Dermoscopic follow‐up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp

Summary

The scalp is a potential location for both benign and malignant tumors. Lymphoproliferative diseases can involve the skin as a primary or secondary manifestation. Dermoscopy is a noninvasive diagnostic tool for rapid diagnosis, screening, and follow‐up of the majority of skin tumors. Mantle cell lymphoma (MCL), a rare type of aggressive systemic lymphoma, usually occurs as a generalized lymphadenopathy, commonly with infiltration of the bone marrow, spleen, gastrointestinal tract, and Waldeyer's ring. In rare cases, it can also involve other structures, such as the lungs, central nervous system, liver, or skin. We report the case of a 74‐year‐old male patient suffering from MCL since 2015. Complete remission was obtained after R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) treatment. During maintenance therapy with rituximab, a solitary tumor occurred on the scalp. Dermoscopy of the lesion suggested relapse because of the presence of multiple chaotically distributed short linear vessels with multiple red dots within the hair follicles. Histological examination confirmed the diagnosis of MCL. After second‐line therapy with rituximab and bendamustine (R‐B), the tumor of the scalp completely disappeared and dermoscopy showed no abnormalities.

https://ift.tt/2EfX2Ei

Improvements in the perception of facial attractiveness following surgical aesthetic treatment; study based on online before and after photos

Summary

Background

Aesthetic surgery procedures such as lip augmentation, eyelid correction, face‐lifting, or Botox treatment for lines and wrinkles are an important part of cosmetic surgery.

Objectives

The aim of the study was to estimate improvement in appearance following plastic surgery using modern collective intelligence methods of validation.

Methods

A total of 108 photographs showing 54 patients prior to and following cosmetic surgery were downloaded from Internet web presentations of several unnamed plastic surgeons. The same number of photographs depicted each of the four investigated areas of treatment—26 lip enhancement, 26 blepharoplasty, 26 face‐lift, 26 botulinum toxin injection. Attractiveness of depicted individuals was assessed by 167 observers. Each photograph was judged separately.

Results

Blepharoplasty produced the most remarkable improvement in attractiveness amounting to 32.79 (SD ± 26.35). Improvement following Botox treatment stood at 30.29 (SD ± 24.55), whereas face‐lifting produces improvement of 28.70 (SD ± 22.76). Improvement following lip augmentation was estimated at 12.70 (SD ± 29.8). Highest Spearman's rank correlation coefficient was obtained for face‐lift and Botox (0.24 and 0.22, respectively).

Conclusions

Blepharoplasty, face‐lifting, and Botox deliver a significant improvement in facial attractiveness. Additionally, face‐lifting and Botox are distinguished by a high level of reproducibility. Our results indicate that lip augmentation is a treatment with a statistically significant, but less marked improvement in attractiveness.

https://ift.tt/2Su2iXK

A new approach to lower eyelid‐cheek junction rejuvenation

Summary

Background

Anti‐aging in lower eyelid‐cheek junction area has always been the upmost widely sought of cosmetic surgery. Removal of orbital fat from inside or outside, removal of part of the skin or even the orbicularis muscle, superficial pull and deep fill and a series of surgical procedures like these have been or are becoming the mainstream of clinical practice. However, aging involves a variety of tissues and causes, which is a dynamic and continuous process. Conventional or a single method cannot fundamentally solve all of the problems of the aging in lower eyelid‐cheek junction area. Therefore, we propose a better‐organized surgical approach based on the whole anatomy of lower eyelid‐cheek junction area.

Methods

A total of 103 patients received lower eyelid‐cheek junction rejuvenation surgery from September 2014 to September 2017 in our department. Efficacy of surgeries was delineated and scored by both patients and surgeons.

Results

All patients of different ages, genders were relatively satisfied with the lower eyelid‐cheek junction rejuvenation surgery in our department. Patients with different past histories of cosmetic surgeries could all benefit from the lower eyelid‐cheek junction rejuvenation surgery.

Conclusion

Rejuvenation of lower eyelid‐cheek junction area should be based on a thorough understanding of periorbital anatomy, age‐related changes of the lid‐cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion.

https://ift.tt/2EeXJh3

The relation between androgenetic thin hair diagnosed by trichoscope and benign prostatic hyperplasia

Summary

Background

Androgenetic alopecia carries a major cosmetic disfigurement and benign prostatic hyperplasia is associated with many urinary tract symptoms and both diseases are mediated by dihydrotestosterone.

Objectives

The study aimed to determine the relationship between hair diameter in androgenetic alopecia diagnosed, by trichoscope, to benign prostatic hyperplasia symptoms and signs.

Methods

Fifty androgenetic alopecia males and 50 normal males as control were included. We used trichoscope for hair examination, transrectal ultrasound for prostate volume, and urodynamic inspectoscope for urinary symptoms, serum total testosterone, dihydrotestosterone, and total prostatic specific antigen were measured in blood samples. All participants answered the International prostate symptom score questionnaire and the International Index of Erectile Function score questionnaire.

