Ιατρικά Άρθρα: 11/29/18

Πέμπτη 29 Νοεμβρίου 2018

A case of multinucleate cell angiohistiocytoma in a 14‐year old boy showing two different clinical and histopathological findings

Multinucleate cell angiohistiocytoma (MCAH) is a rare cutaneous disease entity characterized by multiple red‐to‐brown or violaceous papules usually located on the acral regions such as the face and the distal arms and legs. It affects elderly women more than men and hardly occurs at a young age. The exact pathogenic mechanism of MCAH is not yet clearly understood.

We report an exceptionally rare case of a 14‐year old boy who presented with multiple asymptomatic erythematous papules and a single flat brownish plaque on the left chest. The brownish plaque lesion histologically showed proliferation of dilated small vessels in the upper‐mid dermis and numerous oddly shaped multinucleate cells intermingled with lymphocytes and macrophages. The erythematous papules also showed dilated small vessels in the upper‐mid dermis and multiple interstitial histiocytic infiltrations, but no multinucleate cells were detected. In immunohistochemistry studies, CD68 and vimentin staining were positive for both specimens. Based on the clinicopathological findings and immunohistochemistry studies, MCAH was diagnosed.

To the best of our knowledge, this is the first case report of MCAH occurring in young age and showing two different clinical and histological phases at the same time.

https://ift.tt/2AyEXgq

Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer

AbstractBackground.Interventions aimed at improving access to timely cancer care for patients in low‐ and middle‐income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City.Materials and Methods.From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment.Results.Seventy patients (median age 54, range 19–85) participated in this study. Ninety‐six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0–49), and time to specialist appointment was 27 days (range 1–97). Ninety‐one percent of patients successfully obtained appointments at cancer centers in <3 months.Conclusion.Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients.Implications for Practice.A patient navigation program for patients with suspicion or diagnosis of cancer in a second‐level hospital was feasible and acceptable. It reduced patient‐reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.

https://ift.tt/2DSOkKV

Use of Metformin and Platelet Reactivity in Diabetic Patients Treated with Dual Antiplatelet Therapy

05-2018-0177-dia_10-1055-a-0787-1382-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0787-1382

Background Enhanced platelet reactivity represents one of the major determinants of cardiovascular risk among diabetic patients. The aim of the present study was to evaluate the impact of metformin use on platelet reactivity in diabetic patients receiving dual antiplatelet therapy (DAPT). Methods We included diabetic patients treated with DAPT after an acute coronary syndrome or percutaneous coronary intervention. Platelet reactivity was assessed at 30–90 days by Multiple-electrode aggregometry. In an additional cohort of diabetic patients naïve to antiplatelet therapy, we assessed platelet reactivity by light transmission aggregometry, surface expression of P-selectin and plasma concentration of Thromboxane B2 (TxB2). Results We included 219 diabetic patients, 117 (53.4%) treated with metformin. Metformin was associated with younger age (p=0.03), male gender (p=0.02), lower rate of hypertension (p=0.04), active smoker (p=0.002), previous MI (p<0.001) renal failure (p<0.001), fibrinogen (p<0.001) and C-reactive protein (p=0.04), larger use of diuretics (p=0.04) calcium antagonists (p=0.05), better glycemic control (p<0.001) and higher haemoglobin (p=0.003). The prevalence of HAPR did not significantly differ according to hypoglycemic treatment (p=0.73; adjusted OR[95%CI]=5.63[0.42-76], p=0.19). Moreover, no impact of metformin was observed for HRPR (p=0.77; adjusted OR[95%CI]=1.15[0.55-2.4], p=0.71). Among an additional cohort of 42 diabetic patients naïve to antiplatelet therapy, we confirmed no impact of metformin or insulin on aggregation. Conclusions Our study found no apparent association in diabetic patients treated with DAPT, between the use of metformin and platelet reactivity or the rate of HPR.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

https://ift.tt/2Rjd5nG

The Quality of Systematic Reviews Addressing Peripheral Nerve Repair and Reconstruction

While systematic reviews are regarded as the strongest level of medical evidence, inconsistency in the quality and rigor of systematic reviews raises concerns about their use as a tool in guiding quality delivery in evidence-based clinical practice. The objective of this present study was to assess methodological soundness of systematic reviews with a particular focus on peripheral nerve repair and reconstruction.We performed a comprehensive search using PubMed and Scopus to identify all systematic reviews published on peripheral nerve reconstruction in 9 high-impact surgical journals.

https://ift.tt/2Q86rUQ

Xerostomia Risk After Radiation Therapy and Association With Parotid Dose

This cohort study investigates the association between radiation doses in the parotid glands and self-reported xerostomia among adults treated with whole-brain radiation therapy.

https://ift.tt/2KJvDee

Regional Hyperthermia With Neoadjuvant Chemotherapy for Treatment of Soft Tissue Sarcoma

To the Editor Issels et al analyzed long-term local progression-free survival (LPFS), disease-free survival (DFS), and overall survival (OS) data from an important clinical trial evaluating the efficacy of regional hyperthermia (RHT) added to neoadjuvant chemotherapy (NACT) for localized high–risk soft tissue sarcoma. In the article, added value from RHT was summarized mainly with hazard ratios (HRs). For instance, for DFS, an HR of 0.71 was reported (95% CI, 0.55-0.93; P = .01) in favor of RHT. Median DFS times were 2.8 (95% CI, 2.0-4.9) and 1.5 years (95% CI, 1.1-2.1) for NACT with RHT and NACT alone, respectively. These median CIs overlap, indicating that the difference in median DFS time might not be statistically significant. For OS, the HR was 0.73 (95% CI, 0.54-0.98; P = .04), but median OS time for NACT with RHT was not available. In panels A to C of Figure 2 from the study by Issels et al, the Kaplan-Meier curves of the 2 arms appeared to be parallel after 3 years. Moreover, as noted in the article, NACT with RHT showed delayed OS benefit. These factors suggest that HRs are not constant over time and are difficult to interpret clinically as summary measures for treatment effect.

