receptor α‐positive breast cancer cells
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2wS7pIk
Erratum
International Journal of Cancer, Volume 143, Issue 8, Page E10-E10, 15 October 2018.
https://ift.tt/2Nr7exT
Issue Information
International Journal of Cancer, Volume 143, Issue 8, Page 2082-2083, 15 October 2018.
https://ift.tt/2wSDDCZ
Issue Information
International Journal of Cancer, Volume 143, Issue 8, Page 1833-1839, 15 October 2018.
https://ift.tt/2Nr7ahD
A new system for classifying root and root canal morphology
International Endodontic Journal, Volume 51, Issue 10, Page 1181-1181, October 2018.
https://ift.tt/2Cxi5SA
Corrigendum
International Endodontic Journal, Volume 51, Issue 10, Page 1184-1184, October 2018.
https://ift.tt/2Qf2f1D
Reply to the editor
International Endodontic Journal, Volume 51, Issue 10, Page 1182-1183, October 2018.
https://ift.tt/2CFnKG6
Issue Information
International Endodontic Journal, Volume 51, Issue 10, Page i-iii, 1067, October 2018.
https://ift.tt/2Qf2b1T
Effect of perforation size and furcal lesion on stress distribution in mandibular molars: a Finite Element Analysis
International Endodontic Journal, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CzcgnK
Intraoperative Mortality in Malawi
https://ift.tt/2wTocuy
Radiation Safety Perceptions and Practices Among Pediatric Anesthesiologists: A Survey of the Physician Membership of the Society for Pediatric Anesthesia
https://ift.tt/2NtSbmW
Perioperative Considerations for Evolving Artificial Pancreas Devices
https://ift.tt/2wT6Ttq
Evaluation of the Determinants of Satisfaction With Postoperative Pain Control After Thoracoscopic Surgery: A Single-Center, Survey-Based Study
https://ift.tt/2NtPcLl
-
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...
