Παρασκευή 2 Νοεμβρίου 2018
Takotsubo Cardiomyopathy During Anti‐HER2 Therapy for Metastatic Breast Cancer
AbstractHuman epidermal growth factor receptor 2 (HER2)‐targeted antibodies, including pertuzumab and trastuzumab, improve overall survival and progression‐free survival among women with HER2‐positive metastatic breast cancer, but grade ≥3 cardiotoxicity occurs in approximately 8% of cases. Here we report a case of Takotsubo cardiomyopathy associated with the use of dual anti‐HER2 therapy in a 63‐year‐old woman who presented to the emergency department with an 8‐ to 10‐hour history of progressive dyspnea after completing her third cycle of pertuzumab plus trastuzumab in addition to nab‐paclitaxel chemotherapy. To our knowledge, this patient represents the first reported case of Takotsubo cardiomyopathy associated with pertuzumab plus trastuzumab combination therapy in the literature.
https://ift.tt/2JEaEsU
Donor limb assessment after vascularized groin lymph node transfer for the treatment of breast cancer-related lymphedema: Clinical and lymphoscintigraphy findings
Vascularized lymph node transfer is an established treatment for secondary lymphedema. Different donor sites of lymph node flap have been described. In our institute, vascularized groin lymph node (VGLN) flap is the workhorse flap for treating breast cancer-related lymphedema (BCRL). Potential complications of VGLN flap harvesting include seroma formation, thigh dysaesthesia and iatrogenic lymphedema.
https://ift.tt/2Dkg4sE
Lower eyelid excursion: A functional and cosmetically relevant parameter in the treatment of lower eyelid retraction
The purpose of this study was to assess and quantify lower lid excursion following repair of lower lid retraction.In this retrospective cohort study, a case review of patients who had undergone ear-cartilage grafting for lower lid retraction was undertaken. Surgical correction involved the placement of autologous cartilage between the tarsal plate and lower lid retractors. Measurements taken pre- and post-operatively were the marginal reflex 2 (MRD2) and the lower scleral show (LSS). The lower lid excursion on downgaze (LLE) was measured only post-operatively with a comparison made between operated eyes and control eyes.
https://ift.tt/2JE6SzG
Bioelectrical Impedance Analysis of Water Reduction in Lower-Limb Lymphedema by Lymphaticovenular Anastomosis
J reconstr Microsurg
DOI: 10.1055/s-0038-1675368
Background Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA). Methods The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort. The water volume of affected and unaffected legs was measured using multifrequency BIA before and after LVA. Preoperative measurements were undertaken after compression therapy for at least 3 months. The follow-up period after LVA was a minimum of 6 months. Results Thirty consecutive patients with unilateral lower-limb lymphedema were enrolled. The mean water volume reduction of the affected leg by LVA (ΔLBW) was 0.86 L (standard deviation [SD]: 0.86, median: 0.65) with a mean number of 3.3 anastomoses (SD: 1.7). The mean reduction rate of edema was 45.1% (SD: 36.3). Multiple linear regression analysis revealed water volume difference between the affected and unaffected legs before LVA (excess LBW) as the strongest predictor of ΔLBW (R 2 = 0.759, p < 0.01; β = 0.500, p < 0.01). Conclusion The LVA reduces the volume of accumulated body water in lower-limb lymphedema. As excess LBW most strongly predicted the amount of water volume reduction by LVA, body water volume measurement by BIA before LVA might identify patients with low excess LBW not expected to benefit from LVA, regardless of apparent differences in limb circumference.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2AJGZvl
Scholar : These new articles for Canadian Art Therapy Association Journal are available online
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Scholar : Australian Journal of Linguistics, Volume 38, Issue 4, December 2018 is now available online on Taylor & Francis Online
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Chemoradiotherapy with and without deep regional hyperthermia for squamous cell carcinoma of the anus
Abstract
Purpose
To compare results after chemoradiotherapy with and without deep regional hyperthermia in patients with anal cancer.
Methods
Between 2000 and 2015, a total of 112 consecutive patients with UICC stage I–IV anal cancer received chemoradiotherapy with 5‑fluororuracil and mitomycin C (CRT). In case of insufficient tumor response 4–6 weeks after chemoradiotherapy, patients received an interstitial pulsed-dose-rate brachytherapy boost. Additionally, 50/112 patients received hyperthermia treatments (HCRT).