https://ift.tt/2BF99rI

Regional Hyperthermia With Neoadjuvant Chemotherapy for Treatment of Soft Tissue Sarcoma—Reply

In Reply We thank Dr Sun et al and Dr Roussakow for their thoughtful comments on our recent article in JAMA Oncology.

https://ift.tt/2KGg4Eb

Regional Hyperthermia With Neoadjuvant Chemotherapy for Treatment of Soft Tissue Sarcoma

To the Editor The report by Issels et al on long-term survival in the randomized clinical trial of regional hyperthermia (RHT) plus neoadjuvant chemotherapy vs neoadjuvant chemotherapy alone for treatment of soft tissue sarcoma is misleading. This report is a post hoc analysis of the initial study results, which showed no benefit in overall survival (OS) associated with RHT (hazard ratio [HR], 0.88; 95% CI, 0.64-1.21; P = .43). Issels et al reported the result of a competing-risks analysis that indicated that the specific risk of death from sarcoma was significantly lower after RHT (HR, 0.73; 95% CI, 0.54-0.98; P = .04), though the reported number of non–sarcoma-related deaths suggests that this risk was significantly higher after RHT (15 vs 6 deaths; odds ratio, 2.76; 95% CI, 1.04-7.29; P = .04 by 2-tailed χ² test). In general, there is no gain in OS associated with neoadjuvant therapy with RHT. Instead of reporting the result as a secondary analysis, the authors presented it as the primary result of the study. They did not mention that there was no actual benefit in OS, presented the competing risks-based sarcoma-specific survival (SSS) as the initial study end point, and omitted the significant increase in the non–sarcoma-related mortality. Moreover, in the recent study there is a risk for selection bias because the authors excluded 12 patients apparently owing to withdrawal of consent or metastatic disease, though this exclusion was not included in the previous report after 3 years of follow-up. Interestingly, the authors stated the additional reason for the exclusion in the supplement: these patients did not start their allocated treatment after randomization. This additional reason for exclusion is confusing because it appears that 7 patients were excluded from the RHT arm in the most recent article, whereas the earlier study stated that only 4 did not start treatment. The recent study result is presented as a robust intention-to-treat analysis, though after the exclusions, this is a less reliable per-protocol analysis. Furthermore, the SSS is confounded by fewer cycles of chemotherapy in the control arm (median, 5 cycles) than in the RHT arm (median, 8 cycles), and apparently no adjustment for the confounding was applied. Other possible confounders, including the end point substitution, the competing risks-based nature of the end point, and selection bias resulting from the excluded patients, were not properly addressed. Thus, the conclusion that the advantage in SSS is owing to the longer follow-up may not be justified. In my opinion, this report does not show an advantage of RHT plus neoadjuvant chemotherapy vs neoadjuvant chemotherapy alone. I highlight these issues to prevent possible misinterpretation of this trial's results as positive and to avoid unproven treatments being used in clinical practice.

https://ift.tt/2BFQbBj

Abiraterone Acetate for Nonmetastatic Castration-Resistant Prostate Cancer

This Viewpoint uses results of randomized clinical trials to explore whether the use of abiraterone acetate plus prednisone is a cost-effective and appropriate treatment option for patients with nonmetastatic castration-resistant prostate cancer.

https://ift.tt/2KIk1rQ

Burden of Multiple Myeloma in Taiwan

To the Editor Cowan et al explored the global burden of multiple myeloma (MM) from 1990 to 2016 and reported on the incidence, treatment choices, and frequency of stem cell transplant (SCT) worldwide. As a part of East Asia, Taiwan was reported to have an increase in MM incidence, and lenalidomide and bortezomib were approved for treatment of the disease. However, the frequency of SCT in Taiwan was not shown in Figure 2 of the study by Cowan et al. In Taiwan, at least 15 hospitals are performing SCT. Based on a survey from 2005, 7% of patients undergoing SCT were diagnosed with MM. By analyzing data from the longitudinal Taiwan Health Insurance Database from 2007 to 2015, Chang et al found that about 15.5% of patients with MM underwent SCT. Moreover, according to the Taiwan Bone Marrow Transplant Registry, the overall survival rate of patients with MM who underwent SCT was 76.9% at 3-year follow-up. We hope that this information is helpful to better understand the SCT status in Taiwan.

https://ift.tt/2BGyzWg

Burden of Multiple Myeloma in Taiwan—Reply

In Reply To determine the use of stem cell transplant worldwide, we cited prior data published by the World Bone Marrow Transplant network, which did not include transplant rates for Taiwan. We thank the authors for providing this information, which will be helpful to include in future iterations of the Global Burden of Disease study to improve estimates of diseases requiring stem cell transplant.

