Medicine by Alexandros G.Sfakianakis: 04/06/18

Παρασκευή 6 Απριλίου 2018

Linking puberty and error‐monitoring: Relationships between self‐reported pubertal stages, pubertal hormones, and the error‐related negativity in a large sample of children and adolescents

Developmental Psychobiology, EarlyView.

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Applying iPSCs for Preserving Endangered Species and Elucidating the Evolution of Mammalian Sex Determination

BioEssays, EarlyView.

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The Bursts and Lulls of Multimodal Interaction: Temporal Distributions of Behavior Reveal Differences Between Verbal and Non‐Verbal Communication

Cognitive Science, EarlyView.

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Gold Nanoplate‐Enhanced Chemiluminescence and Macromolecular Shielding for Rapid Microbial Diagnostics

Advanced Healthcare Materials, EarlyView.

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Meet Our Editorial Board Member

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Cell-derived Exosomes as Promising Carriers for Drug Delivery and Targeted Therapy

Exosomes are small vesicles that are secreted by various types of cells, known to mediate signal transduction between cells. During recent years, novel carriers for the delivery of targeted drugs, chemotherapy drugs and RNAs are under development, which is believed to be beneficial for patients. Considering issues of drug nano-formulations in bloodstream, such as nano-toxicity and rapid clearance by mononuclear phagocyte system, exosomes derived from either patient's cells or bodyfluids, seem to be an optimal option. This review presents the current patterns of drug-loaded into exosomes and discusses how exosomes were reconstructed for targeted therapy. Loading either exosomes directly or their donor cells is an alternative, including incubation, electroporation, transfection of exosomes or transfection, incubation, activation of the parent cells. To solve the low efficiency of cargo loading into exosomes, protein loading via optically reversible protein-protein interaction can realize a novel exosomal protein carrier. In addition, targeted therapeutics with exosomes is achieved by three means, via adding targeting peptides into the surface of exosomes, by transferring specific genes within exosomes into tumors to establish a therapeutic target and, lastly, by targeting at exosomes containing tumor associated antigens. Nevertheless, purification and mass production of exosomes need further exploration, as well as more approaches were applied to targeted therapy. Therefore, exosomes could serve as an effective tool for drug delivery and targeted therapy.

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Recent Updates on the Therapeutic Potential of HER2 Tyrosine Kinase Inhibitors for the Treatment of Breast Cancer

HER2 positive breast cancer is characterized by the low survival rate in the metastatic patients. Development of resistance and disease-relapse are the major problems associated with the currently available therapies for HER2 positive breast cancer. There are two major targeted therapies for HER2 positive breast cancer viz. monoclonal antibodies and tyrosine-kinase inhibitors, and both of these therapies have their advantages and limitations. To address the limitations associated with the existing therapies, use of antibodies and TKIs as combination therapy proved to be more effective. Various chemical modifications can be performed on tyrosine-kinase inhibitors to develop novel ligands with increased selectivity for HER2 kinase. A number of tyrosine-kinase inhibitors are in various phases of clinical trials for the treatment of HER2 positive breast cancer. In the current review article, recent developments on various HER2 tyrosine-kinase inhibitors have been reported. Various structurally different scaffolds bind to the HER2 receptor and exhibit potent anti-cancer activities. The structural and pharmacophoric requirements of the scaffolds are discussed in detail so as to discover effective drug candidates for the treatment of HER2 positive breast cancer.

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Synthetic Lethality: From Research to Precision Cancer Nanomedicine

Cancer is an evolutionary disease with multiple genetic alterations, accumulated due to chromosomal instability and/or aneuploidy and it sometimes acquires drug-resistant phenotype also. Whole genome sequencing and mutational analysis helped in understanding the differences among persons for predisposition of a disease and its treatment non-responsiveness. Thus, molecular targeted therapies came into existence. Among them, the concept of synthetic lethality have enthralled great attention as it is a pragmatic approach towards exploiting cancer cell specific mutations to specifically kill cancer cells without affecting normal cells and thus enhancing anti-cancer drug therapeutic index. Thus, this approach helped in discovering new therapeutic molecules for development of precision medicine. Nanotechnology helped in delivering these molecules to the target site in an effective concentration thus reducing off target effects of drugs, dose and dosage frequency drugs. Researchers have tried to deliver siRNA targeting synthetic lethal partner for target cancer cell killing by incorporating it in nanoparticles and it has shown efficacy by preventing tumor progression. This review summarizes the brief introduction of synthetic lethality, and synthetic lethal gene interactions, with a major focus on its therapeutic anticancer potential with the application of nanotechnology for development of personalized medicine.

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Involvement of CD24 in Multiple Cancer Related Pathways Makes It an Interesting New Target for Cancer Therapy

CD24 (cluster of differentiation 24) is a small heavy glycosylated protein, which is overexpressed in many cancer and some cancer stem cells and is associated with the development, invasion, and metastasis of cancer cells. The exact role of CD24 in these processes is not fully understood, however, in this article, it has been tried to present a collection of cancer-related mechanisms attributed to CD24. Based on the literature, CD24 dis-regulates different signaling pathways in various cancer cells, including; Src kinases, STAT3, EGFR, Wnt/β-catenin and MAPK. Src kinases play an important role in the signaling pathways which activate p38 MAPK and STAT3 pathways. Akt and ERK are downstream effectors of CD24-activated EGFR, which promote cell proliferation, invasion and metastasis. CD24 increases the expression of HER2 by the activation of NF-κB transcription factor. Moreover, CD24 up-regulates the expression of miR-21 oncomir through the activation of Src kinases. Identification of the details of these pathways and also new pathways will help researchers to explore new CD24 targeted therapies.

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The PI3K Pathway at the Crossroads of Cancer and the Immune System: Strategies for Next Generation Immunotherapy Combinations

Immunotherapy has led to a paradigm shift in the treatment of some malignancies, providing long-term, durable responses for a subset of patients with advanced cancers. Increasingly, research has identified links between the immune system and critical oncogenic growth factor pathways. The phosphoinositide 3-kinase (PI3K)-AKT-mTOR cascade is frequently hyperactivated in cancer, and plays an integral role in many cellular processes including tumour growth and survival and can underlie resistance to therapies. In this review, we first summarize two key learnings from the initial studies of inhibitors of this pathway, including the profile of immune-related adverse events such as colitis, transaminitis and pneumonitis and the increased incidence of infections with the majority of agents that target the PI3K-AKT-mTOR pathway. We then discuss recent advances in our understanding of the role of this pathway in the tumour micro-environment, and in the regulation of innate and adaptive immune responses, and propose synergistic combination strategies with PI3K-network inhibitors and cancer immunotherapy.

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Reducing the risk of post-surgical cancer recurrence: a perioperative anti-inflammatory anti-stress approach

Future Oncology, Ahead of Print.

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Management of oncological patients in the digital era: anatomic pathology and nuclear medicine teamwork

Future Oncology, Ahead of Print.

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Treatment of venous stenosis in oncologic patients

Future Oncology, Ahead of Print.

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Chest wall mass in a 15 year old female patient

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The Pseudokinase Domain of Saccharomyces cerevisiae Tra1 Is Required for Nuclear Localization and Incorporation into the SAGA and NuA4 Complexes

Tra1 is an essential component of the SAGA/SLIK and NuA4 complexes in S. cerevisiae, recruiting these co-activator complexes to specific promoters. As a PIKK family member, Tra1 is characterized by a C-terminal phosphoinositide 3-kinase (PI3K) domain. Unlike other PIKK family members (e.g. Tor1, Tor2, Mec1, Tel1), Tra1 has no demonstrable kinase activity. We identified three conserved arginine residues in Tra1 that reside proximal or within the cleft between the N- and C-terminal subdomains of the PI3K domain. To establish a function for Tra1's PI3K domain and specifically the cleft region, we characterized a tra1 allele where these three arginine residues are mutated to glutamine. The half-life of the Tra1_Q3 protein is reduced but its steady state level is maintained at near wild-type levels by a transcriptional feedback mechanism. The tra1_Q3 allele results in slow growth under stress and alters the expression of genes also regulated by other components of the SAGA complex. Tra1_Q3 is less efficiently transported to the nucleus than the wild-type protein. Likely related to this, Tra1_Q3 associates poorly with SAGA/SLIK and NuA4. The ratio of Spt7^SLIK to Spt7^SAGA increases in the tra1_Q3 strain and truncated forms of Spt20 become apparent upon isolation of SAGA/SLIK. Intragenic suppressor mutations of tra1_Q3map to the cleft region further emphasizing its importance. We propose that the PI3K domain of Tra1 is directly or indirectly important for incorporating Tra1 into SAGA and NuA4 and thus the biosynthesis and/or stability of the intact complexes.