Results
Median follow-up was 41 (2–165) months. After 5 years follow-up, overall (95.8 vs. 74.5%, P = 0.045), disease-free (89.1 vs. 70.4%, P = 0.027), local recurrence-free (97.7 vs. 78.7%, P = 0.006), and colostomy-free survival rates (87.7 vs. 69.0%, P = 0.016) were better for the HCRT group. Disease-specific, regional failure-free, and distant metastasis-free survival rates showed no significant differences. The adjusted hazard ratios for death were 0.25 (95% CI, 0.07 to 0.92; P = 0.036) and for local recurrence 0.14 (95% CI, 0.02 to 1.09; P = 0.06), respectively. Grades 3–4 early toxicities were comparable with the exception of hematotoxicity, which was higher in the HCRT group (66 vs. 43%, P = 0.032). Incidences of late side effects were similar with the exception of a higher telangiectasia rate in the HCRT group (38.0 vs. 16.1%, P = 0.009).
Conclusion
Additional regional hyperthermia improved overall survival, local control, and colostomy rates. Its potential beneficial role has to be confirmed in a prospective randomized setting. Therefore, the HyCAN trial has already been established by our group and is currently recruiting patients (Clinicaltrials.gov identifier: NCT02369939).
https://ift.tt/2qr8Cn0
Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer
Abstract
Purpose
Combined high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT) is a favorable treatment option in non-metastatic prostate cancer. However, reports on toxicity and outcome have mainly focused on younger patients. We aimed to determine toxicity and biochemical control rates after combined HDR-BT and EBRT in men ≥75 years.
Methods
From 1999 to 2015, 134 patients aged ≥75 years (median 76 years; 75–82 years) were identified. Patients received 18 Gy of HDR-BT (9 Gy/fraction on days 1 and 8) with an iridium-192 source. After 1 week, supplemental EBRT with a target dose of 50.4 Gy was started (delivered in 1.8 Gy fractions).
Results
Median follow-up time was 25 months (0–127 months). No severe (grade 4) gastrointestinal (GIT) or genitourinary (GUT) toxicities were observed. In 76 patients (56.7%), 3D conformal radiation therapy (CRT) and in 34.3% intensity-modulated radiotherapy (IMRT) was applied. CRT-treated patients were at a 2.17-times higher risk (hazard ratio [HR]: 2.17, 95% confidence interval [CI]: 1.31–3.57, p = 0.002) of experiencing GUT. GIT risks could be reduced by 78% using IMRT (HR: 0.22, 95% CI: 0.07–0.75, p = 0.015). Patients with a higher T stage (T2c–3a/b) were less likely to experience GIT or GUT (HR: 0.49, 95% CI: 0.29–0.85, p = 0.011 and HR: 0.5, 95% CI: 0.3–0.81, p = 0.005, respectively).
Conclusion
HDR-BT/EBRT is a well-tolerated treatment option for elderly men ≥75 years with a limited number of comorbidities and localized intermediate- or high-risk prostate cancer. IMRT should be favored since side effects were significantly reduced in IMRT-treated patients.
https://ift.tt/2QeuMnO
The Medical and Psychosocial Associations of Alopecia: Recognizing Hair Loss as More Than a Cosmetic Concern
Abstract
Alopecia encompasses a broad range of hair loss disorders, generally categorized into scarring and non-scarring forms. Depending on the specific pathogenesis of hair loss and geographic location, a number of psychiatric and medical comorbidities, including but not limited to thyroid disease, lupus erythematosus, diabetes mellitus, atopic dermatitis, sinusitis, coronary artery disease, anxiety, depression, and suicidality, have been identified in association with alopecia. In addition to the numerous associated comorbid conditions, patients with alopecia report decreased quality-of-life measures across symptomatic, functional, and global domains. While alopecia can affect patients of all ages, genders, and ethnicities, hair loss may more significantly impact women as hair represents an essential element of femininity, fertility, and female attractiveness in society. Individuals of lower socioeconomic status may also face health disparities in the context of alopecia as a majority of hair loss treatments are considered cosmetic in nature and accordingly are not covered by third-party insurance providers. Although traditionally thought of as a merely aesthetic concern, alopecia encompasses a significant burden of disease with well-defined comorbid associations and genuine psychosocial implications, and thus should be assessed and managed within a proper medical paradigm.
https://ift.tt/2QfcRgH
Cabozantinib in Advanced Salivary Gland Cancer Patients
Condition: Salivary Gland Cancer
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
TORS De-Intensification Protocol Version 2.0: Dose and Volume Reduction in the Neck
Conditions: Oropharyngeal Cancer; Squamous Cell Carcinoma; Human Papilloma Virus
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Add-on Low Dose Dextromethorphan and Memantine in Patients With Amphetamine-type Stimulants Use Disorder
Condition: Stimulants Use Disorder
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Limited short-term effects on human prostate cancer xenograft growth and epidermal growth factor receptor gene expression by the ghrelin receptor antagonist [D-Lys 3 ]-GHRP-6
Abstract
Purpose
The ghrelin axis regulates many physiological functions (including appetite, metabolism, and energy balance) and plays a role in disease processes. As ghrelin stimulates prostate cancer proliferation, the ghrelin receptor antagonist [D-Lys3]-GHRP-6 is a potential treatment for castrate-resistant prostate cancer and for preventing the metabolic consequences of androgen-targeted therapies. We therefore explored the effect of [D-Lys3]-GHRP-6 on PC3 prostate cancer xenograft growth.