https://ift.tt/2KLggCc

Anlotinib for Refractory Advanced Non–small Cell Lung Cancer in China

To the Editor Aguiar and colleagues reported the negative cost-effectiveness of first-line osimertinib for EGFR-mutated advanced non–small cell lung cancer (NSCLC). Anlotinib hydrochloride (AL3818), a novel oral multitarget tyrosine kinase inhibitor, was approved as a third-line treatment for refractory advanced NSCLC by the China Food and Drug Administration (CFDA) on May 9, 2018. Anlotinib targets vascular endothelial growth factor receptors, fibroblast growth factor receptors, platelet-derived growth factor receptors, and c-kit, which are involved in broad-spectrum inhibition of tumor angiogenesis and growth. In the phase 1 trial, anlotinib appeared to have broad antitumor capacity for refractory advanced solid tumors, with acceptable and manageable toxic effects, including hypertension, dermal toxic effects, and hypertriglyceridemia. In the phase 2 trial (NCT01924195) on refractory metastatic or recurrent NSCLC, third-line anlotinib treatment had a significant progression-free survival benefit compared with placebo (4.8 vs 1.2 months; P < .001). Subsequently, in the phase 3 trial (NCT02388919) in a similar setting, anlotinib improved the overall survival compared with placebo (9.6 vs 6.3 months; P = .002), with manageable toxic effects. Based on these serial phase 1 to 3 trials, the CFDA gave anlotinib rapid approval to market according to the updated governmental strategy for accelerated new drug approval. The drug met the requirements of controlling the heavy burden associated with lung cancer and decreasing the cost of new drug development in China.

https://ift.tt/2BGyrGg

Association Between Polycystic Ovary Syndrome and Cancer Risk

This cohort study of Swedish register data examines the association between polycystic ovary syndrome and cancer risk in females aged 15 to 50 years between 1985 and 2009.

https://ift.tt/2KLg7yE

Cost-effectiveness of Maintenance Capecitabine and Bevacizumab for Metastatic Colorectal Cancer

This Markov model study assesses the cost-effectiveness of capecitabine and bevacizumab maintenance therapy after induction chemotherapy for treatment of metastatic colorectal cancer.

https://ift.tt/2BFPNTn

Incidence of Y chromosome microdeletions in patients with Klinefelter syndrome

Abstract

Purpose

The aim of this study was to study the incidence of Y chromosome microdeletions in a Caucasian population of Klinefelter syndrome (KS) patients and to investigate the possible association between Y chromosome microdeletions and KS.

Materials and methods

We conducted a retrospective study on 118 KS patients, 429 patients with non-obstructive azoospermia (NOA), and 155 normozoospermic men. Eight of the 118 KS patients had undergone testicular sperm extraction (TESE). All patients underwent semen examination and Y chromosome microdeletions evaluated by PCR, using specific sequence tagged site (STS) primer sets, which spanned the azoospermia factor AZFa, AZFb, and AZFc regions of the Y chromosome.

Results

Semen analysis of the KS group revealed: 1 patient with oligozoospermia, 1 with severe oligoasthenoteratozoospermia, 2 with cryptozoospermia, and 114 with azoospermia. Eight of the 114 azoospermic KS patients underwent TESE, and spermatozoa were recovered from three of these, all of whom had non-mosaic karyotype 47, XXY. 10.7% of the NOA patients presented AZF microdeletions. In 429 cases with NOA, 8 cases had AZFa + b + c deletion, 6 cases had AZF b + c deletion, 4 cases had AZFa microdeletion, 8 cases had AZFb microdeletion, and 20 cases had AZFc microdeletion. Just one KS patient (0.8%) presented microdeletion in the AZFc region.

Conclusion

The percentage of microdeletions in KS patients was lower than in NOA patients, suggesting that AZF microdeletions and KS do not have a causal relationship and that Y chromosome microdeletions are not a genetic factor linked to KS.

https://ift.tt/2KHDady

Case of malignant melanoma responding to dacarbazine following nivolumab

https://ift.tt/2Q3VXpo

Factors associated with successful switching between biologic therapies for the treatment of psoriasis in daily dermatological real‐life practice: The Resoswitch study

The main aim of this study was to describe switching practices in daily practice. Patients included were those seen in daily routine practice. Efficacy was defined as the achievement of at least 75% improvement in the PASI score (PASI75). A total of 1,157 patients were included. The frequency of switching was 29.9% and switching was efficient in 71.9% of the cases. The study's results allows a better understanding of the profile of patients who require switch and he appears a change of therapeutic class appears to be more effective in psoriasis patients who require a switch in their therapy.

https://ift.tt/2Rmw4gZ

Remembering actions without proprioception

Publication date: Available online 29 November 2018

Source: Cortex

Author(s): Elena Daprati, Angela Sirigu, Daniele Nico

Abstract

It has been suggested that agency signals generated by enactment provide memories with an enduring, episodic, marker that can successively be exploited to facilitate recall. Current theories of motor awareness highlight the role of prospective and retrospective sensorimotor cues in the construction of sense of agency (SA). To explore how these signals impact on memory for actions, we studied the effect of enactment in a patient with complete loss of somatic sensation below nose level, and compared her performance to that of a group of neurologically intact individuals. A memory advantage for enacted material was clearly detectable in the control group and, interestingly, also in sensory deafferented patient GL. This novel finding shows that robust memory for actions can be obtained even in the absence of somatosensory reafferences. We hypothesize that the neural processes evoked by intention to move, together with visual experience about one's actions, provide the long-lasting agency signals that are responsible for the special quality of self-performed actions and may support autobiographical experience. Proprioceptive cues, being more time-constrained, are critical to online SA but do not necessarily partake in offline action representations.