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diploS/HIC: An Updated Approach to Classifying Selective Sweeps

Identifying selective sweeps in populations that have complex demographic histories remains a difficult problem in population genetics. We previously introduced a supervised machine learning approach, S/HIC, for finding both hard and soft selective sweeps in genomes on the basis of patterns of genetic variation surrounding a window of the genome. While S/HIC was shown to be both powerful and precise, the utility of S/HIC was limited by the use of phased genomic data as input. In this report we describe a deep learning variant of our method, diploS/HIC, that uses unphased genotypes to accurately classify genomic windows. diploS/HIC is shown to be quite powerful even at moderate to small sample sizes.

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Impact of the Canonical Wnt Pathway Activation on the Pathogenesis and Prognosis of Adamantinomatous Craniopharyngiomas

Horm Metab Res
DOI: 10.1055/a-0593-5956

CTNNB1 mutations and abnormal β-catenin distribution are associated with the pathogenesis of adamantinomatous craniopharyngioma (aCP). We evaluated the expression of the canonical Wnt pathway components in aCPs and its association with CTNNB1 mutations and tumor progression. Tumor samples from 14 aCP patients and normal anterior pituitary samples from eight individuals without pituitary disease were studied. Gene expression of Wnt pathway activator (WNT4), inhibitors (SFRP1, DKK3, AXIN1, and APC), transcriptional activator (TCF7), target genes (MYC, WISP2, and, CDH1), and Wnt modulator (TP53) was evaluated by qPCR. β-Catenin, MYC, and WISP2 expression was determined by immunohistochemistry (IHC). The transcription levels of all genes studied, except APC, were higher in aCPs as compared to controls and TCF7 mRNA levels correlated with CTNNB1 mutation. CDH1 mRNA was overexpressed in tumor samples of patients with disease progression in comparison to those with stable disease. β-Catenin was positive and aberrantly distributed in 11 out of 14 tumor samples. Stronger β-catenin immunostaining associated positively with tumor progression. MYC positive staining was found in 10 out of 14 cases, whereas all aCPs were negative for WISP2. Wnt pathway genes were overexpressed in aCPs harboring CTNNB1 mutations and in patients with progressive disease. Recurrence was associated with stronger staining for β-catenin. These data suggest that Wnt pathway activation contributes to the pathogenesis and prognosis of aCPs.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Immune Checkpoint Blockade Is Active in Melanoma Brain Metastases [Research Watch]

Treatment with nivolumab alone or nivolumab plus ipilimumab achieves intracranial responses.

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The Structure of GATOR1-Rag GTPases Reveal Modes of Regulation [Research Watch]

A Rag GTPases–DEPDC5 inhibitory interaction mode suppresses GATOR1 GAP activity.

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Trastuzumab Extends Progression-Free Survival in HER2/neu+ Uterine Tumors [Research Watch]

Adding trastuzumab to carboplatin–paclitaxel is well tolerated in patients with uterine serous carcinoma.

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Blocking MICA/MICB Shedding Reactivates Antitumor Immunity [Research Watch]

Inhibition of protease-driven MICA and MICB shedding enhances NK cell–mediated tumor immunity.

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Ibrutinib plus Venetoclax May Be Effective in Mantle-Cell Lymphoma [Research Watch]

Ibrutinib plus venetoclax is superior to monotherapy in patients with mantle-cell lymphoma.

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New Visions and Current Evidence for Safety in Anesthesia

No abstract available

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American Society for Enhanced Recovery: Advancing Enhanced Recovery and Perioperative Medicine

As the population ages, the increasing surgical volume and complexity of care are expected to place additional care delivery burdens in the perioperative setting. In this age of integrated multidisciplinary care of the surgical patients, there is increasing recognition that an evidence-based perioperative pathway is associated with the optimal outcomes. These pathways, collectively referred to as Enhanced Recovery Pathways, have resulted in shortened length of hospital stay, reduced complications, and variance in outcomes, as well as earlier return to baseline activities. The American Society for Enhanced Recovery (ASER) is a multispecialty, nonprofit international organization, dedicated to the practice of enhanced recovery in perioperative patients through education and research. Perioperative Quality Initiatives were formed whose intent is to organize a series of consensus conferences on topics of interest related to perioperative medicine. The journal affiliation between American Society for Enhanced Recovery and Anesthesia& Analgesia will enable these evidence-based practices to be disseminated widely and swiftly to the practicing perioperative health care professionals so they can be adopted to improve the quality of perioperative surgical care. Accepted for publication March 12, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Tong J. Gan, MD, MBA, MHS, FRCA, Department of Anesthesiology, Stony Brook University, HSC Level 4, Rm 060, Stony Brook, NY 11794. Address e-mail to tong.gan@stonybrookmedicine.edu. © 2018 International Anesthesia Research Society

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Dezocine Alleviates Morphine-Induced Dependence in Rats

BACKGROUND: Opioid dependence is a major public health issue without optimal therapeutics. This study investigates the potential therapeutic effect of dezocine, a nonaddictive opioid, in opioid dependence in rat models. METHODS: Dezocine was administered intraperitoneally to a morphine-dependent rat model to investigate its effect on withdrawal and conditioned place preference (CPP). Effect of dezocine on morphine withdrawal syndrome and CPP was analyzed using 2-way analysis of variance (ANOVA) followed by Tukey's post hoc test. Buprenorphine and vehicle solution containing 20% (v/v) dimethyl sulfoxide were used for positive and negative control, respectively. The astrocytes activation in nucleus accumbens was assessed by immunofluorescence assay of glial fibrillary acidic protein. Effect of dezocine and buprenorphine on the internalization of κ opioid receptor (KOR) was investigated using Neuro2A expressing KOR fused to red fluorescent protein tdTomato (KOR-tdT). Buprenorphine and dezocine were screened against 44 G-protein–coupled receptors, ion channels, and transporter proteins using radioligand-binding assay to compare the molecular targets. RESULTS: The mean withdrawal score was reduced in rats treated with 1.25 mg·kg−1 dezocine compared to vehicle-treated control animals starting from the day 1 (mean difference: 7.8; 95% confidence interval [CI], 6.35–9.25; P

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Case Studies in Adult Intensive Care Medicine

No abstract available

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Lack of Evidence for Ceiling Effect for Buprenorphine Analgesia in Humans

No abstract available

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Potential Benefits of Sodium-Glucose Cotransporter-2 Inhibitors in the Perioperative Period

No abstract available

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Diagnostic Accuracy of Point-of-Care Gastric Ultrasound

BACKGROUND: Pulmonary aspiration of gastric contents is associated with significant perioperative morbidity and mortality. Previous studies have investigated the validity, reliability, and possible clinical impact of gastric ultrasound for the assessment of gastric content at the bedside. In the present study, we examined the accuracy (evaluated as sensitivity, specificity, and likelihood ratios) of point-of-care gastric ultrasound to detect a "full stomach" in a simulated scenario of clinical equipoise. METHODS: After a minimum fasting period of 8 hours, 40 healthy volunteers were randomized in a 1:1 ratio to either remain fasted or ingest a standardized quantity of clear fluid or solid. Each subject was randomized twice on 2 independent study sessions at least 24 hours apart. A gastric ultrasound examination was performed by a blinded sonographer following a standardized scanning protocol. Using a combination of qualitative and quantitative findings, the result was summarized in a dichotomous manner as positive (any solid or >1.5 mL/kg of clear fluid) or negative (no solid and ≤1.5 mL/kg of clear fluid) for full stomach. RESULTS: Data from 80 study sessions were analyzed. In this simulated clinical scenario with a pretest probability of 50%, point-of-care gastric ultrasound had a sensitivity of 1.0 (95% confidence interval [CI], 0.925–1.0), a specificity of 0.975 (95% CI, 0.95–1.0), a positive likelihood ratio of 40.0 (95% CI, 10.33–∞), a negative likelihood ratio of 0 (95% CI, 0–0.072), a positive predictive value of 0.976 (95% CI, 0.878–1.0), and a negative predictive value of 1.0 (95% CI, 0.92–1.0). CONCLUSIONS: Our results suggest that bedside gastric ultrasound is highly sensitive and specific to detect or rule out a full stomach in clinical scenarios in which the presence of gastric content is uncertain. Accepted for publication February 27, 2018. Funding: This study was supported by a peer-reviewed grant from Physician Services Incorporated, Ontario, Canada. Conflicts of Interest: See Disclosures at the end of the article. Trial Registry Number: Registration ID: NCT02588495. Reprints will not be available from the authors. Address correspondence to Anahi Perlas, MD, FRCPC, Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Department of Anesthesia, University of Toronto, 399 Bathurst St, McLaughlin Pavilion 2–405, Toronto, ON M5T 2S8, Canada. Address e-mail to anahi.perlas@uhn.ca. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Reduced Ketobemidone Usage in Quadratus Lumborum Block Patients After Cesarean Delivery: Clinical Pharmacology Views