Methods
NOD/SCID mice with PC3 prostate cancer xenografts were administered 20 nmoles/mouse [D-Lys3]-GHRP-6 daily by intraperitoneal injection for 14 days and tumour volume and weight were measured. RNA sequencing of tumours was conducted to investigate expression changes following [D-Lys3]-GHRP-6 treatment. A second experiment, extending treatment time to 18 days and including a higher dose of [D-Lys3]-GHRP-6 (200 nmoles/mouse/day), was undertaken to ensure repeatability.
Results
We demonstrate here that daily intraperitoneal injection of 20 nmoles/mouse [D-Lys3]-GHRP-6 reduces PC3 prostate cancer xenograft tumour volume and weight in NOD/SCID mice at two weeks post treatment initiation. RNA-sequencing revealed reduced expression of epidermal growth factor receptor (EGFR) in these tumours. Further experiments demonstrated that the effects of [D-Lys3]-GHRP-6 are transitory and lost after 18 days of treatment.
Conclusions
We show that [D-Lys3]-GHRP-6 has transitory effects on prostate xenograft tumours in mice, which rapidly develop an apparent resistance to the antagonist. Although further studies on [D-Lys3]-GHRP-6 are warranted, we suggest that daily treatment with the antagonist is not a suitable treatment for advanced prostate cancer.
https://ift.tt/2SKlZM6
Distortions of perceived volume and length of body parts
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Renata Sadibolova, Elisa R. Ferrè, Sally A. Linkenauger, Matthew R. Longo
Abstract
We experience our body as a 3D, volumetric object in the world. Measures of our conscious body image, in contrast, have investigated the perception of body size along one or two dimensions at a time. There is, thus, a discrepancy between existing methods for measuring body image and our subjective experience of having 3D body. Here we assessed in a sample of healthy adults the perception of body size in terms of its 1D length and 3D volume. Participants were randomly assigned to two groups using different measuring units (other body part and non-body object). They estimated how many units would fit in a perceived size of body segments and the whole body. The patterns of length and volume misperception across judged segments were determined as their perceived size proportional to their actual size. The pattern of volume misperception paints the representation of 3D body proportions resembling those of a somatosensory homunculus. The body parts with a smaller actual surface area relative to their volume were underestimated more. There was a tendency for body parts underestimated in volume to be overestimated in length. Perceived body proportions thus changed as a function of judgement type while showing a similarity in magnitude of the absolute estimation error, be it an underestimation of volume or overestimation of length. The main contribution of this study is assessing the body image as a 3D body representation, and thus extending beyond the conventional 'allocentric' focus to include the body on the inside. Our findings highlight the value of studying the perceptual distortions "at the baseline", i.e. in healthy population, so as to advance the understanding of the nature of perceptual distortions in clinical conditions.
Graphical abstract
https://ift.tt/2QjXe7W
Exploring prism exposure after hemispheric damage: reduced aftereffects following left-sided lesions
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Roberta Ronchi, Irene Rossi, Elena Calzolari, Nadia Bolognini, Giuseppe Vallar
Abstract
Prism adaptation is a well-known method used to investigate brain plasticity, and a promising technique for the rehabilitation of unilateral spatial neglect (USN). Only little evidence about the mechanisms of prism adaptation (PA) in patients with left-brain damage is on record, and about putative differences of PA, and the aftereffects (AEs), between patients with left and right brain damage. In the present study, PA and the AEs were assessed in 30 brain-damaged patients, 20 with right-sided lesions (10 with and 10 without USN), and 10 with left-sided lesions without USN, as well as in a control group of 24 age-matched participants. All patients underwent adaptation to lenses shifting the field of vision towards the side of the lesion, followed by two measures for detecting AEs: the proprioceptive (P) and the visuo-proprioceptive (VP) straight-ahead tasks. To investigate the temporal course of AEs in the different groups, the two measures were recorded immediately and 10 minutes after PA. Before PA, and at the end of the 10-minute delayed evaluation, two tasks to assess USN (target cancellation and drawing) were also administered. All patients adapted to prisms. However, left-brain-damaged (LBD) patients presented with reduced AEs, as compared with right-brain-damaged (RBD) patients with USN. Moreover, while both controls and LBD patients adapting to left-shifting prisms had reduced VP AEs in the delayed condition, AEs were not different from zero (i.e., no AEs) in LBD patients. Finally, in the delayed condition USN patients showed an improvement in the drawing, but not in the cancellation, tasks. These results suggest that adaptation to leftward shifting lenses is associated with larger decay of VP AEs, and a role of the left hemisphere in maintaining these AEs after PA. These findings can be of relevance for the clinical application of this technique in neurological populations.