https://ift.tt/2raosTn

The time course of spatial attention during naturalistic visual search

Publication date: Available online 28 November 2018

Source: Cortex

Author(s): Elisa Battistoni, Daniel Kaiser, Clayton Hickey, Marius V. Peelen

Abstract

In daily life, attention is often directed to high-level object attributes, such as when we look out for cars before crossing a road. Previous work used MEG decoding to investigate the influence of such category-based attention on the time course of object category representations. Attended object categories were more strongly represented than unattended categories from 180 ms after scene onset. In the present study, we used a similar approach to determine when attention is spatially focused on the target. Participants completed two tasks. In the first, they detected cars and people at varying locations in photographs of real-world scenes. In the second, they detected a cross that appeared at salient locations in an array of lines. Multivariate classifiers were trained on data of the artificial salience experiment and tested on data of the naturalistic visual search experiment. Results showed that the location of both target and distracter objects could be accurately decoded shortly after scene onset (50 ms). However, the emergence of spatial attentional selection – reflected in better decoding of target location than distracter location – emerged only later in time (240 ms). Target presence itself (irrespective of location and category) could be decoded from 180 ms after stimulus onset. Combined with earlier work, these results suggest that naturalistic category search operates through an initial spatially-global modulation of category processing that then guides attention to the location of the target.

https://ift.tt/2FMIddR

A systematic review of randomised controlled trials investigating the efficacy and safety of testosterone therapy for female sexual dysfunction in postmenopausal women

Summary

The clinical sequelae of oestrogen deficiency during menopause are undoubted. However, the pathophysiological role of testosterone during the menopause is less clear. Several randomised, placebo–controlled clinical trials suggest that testosterone therapy improves sexual function in post‐menopausal women. Some studies suggest that testosterone therapy has additional effects which include increased bone mineral density and decreased serum high density lipoprotein (HDL) cholesterol. Furthermore, the long‐term safety profile of testosterone therapy in post‐menopausal women is not clear. This article will provide a concise and critical summary of the literature, to guide clinicians treating post‐menopausal women.

https://ift.tt/2RlqBa9

Thyrotrophin Receptor Antibody Concentration And Activity, Several Years After Treatment For Graves’ Disease

Summary

Objective

TSH receptor antibodies (TRAb) are responsible for autoimmune hyperthyroid disease (Graves' disease; GD) with TRAb levels tending to decrease following treatment. Measurement of TRAb activity during follow up could prove valuable to better understand treatment effectiveness.

Study Design

TRAb concentration and stimulating (TSAb) and blocking (TSBAb) activity of patient serum were assessed following different treatment modalities and follow up length.

Methods

Sixty‐six subjects were recruited following treatment with carbimazole (n=26), radioiodine (n=27) or surgery (n=13). TRAb, TPO‐Ab, Tg‐Ab and GAD‐Ab were measured at a follow up visit as well as bioassays of TSAb and TSBAb activity.

Results

Forty five percent of all patients remained TRAb positive for more than one year and 23% for more than 5 years after diagnosis, irrespective of treatment method. Overall, TRAb concentration fell from a median (IQR) of 6.25 (3.9‐12.7) to 0.65 (0.38‐3.2) U/L. Surgery conferred the largest fall in TRAb concentration from 11.4 (6.7‐29) to 0.58 (0.4‐1.4) U/L. Seventy percent of TRAb positive patients were positive for TSAb and 1 patient (3%) was positive for TSBAb. TRAb and TSAb correlated well (r = 0.83). In addition, 38/66 patients were Tg‐Ab positive, 47/66 TPO‐Ab positive and 6/66 were GADAb positive at follow up.

Conclusions

TRAb levels generally decreased after treatment but persisted for over 5 years in some patients. TRAb activity was predominantly stimulatory, with only one patient demonstrating TSBAb. A large proportion of patients were Tg‐Ab/TPO‐Ab positive at follow up. All treatment modalities reduced TRAb concentrations, however surgery was most effective.

https://ift.tt/2PZxLo5

Cosyntropin testing does not predict response to glucocorticoids in community‐acquired pneumonia in a randomized controlled trial

Summary

Objective

Glucocorticoids have been shown to improve outcome in community‐acquired pneumonia (CAP). However, glucocorticoids have potential side‐effects, and treatment response may vary. It is thus crucial to select patients with high likelihood to respond favorably. In critical illness, cosyntropin testing is recommended to identify patients in need for glucocorticoids. We investigated whether consyntropin testing predicts treatment response to glucocorticoids in CAP.

Design

Predefined secondary analysis of a randomized controlled trial

Patients

Hospitalized patients with CAP

Measurements

We performed 1μg cosyntropin tests in a randomized trial comparing prednisone 50mg for seven days to placebo. We investigated whether subgroups based on baseline and stimulated cortisol levels responded differently to glucocorticoids with regards to time to clinical stability (TTCS) and other outcomes by inclusion of interaction terms into statistical models.

Results

326 patients in the prednisone and 309 patients in the placebo group were evaluated. Neither basal cortisol nor a Δcortisol<250nmol/L after stimulation nor the combination of basal cortisol and Δcortisol predicted treatment response as measured by TTCS (all p for interaction>0.05). Similarly, we found no effect modification with respect to mortality, rehospitalization, antibiotic treatment duration or CAP‐related complications (all p for interaction>0.05). However, glucocorticoids had a stronger effect on shortening length of hospital stay in patients with a baseline cortisol of ≥938 nmol/L (p for interaction=0.015).

Conclusions

Neither baseline nor stimulated cortisol after low‐dose cosyntropin testing at a dose of 1 μg predicted glucocorticoid responsiveness in mild to moderate CAP. A treatment decision for or against adjunct glucocorticoids in CAP should not be made depending on cortisol values or cosyntropin testing results.

https://ift.tt/2Rii9Zb

Palliative care in everyday practice of radiation oncologists

Abstract

Purpose

Little is known about the attitudes of radiation oncologists towards palliative care, about their competences in this field, and about the collaboration with palliative care specialists. Our aim was to close this gap and understand more about the importance of an additional qualification in palliative care.