No abstract available

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Profound Intraoperative Hypotension Associated With Transfusion via the Belmont Fluid Management System

This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients. Accepted for publication February 1, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joanna Miller, MD, Mount Sinai Hospital, 1 Gustave Levy Pl, New York, NY 10129. Address e-mail to joanna.miller@mountsinai.org. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial

BACKGROUND: In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol. METHODS: Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0.1–0.5 μg·kg−1·hour−1, or a propofol group (n = 24), which received a continuous infusion of propofol via a target-controlled infusion to maintain the effect-site concentration within a range of 0.5–2.0 μg/mL. The drug infusion rate was determined according to the sedation level, targeting a modified observer's assessment of alertness/sedation score of 3 or 4. The cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia were recorded at 24 and 48 hours postoperatively (primary outcome). The postoperative numerical rating scale for pain was assessed at 6, 12, 24, and 48 hours (secondary outcome). The postoperative use of additional rescue analgesic (ketoprofen) and antiemetic drugs was also compared between the 2 groups at 24 and 48 hours. RESULTS: Dexmedetomidine significantly reduced postoperative fentanyl consumption (median [interquartile range]) during 0–24 hours (45 [30–71] vs 150 [49–248] μg, P = .004; median difference = −105 μg [99.98% CI, 210–7.5]), 24–48 hours (90 [45–143] vs 188 [75–266] μg, P = .005; median difference = −98 μg [99.98% CI, 195–45]), and 0–48 hours (135 [68–195] vs 360 [146–480] μg, P = .003; median difference = −225 μg [99.98% CI, 405–7.5]). The numerical rating scale (median [interquartile range]) was lower at 6 hours (1 [0–2] vs 2 [1–3], P = .003), 12 hours (1 [1–2] vs 3 [2–3], P

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Flupirtine, an Effective Analgesic, but Hepatotoxicity Should Limit Its Use

No abstract available

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Eating Pecans May Cut Risk of Cardiovascular Disease, Diabetes

FRIDAY, April 6, 2018 -- Eating pecans every day for four weeks improves certain markers of cardiometabolic disease risk, according to a study published online March 11 in Nutrients. Diane L. McKay, Ph.D., from Tufts University in Boston, and...

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Small Employers Often Don't Provide Tobacco Cessation Help

FRIDAY, April 6, 2018 -- Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs, according to a report published in the March issue of Health Affairs. Michael F. Pesko, Ph.D., from Georgia State...

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U.S. Providers Fix Complications From Medical Tourism Procedures

FRIDAY, April 6, 2018 -- Cosmetic surgery procedures done in developing countries can carry substantial risks of complications that U.S. providers and payers must handle, according to a study published in the April issue of Plastic and...

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Interns' Schedule Takes Toll on Sleep, Physical Activity, Mood

FRIDAY, April 6, 2018 -- New interns' intense and changing schedules take a toll on sleep, activity, and mood, according to a study published online March 14 in the Journal of General Internal Medicine. David A. Kalmbach, Ph.D., from University of...

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Summer Food Assistance Program Cuts Families' Food Insecurity

FRIDAY, April 6, 2018 -- A summer food assistance program that provides electronic benefits transfer cards to low-income households with school-age children improves food security and diet quality during the summer months, according to a study...

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Long-Standing Abdominal Complaints and Hyperamylasemia Due to Foreign Body Ingestion

A 38-year old man was referred for endoscopic retrograde cholangiopancreatography. A gastroduodenoscopy performed elsewhere for chronic dyspepsia showed a foreign body in the duodenum that was considered to be an endoprothesis in either the pancreas or biliary tract. His medical history showed previous hospital admissions as a result of dyspepsia in 2012 and 2015, and the patient had been homeless for several months in 2012. Laboratory tests in 2012 showed an increased amylase level of 575 U/L (normal range, 0–100 U/L), but at these previous admissions the patient repeatedly had left the hospital before further imaging had taken place.

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Laparoscopic Assessment to Determine the Likelihood of Achieving Optimal Cytoreduction in Patients Undergoing Primary Debulking Surgery for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Objective: The objective of this study was to evaluate the safety and efficacy of laparoscopic assessment to determine the likelihood of achieving optimal cytoreduction (OC) in patients undergoing primary debulking surgery (PDS) for ovarian cancer. Methods: All patients who underwent diagnostic laparoscopy and PDS at our institution from January 2008 to December 2013 were identified. We determined the likelihood of achieving optimal cytoreduction by laparoscopic assessment based on tumor site, pattern of spread, and disease burden. Sensitivity was defined as the number of patients who achieved optimal cytoreduction after laparoscopic assessment divided by the number of patients with disease deemed resectable by laparoscopy. Results: We identified 55 patients during study period. Twenty-one of the 55 patients (38%) were early stage disease. Six (10.9%) patients had disease deemed unresectable and 49 (89.1%) had disease deemed resectable at the time of laparoscopy. OC was achieved in 48 of 49 (97.9%) patients. The sensitivity of laparoscopy in predicting OC was 98% (95% confidence interval, 89.3%-99.9%). The operation was completed laparoscopically in 23 of 49 patients (47%); in 26 of 49 (53%), PDS was performed by laparotomy. There were no port site metastases reported. The rate of postoperative complications was 16%. With a median follow-up of 30 months, the median overall survival was not reached and the 75th percentile for overall survival was 37 months. Conclusions: Laparoscopy was shown to have a high sensitivity in predicting OC and is a feasible tool in triaging patients with ovarian cancer. Laparoscopy is not associated with adverse surgical outcomes. V.A. and A.K. contributed equally. The authors declare no conflicts of interest. Reprints: Linus Chuang, MD, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, 1176 Fifth Avenue, 1st Floor, New York, NY 10029. E-mail: linus.chuang@mountsinai.org. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Impact of Concomitant Urologic Intervention on Clinical Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Introduction: The impact of concomitant urologic procedures (UPs) on perioperative and long-term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is uncertain. Methods: In total, 935 consecutive CRS/HIPEC procedures were performed between 1996 and 2016 in Sydney, Australia. Among these, 73 (7.8%) involved concomitant UP. The association of concomitant UP with 21 perioperative outcomes and overall survival was assessed using univariate and multivariate analyses. Results: In-hospital mortality was 1.8%. Patients requiring UP were more likely to require transfusion of ≥5 units of red blood cells (P=0.031) and have a complete cytoreduction (79% vs. 60%, P

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Validation of the Proxy Version of Symptom Screening in Pediatrics Tool (SSPedi) in Children Receiving Cancer Treatments

Primary objectives were to evaluate the inter-rater reliability and validity of proxy-report Symptom Screening in Pediatrics Tool (SSPedi) in children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients. Secondary objective was to describe the inter-rater reliability of each SSPedi item.

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Working Memory Training Following Neonatal Critical Illness: A Randomized Controlled Trial

Objectives: To test the immediate and long-term effectiveness of Cogmed Working Memory Training following extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia. Design: A nationwide randomized controlled trial assessing neuropsychologic outcome immediately and 1 year post Cogmed Working Memory Training, conducted between October 2014 and June 2017. Researchers involved in the follow-up assessments were blinded to group allocation. Setting: Erasmus MC-Sophia Children's Hospital, Rotterdam, and Radboud University Medical Center, Nijmegen, the Netherlands. Patients: Eligible participants were neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia survivors (8–12 yr) with an intelligence quotient greater than or equal to 80 and a z score less than or equal to –1.5 on at least one (working) memory test at first assessment. Interventions: Cogmed Working Memory Training, comprising 25 45-minute training sessions for 5 consecutive weeks at home. Measurements and Main Results: Participants were randomized to Cogmed Working Memory Training (n = 19) or no intervention (n = 24) (two dropped out after T0). Verbal working memory (estimated coefficient = 0.87; p = 0.002) and visuospatial working memory (estimated coefficient=0.96, p = 0.003) significantly improved at T1 post Cogmed Working Memory Training but was similar between groups at T2 (verbal, p = 0.902; visuospatial, p = 0.416). Improvements were found at T2 on long-term visuospatial memory following Cogmed Working Memory Training (estimated coefficient = 0.95; p = 0.003). Greater improvements in this domain at T2 following Cogmed Working Memory Training were associated with better self-rated school functioning (r = 0.541; p = 0.031) and parent-rated attention (r = 0.672; p = 0.006). Conclusions: Working memory improvements after Cogmed Working Memory Training disappeared 1 year post training in neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia survivors. Gains in visuospatial memory persisted 1 year post intervention. Cogmed Working Memory Training may be beneficial for survivors with visuospatial memory deficits. Trial Registration NTR4571: https://ift.tt/2EqGKnm. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Supported, in part, by the Sophia Stichting Wetenschappelijk Onderzoek: S14-21 and Revalidatiefonds (project number: R2014006). Dr. Verhulst received funding from Erasmus University Medical Center, Rotterdam. Dr. White's institution received funding from Sophia Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: h.ijsselstijn@erasmusmc.nl Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Feasibility and Safety of Intravascular Temperature Management for Severe Heat Stroke: A Prospective Multicenter Pilot Study