https://ift.tt/2qlps6O
The time course of encoding and maintenance of task-relevant versus irrelevant object features in working memory
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Andrea Bocincova, Jeffrey S. Johnson
Abstract
Access to WM can be restricted on the basis of goal-relevant properties such as spatial location. However, the extent of voluntary control over which features of an attended multi-feature object are encoded and maintained in WM is debated. Some evidence suggests that attending to an object leads to obligatory storage of all of its features, whereas other evidence suggests that access to WM can be restricted to only goal-relevant features. Another possibility is that all features are initially encoded, but irrelevant features are removed from WM over time. To address these various possibilities, we used pattern classification of EEG signals to track the temporal evolution of representations reflecting the encoding and storage of task-relevant and irrelevant features in WM. In different blocks, participants remembered the orientation, color or both orientation and color of a colored, oriented grating. The color and orientation of the grating was randomly drawn from two distinct feature bins on each trial. To examine trial-specific activity reflecting storage of the object's features, a support vector machine (SVM) classifier was trained to classify what bin the stimulus features came from. Importantly, for orientation, the classifier produced reliably above-chance classification across the delay when orientation was task-relevant but not when it was task-irrelevant. Interestingly, orientation could be accurately classified on trials for which both orientation and color were remembered. Moreover, a separate measure corresponding to the probability of a feature belonging to the correct bin was significantly higher when orientation was task-relevant compared to task-irrelevant during encoding. Above-chance classification for color was only present during the initial 500 ms across all conditions. Our results suggest that although information about all of an object's features is present in the initial stimulus-evoked neural response, information about the task-irrelevant features is attenuated during stimulus encoding and is largely absent throughout the delay.
https://ift.tt/2QfbQ8z
The frontal aslant tract (FAT) and its role in speech, language and executive function
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Anthony Steven Dick, Dea Garic, Paulo Graziano, Pascale Tremblay
Abstract
In this review, we examine the structural connectivity of a recently-identified fiber pathway, the frontal aslant tract (FAT), and explore its function. We first review structural connectivity studies using tract-tracing methods in non-human primates, and diffusion-weighted imaging and electrostimulation in humans. These studies suggest a monosynaptic connection exists between the lateral inferior frontal gyrus and the pre-supplementary and supplementary motor areas of the medial superior frontal gyrus. This connection is termed the FAT. We then review research on the left FAT's putative role in supporting speech and language function, with particular focus on speech initiation, stuttering and verbal fluency. Next, we review research on the right FAT's putative role supporting executive function, namely inhibitory control and conflict monitoring for action. We summarize the extant body of empirical work by suggesting that the FAT plays a domain general role in the planning, timing, and coordination of sequential motor movements through the resolution of competition among potential motor plans. However, we also propose some domain specialization across the hemispheres. On the left hemisphere, the circuit is proposed to be specialized for speech actions. On the right hemisphere, the circuit is proposed to be specialized for general action control of the organism, especially in the visuo-spatial domain. We close the review with a discussion of the clinical significance of the FAT, and suggestions for further research on the pathway.
https://ift.tt/2qpTTsn
Robust neurocognitive individual differences in grammatical agreement processing: A latent variable approach
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Darren Tanner
Abstract
Many neurocognitive accounts of language processing presume that neural responses detected in grand mean analyses of cortical electrophysiological activity reflect the normative brain response in the population under investigation. However, emerging work now shows that individuals' brain responses can vary systematically in both the size and type of effect elicited. The present research therefore examined individual differences in neural activity elicited by grammatical agreement anomalies during language comprehension in a large cohort of highly literate, monolingual English speakers (N = 114), a population generally assumed to be relatively homogenous in terms of linguistic knowledge and processing. Results showed systematic variability in event-related brain potentials (ERPs) elicited by subject-verb agreement anomalies, with brain responses varying on a continuum between N400 and P600 dominant responses. Similar variation was found both when agreement was realized via inflectional morphology or via lexical alternations. Individuals' brain response type correlated strongly across these two conditions. Similar variation was also found for ERPs elicited during rapid serial visual presentation and when self-paced ERPs were recorded. Multilevel latent variable regression showed that variation in brain response amplitude and type was not related to individual differences in language experience or verbal working memory capacity, despite high statistical power. These findings indicate that descriptions of processing dynamics predicated solely on grand mean analyses of central tendency can fail to provide an accurate, generalizable account of how processing unfolds in many or most individual members of the population studied. Furthermore, these findings show that systematic individual variation in engagement of neural system supporting grammatical processing is found even in language users at the highest end of the proficiency spectrum and in grammatically simple sentences. This study therefore has implications for studies of language processing in atypical populations.
