AbstractBackground.Discussions regarding palliative care and end‐of‐life care issues are frequently delayed past the time of usefulness, resulting in unwanted medical care. We sought to develop a patient‐reported outcome (PRO) instrument that allows patients to voice their symptom burdens and facilitate timing of discussions.Subjects, Materials, and Methods.A seven‐item PRO instrument (Cota Patient Assessed Symptom Score‐7 item [CPASS‐7]) covering physical performance status, pain, burden, and depression was administered (September 2015 through October 2016) with correlation to overall survival, correcting for time to complete survey since diagnosis.Results.A total of 1,191 patients completed CPASS‐7 at a median of 560 days following the diagnosis of advanced cancer. Of these patients, 49% were concerned that they could not do the things they wanted; 35% reported decreased performance status. Financial toxicity was reported by 39% of patients, with family burdens noted in 25%. Although depression was reported by 15%, 43% reported lack of pleasure. Pain was reported by 33%. The median CPASS‐7 total symptom burden score was 16 (possible 0–112). With a median follow‐up of 15 months from initial survey, 46% had died. Patients with symptom burden scores <29 and ≥29 had a 6‐month overall survival rate of 87% and 67%, respectively, and 12‐month survival rates of 72% and 50%. A one‐point score increase resulted in a 1.8% increase in expected hazard.Conclusion.Patients with advanced cancer with higher levels of symptom burden, as self‐reported on the CPASS‐7, had inferior survival. The PRO facilitates identification of patients appropriate for reassessment of treatment goals and potentially palliative and end‐of‐life care in response to symptom burden concerns.Implications for Practice.A seven‐item patient‐reported outcome (PRO) instrument was administered to 1,191 patients with advanced cancers. Patients self‐reporting higher levels of physical and psychological symptom burden had inferior overall survival rates. High individual item symptom PRO responses should serve as a useful trigger to initiate supportive interventions, but when scores indicate global problems, discussions regarding end‐of‐life care might be appropriate.
https://ift.tt/2ItWTwl
Παρασκευή 28 Σεπτεμβρίου 2018
A Patient‐Reported Outcome Instrument to Assess Symptom Burden and Predict Survival in Patients with Advanced Cancer: Flipping the Paradigm to Improve Timing of Palliative and End‐of‐Life Discussions and Reduce Unwanted Health Care Costs
A Randomized Phase II Trial (TAMIGA) Evaluating the Efficacy and Safety of Continuous Bevacizumab Through Multiple Lines of Treatment for Recurrent Glioblastoma
AbstractBackground.We assessed the efficacy and safety of bevacizumab (BEV) through multiple lines in patients with recurrent glioblastoma who had progressed after first‐line treatment with radiotherapy, temozolomide, and BEV.Patients and Methods.TAMIGA (NCT01860638) was a phase II, randomized, double‐blind, placebo‐controlled, multicenter trial in adult patients with glioblastoma. Following surgery, patients with newly diagnosed glioblastoma received first‐line treatment consisting of radiotherapy plus temozolomide and BEV, followed by six cycles of temozolomide and BEV, then BEV monotherapy until disease progression (PD1). Randomization occurred at PD1 (second line), and patients received lomustine (CCNU) plus BEV (CCNU + BEV) or CCNU plus placebo (CCNU + placebo) until further disease progression (PD2). At PD2 (third line), patients continued BEV or placebo with chemotherapy (investigator's choice). The primary endpoint was survival from randomization. Secondary endpoints were progression‐free survival in the second and third lines (PFS2 and PFS3) and safety.Results.Of the 296 patients enrolled, 123 were randomized at PD1 (CCNU + BEV, n = 61; CCNU + placebo, n = 62). The study was terminated prematurely because of the high drop‐out rate during first‐line treatment, implying underpowered inferential testing. The proportion of patients receiving corticosteroids at randomization was similar (BEV 33%, placebo 31%). For the CCNU + BEV and CCNU + placebo groups, respectively, median survival from randomization was 6.4 versus 5.5 months (stratified hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.69–1.59), median PFS2 was 2.3 versus 1.8 months (stratified HR, 0.70; 95% CI, 0.48–1.00), median PFS3 was 2.0 versus 2.2 months (stratified HR, 0.70; 95% CI, 0.37–1.33), and median time from randomization to a deterioration in health‐related quality of life was 1.4 versus 1.3 months (stratified HR, 0.76; 95% CI, 0.52–1.12). The incidence of treatment‐related grade 3 to 4 adverse events was 19% (CCNU + BEV) versus 15% (CCNU + placebo).Conclusion.There was no survival benefit and no detriment observed with continuing BEV through multiple lines in patients with recurrent glioblastoma.Implications for Practice.Previous research suggested that there may be value in continuing bevacizumab (BEV) beyond progression through multiple lines of therapy. No survival benefit was observed with the use of BEV through multiple lines in patients with glioblastoma who had progressed after first‐line treatment (radiotherapy + temozolomide + BEV). No new safety concerns arose from the use of BEV through multiple lines of therapy.