Methods

Medical members of the German Society for Radiation Oncology (DEGRO) were electronically surveyed during November–December 2016.

Results

The survey was emailed successfully to 1110 addressees, whereas a total of 205 questionnaires were eligible for analysis (response rate 18.4%). 55 (26.8%) of the respondents had an additional qualification in palliative care. Physicians who had an additional qualification in palliative care (PC qualification) reported palliative care needs for their patients more frequently than the other respondents (89.0 vs. 82.7%, p = 0.008). Furthermore, they were most likely to report a high confidence in palliative care competences, such as "communication skills & support for relatives" (83.6 vs. 59.3%, p = 0.013), "symptom control," and "pain management" (94.5 vs. 67.7%, p < 0.001 and 90.9 vs. 73.3%, p = 0.008, respectively). Respondents with a PC qualification more often involved palliative care specialists than the other respondents (63.3 vs. 39.3%, p = 0.007). Perceived main barriers regarding palliative care in radiation oncology included time aspects (9.2%), stigmata (8.5%), and the lack of interdisciplinary collaboration (8.5%).

Conclusions

This analysis demonstrated that aspects of palliative care strongly impact on daily practice in radiation oncology. Additional qualifications and comprehensive training in palliative medicine may contribute to improved patient care in radiation oncology.

https://ift.tt/2BEo3OX

Perspectives of Sunless‐Only Tanning Business Owners

Abstract

To date, 16 states in the US restrict minors from using tanning beds.¹ The principal argument against policy restricting indoor tanning is the concern it would harm small businesses.^2‐4 One counterargument is that tanning businesses could stay financially viable by offering UV‐free sunless tanning services (e.g., spray or airbrush tanning) which would serve customers' desire for a tan while not exposing them to the risks associated with ultraviolet (UV) radiation exposure. Sunless only tanning businesses are already in existence and owners may provide insights on this alternative business model.

https://ift.tt/2FMWmHP

A prospective, observational safety study of patients with BRAFV600‐mutated unresectable or metastatic melanoma treated with vemurafenib [Zelboraf Safety Study (ZeSS)]

Abstract

Vemurafenib is approved in more than 90 countries for the treatment of patients with BRAF ^V⁶⁰⁰‐mutated metastatic melanoma.^1,2 In the pivotal BRIM‐3 trial, treatment‐emergent cutaneous side effects were associated with vemurafenib, including the development of epithelial tumours and, in rare cases, new primary melanomas.^3,4 QTc interval prolongation and hepatic laboratory abnormalities were also noted.^3,4

https://ift.tt/2re3jrs

Comparison of microneedling and full surface erbium laser dermabrasion for autologous cell suspension grafting in non‐segmental vitiligo: a randomized controlled trial

Abstract

Autologous cell suspension is a well‐demonstrated effective approach for treating segmental or stable and localized forms of vitiligo¹. Full surface dermabrasion is considered as the gold standard technique for preparing the skin before grafting. Fractional ablative laser or microneedling have been shown to enhance the penetration into the skin of topical agents².

https://ift.tt/2FO0oQe

Association of Pyrin mutations and Autoinflammation with Complex Phenotype Hidradenitis Suppurativa: A Case Control Study

Abstract

Background

Hidradenitis suppurativa (HS) is a rare, debilitating neutrophilic dermatosis characterised by chronic inflammation of hair follicles. Many inflammatory conditions may accompany HS.

Aim

To investigate the association of variants of the MEFV gene with a complex HS phenotype.

Methods

First, we identified the clinical characteristics of 119 HS patients with a complex phenotype (Hurley stage III disease and/or additional inflammatory symptoms). Then, we searched for MEFV variants among these patients. The odds ratios (OR) for pathogenic MEFV mutations were calculated using data from these HS patients and 191 healthy controls.

Results

The male/female ratio was higher, and the mean age of onset was earlier, in our complex HS group compared with HS patients in general. Five of the HS patients (4.2%) had a diagnosis of familial Mediterranean fever (FMF) with a standardized morbidity ratio of 45 (CI: 16.50‐99.84, p<0.001) when compared with the frequency of FMF in the general Turkish population. Of the patients with complex HS, 38% were positive for pathogenic variants of MEFV. The odds ratio for carrying a pathogenic MEFV allele was 2.80 (CI: 1.31‐5.97, p<0.001).

Conclusion

The frequency of MEFV mutations in a group of patients with complex HS was higher than that in healthy controls, suggesting that MEFV mutations may contribute to the pathogenesis of HS. Understanding the role of autoinflammation in HS is of fundamental importance for the development of novel therapies.

https://ift.tt/2raMw8D

Safety of guselkumab in patients with moderate‐to‐severe psoriasis treated through 100 weeks: a pooled analysis from the randomised VOYAGE 1 and VOYAGE 2 studies

Summary

Background

Long‐term evaluation is required to confirm the safety profile of newer biologic agents. Objectives

To report on pooled safety data from the on‐going VOYAGE 1 (NCT02207231) and VOYAGE 2 (NCT02207244) trials through 100 weeks of follow‐up.

Methods

Patients were randomized to guselkumab 100 mg at weeks 0 and 4 and every‐8‐weeks thereafter; placebo at weeks 0, 4, 12 followed by guselkumab 100 mg at weeks 16 and 20 and every‐8 weeks thereafter; or adalimumab 80 mg at week 0, 40 mg at week 1, and 40 mg every 2 weeks thereafter. Adalimumab patients crossed over to guselkumab at week 52 (VOYAGE1) and at/after week 28 based on clinical response (VOYAGE2). Open‐label extensions, when all patients received guselkumab, started at week 52 (VOYAGE1) and week 76 (VOYAGE2). Rates of adverse events (AEs) per 100 patient‐years [PY] are presented through 100 weeks of follow up.