Objectives: Heat stroke is a life-threatening condition with high mortality and morbidity. Although several cooling methods have been reported, the feasibility and safety of treating heat stroke using intravascular temperature management are unclear. This study evaluated the efficacies of conventional treatment with or without intravascular temperature management for severe heat stroke. Design: Prospective multicenter study. Setting: Critical care and emergency medical centers at 10 tertiary hospitals. Patients: Patients with severe heat stroke hospitalized during two summers. Interventions: Conventional cooling with or without intravascular temperature management. Measurements and Main Results: Cooling efficacy, Sequential Organ Failure Assessment score, occurrence rate of serious adverse events, and prognosis based on the modified Rankin Scale and Cerebral Performance Category. Patient outcomes were compared between five centers that were prospectively assigned to perform conventional cooling (control group: eight patients) and five centers that were assigned to perform conventional cooling plus intravascular temperature management (intravascular temperature management group: 13 patients), based on equipment availability. Despite their higher initial temperatures, all patients in the intravascular temperature management group reached the target temperature of 37°C within 24 hours, although only 50% of the patients in the control group reached 37°C (p

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Use of Cerebrospinal Fluid (1,3)-β-D-Glucan to Monitor Treatment Response in Candida albicans Meningitis in an HIV-infected Patient

Candida meningitis is rare in the setting of human immunodeficiency virus (HIV) infection and often presents a diagnostic challenge. Its clinical features typically mimic those of cryptococcal or tuberculous meningitis and Candida can be difficult to culture from cerebrospinal fluid. Furthermore, optimal treatment and monitoring parameters are not well defined. Cerebrospinal fluid levels of (1,3)-β-D-glucan, which is a component of the fungal cell wall, have been used to diagnose and monitor response to therapy in other cases of fungal meningitis, but its utility in the setting of Candida meningitis and HIV infection is less clear. Here, we present a case of spontaneous Candida albicans meningitis in a woman with advanced HIV infection and report on the clinical utility of cerebrospinal fluid (1,3)-β-D-glucan for diagnosis and monitoring of chronic infection. Correspondence to: Caitlin A. Moran, MD, Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303. E-mail: cmoran4@emory.edu. The authors have no conflicts of interest. Consent for publication: Informed consent for publication of this case report was provided by the patient. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Clinically Significant Drug Interactions Among Human Immunodeficiency Virus–Positive Patients on Antiretroviral Therapy in an Outpatient Setting

Human immunodeficiency virus (HIV) treatment is complicated by antiretrovirals prone to clinically significant drug interactions (CSDIs). Objectives were to examine relationships of patient and medication characteristics and provider training level with CSDIs in an outpatient HIV clinic. A clinical pharmacist reviewed medication lists of randomly selected adult HIV-positive patients on antiretrovirals for accuracy and presence of a CSDI, defined as grade C, D, or X using Lexicomp software. Characteristics were compared between patients with and without CSDIs by χ2 tests for categorical variables and t tests for continuous variables. Associations between these parameters and CSDIs (presence vs absence) were evaluated by logistic regression. Associations between provider type (infectious disease physician [IDMD], infectious disease fellow [Fellow], and nurse practitioner [NP]) and number of CSDIs per patient, and provider response to being informed of a CSDI were analyzed by χ2 tests. Of 107 records reviewed, 405 CSDIs were identified in 83 (76%) patient records. Clinically significant drug interaction presence was associated with older age, increased medications, protease inhibitor-based regimen, and medication list inaccuracies. Patients with and without CSDIs did not differ in sex, race, HIV viral load, or nonnucleoside reverse-transcriptase inhibitor regimen. Older age (odds ratio [95% confidence interval], 3.53 [1.21–11.64]) and a protease inhibitor-based regimen (odds ratio [95% confidence interval], 8.49 [2.18–46.07]) were associated with having a CSDI. Fellows were more likely to report being unaware of CSDIs than IDMDs and NPs and to request additional information versus IDMDs and NPs. These findings suggest that providers may benefit from involving a pharmacist to identify and educate about CSDIs. Correspondence to: Lea M. Monday, MD, PharmD, Department of Internal Medicine, 4201 St Antoine St, Suite 2E, Detroit, MI 48201. E-mail: lmonday@med.wayne.edu. Funding for this study was provided to L.M.M. by Infectious Disease Society of America Medical Scholars Award Grant (US $2000). The authors have no conflicts of interest to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Piperacillin-Tazobactam–Induced Neutropenia and Fever: A Report of 11 Cases

Background This study aims to describe our experience with 11 cases of piperacillin-tazobactam–related neutropenia and fever that were observed over a 6-year period and detail some of their clinical findings, risk factors, management, and outcome. Method Review of the records of all cases of piperacillin-tazobactam–related neutropenia and fever reported to the adverse drug reaction reporting system of the Department of Pharmacy at Hamad General Hospital in the period between 2010 and 2015 was performed. Results During the study period, 11 cases of piperacillin-tazobactam–related neutropenia and fever were identified. Nine were males, and 2 were females, with a mean age of 36 years. All patients had neutropenia, and 10 had fever at the same time. The mean duration of piperacillin-tazobactam use before the development of neutropenia and fever was 17.3 days. Concomitant anemia and thrombocytopenia were observed in 82% and 55%, respectively. Recovery was fast with resolution of fever and neutropenia in 1.5 days and 2.9 days, respectively. All patients survived. Conclusion Piperacillin-tazobactam is a commonly used antibiotic in Qatar. Neutropenia and fever related to piperacillin-tazobactam does occur, however, very rarely. The most important risk factor for its occurrence is prolonged use of more than 17 days. Discontinuation of the drug results in rapid resolution with no sequelae. We report these cases to alert physicians to this uncommon adverse effect of piperacillin-tazobactam and to encourage reporting. Correspondence to: Hussam Al Soub, MD, CABM, FACP, Department of Internal Medicine, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. E-mail: hussamalsoub@yahoo.com. The authors have no funding or conflicts of interest to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Retrospective Case Series of Telavancin for the Treatment of Staphylococcus aureus Bacteremia: A Real-World Experience

Purpose Telavancin (TLV) is approved for complicated skin and skin structure infections and hospital-acquired pneumonia. This report represents a retrospective analysis of patients with Staphylococcus aureus bacteremia who, at the physician's discretion, received TLV at some time during their course. Methods The primary outcome measure was the percent of patients cured or improved at the end of TLV therapy (EOTT). The secondary outcome was the percent of patients cured or improved at least 30 days after discontinuation of TLV therapy. Results There were 46 cases of S. aureus bacteremia, with 44 (95.7%) being methicillin-resistant S. aureus and 2 (4.3%) methicillin-susceptible S. aureus. At EOTT, 30 (65.2%) were considered cured, 9 (19.6%) had an incomplete response, and 7 (15.2%) had died. At the 30-day follow-up after EOTT, 32 were cured (69.6%), 6 (13%) had an incomplete response, and 8 (17.4%) had died. For the 7 patients who died by EOTT, 2 deaths were not associated with infection. While there was no difference in the median length of stay between patients who were cured, had incomplete response, or died, the median duration of TLV therapy for the cured group was 29.5 days (minimum, 4; 25th percentile, 14.75; 75th percentile, 42.0; maximum, 67 days) compared with 11 days (minimum, 1; 25th percentile, 5; 75th percentile, 34; maximum, 47 days) for those with an incomplete response and 4 days (minimum, 1; 25th percentile, 1; 75th percentile, 15; maximum, 15 days) for those who died. Additional antibiotics were permitted prior to, concurrent with, and after TLV. More than 78% of patients received antibiotics prior to TLV (n = 36), 30.4% received antibiotics concurrent with TLV (n = 14), and 19.6% received antibiotics after TLV (n = 9). Five patients received TLV only. The median duration of antibiotics prior to TLV was 4 days (minimum, 1; 25th percentile, 2; 75th percentile, 7.75; maximum, 25 days). The median duration of antibiotics concurrent with TLV was 5 days (minimum, 1; 25th percentile, 1; 75th percentile, 11; maximum, 37 days). The median duration of antibiotics after TLV was 19 days (minimum, 2; 25th percentile, 10.5; 75th percentile, 117.5; maximum, 545 days). When comparing patients who were cured versus those who had an incomplete response, 26 (89.7%) of 29 patients who received TLV longer than any other antibiotic before EOTT were cured compared with 4 (40.0%) of 10 patients who received TLV for a shorter number of days than other antibiotics (P = 0.001). The most common adverse effect was anemia in 9 (19.6%), followed by rises in hepatic enzymes and serum creatinine in 5 (10.9%) each. No adverse events led to the discontinuation of TLV therapy. Conclusions Although it is difficult to determine the efficacy of TLV by itself, patients who received TLV for a longer duration than other antibiotics before EOTT were more likely to be cured as opposed to having an incomplete response compared with patients who received TLV as a smaller proportion of their total antibiotic days. A favorable outcome was achieved for many patients receiving the antimicrobial regimen that included TLV for the treatment of methicillin-resistant S. aureus bacteremia. Correspondence to: Louis D. Saravolatz, MD, MACP, 19251 Mack Ave, Suite 335, Grosse Pointe Woods, MI 48236. E-mail: louis.saravolatz@stjohn.org. This work was supported by Theravance Pharmaceuticals through an investigator-initiated grant. L.D.S., A.H., J.R., and K.O.C. participate in the speakers' bureau for Theravance. The other authors have no conflicts of interest to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Transcriptome analyses reveal FOXA1 dysregulation in mammary and extramammary Paget's disease