https://ift.tt/2QiL2UZ
Prisms for timing better: A review on application of prism adaptation on temporal domain
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Filomena Anelli, Francesca Frassinetti
Abstract
The possibility to induce a transient modulation of visuo-spatial attention boosted so far the implementation of the prism adaptation in a variety of domains. This sensorimotor technique has been adopted to investigate the neural plasticity in neurologically healthy individuals, as well as to ameliorate deficit of visuo-spatial attention (which characterizes neglect patients' performance). We review here evidence about a new promising application of prisms in exploring how the human brain represents the subjective time flow on a spatially oriented "mental time line". Converging observations in healthy individuals suggest that altering spatial attention processing via prism adaptation can influence the spatial representation of time. These modulatory effects are generalizable to different aspects of time, such as the abilities to estimate time duration and to mentally travel in time. Furthermore, data from brain damaged patients, with a special focus on right brain-damaged patients with neglect, indicate that prismatic procedure ameliorates temporal deficits, hence paving the way to novel clinical applications. We conclude by discussing the possible cognitive mechanisms and neural circuits of the prism adaptation effects on time.
https://ift.tt/2qlp7RA
Limited short-term effects on human prostate cancer xenograft growth and epidermal growth factor receptor gene expression by the ghrelin receptor antagonist [D-Lys 3 ]-GHRP-6
Abstract
Purpose
The ghrelin axis regulates many physiological functions (including appetite, metabolism, and energy balance) and plays a role in disease processes. As ghrelin stimulates prostate cancer proliferation, the ghrelin receptor antagonist [D-Lys3]-GHRP-6 is a potential treatment for castrate-resistant prostate cancer and for preventing the metabolic consequences of androgen-targeted therapies. We therefore explored the effect of [D-Lys3]-GHRP-6 on PC3 prostate cancer xenograft growth.
Methods
NOD/SCID mice with PC3 prostate cancer xenografts were administered 20 nmoles/mouse [D-Lys3]-GHRP-6 daily by intraperitoneal injection for 14 days and tumour volume and weight were measured. RNA sequencing of tumours was conducted to investigate expression changes following [D-Lys3]-GHRP-6 treatment. A second experiment, extending treatment time to 18 days and including a higher dose of [D-Lys3]-GHRP-6 (200 nmoles/mouse/day), was undertaken to ensure repeatability.
Results
We demonstrate here that daily intraperitoneal injection of 20 nmoles/mouse [D-Lys3]-GHRP-6 reduces PC3 prostate cancer xenograft tumour volume and weight in NOD/SCID mice at two weeks post treatment initiation. RNA-sequencing revealed reduced expression of epidermal growth factor receptor (EGFR) in these tumours. Further experiments demonstrated that the effects of [D-Lys3]-GHRP-6 are transitory and lost after 18 days of treatment.
Conclusions
We show that [D-Lys3]-GHRP-6 has transitory effects on prostate xenograft tumours in mice, which rapidly develop an apparent resistance to the antagonist. Although further studies on [D-Lys3]-GHRP-6 are warranted, we suggest that daily treatment with the antagonist is not a suitable treatment for advanced prostate cancer.
https://ift.tt/2SKlZM6
Guidelines of care for the management of primary cutaneous melanoma
Publication date: Available online 1 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Work Group, Susan M. Swetter, Hensin Tsao, Christopher K. Bichakjian, Clara Curiel-Lewandrowski, David E. Elder, Jeffrey E. Gershenwald, Valerie Guild, Jane M. Grant-Kels, Allan C. Halpern, Timothy M. Johnson, Arthur J. Sober, John A. Thompson, Oliver J. Wisco, Samantha Wyatt, Shasa Hu, Toyin Lamina
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer–related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
https://ift.tt/2znU6R6
Histochemical study of the distribution of epidermal melanoblasts and melanocytes in Asian human skin
Skin Research and Technology, EarlyView.