Results

A significant difference between patient and control groups was detected as regards hair thickness (P = 0.001), prostatic volume (P = 0.013), urinary symptoms, prostatic specific antigen level (P = 0.015). A significant difference was detected between thin (<0.03 mm, n = 26) and medium to thick hair (>0.03, n = 24) subgroups of patients as regards age (P = 0.001), dihydrotestosterone level (P = 0.001), testosterone level (P = 0.001), and urinary symptoms (P = 0.001).

Conclusion

Androgenetic alopecia patients with thin hair diagnosed by trichoscopy are more prone to prostatic enlargement and its related symptoms. Androgenetic alopecia severity can be diagnosed by trichoscopy in addition to Hamilton‐Norwood scale.

https://ift.tt/2StVzgz

Mutilating genital aphthous ulceration causing perforation in two women

https://ift.tt/2rlQtHF

Zosteriform lymphangitis carcinomatosis in the cervical area arising from pyriform fossa adenocarcinoma

https://ift.tt/2GeseFR

Chronic mercury exposure and blood pressure in children and adolescents: a systematic review

Abstract

The aim of this paper is to systematically review the scientific literature on the possible relation of chronic mercury exposure and blood pressure among children and adolescents. We searched for observational studies in 6 electronic databases and grey literature for English, French or Spanish language studies published up to 30^th November 2017. We performed a quality assessment of primary studies. We identified 8 articles involving 5 cohorts, 1 cross-sectional study and 1 case-control study. The participants had mean ages of between 3 and 17 years. Mercury was analysed in different matrices and periods of exposure. Four articles evaluated prenatal exposure, 2 evaluated both prenatal and postnatal exposures and 2 postnatal exposure. Blood pressure was measured according to different protocols. The association between mercury and blood pressure was adjusted by different covariates in each study. Four articles found a positive significant association between chronic mercury exposure and blood pressure in children or adolescents. Among these 4 articles, three of them evaluated prenatal exposure. There are still few studies assessing chronic mercury exposure and blood pressure in children and adolescents with inconsistency in results. Designs are very heterogeneous, which hampers their comparability. Evidence of this association is scarce and further research is needed.

https://ift.tt/2E7SpLJ

Spatial identification of environmental health hazards potentially associated with adverse birth outcomes

Abstract

Reduced birth weight (RBW) and reduced head circumference (RHC) are adverse birth outcomes (ABOs), often linked to environmental exposures. However, spatial identification of specific health hazards, associated with these ABOs, is not always straightforward due to presence of multiple health hazards and sources of air pollution in urban areas. In this study, we test a novel empirical approach to the spatial identification of environmental health hazards potentially associated with the observed RHC and RBW patterns. The proposed approach is implemented as a systematic search, according to which alternative candidate locations are ranked based on the strength of association with the observed birth outcome patterns. For empirical validation, we apply this approach to the Haifa Bay Area (HBA) in Israel, which is characterized by multiple health hazards and numerous sources of air pollution. We identified a spot in the local industrial zone as the main risk source associated with the observed RHC and RBW patterns. Multivariate regressions, controlling for personal, neighborhood, and geographic factors, revealed that the relative risks of RHC and RBW tend to decline, other things being equal, as a function of distance from the identified industrial spot. We recommend the proposed identification approach as a preliminary risk assessment tool for environmental health studies, in which detailed information on specific sources of air pollution and air pollution dispersion patterns is unavailable due to limited reporting or insufficient monitoring.

https://ift.tt/2QBzFdT

Treatment Outcomes and Sensitivity to Hormone Therapy of Aggressive Angiomyxoma: A Multicenter, International, Retrospective Study

AbstractBackground.Aggressive angiomyxoma (AA) is a rare, locally aggressive tumor usually arising from pelvis or perineum, with a high local‐recurrence rate after complete surgery. Anecdotal responses to hormone therapy have been reported. In the present study we aimed at studying surgical treatment outcomes and sensitivity to hormone therapy of AA.Materials and Methods.We conducted a multicenter, international retrospective effort including patients with AA treated at three European referral centers (Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy and the Italian Rare Cancer Network; Centre Léon Bérard, Lyon, France; and Hospital Universitario Virgen del Rocio, Seville, Spain).Results.A total of 36 patients were included. Median follow‐up was 51.3 months. Thirty‐three patients (92%) underwent complete (R0 + R1) surgery, with a local relapse rate of 50% and a median relapse‐free survival of 39 months (95% confidence interval [CI], 27–68.1). Thirteen patients received a first‐line systemic treatment with hormone therapy for locally advanced disease, with an overall response rate of 62% and a median progression‐free survival of 24.6 months (95% CI, 11.0–39.7). In two patients, adding an aromatase inhibitor (AI) on progression to first‐line GnRH agonist (GnRHa) resulted in a new tumor response.Conclusion.Our findings confirm that in AA, surgical local control may be challenging, with a significant rate of local relapse despite complete surgery. Hormone therapy is an active treatment option, with a potential of disease control and of being combined with surgery. The addition of an AI to first‐line GnRHa could be an effective second‐line systemic therapy in premenopausal female patients with AA.Implications for Practice.In this retrospective effort including 36 patients with aggressive angiomyxoma, local relapse rate after complete surgery was 50%, with a median relapse‐free survival of 39 months, confirming that local control is challenging. Overall response rate to first‐line hormone therapy was 62%, with a median progression‐free survival of 24.6 months. Thus, hormone therapy has a potential of disease control and of being combined with surgery.