https://ift.tt/2zD3vW5
Neutrophil- and Platelet- to Lymphocyte Ratio in Patients with Euthyroid Hashimoto’s Thyroiditis
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0723-3441
Background Hashimoto's thyroiditis (HT) is the most prevalent autoimmune thyroid disorder. Both neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are reported to be increased in various inflammation-related diseases, but their clinical significance in HT remains unclear. Objectives The aim of this study was to investigate the relationship between thyroid autommunity and NLR and PLR as markers of systemic inflammation in HT. Methods In this study, we evaluated 145 women with HT and 60 age-matched healthy controls. We compared the PLR and the NLR of HT patients with controls and the correlation between the NLR, PLR, and C-reactive protein (CRP), thyroid-stimulating hormone (TSH) and thyroid antibody titers in the patient group. Also we compared the PLR and the NLR of HT patients that received levothyroxine with those who did not receive levothyroxine Results There were no significant differences between patient and control groups in terms of overall leukocyte counts, neutrophil counts, and other laboratory tests. In the patient group lymphocyte counts were lower while the platelet counts, NLR (2.29±0.65 vs1.68±0.40), PLR (164.95±55.14 vs106.88±32.19) were higher than those of the control (p<0.001 for all comparisons). Conclusion In this study we found that NLR and PLR were higher in euthyroid Hashimoto patients than in a healthy control group. NLR and PLR are likely non-specific indicators of immune disorder and their implications for HT and other conditions remain to be elucidated.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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ATA 2018 Abstracts Available Online
We are pleased to provide complimentary access to the conference program and meeting abstracts for the 88th Annual Meeting of the American Thyroid Association, October 3-7, 2018 in Washington, DC. The Abstracts are available now on the Thyroid® website:
88th Annual Meeting of the American Thyroid Association Abstracts
Abstract Author Index
Short Call Abstracts
Short Call Author Abstract Index
The post ATA 2018 Abstracts Available Online appeared first on American Thyroid Association.
https://ift.tt/2OjDZgJ
Randomized in situ study on the efficacy of CO 2 laser irradiation in increasing enamel erosion resistance
Abstract
Objectives
The aim of this double-blind, randomized in situ study was to evaluate the erosion-preventive effect of a specific set of CO2 laser parameters, associated or not with fluoride.
Methods
Two hundred forty bovine enamel blocks were prepared for individual palatal appliances (n = 6 samples/appliance). The study had four phases of 5 days each, with ten volunteers and the following treatments: CO2 laser irradiation (L), fluoride treatment (F), combined fluoride and laser treatment (FL), and no treatment, control (C). Laser irradiation was performed at 0.3 J/cm2 (5 μs/226 Hz/10.6 μm) and the fluoride gel contained AmF/NaF (12′500 ppm F−/pH = 4.8–6). For erosive demineralization, the appliances were immersed extra-orally in citric acid (0.05 M/20 min/pH = 2.3) twice daily. Analysis of enamel surface loss was done using a 3D-laser profilometer on 3 days. Additionally, fluoride uptake was quantified and scanning electron microscopies were done. Data were analyzed with repeated measures ANOVA and post hoc pairwise comparisons (α = 0.05).
Results
At all analyzing days, both laser groups caused the lowest means of enamel loss, which were also statistically significant lower than C (p < 0.05). At day 5, FL means ± SD (33.6 ± 12.6 μm) were even significantly lower than all other groups (C 67.8 ± 15.4 μm; F 57.5 ± 20.3 μm; L 46.8 ± 14.5 μm). Significantly increased enamel fluoride uptake was observed for both fluoride-containing groups (p < 0.05) at day 1.