Paget's disease (PD) is an uncommon intraepithelial adenocarcinoma with unknown pathogenesis. There are two anatomic subtypes: mammary (MPD) and extramammary (EMPD). Little is known about their molecular characteristics. Our objective was to discover novel molecular markers for PD and its subtypes. In the discovery phase, we used transcriptome analyses to uncover the most differentially expressed genes and pathways in EMPD biopsies compared with normal skin. In the validation phase, we performed immunohistochemistry analyses on the most promising marker (FOXA1) and other markers selected from a literature review (GATA3, estrogen receptor [ER], and androgen receptor [AR]) on independent biopsies of MPD (n=86), EMPD (n=59), and normal skin (n=21).

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Somatic polymerase epsilo mutations as another route leading to loss of DNA MMR protein expression in endometrial carcinoma—reply

Laura J. Tafe MD laura.j.tafe@hitchcock.org

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Fine‐needle aspiration of tubulocystic renal cell carcinoma

Diagnostic Cytopathology, EarlyView.

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Early Response Assessment on Mid-Treatment CT Predicts Loco-Regional Recurrence in Oropharyngeal Cancer Patients Treated with Definitive Radiation Therapy

In a cohort study of 96 oropharyngeal cancer patients undergoing definitive radiation therapy, we identified early response assessment based on mid-treatment CT at the 15th RT fraction as an independent predictor of locoregional recurrence. Combining this with p-16 and smoking status, we were able to effectively distinguish high-risk and low-risk patients, potentially allowing for more precise risk-adaptive treatment stratification.

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A dietary pattern based on estrogen metabolism is associated with breast cancer risk in a prospective cohort of postmenopausal women

International Journal of Cancer, EarlyView.

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Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

International Journal of Cancer, EarlyView.

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Garlic intake and gastric cancer risk: Results from two large prospective US cohort studies

International Journal of Cancer, EarlyView.

https://ift.tt/2EqKa9O

Approaching Fatigue and Error in Emergency Medicine: Narrowing the Gap Between Work as Imagined and Work as Really Done

SEE RELATED ARTICLE, P. ■■■.

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Prognostic Utility of Initial Lactate in Patients With Acute Drug Overdose: A Validation Cohort

Previous studies have suggested that the initial emergency department (ED) lactate concentration may be an important prognostic indicator for inhospital mortality from acute drug poisoning. We conduct this cohort study to formally validate the prognostic utility of the initial lactate concentration in a larger, distinct patient population with acute drug overdose.

https://ift.tt/2GCD209

Prevalence of Childhood Permanent Hearing Loss after Early Complex Cardiac Surgery

To estimate the prevalence of childhood permanent hearing loss (PHL) after early cardiac surgery.

https://ift.tt/2IySFC8

In-Hospital Outcomes in Large for Gestational Age Infants at 22-29 Weeks of Gestation

To estimate the risks of mortality and morbidities in large for gestational age (LGA) infants relative to appropriate for gestational age infants born at 22-29 weeks of gestation.

https://ift.tt/2uS5vJF

Parent-Child Sexual Communication Among Middle School Youth

Middle school youth (N = 1472) in Central Indiana completed a survey about parent-adolescent sexual communication. Being older, female, mixed race, ever had sex, ever arrested, and higher HIV knowledge were associated with more frequent sexual communication.

https://ift.tt/2q9i4Me

Modified Healthy Eating Index and Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study

To assess the relationship between modified healthy eating index (mHEI) with the development of metabolic syndrome (MetS) among children and adolescents.

https://ift.tt/2qaYpvk

Characteristics Associated with Confidential Consultation for Adolescents in Primary Care

To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training.

https://ift.tt/2qbi4v9

Statewide Initiative to Reduce Postnatal Growth Restriction among Infants <31 Weeks of Gestation

To decrease the incidence of postnatal growth restriction, defined as discharge weight <10th percentile for postmenstrual age, among preterm infants cared for in New York State Regional Perinatal Centers.

https://ift.tt/2qchpc4

Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical fusion surgery: a nationwide analysis of 52,818 patients

Publication date: Available online 6 April 2018
Source:The Spine Journal
Author(s): David N. Bernstein, Etka Kurucan, Emmanuel N. Menga, Robert W. Molinari, Paul T. Rubery, Addisu Mesfin
Background ContextNumerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with non-cervical spine involvement.PurposeTo compare patient characteristics, comorbidities and complications in patients with and without RA undergoing primary non-cervical spine fusions.Study Design/SettingRetrospective national database review.Patient SampleA total of 52,818 adult spinal deformity patients undergoing non-cervical spine fusions (1,814 patients with RA and 51,004 patients without RA).Outcome MeasuresPatient characteristics, as well as complication and mortality rates.MethodsUsing the Nationwide Inpatient Sample (NIS) from 2003-2014, ICD-9-CM diagnosis and procedure codes were used to identify patients ≥ 18 years old with and without RA undergoing primary non-cervical spine fusions. Univariate analysis was utilized to determine patient characteristics, comorbidities, and complication values for each group. Bivariate analysis was used to compare the two groups. Significance was set at p<0.05.ResultsPatients with RA were older (p<0.001), were more likely to be women (p<0.001), had increased rates of osteoporosis (p<0.001), had a greater percentage of their surgeries reimbursed by Medicare (p<0.001) and more often had weekend admissions (p = 0.014). There was no difference in all other characteristics. Patients with RA had higher rates of iron deficiency anemia, congestive heart failure, chronic pulmonary disease, depression and fluid & electrolyte disorders (all, p<0.001). Patients without RA had higher rates of alcohol abuse (p = 0.027). There was no difference in all other complications. There was no difference in mortality rate (p = 0.99). Total complications were greater in patients with RA (p<0.001). Patients with RA had higher rates of infection (p = 0.032), implant-related complications (p 0.010), incidental durotomies (p = 0.001) and urinary tract infections (p<0.001). No difference existed between other complications.ConclusionsPatients with RA have an increased number of comorbidities and complication rate compared to patients without RA. Such knowledge can help surgeons and patients with RA have beneficial preoperative discussions regarding outcomes.

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Does approach matter? a comparative radiographic analysis of spinopelvic parameters in single level lumbar fusion.