https://ift.tt/2RuOXOn
Identification of novel susceptibility genes associated with seven autoimmune disorders using whole genome molecular interaction networks
Publication date: Available online 1 November 2018
Source: Journal of Autoimmunity
Author(s): Sam Kara, Gerardo A. Pirela-Morillo, Conrad T. Gilliam, George D. Wilson
Abstract
Convergent evidence from multiple and independent genetics studies implicate a small number of genes that predispose individuals to multiple autoimmune disorders (AuD). These intersecting loci reinforced the hypothesis that disorders with overlapping etiology group into a cluster of closely related genes within a whole genome molecular interaction network. We tested the hypothesis that "biological network proximity" within a whole genome molecular interaction network can be used to inform the search for multigene inheritance. Using a set of nine previously published genome wide association studies (GWAS) of AuD genes, we generated AuD-specific molecular interaction networks to identify networks of associated genes. We show that all nine "seed genes" can be connected within a 35-member network via interactions with 26 connecting genes. We show that this network is more connected than expected by chance, and 13 of the connecting genes showed association with multiple AuD upon GWAS reanalysis. Furthermore, we report association of SNPs in five new genes (IL10RA, DGKA, GRB2, STAT5A, and NFATC2) which were not previously considered as AuD candidates, and show significant association in novel disease samples of Crohn's disease and systemic lupus erythematosus. Furthermore, we show that the connecting genes show no association in four non-AuD GWAS. Finally, we test the connecting genes in psoriasis GWAS, and show association to previously identified loci and report new loci. These findings support the hypothesis that molecular interaction networks can be used to inform the search for multigene disease etiology, especially for disorders with overlapping etiology.
https://ift.tt/2CUrXnU
Editorial: The Fourteenth International Bologna Conference on Magnetic Resonance in Porous Media (MRPM14)
Publication date: Available online 1 November 2018
Source: Magnetic Resonance Imaging
Author(s): Clifford R. Bowers, Sergey Vasenkov
https://ift.tt/2znKyFK
High‐dose preoperative cholecalciferol to prevent post‐thyroidectomy hypocalcaemia: a randomized, double‐blind placebo‐controlled trial
Clinical Endocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2P5xkrF
Confocal microscopy features of patch‐stage mycosis fungoides and its correlation with horizontal histopathologic sections. A case series
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2JwY0vF
Dermoscopy of patch test reactions. Study of applicability in differential diagnosis between allergic and irritant reactions
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PD5wdC
Loss of function desmoplakin I and II mutations underlie dominant arrhythmogenic cardiomyopathy with a hair and skin phenotype
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Rt82kg
Near-infrared spectroscopy in vegetables and humans: An observational study
BACKGROUND Cerebral near-infrared spectroscopy (NIRS) of tissue oxygen saturation is claimed to be a surrogate marker for global cerebral perfusion. Increasingly, NIRS target-based therapy has been used during cardiac surgery in the hope of decreasing the incidence of adverse neurological outcome. OBJECTIVES We report NIRS values for some common vegetables and faculty at a world-class medical institution. DESIGN Observational nonblinded study. SETTING Single tertiary care institution and local urban vegetable market. PARTICIPANTS Five yams (Dioscorea cayenensis), five courgettes (Cucurbita pepo) and five butternut squashes (Cucurbita moschata) were studied. Five cardiothoracic surgeons and anaesthesiologists were the control group. INTERVENTIONS None. MAIN OUTCOME MEASURES NIRS value of each species. RESULTS Mean NIRS value for the control group was 71% [95% confidence interval (CI) 68 to 74] and was similar to that of the yellow squashes [75% (95% CI 74 to 76)]. These values were significantly greater than the NIRS measurements of both the butternut squash and yam [63% (95% CI 62 to 64) and 64% (95% CI 63 to 65), respectively, P https://ift.tt/2P1IEVQ
Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial
BACKGROUND Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). OBJECTIVE We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. DESIGN A randomised controlled study. SETTING Single University Hospital. PATIENTS One hundred and ten patients scheduled for heart valve surgery with CPB. INTERVENTIONS We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. MAIN OUTCOME MEASURES The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. RESULTS The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). CONCLUSION Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, no.: NCT01999829.https://ift.tt/2P6ch8s
Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial
BACKGROUND Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. OBJECTIVES To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. DESIGN Randomised controlled double blind trial. SETTING Two University Hospital Centres and two private Clinics from January to September 2014. PATIENTS Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. INTERVENTIONS Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. MAIN OUTCOME MEASURES Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. RESULTS The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group, and 3/87 (3.4%) in droperidol 1.25 mg group. The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. CONCLUSION The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. TRIAL REGISTRATION Clinicaltrials.gov: NCT01942343.https://ift.tt/2CX1ciH