https://ift.tt/2zM4aV7

Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade

AbstractBackground.The diagnosis of mixed invasive ductal and lobular carcinoma (IDC‐L) in clinical practice is often associated with uncertainty related to its prognosis and response to systemic therapies. With the increasing recognition of invasive lobular carcinoma (ILC) as a distinct disease subtype, questions surrounding IDC‐L become even more relevant. In this study, we took advantage of a detailed clinical database to compare IDC‐L and ILC regarding clinicopathologic and treatment characteristics, prognostic power of histologic grade, and survival outcomes.Materials and Methods.In this retrospective cohort study, we identified 811 patients diagnosed with early‐stage breast cancer with IDC‐L or ILC. Descriptive statistics were performed to compare baseline clinicopathologic characteristics and treatments. Survival rates were subsequently analyzed using the Kaplan–Meier method and compared using the Cox proportional hazards model.Results.Patients with ILC had more commonly multifocal disease, low to intermediate histologic grade, and HER2‐negative disease. Histologic grade was prognostic for patients with IDC‐L but had no significant discriminatory power in patients with ILC. Among postmenopausal women, those with IDC‐L had significantly better outcomes when compared with those with ILC: disease‐free survival (DFS) and overall survival (OS; adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.31–0.95). Finally, postmenopausal women treated with an aromatase inhibitor had more favorable DFS and OS than those treated with tamoxifen only (OS adjusted HR, 0.50; 95% CI, 0.29–0.87), which was similar for both histologic types (p = .212).Conclusion.IDC‐L tumors have a better prognosis than ILC tumors, particularly among postmenopausal women. Histologic grade is an important prognostic factor in IDC‐L but not in ILC.Implications for Practice.This study compared mixed invasive ductal and lobular carcinoma (IDC‐L) with invasive lobular carcinomas (ILCs) to assess the overall prognosis, the prognostic role of histologic grade, and response to systemic therapy. It was found that patients with IDC‐L tumors have a better prognosis than ILC, particularly among postmenopausal women, which may impact follow‐up strategies. Moreover, although histologic grade failed to stratify the risk of ILC, it showed an important prognostic power in IDC‐L, thus highlighting its clinical utility to guide treatment decisions of IDC‐L. Finally, the disease‐free survival advantage of adjuvant aromatase inhibitors over tamoxifen in ILC was consistent in IDC‐L.

https://ift.tt/2Pkx3wl

Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy

AbstractBackground.In the U.S., neoadjuvant chemotherapy (NAC) for nonmetastatic breast cancer (BC) is used with extensive disease and aggressive molecular subtypes. Little is known about the influence of demographic characteristics, clinical factors, and resource constraints on NAC use in Africa.Materials and Methods.We studied NAC use in a cohort of women with stage I–III BC enrolled in the South African Breast Cancer and HIV Outcomes study at five hospitals. We analyzed associations between NAC receipt and sociodemographic and clinical factors, and we developed Cox regression models for predictors of time to first treatment with NAC versus surgery.Results.Of 810 patients, 505 (62.3%) received NAC. Multivariate analysis found associations between NAC use and black race (odds ratio [OR] 0.49; 95% confidence limit [CI], 0.25–0.96), younger age (OR 0.95; 95% CI, 0.92–0.97 for each year), T‐stage (T4 versus T1: OR 136.29; 95% CI, 41.80–444.44), N‐stage (N2 versus N0: OR 35.64; 95% CI, 16.56–76.73), and subtype (triple‐negative versus luminal A: OR 5.16; 95% CI, 1.88–14.12). Sites differed in NAC use (Site D versus Site A: OR 5.73; 95% CI, 2.72–12.08; Site B versus Site A: OR 0.37; 95% CI, 0.16–0.86) and time to first treatment: Site A, 50 days to NAC versus 30 days to primary surgery (hazard ratio [HR] 1.84; 95% CI, 1.25–2.71); Site D, 101 days to NAC versus 126 days to primary surgery (HR 0.49; 95% CI, 0.27–0.89).Conclusion.NAC use for BC at these South African hospitals was associated with both tumor characteristics and heterogenous resource constraints.Implications for Practice.Using data from a large breast cancer cohort treated in South Africa's public healthcare system, the authors looked at determinants of neoadjuvant chemotherapy use and time to initiate treatment. It was found that neoadjuvant chemotherapy was associated with increasing tumor burden and aggressive molecular subtypes, demonstrating clinically appropriate care in a lower resource setting. Results of this study also showed that time to treatment differences between chemotherapy and surgery varied by hospital, suggesting that differences in resource limitations were influencing clinical decision making. Practice guidelines and care quality metrics designed for low‐ and middle‐income countries should accommodate heterogeneity of available resources.