Publication date: Available online 6 April 2018
Source:The Spine Journal
Author(s): Seth Ahlquist, Howard Y. Park, Jonathan Gatto, Ayra N. Shamie, Don Y. Park
Background ContextLumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion, however comparative data of these techniques is limited.PurposeTo directly compare the impact of various lumbar fusion techniques (ALIF, LLIF, TLIF, PLF) based on radiographic parameters.Study Design/SettingA single-center retrospective study examining pre-operative and post-operative radiographs.Patient SampleA consecutive list of lumbar fusion surgeries performed by multiple spine surgeons at a single institution from 2013-2016 were identified.Outcome MeasuresRadiographic measurements utilized included segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic incidence-lumbar lordosis mismatch (PI-LL), anterior and posterior disk height (DH-A, DH-P respectively), and foraminal height (FH).MethodsRadiographic measurements were performed on pre-operative and post-operative lateral lumbar radiographs on all single-level lumbar fusion cases. Demographic data was collected including age, gender, approach, diagnosis, surgical level, and implant lordosis. Paired sample t-test, one-way ANOVA, McNemar Test, and independent sample t-test were used to establish significant differences in the outcome measures. Multiple linear regression was performed to determine a predictive model for lordosis from implant lordosis, fusion technique, and surgical level.ResultsThere were 164 patients (78 males, 86 females) with a mean age of 60.1 years and average radiographic follow up time of 9.3 months. These included 34 ALIF, 23 LLIF, 63 TLIF, and 44 PLF surgeries. ALIF and LLIF significantly improved SL (7.9° & 4.4°), LL (5.5° & 7.7°), DH-A (8.8 mm & 5.8 mm), DH-P (3.4 mm & 2.3 mm), and FH (2.8 mm & 2.5 mm), respectively (p ≤ .003). TLIF significantly improved these parameters, albeit to a lesser extent: SL (1.7°), LL (2.7°), DH-A (1.1 mm), DH-P (0.8 mm), and FH (1.1 mm), p ≤ .02. PLF did not significantly alter any of these parameters while significantly reducing FH (-1.3 mm, p = .01). One-way ANOVA showed no significant differences between ALIF and LLIF other than ALIF with greater ΔDH-A (3.0 mm, p = .02). Both ALIF and LLIF significantly outperformed PLF in pre-operative to post-operative change in all parameters p ≤ .001. Additionally, ALIF significantly outperformed TLIF in the change in SL (6.2°, p < .001) and LLIF significantly outperformed TLIF in the change in LL (5.0°, p = .02). Both outperformed TLIF in ΔDH-A (7.7 mm & 4.7 mm) and ΔDH-P (2.6 mm & 1.5 mm), respectively (p ≤ .02). ALIF was the only fusion technique that significantly improved the proportion of patients with a PI-LL < 10° (0.41 to 0.66, p = .02). Lordotic cages had superior improvement of all parameters as compared to non-lordotic cages (p <.001). Implant lordosis (m = 1.1), fusion technique (m = 6.8), and surgical level (m = 6.9) significantly predicted post-operative SL (p < .001, R2 = .56).ConclusionsThis study demonstrated that these four lumbar fusion techniques yield divergent radiographic results. ALIF and LLIF produced greater improvements in radiographic measurements post-operatively as compared to TLIF and PLF. ALIF was the most successful in improving PI-LL mismatch, an important parameter relating to sagittal alignment. Lordotic implants provided better sagittal correction and surgeons should be cognizant of the impact that these differing implants and techniques produce after surgery. Surgical technique is an important determinant of post-operative alignment and has ramifications upon sagittal alignment in lumbar fusion surgery.

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Role of radiation therapy in primary breast diffuse large B‐cell lymphoma in the Rituximab era: a SEER database analysis

Cancer Medicine, EarlyView.

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{beta}-Blocker Dialyzability in Maintenance Hemodialysis Patients: A Randomized Clinical Trial

Background and objectives

There is a paucity of data available to describe drug dialyzability. Of the available information, most was obtained before implementation of modern hemodialysis membranes. Our study characterized dialyzability of the most commonly prescribed β-blockers in patients undergoing high-flux hemodialysis.

Design, setting, participants, & measurements

Patients on hemodialysis (n=8) were recruited to an open label, pharmacokinetic, four-way crossover trial. Single doses of atenolol, metoprolol, bisoprolol, and carvedilol were administered on separate days in random order to each patient. Plasma and dialysate drug concentrations were measured, and dialyzability was determined by the recovery clearance and arterial venous difference methods.

Results

Using the recovery clearance method, the dialytic clearance values for atenolol, metoprolol, bisoprolol, and carvedilol were 72, 87, 44, and 0.2 ml/min, respectively (P<0.001). Applying the arterial venous difference method, the dialytic clearance values of atenolol, metoprolol, bisoprolol, and carvedilol were 167, 114, 96, and 24 ml/min, respectively (P<0.001).

Conclusions

Atenolol and metoprolol are extensively cleared by hemodialysis compared with the negligible dialytic clearance of carvedilol. Contrary to estimates of dialyzability on the basis of previous literature, our data indicate that bisoprolol is also dialyzable. This finding highlights the importance of conducting dialyzability studies to definitively characterize drug dialytic clearance.

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Evaluation and Management of CKD in the Nonkidney Solid Organ Transplant Recipient

https://ift.tt/2GEKB2k

Metabolic and Hypertensive Complications of Pregnancy in Women with Nephrolithiasis

Background and objectives

Kidney stones are associated with future development of hypertension, diabetes, and the metabolic syndrome. Our objective was to assess whether stone formation before pregnancy was associated with metabolic and hypertensive complications in pregnancy. We hypothesized that stone formation is a marker of metabolic disease and would be associated with higher risk for maternal complications in pregnancy.

Design, setting, participants, & measurements

We conducted a retrospective cohort study of women who delivered infants at the Massachusetts General Hospital from 2006 to 2015. Women with abdominal imaging (computed tomography or ultrasound) before pregnancy were included in the analysis. Pregnancy outcomes in women with documented kidney stones on imaging (stone formers, n=166) were compared with those of women without stones on imaging (controls, n=1264). Women with preexisting CKD, hypertension, and diabetes were excluded.

Results

Gestational diabetes and preeclampsia were more common in stone formers than nonstone formers (18% versus 6%, respectively; P<0.001 and 16% versus 8%, respectively; P=0.002). After multivariable adjustment, previous nephrolithiasis was associated with higher risks of gestational diabetes (adjusted odds ratio, 3.1; 95% confidence interval, 1.8 to 5.3) and preeclampsia (adjusted odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6). Infants of stone formers were born earlier (38.7±2.0 versus 39.2±1.7 weeks, respectively; P=0.01); however, rates of small for gestational age offspring and neonatal intensive care admission were similar between groups (8% versus 7%, respectively; P=0.33 and 10% versus 6%, respectively; P=0.08). First trimester body mass index significantly influenced the association between stone disease and hypertensive complications of pregnancy: in a multivariable linear regression model, stone formation acted as an effect modifier of the relationship between maximum systolic BP in the third trimester and body mass index (P interaction <0.001).

Conclusions

In women without preexisting diabetes, hypertension, and CKD, a history of nephrolithiasis was associated with gestational diabetes and hypertensive disorders of pregnancy, especially in women with high first trimester body mass index.

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Urgent: Stop Preventable Infections Now

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Community-Based CKD Screening in Black Americans

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Treatment of Severe Hyponatremia

Patients with severe (serum sodium ≤120 mEq/L), symptomatic hyponatremia can develop life-threatening or fatal complications from cerebral edema if treatment is inadequate and permanent neurologic disability from osmotic demyelination if treatment is excessive. Unfortunately, as is true of all electrolyte disturbances, there are no randomized trials to guide the treatment of this challenging disorder. Rather, therapeutic decisions rest on physiologic principles, animal models, observational studies, and single-patient reports. European guidelines and recommendations of an American Expert panel have come to similar conclusions on how much correction of hyponatremia is enough and how much is too much, but there are important differences. We review the evidence supporting these recommendations, identifying areas that rest on relatively solid ground and highlighting areas in greatest need of additional data.

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Clear the Fog around Parathyroid Hormone Assays: What Do iPTH Assays Really Measure?

Conclusions

Colistin is associated with substantial excess AKI that is apparent within the first 72 hours of treatment. Colistin's toxicity varied according to baseline hemoglobin concentration.

Podcast

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_03_15_CJASNPodcast_18_4_M.mp3

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Black Americans Perspectives of Barriers and Facilitators of Community Screening for Kidney Disease

Background and objectives

Incidence of ESKD is three times higher in black Americans than in whites, and CKD prevalence continues to rise among black Americans. Community-based kidney disease screening may increase early identification and awareness of black Americans at risk, but it is challenging to implement. This study aimed to identify participants' perspectives of community kidney disease screening. The Health Belief Model provides a theoretic framework for conceptualization of these perspectives and optimization of community kidney disease screening activities.

Design, setting, participants, & measurements

Researchers in collaboration with the Tennessee Kidney Foundation conducted three focus groups of adults in black American churches in Nashville, Tennessee. Questions examined views on CKD information, access to care, and priorities of kidney disease health. Content analysis was used. Guided by the Health Belief Model, a priori themes were generated, and additional themes were derived from the data using an inductive approach.

Results

Thirty-two black Americans completed the study in 2014. Participants were mostly women (79%) with a mean age of 56 years old (range, 24–78). Two major categories of barriers to kidney disease screening were identified: (1) participant factors, including limited kidney disease knowledge, spiritual/religious beliefs, emotions, and culture of the individual; and (2) logistic factors, including lack of convenience and incentives and poor advertisement. Potential facilitators of CKD screening included provision of CKD education, convenience of screening activities, and use of culturally sensitive and enhanced communication strategies. Program recommendations included partnering with trusted community members, selecting convenient locations, tailored advertising, and provision of compensation.