Peri-operative respiratory adverse events in children with upper respiratory tract infections allowed to proceed with anaesthesia: A French national cohort study
BACKGROUND Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery. OBJECTIVE To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia. DESIGN Multicentre cohort study performed over 6 months in France. SETTING Sixteen centres with dedicated paediatric anaesthetists. PATIENTS Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks. MAIN OUTCOMES The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI. RESULTS Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms. CONCLUSION The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications – close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI. TRIAL REGISTRATION The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436).https://ift.tt/2P6OuW4
Green blood plasma from a patient with breast cancer after sentinel lymph node biopsy
No abstract availablehttps://ift.tt/2CX0T7x
Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: An observational study
BACKGROUND Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room. OBJECTIVES Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score. DESIGN Prospective, observational cohort study. SETTING University hospital – Germany/Berlin. Children were included between September 2015 and February 2017. PATIENTS A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included. MAIN OUTCOME MEASURES Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction. RESULTS A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events – such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes – were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004). CONCLUSION Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia. CLINICAL TRIAL NCT02481999.https://ift.tt/2P87eEv
Ultrasound assessment of gastric emptying time after a standardised light breakfast in healthy children: A prospective observational study
OBJECTIVES Current guidelines recommend 6 h of fasting for solids before anaesthesia. However, prolonged fasting may lead to discomfort, hunger, thirst, misbehaviour and lipolysis. To prevent this, a more liberal fasting regimen has been empirically implemented in our children's hospital, allowing a shorter fasting time of 4 h for a standardised light breakfast. AIM The aim of this study was to determine the gastric emptying time after a standardised light breakfast in healthy children. DESIGN A prospective observational noninterventional study. METHODS After fasting overnight, the children had a standardised light breakfast. Before and afterwards, ultrasound examinations of the gastric antrum were performed hourly to determine the gastric antral area (GAA), which is a surrogate parameter for gastric volume in children in the right lateral position (RLP). Demographic data and fasting times are presented as mean ± SD (range) and GAA as median (interquartile range). RESULTS Twenty-two children aged 7.8 (2.5 to 13.6) years volunteered for this study. After fasting overnight [735 ± 120 (467 to 930) min], the initial GAA was 3.06 (2.35 to 4.03) cm2 in RLP. After the light breakfast, GAA in RLP initially increased and decreased subsequently. After 4 h, GAA in RLP was lower than the initial value (median of differences −0.54, 95% confidence interval −1.00 to −0.07, P https://ift.tt/2P5ng1R
How current transfusion practices in geriatric patients with hip fracture still differ from current guidelines and the effects on outcome: A retrospective observational study
BACKGROUND Transfusion guidelines have become increasingly restrictive. We investigated actual transfusion practices in geriatric hip fracture patients, why they differ from current guidelines and how this affects outcome. OBJECTIVES The primary aim was to examine transfusion timing, evaluate how many red blood cell (RBC) transfusions are in keeping with guidelines and how this affects morbidity (infection, cardiac events and delirium), mortality and length of stay (LOS). Our secondary aim was to test the hypothesis that guidelines were more likely to be deviated from shortly before discharge and with consecutive transfusions. DESIGN A retrospective observational study. SETTING The Luzerner Kantonsspital, a major trauma centre, over a 12-month period from 1 February 2015 to 31 January 2016. PATIENTS All patients over 70 years of age admitted to the Luzerner Kantonsspital with hip fractures over a 12-month period in 2015 to 2016 were included. RESULTS 156 patients were included, to which 141 units of RBCs were transfused. All pre and intra-operative transfusions were according to guidelines; 110 transfusions were postoperative and 37 of these were not according to guidelines. Patients who were transfused had longer LOS in hospital (P = 0.002) and an odds ratio (OR) of 2.7 of contracting an infection (P = 0.04) in comparison with patients who were not transfused. No significant differences in mortality, LOS or morbidity were found between patients transfused according to guidelines and more liberal thresholds. Guidelines were more likely to be deviated from within the last 2 days before discharge than prior to this (58 vs. 24%, P = 0.03). Furthermore, 24 stable patients received two consecutive RBC units resulting in posttransfusion haemoglobin values of between 83 and 124 g l−1. CONCLUSION Most RBC transfusions occur postoperatively, many still according to liberal transfusion thresholds, in particular shortly before discharge and as part of consecutive transfusions. Transfused patients had longer LOS and more infections than patients not transfused, but there was no difference in mortality, LOS or morbidity between patients transfused according to current guidelines and those where guidelines were deviated from.https://ift.tt/2CU3S0u