https://ift.tt/2zKrNgF

Predictors of Survival in Patients with Advanced Gastrointestinal Malignancies Admitted to the Intensive Care Unit

AbstractBackground.Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions.Patients and Methods.The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival.Results.The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6‐month mortality was 75%. In multivariate analysis, high admission SOFA score > 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score > 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU.Conclusion.For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long‐term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication.Implications for Practice.Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.

https://ift.tt/2PnoaSE

The enhanced lipid productivity of Chlorella minutissima and Chlorella pyrenoidosa by carbon coupling nitrogen manipulation for biodiesel production

Abstract

Biodiesel production from microalgae has been researched extensively and attempted to commercialize on a large scale, but there are major hurdles in the production process like harvesting and low lipid content, which should be studied to enhance the process and make it economical. Present study aimed to improve the lipid productivity of Chlorella minutissima and Chlorella pyrenoidosa by modifying the carbon and nitrogen content of the medium. Both organisms were grown in BG11 medium for the first 6 days and thereafter grown in a modified BG11 medium completely deprived of nitrogen for 2 to 10 days. Nitrogen deprivation increased the lipid productivity of Chlorella minutissima to 20% and that of Chlorella pyrenoidosa to 17.6% by day 6. This was further coupled with carbon addition in the form of citric acid (5 g/L), sodium acetate (5 g/L), sodium carbonate (5 g/L), and sodium potassium tartarate (5 g/L), which increased the total lipid productivity of Chlorella minutissima up to 24% and that of Chlorella pyrenoidosa up to 23%. The highest lipid productivity of up to 24% for Chlorella minutissima and up to 23% for Chlorella pyrenoidosa was observed with nitrogen deprivation coupled with sodium acetate. Acidic transesterification revealed the presence of fatty acid methyl esters, majority of which consisted of hexadecanoic acid methyl ester and octadecanoic acid methyl ester. Maximum of 3% fatty acid methyl esters for Chlorella minutissima and 4% for Chlorella pyrenoidosa were obtained under nitrogen deprivation and sodium acetate as a carbon source. Thus, nitrogen deprivation coupled with sodium acetate as an increased carbon source in BG11 medium helps to increase the lipid productivity of Chlorella minutissima and Chlorella pyrenoidosa, and produces long-chain fatty acid methyl esters of C17 and C19 along with C21, C25, and C29.

https://ift.tt/2E2PIL5

A Case of Thyrotoxicosis due to Simultaneous Occurrence of Subacute Thyroiditis and Graves' Disease.

A Case of Thyrotoxicosis due to Simultaneous Occurrence of Subacute Thyroiditis and Graves' Disease.

Case Rep Endocrinol. 2018;2018:3210317

Authors: Kageyama K, Kinoshita N, Daimon M

Abstract
Subacute thyroiditis is an inflammatory disorder of the thyroid. Graves' disease is an autoimmune thyroid disease in which thyroid hormones are overproduced. Here we present a rare case of thyrotoxicosis due to the simultaneous occurrence of both diseases. Prompt diagnosis and therapy are required to prevent complications in patients with thyrotoxicosis.

PMID: 30510812 [PubMed]

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Does isotretinoin cause depression and anxiety in acne patients?

Background

Acne is the most common skin disease, and isotretinoin is the most powerful drug amongst the various drugs used for its treatment. A causal relationship has not yet been established between isotretinoin use and depression.

Objectives

The aim of this study is to research the effect of isotretinoin treatment on depression in a group of patients undergoing isotretinoin therapy.

Methods

Behavioral tests measuring anxiety and depression, and the measures assessing acne severity and quality of life were applied to 112 acne patients consulted at Dermatology Clinic of Beyazit Medico Social Center of Istanbul University.

Results

In this study, 72 acne patients (61 female and 11 male) were evaluated. A significant decrease was observed in HAD‐D, GAGS and CADI scores at the end of the therapy. There was no significant relationship between patients' depression history and HAD‐D scores at the end of first month of therapy and at the end of treatment.

Conclusion

Although the psychiatrists are concerned about the potential psychiatric side effects of isotretinoin, our data support no causal relationship between isotretinoin use and depression in acne patients.

This article is protected by copyright. All rights reserved.

https://ift.tt/2GbgnrI

Alitretinoin for palmoplantar keratodermas: a novel case and review of the literature

Papillon‐Lefèvre syndrome (PLS) is a rare, autosomal recessive disorder of keratinization, characterized by palmoplantar keratoderma (PPK) and severe chronic periodontitis which leads to an early loss of primary and permanent teeth. Oral retinoids, such as etretinate, isotretinoin and acitretin, represent the most important therapeutic options for keratoderma of PLS, with varying results in terms of efficacy. We report here the first case of 55‐year‐old woman diagnosed with PLS treated with alitretinoin.