Conclusions

Findings of this study suggest that provider-delivered culturally sensitive education and stakeholder engagement are critical to increase trust, decrease fear, and maximize participation and early identification of kidney disease among black Americans considering community screening.

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Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population: A Randomized, Controlled Trial

Background and objectives

Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center–based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list.

Design, setting, participants & measurements

We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients.

Results

At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (<500 days from referral) to late (≥500 days) follow-up. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03).

Conclusions

A transplant center–based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.

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Associations of Plasma Amino Acid and Acylcarnitine Profiles with Incident Reduced Glomerular Filtration Rate

Background and objectives

Metabolomics is instrumental in identifying novel biomarkers of kidney function to aid in the prevention and management of CKD. However, data linking the metabolome to incident eGFR are sparse, particularly in Asian populations with different genetic backgrounds and environmental exposures. Therefore, we aimed to investigate the associations of amino acid and acylcarnitine profiles with change in eGFR in a Chinese cohort.

Design, setting, participants, & measurements

This study included 1765 community-living Chinese adults aged 50–70 years with baseline eGFR≥60 ml/min per 1.73 m². At baseline, 22 amino acids and 34 acylcarnitines in plasma were quantified by gas or liquid chromatography coupled with mass spectrometry. Annual rate of change in eGFR was calculated, and incident eGFR decline was defined as eGFR<60 ml/min per 1.73 m² by the end of 6 years of follow-up.

Results

The mean (SD) unadjusted annual change in eGFR was 2.2±2.0 ml/min per 1.73 m² and the incidence of reduced eGFR was 16%. After Bonferroni correction, 13 of 56 metabolites were significantly associated with annual eGFR change. After multivariable adjustment of baseline covariates, including baseline eGFR, seven of the 13 metabolites, including cysteine, long-chain acylcarnitines (C14:1OH, C18, C18:2, and C20:4), and other acylcarnitines (C3DC and C10), were significantly associated with incident reduced eGFR (relative risks ranged from 1.16 to 1.25 per SD increment of metabolites; P<3.8E-03 after Bonferroni correction of multiple testing of the 13 metabolites). Moreover, principal component analysis identified two factors, consisting of cysteine and long-chain acylcarnitines, respectively, that were associated with incident reduced eGFR.

Conclusions

Elevated plasma levels of cysteine and a panel of acylcarnitines were associated with a higher incidence of reduced eGFR in Chinese adults, independent of baseline eGFR and other conventional risk factors.

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Correlation of Urine Ammonium and Urine Osmolal Gap in Kidney Transplant Recipients

https://ift.tt/2GIwZ6l

Association of Nonoxidized Parathyroid Hormone with Cardiovascular and Kidney Disease Outcomes in Chronic Kidney Disease

Background and objectives

In patients with CKD, elevated plasma parathyroid hormone (PTH) levels are associated with greater cardiovascular morbidity and mortality. However, the reference method for PTH measurement is disputed. It has been argued that measurement of nonoxidized PTH better reflects biologically active PTH than measurements with conventional assays.

Design, setting, participants, & measurements

PTH and nonoxidized PTH levels were measured at study baseline in 535 patients with CKD with an eGFR range between 89 and 15 ml/min per 1.73 m². Patients were followed over 5.1 years for the occurrence of acute heart failure, atherosclerotic events, CKD progression (doubling of serum creatinine or initiation of RRT), or all-cause death.

Results

Atherosclerotic events, acute heart failure, CKD progression, and deaths from any cause occurred in 116, 58, 73, and 85 patients, respectively. In Kaplan–Meier analyses, patients at the highest PTH and nonoxidized-PTH tertile (79–543 and 12–172 pg/ml, respectively) showed a higher rate of atherosclerotic events, acute heart failure, CKD progression, and death from any cause. After adjustment for eGFR and albuminuria, nonoxidized PTH was no longer associated with atherosclerotic events (hazard ratio third versus first tertile, 1.04 [95% confidence intervals, 0.62–1.75]), acute heart failure (hazard ratio third versus first tertile, 1.24 [95% confidence intervals, 0.59–2.62]), CKD progression (hazard ratio third versus first tertile, 0.93 [95% confidence intervals, 0.46–1.90]), and death from any cause (hazard ratio third versus first tertile, 1.23 [95% confidence intervals, 0.66–2.31]), and PTH lost its association with atherosclerotic events (hazard ratio third versus first tertile, 0.80 [95% confidence intervals, 0.46–1.38]) and CKD progression (hazard ratio third versus first tertile, 0.99 [95% confidence intervals, 0.46–2.10]), although it remained associated with acute heart failure (hazard ratio third versus first tertile, 2.76 [95% confidence intervals, 1.11–6.89]) and all-cause death (hazard ratio third versus first tertile, 2.35 [95% confidence intervals, 1.13–4.89]). After further adjustment for cardiovascular and kidney risk factors, PTH remained associated with all-cause death (hazard ratio third versus first tertile, 2.79 [95% confidence intervals, 1.32–5.89]), but with no other end point.

Conclusions

In a cohort of patients with CKD, PTH was associated with all-cause mortality; there was no association of nonoxidized PTH with any of the clinical outcomes examined.

https://ift.tt/2H17h05

Commentary on Treatment of Severe Hyponatremia

https://ift.tt/2GDzrL5

Computer-Based Training in Eating and Nutrition Facilitates Person-Centered Hospital Care: A Group Concept Mapping Study

Studies have shown that computer-based training in eating and nutrition for hospital nursing staff increased the likelihood that patients at risk of undernutrition would receive nutritional interventions. This article seeks to provide understanding from the perspective of nursing staff of conceptually important areas for computer-based nutritional training, and their relative importance to nutritional care, following completion of the training. Group concept mapping, an integrated qualitative and quantitative methodology, was used to conceptualize important factors relating to the training experiences through four focus groups (n = 43), statement sorting (n = 38), and importance rating (n = 32), followed by multidimensional scaling and cluster analysis. Sorting of 38 statements yielded four clusters. These clusters (number of statements) were as follows: personal competence and development (10), practice close care development (10), patient safety (9), and awareness about the nutrition care process (9). First and second clusters represented "the learning organization," and third and fourth represented "quality improvement." These findings provide a conceptual basis for understanding the importance of training in eating and nutrition, which contributes to a learning organization and quality improvement, and can be linked to and facilitates person-centered nutritional care and patient safety.

https://ift.tt/2GF7tCX

Using an Interactive Video Simulator to Improve Certified Nursing Assistants’ Dressing Assistance and Nursing Home Residents’ Dressing Performance: A Pilot Study

This pilot study examined the initial effects and estimated effect size of a computer-based simulation education program on certified nursing assistants' level of assistance when dressing nursing home residents with dementia and on residents' dressing performance. Nine dyads, assigned to either the experimental or control group, completed the study. Both groups received a traditional 1-hour education module delivered by a research assistant. The experimental group was then instructed to undertake an additional 2-hour intervention using a video simulator that enabled nursing assistants to practice level of assistance skills. The appropriateness of dressing assistance from nursing assistants and residents' dressing performance was measured before and 6 weeks after the intervention. The results showed that the two groups did not significantly differ in either appropriate levels of dressing assistance (P = .42) or residents' dressing performance (P = .38). A lack of effort by some assistants to properly assist residents and low statistical power may explain the lack of significance. The effect sizes of the experimental intervention on appropriate levels of dressing assistance and resident dressing performance were 0.69 and 0.89, respectively. Incorporating a strategy to improve motivation should be considered in future studies.

https://ift.tt/2qcb3te

Welcome and What’s Planned for the 2018 Nursing Knowledge: Big Data Science Conference

No abstract available

https://ift.tt/2GCZNBc

eNews Tool to Prevent Central Line–Associated Bloodstream Infection

No abstract available

https://ift.tt/2qe6mij

Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records

In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = −0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

https://ift.tt/2GDTqxp

Professionals' Use of a Multidisciplinary Communication Tool for Patients With Dementia in Primary Care

In this descriptive study, the use of a professional e-communication tool, Congredi, is evaluated. Ninety-six Congredi records of patients with dementia could be divided into the subgroups low-complex care (n = 43) and high-complex care (n = 53). If Congredi is an adequate communication tool for professionals, the changing involvement of caregivers must also be reflected within the two subgroups. We hypothesized that use would be more intensive in the high-complex group in comparison with the low-complex group. Data were gathered during 42 weeks. Results showed that the mean number of care activities in the high-complex group was significantly higher than in the low-complex group (10.43 vs 5.61, P = .001). The number of professionals involved with the high-complex care group (3.58) was higher compared to the low-complex care group (2.51) (P = .000). The most frequent use was by case managers and nurses (43.4%) in the high-complex group and by several case managers (41.9%) in the low-complex group. It was concluded that professionals used Congredi adequately in the multidisciplinary care of patients with dementia because the changing involvement of caregivers and the level of care activities were reflected in the use of Congredi.