Conclusion
Compared to the control, the CO2 laser irradiation with a specific set of laser parameters (0.3 J/cm2/5 μs/226 Hz) either alone or in combination with a fluoride gel (AmF/NaF) could significantly decrease enamel erosive loss up to 5 days in situ.
Clinical relevance
Combined CO2 laser-fluoride treatment has a significant anti-erosive effect.
https://ift.tt/2P1xdJW
A patient with classical galactosemia is graduated with a university degree
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
https://ift.tt/2IoOwC4
Inositol in Polycystic Ovary Syndrome: Restoring Fertility through a Pathophysiology-Based Approach
Publication date: Available online 27 September 2018
Source: Trends in Endocrinology & Metabolism
Author(s): Antonio Simone Laganà, Simone Garzon, Jvan Casarin, Massimo Franchi, Fabio Ghezzi
Myo-inositol (MI) and D-chiro-inositol (DCI) are insulin second messengers, and MI is involved in follicular gonadotropin pathways which orchestrate ovulation. The tissue-specific MI/DCI ratio is modulated by insulin through aromatase and is altered in insulin resistance (IR), with reduced epimerization of MI to DCI in insulin-sensitive tissues. In ovaries, the MI/DCI ratio is 100:1, but is dramatically reduced by insulin-stimulated epimerase in hyperinsulinemic women with polycystic ovary syndrome (PCOS). Inositols have proved to be effective in PCOS, improving metabolic and hormonal state, and restoring spontaneous ovulation. In assisted reproductive technology, inositol improved ovarian stimulation parameters, although data concerning fertility outcomes are conflicting. Given their functions, inositols are an attractive treatment option for PCOS, although well-designed studies on spontaneous and non-spontaneous fertility are needed.
https://ift.tt/2zDfIdt
Classical paintings may trigger pain and pleasure in the gendered brain
Publication date: Available online 28 September 2018
Source: Cortex
Author(s): Beatrice de Gelder, Rebecca Watson, Minye Zhan, Matteo Diano, Marco Tamietto, Maarten J. Vaessen
Abstract
The human body is the most common object of pictorial representation in western art and its representations trigger a vast range of experiences from pain to pleasure. The goal of this study was to investigate brain activity triggered by paintings of male and female body images exemplifying conditions associated with pleasure or pain. Our findings show participant-general as well as gender specific brain activity for either the pain or the pleasure conditions. Although our participants were fully aware that they were viewing artworks, the inferior parietal lobule - known for its role in the perception of emotional body images - and the somatosensory cortex related to touch were selectively active for female body paintings in all participants in the pleasure conditions. As regards gender we observed that the sight of female bodies activates the subgenual anterior cingulate cortex in males, an area known to subserve autonomic arousal. In contrast, in females the sight of the male body activated reward and control related parts of the dorsal anterior cingulate cortex. This supports the notion that some basic evolutionary processes operate when we view body images, also when they are paintings far removed from daily experience.
https://ift.tt/2xJTk0G
Fast and robust quantification of liquid inside thin fibrous porous materials with single-sided NMR
Publication date: Available online 27 September 2018
Source: Magnetic Resonance Imaging
Author(s): Behzad Mohebbi, Jan Claussen, Bernhard Blümich
Abstract
Single-sided NMR with the NMR-MOUSE is employed for the characterization of fluids in fibrous and open foam materials. One of the key aspects of this study is the quantification of the fluid amount. To this end critical information was provided by a relaxation study. Using 2 mM/L of a Gd3+ relaxation agent the repetition time could be shortened to 250 ms, improving the correlation coefficient between liquid amount and signal amplitude from R2 = 0.893 to R2 = 0.982. To assess reproducibility and instrument precision, calibration experiments were repeated several times and their variation investigated. The results showed that the device is highly precise and robust with a standard deviation for liquid quantification of less than 1%.
https://ift.tt/2zCyhi0
A Study to Evaluate the Effect of ACT-774312 in Subjects With Bilateral Nasal Polyposis
Interventions: Drug: ACT-774312; Drug: Placebo
Sponsor: Idorsia Pharmaceuticals Ltd.