This article is protected by copyright. All rights reserved.

https://ift.tt/2rnoXcJ

When IL‐17 inhibitors fail: real‐life evidence to switch from secukinumab to adalimumab or ustekinumab

Psoriasis is a chronic, systemic inflammatory disease that in the moderate to severe forms may benefit of biologics, namely TNF and IL‐12/23 and IL‐17 inhibitors. Loss of response, lack of response or discontinuation due to adverse events represent a concrete therapeutic challenge for dermatologists that have to switch patients to other treatments. Although some evidences already exist toward the switch from IL‐12/23 and TNF inhibitors to IL‐17 inhibitors, conversely nothing is present toward the switch from IL‐17 inhibitors to IL‐12/23 and TNF inhibitors. We performed a real‐life study enrolling 50 patients randomly switched to adalimuamb, a TNF inhibitor, or ustekinumab, an IL‐12/23 inhibitor. Our observational study suggests that switching from IL‐17i to TNFi and IL‐12/23i is a safe and effective therapeutic strategy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Gdy0rh

Clindamycin as Unique Antibiotic Choice in Hidradenitis Suppurativa

Background and Objective

The Rifampicin (RF) ‐ Clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy.

The aim of this study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS.

Methods

In the period January 2017 ‐ May 2018 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by J.E. Revuz, Hidradenitis Suppurativa Physician Global Assessment/HS‐PGA and International Hidradenitis Suppurativa Severity Score System/IHS4) before (W0) and after (W12) CL oral therapy.

Results

CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p≤0.01). There was also a statistically significant change in the mean VAS for pain.

Conclusions

This study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF‐CL combination in a selected group of patients.

This article is protected by copyright. All rights reserved.

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Uncertain diagnosis and prognosis in advanced melanoma: A qualitative study of the experiences of bereaved carers in a time of immune and targeted therapies

Abstract

Background

Recent advances in advanced melanoma therapies are associated with improved survival for some patients. How patients with diagnoses of advanced disease and their carers experience this expanding treatment paradigm, however, is not well understood.

Objectives

We explored bereaved carers' accounts of the trajectory of advanced melanoma involving treatment by immune or targeted therapies to build an understanding of their experiences of care relating to diagnosis and prognosis.

Methods

A qualitative exploratory design, using methods drawn from grounded theory was adopted. Analyses drew on in‐depth interviews with 20 bereaved carers from three metropolitan melanoma treatment centres in Australia. A flexible interview guide and a structured approach of concurrent data collection and analysis were applied.

Results

Carers described qualities of the experience including the shock of diagnosis after a sometimes‐innocuous presentation with vague symptoms. They reported an unclear prognosis with complexity arising from interplay between an uncertain disease trajectory and often ambiguous expectations of outcomes of emerging immune and targeted therapies. Uncertainty dominated carers' experiences, increasing the complexity of care planning.

Conclusions

Effective communication of an advanced melanoma diagnosis and prognosis is critical. Recognition of the uncertainty inherent in the benefit of immune and targeted therapies in a constructive manner may facilitate more timely and effective care planning conversations between patients, carers and medical specialists.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSguUZ

Notch dysregulation and HS: let's talk about Numb

Abstract

We read with great interest the article by J. W. Frew regarding Notch Dysregulation as an Epiphenomenon in Inflammatory Skin Diseases.¹ The paper pointed out some controversies among Notch activity and keratinocyte proliferation as well as maturation in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis and Lichen Planus. Because of a recognized involvement of Notch in HS, but at the same time still not clear, we also explored other components of the same signalling.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyYaf

The illusion of conventional histological resection margin control

Abstract

An advantage of surgical treatment for basal cell carcinoma (BCC) over other therapeutic options is the possibility of histological margin control. The general understanding is that only 1‐2% of the actual margins are checked histologically using the 'bread loaf' or step sectioning technique for conventional excision specimens, but the percentage of resection margins that are microscopically evaluated have not actually been quantified to date. [1, 2] This study's objective was to calculate the mean percentage of resection margins of BCC excision specimens that is histologically evaluated.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BRkTYf

Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins

Abstract

Background

Frozen histological sections are currently used for intra‐operative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool, which offers a promising and faster alternative to frozen histology.

Objective

The aim of the present study is to prospectively evaluate in a clinical setting, the accuracy of FCM as compared to frozen sections in BCC's margin assessment.

Methods

Patients with BCC, scheduled for Mohs surgery were prospectively enrolled. Freshly‐excised surgical specimens were first examined through FCM and then frozen sections were evaluated. Permanent sections were finally obtained, in order to validate our sample technique.

A blind re‐evaluation was also performed for discordant cases between FCM and frozen sections.

Sensitivity and specificity levels, as well as positive and negative predicting values were calculated and ROC curves were generated.