Results

Through week 52, observed rates for guselkumab‐ and adalimumab‐treated patients, respectively, were 262.45/100PY and 328.28/100PY for AEs, 6.20/100PY and 7.77/100PY for serious AEs (SAEs), 1.22/100PY and 1.79/100PY for serious infections (SIs), 0.28/100PY and 0.40/100PY for malignancies other than nonmelanoma skin cancers (NMSCs), 0.56/100PY and 0.40/100PY for NMSCs, and 0.47/100PY and 0.40/100PY for MACE. Rates among guselkumab‐treated patients through week 52 and week 100, respectively, were (262.45/100PY and 210.41/100PY) for AEs, 6.20 and 6.29/100PY), for SAEs, 1.22/100PY and 1.06/100PY for SIs, 0.28/100PY and 0.38/100PY for malignancies, 0.56/100PY and 0.39/100PY for NMSCs, and 0.47/100PY and 0.38/100PY for MACE. Among adalimumab‐treated patients, rates of AEs (328.28/100PY vs 160.15/100PY), SAEs (7.77/100PY vs 4.44/100PY), SIs (1.79/100PY vs 0/100PY), malignancies (0.40/100PY vs 0.40/100PY), NMSCs (0.40/100PY vs 0.81/100PY), and MACE (0.40/100PY vs 0.20/100PY) showed some variability before and after crossover to guselkumab, though no new safety signals were noted after crossover.

Conclusions

The safety profile for guselkumab remains favorable through 100 weeks of treatment in patients with moderate‐to‐severe psoriasis.

https://ift.tt/2FPtpLp

Reticulate acropigmentation of Kitamura with a novel mutation in ADAM10

https://ift.tt/2Q5joi7

Facial comedonal acne in orofaciodigital syndrome type 1 caused by a novel frameshift variant in OFD1

https://ift.tt/2RlxyIr

Oral tranexamic acid for the treatment of melasma

https://ift.tt/2Q0kpI5

Mild clinical presentation of a patient with a mutation in the NSDHL gene

https://ift.tt/2RkMJ4v

Assessing changes in some facial signs of fatigue in Chinese women, induced by a single working day

Abstract

Background

The impacts of physical fatigue upon some facial signs, induced by a whole day work, have been previously described on Caucasian women. The present study aimed at assessing those possibly experienced by Chinese working women under comparable conditions.

Material and Methods

Standard photographs of 60 Chinese women working in the same company (aged 20–40 y) were taken at three occasions during their working day (just before, at 4 and 8 hours). Focusing on facial signs allowed a panel of experts to grade their respective severities, helped by a referential atlas dedicated to Asian skin. A naïve panel, comprising 64 Chinese women (aged 20–60 y) graded, through an analogic 0–10 scale, the global facial aspect of each subject, particularly its tired‐look and dullness and estimated the age of each subject (perceived age). Paired‐comparisons in blind and random modes (T0/T4, T4/T8, T0/T8) allowed this naive panel to assess the subjects with a younger/older look, a dullest aspect.

Results

A daily work induces, in Chinese women, changes in some facial signs (Nasolabial, Periorbital and Inter‐ocular wrinkles, Cheek skin pores). The latter appear more marked between T0 and T4 than between T4 and T8. As compared to those observed among Caucasian women, these changes, although subtle, are of a higher amplitude and concern different facial signs. The naïve panel allowed to describe an increase in the tired look and dullness along the day, more so among the older group (31–40 y), together with an increased perceived age. Tired look, dullness and perceived age appear strongly linked.

Conclusion

Despite some possible differences in working conditions, some facial signs of Chinese women seem more affected by a fatigue induced by a working day in urban environment, than those of Caucasian women in similar conditions.

https://ift.tt/2racLMt

Scholar : Undersea "Hyperbaric Medicine" - νέα αποτελέσματα

[HTML] ВЛИЯНИЕ ГИПЕРОКСИИ И ГИПОКСИИ НА АДАПТАЦИЮ ПРИ МЫШЕЧНОЙ РАБОТЕ

АС Радченко, ПД Шабанов - Обзоры по клинической фармакологии и …, 2018

В настоящем кратком обзоре излагается мнение об использовании
гипероксии (ГО) в спортивной тренировке, которая в последние годы
рекомендуется некоторыми авторами для повышения специальной …

Δημιουργία λίστας των ειδοποιήσεών μου

Ακύρωση ειδοποίησης

Αυτή η ειδοποίηση αποστέλλεται από τον Μελετητή Google. Ο Μελετητής Google είναι μια υπηρεσία που παρέχεται από την Google.