Not yet recruiting
https://ift.tt/2zCWdBJ
Examine the Prognostic Role of FLT PET/CT for Patients With LR-NPC Treated by Carbon Ion Therapy
Intervention: Diagnostic Test: FLT PET/CT
Sponsor: Shanghai Proton and Heavy Ion Center
Not yet recruiting
https://ift.tt/2OTlU6s
Arginase-1 Peptide Vaccine in Patients With Metastatic Solid Tumors
Intervention: Biological: ARG1-18,19,20
Sponsor: Inge Marie Svane
Not yet recruiting
https://ift.tt/2zCsBVe
A Phase 3 Study of the Effects of GC4419 on Radiation Induced Oral Mucositis in Patients With Head/Neck Cancer
Interventions: Drug: GC4419; Drug: Placebo
Sponsor: Galera Therapeutics, Inc.
Not yet recruiting
https://ift.tt/2OVyulB
Effect of Age of Onset of Psoriasis on Clinical Outcomes with Systemic Treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR)
Abstract
Objective
Our objective was to compare therapeutic response among patients with early-onset psoriasis (EOP) and late-onset psoriasis (LOP) receiving adalimumab, etanercept, infliximab, ustekinumab, or methotrexate in the Psoriasis Longitudinal Assessment and Registry (PSOLAR).
Methods
Patients were grouped by age of onset: EOP (age ≤ 40 years) or LOP (age > 40 years). Repeated-measures analysis with logistic regression was used to calculate the adjusted odds ratio (AOR; adjusted for baseline characteristics) for achieving a Physician's Global Assessment score of cleared/minimal (PGA 0/1) or a percentage of body surface area involved with psoriasis < 3% (%BSA < 3) or %BSA < 1 for all patients; similar sensitivity analyses were performed for each treatment group.
Results
Of 7511 patients, 5479 (72.9%) had EOP. The LOP group had a higher likelihood of achieving PGA 0/1 after treatment than did the EOP group in all patients (AOR 1.14 [95% confidence interval (CI) 1.05–1.25]; p = 0.0019); the same was true in subgroups of etanercept-treated (AOR 1.38 [95% CI 1.14–1.66]; p = 0.0010) and methotrexate-treated (AOR 1.62 [95% CI 1.16–2.26]; p = 0.0049) patients. No significant difference was found between the EOP and LOP groups with regard to the likelihood of achieving %BSA < 3 or %BSA < 1 among all patients. However, LOP patients were more likely than EOP patients to achieve %BSA < 3 or %BSA < 1 in subgroups treated with infliximab (AOR 1.45 [95% CI 1.09–1.93; p = 0.0103] and AOR 1.36 [95% CI 1.03–1.78; p = 0.0290], respectively) and etanercept (AOR 1.30 [95% CI 1.06–1.61; p = 0.0123] and AOR 1.34 [95% CI 1.09–1.64; p = 0.0053], respectively).
Conclusion
Our real-world data from PSOLAR indicate that there are differences in some patient characteristics between EOP and LOP and that patients with EOP are less likely than those with LOP to respond to certain systemic treatments. (ClinicalTrials.gov identifier: NCT00508547).
https://ift.tt/2N79ZQH
Scholar : Xenobiotica, Volume 48, Issue 11, November 2018 is now available online on Taylor & Francis Online
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Scholar : Asia Pacific Journal of Public Administration, Volume 40, Issue 3, September 2018 is now available online on Taylor & Francis Online
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Oleandrin synergizes with cisplatin in human osteosarcoma cells by enhancing cell apoptosis through activation of the p38 MAPK signaling pathway
Abstract
Purpose
Our previous studies have reported the antitumor effect of oleandrin on osteosarcoma; however, its chemosensitizing effect in osteosarcoma treatment is still unknown. Therefore, we explored the sensitizing effects of oleandrin to cisplatin in osteosarcoma and investigated the potential mechanisms.
Methods
After exposure to oleandrin and/or cisplatin, CCK-8 and colony formation assays, DAPI staining and flow cytometry were performed to detect cell proliferation and apoptosis in 143B, U-2OS and MG-63 osteosarcoma cells. The median-effect analysis was applied to evaluate the combined effect. Western blot was used to determine the expression of related proteins. Osteosarcoma xenografts and histological observations were applied to confirm the combined effect in vivo.