Results

We enrolled 127 BCCs in as many patients (40.2% females). A total number of 753 sections were examined. All BCCs were located on the head and neck area. When evaluating the performance of FCM as compared to frozen sections 79.8% sensitivity, 95.8% specificity, 80.5% positive predicting and 95.7% negative predicting values were found (Area Under the Curve: .88, 95%CI .84‐.92; P<.001). A total of 49 discordant cases between FCM and frozen sections evaluations were blindly re‐evaluated, of which 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment.

Conclusions

We found high levels of accuracy for FCM as compared to frozen sections evaluation, in intra‐operative BCC's margin assessment during Mohs surgery. Some technical issues still prevent a wide use of this technique, but new upcoming devices promise to overcome these limitations.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyVez

Correlation of the Refined Hurley Classification for Hidradenitis suppurativa with Patient Reported Quality of Life and Objective Disease Severity Assessment

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic, debilitating, heterogeneous disease requiring different treatment approaches. Recently, we refined the classic Hurley classification into a seven‐stage classification in order to guide these treatment choices. This new classification subdivides Hurley stage I and II into three sub‐stages namely mild (A), moderate (B), and severe (C) HS disease. Hurley stage III is not sub‐categorised and always severe.

Aim

To investigate the correlation between the given severity grades of Hurley I and Hurley II in the refined Hurley classification, and the patient reported quality of life and physician‐assessed objective severity score.

Methods

In this cross‐sectional study, HS patients participating in the observational cohorts of two Dutch tertiary referral centres were included before June 2017. The patient reported Dermatology Life Quality Index (DLQI) and physician‐assessed International HS Severity Score System (IHS4) scores were compared between the refined Hurley stages.

Results

In total, 433 patients were analysed. DLQI and IHS4 scores increased within Hurley stage I and II from A through C. There was a significant positive correlation of DLQI and IHS4 with increasing refined Hurley sub‐stages (refined Hurley stage I (A, B, and C) to DLQI: r_s=0.259, p<0.001 and refined Hurley stage II (A, B, and C) to DLQI r_s=0.185, p=0.010; refined Hurley stage I (A, B, and C) to IHS4 r_s=0.603, p<0.001 and refined Hurley stage II (A, B, and C) to IHS4 r_s=0.532, p<0.001).

Conclusion

The refined Hurley classification accurately correlates with HS severity assessed by both patients and clinicians. Therefore, the refined Hurley classification is a useful tool for the quick assessment of severity in HS.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSiQU4

Bone turnover markers, BMD and TBS after short-term, high-dose glucocorticoid therapy in patients with Graves’ orbitopathy: a small prospective pilot study

Abstract

Purpose

Chronic GC administration has numerous side effects, but little is known about the side effects of their short-term use (< 3 months)—particularly, when high doses are involved, as in the treatment of Graves' orbitopathy (GO). We investigated the effects of short-term, high-dose GC on bone turnover markers, bone mineral density (BMD), and trabecular bone scores (TBS).

Methods

Eleven patients (10 females and 1 male; median age 56 years) with active GO who were candidates for treatment with intravenous (iv) methylprednisone were consecutively enrolled. All patients were pretreated with a loading dose of 300,000 units of cholecalciferol, then given a median cumulative dose of 4.5 g (range 1.5–5.25 g) iv methylprednisone. Biochemical parameters of bone metabolism (25OHD3, PTH, P1NP, CTX and bALP) were measured at the baseline, and then 1 week and 1, 3, 6 and 12 months. BMD and TBS were obtained by X-ray absorptiometry (DXA) at the baseline and at 6 and 12 months. On DXA image, morphometric vertebral fracture assessment (VFA) was done.

Results

There were no significant changes in PTH, bALP or P1NP. A significant drop in CTX was seen at 1 month (down Δ49.31% from the baseline, p = 0.02), with a return to the baseline at the 3-month measurement. There was a moderate (not significant), but persistent reduction in P1NP. No changes in BMD or TBS came to light. No vertebral fractures were documented.

Conclusions

Short-term, high-dose GC treatment caused a rapid, transient suppression of bone resorption, with no effects on BMD or bone micro-architecture (TBS).

https://ift.tt/2Qid72N

Dermoscopy of angioleiomyoma: A case report

https://ift.tt/2zLnbXL

A rare association of paraneoplastic pemphigus with gastric signet cell ring carcinoma