The degree of adherence to CONSORT reporting guidelines for the abstracts of randomised clinical trials published in anaesthesia journals: A cross-sectional study of reporting adherence in 2010 and 2016
BACKGROUND Abstracts are intended to be concise summaries of the entire randomised clinical trial (RCT). Despite their importance, few studies have examined the reporting quality of abstracts in the anaesthesiology literature. OBJECTIVES To examine the quality of RCT abstract reporting according to the CONSORT for Abstracts guidelines and determine whether recommended items omitted from the abstract were present in the body of the article. DESIGN A cross-sectional study of RCTs. SETTING This study was performed at the University of Western Ontario and University Hospital, London Health Sciences Centre. PARTICIPANTS All RCTs meeting inclusion criteria that were published in 2010 or 2016 in six general anaesthesiology journals (Anaesthesia, Anesthesia & Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anesthesia and European Journal of Anaesthesiology). MAIN OUTCOME MEASURES The 16 checklist items from the CONSORT for Abstracts statement were used to create a convenience score as a proxy for RCT abstract reporting quality, with each criterion measured as being reported in abstract, not reported in abstract but reported in full-text article, or not reported in abstract or full-text article. RESULTS Of the 395 RCTs identified, 219 were published in 2010 and 176 were published in 2016. Out of the maximum possible score of 16, the median abstract score increased from 4 points [interquartile range (IQR): 3 to 5] in 2010 to 6 points [IQR: 5 to 8] in 2016. Although most checklist items showed improvement from 2010 to 2016, around 75% of RCTs in 2016 met fewer than half of the 16 items with no RCTs reporting all 16 items in the abstract. A majority of the RCTs had the information present in the full-text. In 2016, only 71 out of 176 (40%) of RCTs reported outcomes conforming to the CONSORT guidelines (with an effect size and a confidence interval around the effect size) in the Abstract. CONCLUSION Abstracts for many anaesthesiology RCTs are incomplete selective summaries of the entire article.https://ift.tt/2P4GHYU
Intra-osseous-access-associated lower limb compartment syndrome in a critically injured paediatric patient
No abstract availablehttps://ift.tt/2CUYjPE
ICU mortality and variables associated with ICU survival in Poland: A nationwide database study
BACKGROUND Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs. OBJECTIVES Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland. DESIGN Retrospective analyses of a database reporting ICU stays in Poland. SETTINGS AND PATIENTS The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012. MAIN OUTCOME MEASURES ICU mortality and variables associated with ICU survival. RESULTS A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P https://ift.tt/2P5GIvE
Comparison of the peripheral antinociceptive effect of somatostatin with bupivacaine and morphine in the rodent postoperative pain model
BACKGROUND AND OBJECTIVES Infiltration of surgical wound with local anaesthetics attenuate postoperative pain. However, side effects can also occur. Somatostatin (SST) and its analogues like octreotide reportedly reduce peripheral sensitisation. The current study evaluates peripherally mediated antinociceptive effect of SST in a rat model of postoperative pain. This was compared with bupivacaine and morphine under identical experimental conditions. DESIGN Randomised vehicle-controlled blind study. SETTING Pain research laboratory, All India Institute of Medical Sciences, New Delhi from February 2014 to July 2017. EXPERIMENTAL SUBJECT Rodent hind paw incision model. INTERVENTIONS Sprague-Dawley rats were subjected to incision and one of the following drugs administered into the open wound once by a micropipette: SST (10, 30 or 100 μg), bupivacaine (3, 10, 30, 50 or 100 μg) or morphine (100 μg). Antinociceptive effect of SST was further evaluated for its reversibility, site of action, effect on spinal c-fos expression and blood glucose level. The site of action of morphine was also investigated. MAIN OUTCOME MEASURE Nociception was estimated by nonevoked (guarding behaviour) and evoked (mechanical allodynia and thermal hyperalgesia) pain behaviours between 2 h and days 4 to 7. RESULTS Nociception was maximum 2 h after incision. SST (10 to 100 μg) significantly attenuated guarding behaviour between 2 h and day 2. A delayed inhibitory effect was observed on allodynia. Bupivacaine (10 to 100 μg doses) similarly decreased guarding score up to day 2 though evoked pain behaviours were relatively unaffected. In contrast, morphine produced a potent but transient inhibitory effect on guarding score at 2 h, which was mediated by both peripheral and central opioid receptors. The antinociceptive effect of SST was peripherally mediated by type 2 receptors and was associated with decreased c-fos staining. Blood glucose level was unaltered. CONCLUSION Guarding behaviour, which likely represents pain-at-rest following surgery, was attenuated by both bupivacaine and SST to comparable extents. This novel peripherally mediated antinociceptive effect of SST needs further evaluation.https://ift.tt/2P46MHq
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