Results
Compared with cisplatin or oleandrin alone, the combined treatment significantly inhibited cell proliferation and induced cell apoptosis. The median-effect analysis indicated a synergistic cytotoxic effect. The combined treatment downregulated Bcl-2 and upregulated Bax and cleaved caspase-3, -8 and -9. And the suppression of caspases reduced cell death. Furthermore, oleandrin alone or with cisplatin, activated the p38 MAPK/Elk-1 pathway. The inhibition of the p38 MAPK pathway increased cell viability and reduced apoptosis. In vivo, the combined treatment was also verified to significantly inhibit tumor growth, induce apoptosis and activate the p38 MAPK pathway.
Conclusions
The combination of oleandrin with cisplatin exerts a synergistic antitumor effect in osteosarcoma, which relates to the activation of the p38 MAPK pathway.
https://ift.tt/2OVR7pm
Scholar : American Journal of Clinical Hypnosis, Volume 61, Issue 2, October 2018 is now available online on Taylor & Francis Online
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Prediction of Electrode Contacts for Clinically Effective Deep Brain Stimulation in Essential Tremor
Stereotact Funct Neurosurg
https://ift.tt/2N4nYXj
Mechanical and hydrolytic degradation of an Ormocer®-based Bis-GMA-free resin composite
Abstract
Objectives
The aim of the study was to evaluate the mechanical stability of bisphenol A-glycidyl methacrylate (Bis-GMA) and Ormocer-based resin composites before and after water absorption and to examine water saturation.
Material and methods
Disc-shaped specimens of the Bis-GMA (Grandio SO, Voco) and the Ormocer-based (Admira Fusion, Voco) dental resin composites were produced, stored in water, and weighed after pre-determined times to measure the absorbed water. Bend bars were produced and stored for 24 h in dry conditions as well as in distilled water for 14 days or 60 days at 37 °C. The initial flexural strength (FS) under quasi-static loading and flexural fatigue strength (FFS) under cyclic loading were determined under 4-point bending. Fracture toughness (KIc) of both composites was measured using the single-edge-V-notch-beam (SEVNB) technique after the same storage conditions under 3-point bending.
Results
Within the first 14 days, storage conditions did not affect the initial FS of Grandio SO, while a significant drop in initial FS was observed for Admira Fusion after 2 weeks in water and most of the water was absorbed within this time. FFS for the Bis-GMA composite was not reduced before 2 months in water, whereas for the Ormocer®-based composite, there has been a significant decrease in strength after cyclic fatigue already at 2 weeks of water storage. KIc of Admira Fusion decreased significantly after both storage periods, while KIc of Grandio SO decreased only significantly after 2 weeks of water storage.
Conclusion
All mechanical properties of the Bis-GMA composite were superior to those of the Ormocer®-based material, except water sorption.
Clinical significance
Water storage seems to have a much more pronounced effect on the mechanical properties of Ormocer®-based dental composites in comparison to Bis-GMA-based composites.
https://ift.tt/2xJRblz
Tofacitinib for the treatment of lichen planopilaris: A case series
Dermatologic Therapy, EarlyView.
https://ift.tt/2DDpaS9
Retrospective Analysis of 91 Kaposi’s Sarcoma Cases: A Single-Center Experience and Review of the Literature
Dermatology
https://ift.tt/2OSw1bG
Retinal Nerve Fiber Layer and Peripapillary Capillary Density Reduction Detected Using Optical Coherence Tomography Enface Images and Angiography in Optic Tract Syndrome
https://ift.tt/2OZos33
Use of cold atmospheric pressure plasma to treat warts: a potential therapeutic option
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2QftzMp
A painful vegetating finger
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2R51fxJ
Loricrin palmoplantar keratoderma: full‐thickness skin grafting for pseudoainhum
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2Qe2Wrm
Impact of a combined dermatology–rheumatology clinic on management of autoimmune connective tissue disorders
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2R50UuX
Melanocytic soluble adenylyl cyclase protein expression around lentigo maligna and in contralateral control skin
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2Qc89zV
Erythematous lesion with peripheral purpura on the face
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2R50pkz
Grover disease and bullous pemphigoid: a clinicopathological study of six cases
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2Qd9ruo
Pitfalls in diagnosing primary cutaneous aggressive epidermotropic CD8+ T‐cell lymphoma
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OXdACr
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Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an un...
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