https://ift.tt/2PlIeF4

Deep Brain Stimulation Surgery without Sedation

Background: Sedatives and opioids used during deep brain stimulation (DBS) surgery interfere with optimal target localization and add to side effects and risks, and thus should be minimized. Objective: To retrospectively test the actual need for sedatives and opioids when cranial nerve blocks and specific therapeutic communication are applied. Methods: In a case series, 64 consecutive patients treated with a strong rapport, constant contact, non-verbal communication and hypnotic suggestions, such as dissociation to a "safe place," reframing of disturbing noises and self-confirmation, were compared to 22 preceding patients under standard general anaesthesia or conscious sedation. Results: With introduction of the protocol the need for sedation dropped from 100% in the control group to 5%, and from a mean dose of 444 mg to 40 mg in 3 patients. Remifentanil originally used in 100% of the patients in an average dose of 813 µg was reduced in the study group to 104 µg in 31% of patients. There were no haemodynamic reactions indicative of stress during incision, trepanation, electrode insertion and closure. Conclusion: With adequate therapeutic communication, patients do not require sedation and no or only low-dose opioid treatment during DBS surgery, leaving patients fully awake and competent during surgery and testing.
Stereotact Funct Neurosurg

https://ift.tt/2Qv2lp9

Targeted disruption of PI3K/Akt/mTOR signaling pathway, via PI3K inhibitors, promotes growth inhibitory effects in oral cancer cells

Abstract

Purpose

The phosphoinositide-3-kinase (PI3K) pathway is the frequently altered in human cancer. This has led to the development and study of novel PI3K inhibitors for targeted therapy and also to overcome resistance to radiotherapy.

Method

The anti-tumour effects of PI3K inhibitors (PI-828, PI-103 and PX-866) in terms of cell proliferation, colony formation, induction of apoptosis, cell cycle arrest, invasion, autophagy, and pNF-κB/p65 translocation in SCC-4, SCC-9 and SCC-25 cells were studied by performing MTT, clonogenic, DAPI staining, propidium iodide staining, annexin-V binding, matrigel invasion, acridine orange staining and immuno-fluorescence assay. Western blot assay was performed to assess the alteration in the expression of various proteins.

Result

PI-828 and PI-103 treatment exhibited dose-dependent inhibition of growth and proliferation of OSCC cells with a concomitant induction of apoptosis, altered cell cycle regulation and decreased invasiveness (p < 0.01). PX-866 induced apoptosis, cell cycle arrest, autophagy and a significant decrease in the invasiveness of oral cancer cells as compared to untreated cells (p < 0.01). These compounds significantly reduced expression of COX-2, cyclin-D1 and VEGF in the treated cells besides cytoplasmic accumulation of pNF-κB/p65 protein. In addition to PI3Kα, inactivation of downstream components, i.e. Akt and mTOR was seen.

Conclusion

PI3K inhibitors such as PI-103, PI-828 and PX-866 may be developed as potential therapeutic agents for effective treatment of oral squamous cell carcinoma (OSCC) patients, associated with activated PI3K/Akt pathway.

https://ift.tt/2BSrWjK

Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis

Abstract

Background

Italian consensus for the classification and reporting of thyroid cytology has proposed to discriminate the cancer prevalence of high (Tir 3B) vs. low (Tir 3A) risk indeterminate nodules. To obtain more robust evidence on this topic, we performed a meta-analysis of the Odds Ratio (OR) of malignancy of Tir 3B vs. Tir 3A nodules.

Methods

A comprehensive literature exploration of online databases was conducted until May 2018. Original articles reporting histology of nodules cytologically classified as Tir 3A and Tir 3B were eligible. Pooled cancer prevalence in Tir 3A and Tir 3B, and OR of Tir 3B vs. Tir 3A were calculated.

Results

The search revealed 95 articles, and 10 were included for the meta-analysis. Overall, 1168 indeterminate lesions were reported (441 Tir 3A and 727 Tir 3B), of which 391 were cancers. The pooled cancer prevalence was 17% in Tir 3A and 47% in Tir 3B. The OR of Tir 3B vs. Tir 3A was 4.24 (95% CI 2.75 to 6.53) with mild heterogeneity and without publication bias. When we considered non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as non-malignant, cancer rate was lower, and OR of Tir 3B against Tir 3A was 2.93 (95% CI 1.60 to 5.37), with no heterogeneity but with publication bias.

Conclusions

The Italian system for thyroid cytology is reliable to assess indeterminate lesions at low and high risk, being Tir 3B associated with a cancer risk significantly higher than Tir 3A, also when considering NIFTP as non-malignant entity.

https://ift.tt/2rlEoCh

Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis

Abstract

Background

Italian consensus for the classification and reporting of thyroid cytology has proposed to discriminate the cancer prevalence of high (Tir 3B) vs. low (Tir 3A) risk indeterminate nodules. To obtain more robust evidence on this topic, we performed a meta-analysis of the Odds Ratio (OR) of malignancy of Tir 3B vs. Tir 3A nodules.

Methods

A comprehensive literature exploration of online databases was conducted until May 2018. Original articles reporting histology of nodules cytologically classified as Tir 3A and Tir 3B were eligible. Pooled cancer prevalence in Tir 3A and Tir 3B, and OR of Tir 3B vs. Tir 3A were calculated.