Scholar : CPAP - νέα αποτελέσματα

Effect of Adaptive Servo-Ventilation on Periodic Limb Movements in Sleep in Patients With Heart Failure

J Xie, N Covassin, AA Chahal, PJ Schulte, P Singh… - The American Journal of …, 2018

… effectively reduces CSA. Prior data have shown PLMS decreased in patients with mild
obstructive sleep apnea (OSA) after treatment of continuous positive airway pressure
(CPAP), but increased in subjects with severe OSA. 13 To …

Management of severe bronchiolitis: impact of NICE guidelines

B Griffiths, S Riphagen, J Lillie - Archives of Disease in Childhood, 2018

… 2015–2016 (p<0.001). There was a trend towards reduction in CPAP use (44%
vs 36%) and increase in the use of bilevel positive airway pressure but neither
reached statistical significance. Antibiotics. The use of antibiotics …

[PDF] EFFECTS OF MECHANICAL INSPIRATION AND EXPIRATION EXERCISE ON VELOPHARYNGEAL INCOMPETENCE IN SUBACUTE STROKE PATIENTS

J Kyung Won - J Rehabil Med, 2019

… One study showed that treatment with continuous positive airway pressure (CPAP) was
effective in patients with VPI (14) … Like the CPAP therapy, MIE exercise also might
strengthen the oropharyngeal muscles, which are involved in velopharyngeal closure …

Impact of prone positioning in infants with Pierre Robin sequence: a polysomnography study

L Coutier, A Guyon, P Reix, P Franco - Sleep Medicine, 2018

… There were 15 (83%) infants who did not have respiratory support; before PSG, the PP
was used for 14 infants, and the SP was used for 4 infants (1 in ambient air and 3 with
respiratory support). 2 already had NIV (CPAP settings: 6 cmH2O), and 1 had an NPT …

Sedation and neurodevelopmental outcomes in PICU: identification of study groups

DE Withington, R Mujallid, Z Al Sabaa - Pediatric Anesthesia

… are presented in Table 1. Ten of thirty-three patients had CPAP/BIPAP before intubation,
failure to tolerate either the mask or CPAP/BIPAP or lack of improvement with this strategy …
In the CPAP group 18/39 cases had RSV positive bronchiolitis with others having …

[PDF] Häusliche Betreuung nichtinvasiv heimbeatmeter Patienten durch ein spezialisiertes Team (TAB)

KK Herberger - 2018

… ASB assisted spontaneous breathing (Beatmungsmodus) assPCV assisted
pressure controlled ventilation (Beatmungsmodus) aVK ambulante
Verlaufskontrolle BMI Body Mass Index CO2 Kohlendioxid COPD Chronic …

[PDF] Análise comparativa de fórmulas preditivas de avaliação da capacidade funcional com o teste cardiopulmonar de jogadoras de futebol profissional

A Fenley, RS Floriano, TO Chaves, I Nasser, MS Reis - Fisioterapia e Pesquisa, 2018

… Eur J Heart Fail. 2004;6(7):917-26. doi: 10.1016/j. ejheart.2004.02.010 15.
Reis HV, Borghi-Silva A, Catai AM, Reis MS. Impact of CPAP on physical
exercise tolerance and sympathetic- vagal balance in patients with chronic …

[HTML] Comparative analysis of predictive formulas for the evaluation of functional capacity with cardiopulmonary test in professional female soccer players

A Fenley, RS Floriano, TO Chaves, I Nasser, MS Reis - Fisioterapia e Pesquisa, 2018

… 2004;6(7):917-26. doi: 10.1016/j.ejheart.2004.02.010 [ Links ]. 15. Reis
HV, Borghi-Silva A, Catai AM, Reis MS. Impact of CPAP on physical
exercise tolerance and sympathetic-vagal balance in patients with chronic …

[PDF] Partilha de experiências e conhecimento com o pulmão no centro

CR Cordeiro, S Valente

Page 1. SALETE VALENTE, MD E CARLOS ROBALO CORDEIRO, PhD
DESCENTRALIZAR O DEBATE O pulmão no centro da questão CONGRESSO JORNAL
CPC Esta publicação está também disponível em formato digital Faça o download gratuito …

[PDF] Red Cell and blood component Transfusion in Neonates

VR Kairamkonda, S Armitage

… Table 1. Summary of BCSH recommendations for neonatal top- up transfusions Postnatal
age Suggested transfusion threshold Hb (g/L) Ventilated On oxygen/CPAP Off oxygen
First 24 hours <120 <120 <100 ≤Week 1 (days 1–7) <120 <100 <100 …

Δημιουργία λίστας των ειδοποιήσεών μου

Ακύρωση ειδοποίησης

Scholar : intitle:laryngeal - new results

[HTML] Laryngeal synovial sarcoma: Report of 2 cases

M Bellakhdhar, A Cheniti, M Ghammem, A Bdioui… - Journal of the Egyptian …, 2018

Synovial sarcoma is a malignant mesenchymal tumor. It most commonly occurs in
the lower extremities of young adults. The head and neck are rare sites, accounting
for less than 10%. The larynx is an extremely rare site. We report two cases of 27 and …

[PDF] The Risk of Recurrent Laryngeal Nerve Injury with Laterality Of Approach in Anterior Cervical Discectomy and Fusion Procedures: A Randomized, Prospective Study …

W Beutler, S Shah, M Bhatia

Page 1. The Risk of Recurrent Laryngeal Nerve Injury with Laterality Of Approach in
Anterior Cervical Discectomy and Fusion Procedures: A Randomized, Prospective Study
Over 10 Years William Beutler, MD; Shalin Shah, DO; Manminder Bhatia, DO Page 2 …

List my alerts

Cancel alert

This alert is sent by Google Scholar. Google Scholar is a service by Google.