https://ift.tt/2qdn55z

Barriers for Hospital-Based Nurse Practitioners Utilizing Clinical Decision Support Systems: A Systematic Review

There is a national focus on the adoption of healthcare technology to improve the delivery of safe, efficient, and high-quality patient care. Nurse practitioners fulfill an emerging strategic role in the hospital setting. A comprehensive literature review focused on the question: What are the barriers for nurse practitioners utilizing clinical decision support in the hospital setting? Nine studies conducted from 2011 to 2017 were the basis for this review, which identified 13 barriers for nurse practitioners utilizing clinical decision support in the hospital. Having the right information, including up-to-date evidence-based practice guidelines, accurate clinical pathways, and current clinical algorithms, was the most common barrier. Providing reliable clinical decision support is crucial as nurse practitioners become more dependent on hospital technology systems in the delivery of safe patient care. Eliminating barriers to the use of clinical decision support is important for informaticists and nurse practitioners because both groups concentrate on acceptance of decision support systems in the hospital to meet the goal of safe and high-quality patient care.

https://ift.tt/2GHFu5y

Barriers for Hospital-Based Nurse Practitioners Utilizing Clinical Decision Support Systems: A Systematic Review

No abstract available

https://ift.tt/2qe65vN

Why we prefer levetiracetam over phenytoin for treatment of status epilepticus

Acta Neurologica Scandinavica, EarlyView.

https://ift.tt/2GHFqCQ

S18-2. Advancement of research in event related potentials (ERP): Brain functional evaluation in children with developmental disorders

ERP is the measured brain response with electroencephalography that is direct result of a specific event. First cognitive components were discovered in the 1960s, and currently ERP is one of the most widely used methods in cognitive neuroscience research. The studies of ERP for pediatrics make advance with developmental disorders. It is possible for ERP to stimulate with suitable tasks for each disorder. Patients with ADHD have problems with executive functions, especially inhibitory function. NoGo potentials indicate inhibitory function.

https://ift.tt/2uRFWZm

S21-1. A new analysis method using surface electromyography to assess finger function in patients with severe stroke

We have conducted our research into kinesthetic illusions induced by visual stimuli (KiNvis), which are sensations of being in motion that result from watching artificial images of the body part moving. Our previous studies revealed characteristic neural networks related to KiNvis; since then, we have initiated clinical studies adapting KiNvis in patients with stroke. In patients with severe stroke, it is often difficult to measure joint angles, because voluntary movement does not occur or simultaneous contraction of the agonist and antagonist muscles prevent controlled voluntary joint exercise.

https://ift.tt/2Hdw2nn

S19-2. The possibility for applying to rehabilitation in MEG study – Variation of cortical magnetic fields by sensory input

MEG provides good localization accuracy within a few millimeters, particularly for superficial cortical sources such as those located in M1 and somatosensory cortex. Although exercising is the basic approach for patients in rehabilitation, the evidences is unclear. We have investigated the changes in cortical magnetic fields according to external stimulus as somatosensory, visual during movements.At first, we investigated practice-induced changes in PPC visuomotor processing during a Go/NoGo task in healthy subjects.

https://ift.tt/2uQ35eT

S17-4. Nerve and muscle ultrasound assessment in ALS

In the diagnosis and assessment of amyotrophic lateral sclerosis (ALS), the roles of nerve and muscle ultrasound vary widely. Nerve ultrasound has revealed that cross-sectional area (CSA) was decreased in the median and ulnar nerves and the nerve roots in ALS. In addition, a longitudinal study demonstrated the possibility that ulnar nerve CSA could be a useful biomarker to monitor disease progression in ALS. Muscle ultrasound is useful for detecting widespread fasciculations in the diagnosis of ALS.

https://ift.tt/2HeqXvc

Zika virus and Guillain–Barré syndrome in Bangladesh

Annals of Clinical and Translational Neurology, EarlyView.

https://ift.tt/2JqYcw6

Prevalence and Predictors of Preoperative Venous Thromboembolism in Asymptomatic Patients Undergoing Major Oncologic Surgery

Abstract

Background

Postoperative venous thromboembolism (VTE) is a leading cause of in-hospital mortality for cancer patients; however, the prevalence of preoperative VTE remains unclear.

Objective

The aim of this study was to evaluate the prevalence and risk factors associated with preoperative VTE in asymptomatic patients undergoing major oncologic surgery.

Methods

Retrospective analysis of 346 patients identified from our prospectively maintained database of patients undergoing abdominopelvic oncologic surgery from 2009 to 2016.

Results

The prevalence of preoperative VTE found on screening venous duplex scan was 10.1%. Patients with a history of prior VTE were more likely to have a preoperative deep vein thrombosis (DVT) versus those with no prior VTE (42.9% vs. 4.5%, p < 0.01). Relative risk for prior VTE was 8.2 [95% confidence interval (CI) 4.7–14.3]. Older age was also associated with preoperative VTE. Regression modeling determined that patients were 1.24-fold as likely to have a preoperative DVT for every 5-year increase in age (relative risk 1.24, 95% CI 1.09–1.42). Patients with preoperative DVT were more likely to have been diagnosed with sepsis 1 month prior to surgery (8.6% vs. 1.6%, p = 0.04). There were no postoperative pulmonary emboli. The overall postoperative complication rate was higher in those with a preoperative DVT (25.7% vs. 13.2%, p = 0.071).

Conclusion

Asymptomatic patients undergoing major oncologic surgery have a 10.1% prevalence of preoperative DVT. Increasing age, recent diagnosis of sepsis, and a history of prior VTE are significantly associated with preoperative DVTs. This suggests high-risk oncologic patients may benefit from screening lower extremity venous duplex ultrasound prior to Surgery.

https://ift.tt/2qcOcyc

The median patient age was 71.9 years, and 39.3% of patients were males. All patients underwent curative surgery (33.9%, simple cholecystectomy; 66.1%, more advanced procedures, such as hepatectomy; and 32.1%, bile duct reconstruction). On univariate analysis, preoperative carbohydrate antigen 19-9 (CA19–9) ≥ 37 U/mL (p = 0.042), postoperative complications (p = 0.043), and a high GBRS (p < 0.001) were prognostic factors for worse overall survival. On multivariate analysis, CA19–9 ≥ 37 U/mL (p = 0.039 and p = 0.043, respectively) and a high GBRS (p = 0.001 and p = 0.010, respectively) were independent risk factors for poor overall and recurrence-free survival. After propensity score-matched analysis, the GBRS precisely predicted prognosis of patients with GBC.

Conclusions

The GBRS is an easy and novel prognostic predicting score. Our validation revealed good discrimination, suggesting its clinical utility to improve individualized prediction of survival for patients undergoing resection of GBC.

https://ift.tt/2qaUrmo

Patterns of Treatment Failure in Patients with Sinonasal Mucosal Melanoma

Abstract

Background

Head and neck mucosal melanoma is a locally aggressive tumor with a high recurrence rate. The paranasal sinuses and nasal cavity are the most common primary tumor sites.

Objective

The purpose of this retrospective study was to identify independent predictors of outcome in sinonasal mucosal melanoma (SNMM) and characterize the patterns of treatment failure.

Methods

This study included 198 patients with SNMM who had been treated at The University of Texas MD Anderson Cancer Center from 1 January 1991 through 31 December 2016. The survival outcomes included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), local recurrence-free survival, and distant metastasis-free survival. A stepwise regression analysis was used to assess associations in the multivariate models.

Results

The 5-year OS, DSS, and DFS rates were 38, 58, and 27%, respectively. Independent predictors of poor OS and DSS were the paranasal sinuses as the primary tumor site [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.11–2.66; and HR 2.12, 95% CI 1.21–3.74, respectively] and the presence of distant metastases at presentation (HR 4.53, 95% CI 2.24–7.83; and HR 3.6, 95% CI 1.12–7.1). Recurrence occurred in 96 patients (48%). The most common cause of treatment failure was distant metastasis in 69 of 198 patients (35%), followed by local [36 (18%)] and regional [22 (11%)] recurrence.

Conclusion

The most common cause of treatment failure in SNMM is distant metastasis. The tumor site and the presence of metastatic disease at presentation were the only independent predictors of survival. These data can be used to inform quality improvement efforts and the counseling of high-risk SNMM patients.

https://ift.tt/2IBEVXA

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Αναζήτηση αυτού του ιστολογίου

Παρασκευή 6 Απριλίου 2018

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