Scholar : ΑΠΟΚΑΤΑΣΤΑΣΗ - νέα αποτελέσμ

Multi storey buildings

I Vayas, J Ermopoulos, G Ioannidis - Design of Steel Structures to Eurocodes, 2019

… "1" "1" "2" "3" "3" "4" "4" "2" M' ΚΟΧΛΙΩΤΗ ΑΠΟΚΑΤΑΣΤΑΣΗ ΔΙΑΤΟΜΗΣ
ΣΤΥΛΟΥ Κ27 TOMH"1" - "1" Fig. 7.4. Continuity of a column with crossed
I-section. Bolted connection using flange and web plates ing, mostly, bolted …

Δημιουργία λίστας των ειδοποιήσεών μου

Ακύρωση ειδοποίησης

Scholar : Obstructive sleep apnea - νέα αποτελέσματα

Effect of Adaptive Servo-Ventilation on Periodic Limb Movements in Sleep in Patients With Heart Failure

J Xie, N Covassin, AA Chahal, PJ Schulte, P Singh… - The American Journal of …, 2018

… desaturation of ≥4%. Apneas without evidence of respiratory effort were scored as central,
while those with respiratory effort were categorized as obstructive. Apnea-hypopnea index
(AHI) was calculated as the average number of apneas and hypopneas per hour of sleep …

Impact of prone positioning in infants with Pierre Robin sequence: a polysomnography study

L Coutier, A Guyon, P Reix, P Franco - Sleep Medicine, 2018

… Obstructive hypopnea index (OHI), n/h … This gain in breathing quality in the
PP could explain part of the improvement of sleep quality, as described by
Reddy … 22 but also to the decrease of upper airway obstruction related to …

Sleep disordered breathing in children disrupts the maturation of autonomic control of heart rate and its association with cerebral oxygenation

LM Walter, K Tamanyan, AJ Weichard, MJ Davey… - The Journal of Physiology, 2018

… Hayakawa T, Terashima M, Kayukawa Y, Ohta T & Okada T (1996).
Changes in cerebral oxygenation and hemodynamics during obstructive
sleep apneas. Chest 109, 916-921 … Lumeng JC & Chervin RD (2008) …

Sleep duration and all-cause mortality: links to physical activity and prefrailty in a 27-year follow up of older adults in the UK

K Morgan, I Hartescu - Sleep Medicine, 2018

… 3. Adjusted only for age and gender, Model 1 shows that those who slept
for ≥ 9 … contributing, directly or indirectly, to longer term mortality risk among
those sleeping ≥ 9 hours … Designed at a time when clinical awareness of …

Technique: Transversus Abdominis Release

LA Martin-del-Campo, YW Novitsky - The SAGES Manual of Hernia Surgery, 2019

… As long as the patient does not develop obstruction or other indication of
emergent repair, elective cases are delayed until preoperative optimization …
Diabetes control needs to be optimized (HbA1c ˂ 7.5%), and patients are …

[HTML] อัตรา การ พัฒนา ไป เป็น โรค เบาหวาน และ การ ศึกษา ความ สัมพันธ์ เกี่ยว กับ ปัจจัย การ นอน หลับ และ ระดับ กรด ยูริก ใน เลือด กับ ระดับ HbA1c ใน เลือด ใน ผู้ ที่ มี ภาวะ prediabetes ปี …

ธัญ ญ รัตน์ อ โน ทั ย สินทวี, T Anothaisintawee… - 2018

… สูง 3) พฤติกรรมทางด้านสุขภาพ เช่น การดื่มเหล้า, สูบบุหรี่ 4) ข้อมูลเกี่ยวกับการนอน
หลับ โดยระยะเวลาการนอนหลับและคุณภาพของการนอนหลับ (sleep duration and
quality) จะวัดโดยใช้แบบสอบถาม Pittsburgh Sleep Quality Index (PSQI) …

Δημιουργία λίστας των ειδοποιήσεών μου

Ακύρωση ειδοποίησης

Ετικέτες

Πέμπτη 29 Νοεμβρίου 2018

Abstract

Purpose

Materials and methods

Results

Conclusion

Abstract

Abstract

Summary

Summary

Objective

Study Design

Methods

Results

Conclusions

Summary

Objective

Design

Predefined secondary analysis of a randomized controlled trial

Patients

Hospitalized patients with CAP

Measurements

Results

Conclusions

Abstract

Purpose

Methods

Results

Conclusions

Abstract

Abstract

Abstract

Abstract

Background

Aim

Methods

Results

Conclusion

Summary

Background

Methods

Results

Conclusions

Abstract

Background

Material and Methods

Results

Conclusion

[HTML] ВЛИЯНИЕ ГИПЕРОКСИИ И ГИПОКСИИ НА АДАПТАЦИЮ ПРИ МЫШЕЧНОЙ РАБОТЕ

[PDF] EFFECTS OF MECHANICAL INSPIRATION AND EXPIRATION EXERCISE ON VELOPHARYNGEAL INCOMPETENCE IN SUBACUTE STROKE PATIENTS

[PDF] Häusliche Betreuung nichtinvasiv heimbeatmeter Patienten durch ein spezialisiertes Team (TAB)

[PDF] Análise comparativa de fórmulas preditivas de avaliação da capacidade funcional com o teste cardiopulmonar de jogadoras de futebol profissional

[HTML] Comparative analysis of predictive formulas for the evaluation of functional capacity with cardiopulmonary test in professional female soccer players

[PDF] Partilha de experiências e conhecimento com o pulmão no centro

[PDF] Red Cell and blood component Transfusion in Neonates

[HTML] Laryngeal synovial sarcoma: Report of 2 cases

[PDF] The Risk of Recurrent Laryngeal Nerve Injury with Laterality Of Approach in Anterior Cervical Discectomy and Fusion Procedures: A Randomized, Prospective Study …

[HTML] Effects of inspiratory muscle training on autonomic control: systematic review

[PDF] Häusliche Betreuung nichtinvasiv heimbeatmeter Patienten durch ein spezialisiertes Team (TAB)

Αναζήτηση αυτού του ιστολογίου