Results

The search revealed 95 articles, and 10 were included for the meta-analysis. Overall, 1168 indeterminate lesions were reported (441 Tir 3A and 727 Tir 3B), of which 391 were cancers. The pooled cancer prevalence was 17% in Tir 3A and 47% in Tir 3B. The OR of Tir 3B vs. Tir 3A was 4.24 (95% CI 2.75 to 6.53) with mild heterogeneity and without publication bias. When we considered non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as non-malignant, cancer rate was lower, and OR of Tir 3B against Tir 3A was 2.93 (95% CI 1.60 to 5.37), with no heterogeneity but with publication bias.

Conclusions

The Italian system for thyroid cytology is reliable to assess indeterminate lesions at low and high risk, being Tir 3B associated with a cancer risk significantly higher than Tir 3A, also when considering NIFTP as non-malignant entity.

https://ift.tt/2rlEoCh

Study on the Effect of Sound Therapy on Chronic Primary Tinnitus

Condition:   Tinnitus
Interventions:   Device: CAABT;   Device: TMT
Sponsor:   Beijing Friendship Hospital
Recruiting

https://ift.tt/2QdkpVi

Liposomal iRInotecan, Carboplatin or oXaliplatin for Esophagogastric Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Liposomal Irinotecan;   Drug: Carboplatin;   Drug: Capecitabine;   Drug: Oxaliplatin;   Drug: 5-fluorouracil;   Drug: Leucovorin
Sponsors:   Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA);   Servier
Not yet recruiting

https://ift.tt/2RCIykD

Study of Pembrolizumab Given Prior to Surgery and in Combination With Radiotherapy Given Post-surgery for Advanced Head and Neck Squamous Cell Carcinoma (MK-3475-689)

Condition:   Head and Neck Neoplasms
Interventions:   Biological: Pembrolizumab 200 mg;   Radiation: Radiotherapy 60 Gray/day;   Radiation: Radiotherapy 66 Gray/day;   Radiation: Radiotherapy 70 Gray/day;   Drug: Cisplatin 100 mg/m^2
Sponsor:   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2RAjVoN

GETNE Registration of Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Grupo Espanol de Tumores Neuroendocrinos
Not yet recruiting

https://ift.tt/2QcaAXD

The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master’s program

Abstract

Objectives

Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF).

Materials and methods

Patients treated by postgraduate students in an Endodontics Master's Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as "healthy" (PAI ≤ 2 in absence of signs/symptoms), "endodontically diseased" (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or "non-endodontically diseased" (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05).

Results

At 10 years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered "endodontically diseased"). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as "healthy." Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively.

Conclusions

After 10 years, teeth filled with Thermafil in a specialist master's program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques.

Clinical relevance

Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.

https://ift.tt/2rnLar8

Episodic Recognition Memory and the Hippocampus in Parkinson’s disease: A Review

Publication date: Available online 4 December 2018

Source: Cortex

Author(s): Tanusree Das, Jaclyn Joyce Hwang, Kathleen L. Poston

Abstract

Parkinson's disease is a progressive neurodegenerative disorder of aging. The hallmark pathophysiology includes the development of neuronal Lewy bodies in the substantia nigra of the midbrain with subsequent loss of dopaminergic neurons. These neuronal losses lead to the characteristic motor symptoms of bradykinesia, rigidity, and rest tremor. In addition to these cardinal motor symptoms patients with PD experience a wide range of non-motor symptoms, the most important being cognitive impairments that in many circumstances lead to dementia. People with PD experience a wide range of cognitive impairments; in this review we will focus on memory impairment in PD and specifically episodic memory, which are memories of day-to-day events of life. Importantly, these memory impairments severely impact the lives of patients and caregivers alike.

Traditionally episodic memory is considered to be markedly dependent on the hippocampus; therefore, it is important to understand the exact nature of PD episodic memory deficits in relation to hippocampal function and dysfunction. In this review, we discuss an aspect of episodic memory called recognition memory and its subcomponents called recollection and familiarity. Recognition memory is believed to be impaired in PD; thus, we discuss what aspects of the hippocampus are expected to be deficient in function as they relate to these recognition memory impairments. In addition to the hippocampus as a whole, we will discuss the role of hippocampal subfields in recognition memory impairments.

https://ift.tt/2AP0uS2

Impairment of Lipophagy by PNPLA1 Mutations Cause Lipid Droplet Accumulation in Primary Fibroblasts of Autosomal Recessive Congenital Ichthyosis Patients

Publication date: Available online 4 December 2018

Source: Journal of Dermatological Science

Author(s): Gizem Onal, Ozlem Kutlu, Ebru Ozer, Devrim Gozuacik, Aysen Karaduman, Serap Dokmeci (Emre)

Abstract

Background

Autosomal Recessive Congenital Ichthyosis (ARCI) is a group of epidermal keratinization disorders. One of the disease-associated proteins, patatin-like phospholipase domain-containing protein-1 (PNPLA1), plays a key role in the epidermal omega-O-acylceramide synthesis and localizes on the surface of lipid droplets (LDs).

Objective

Previously, routine clinical test results showed abnormal LD accumulation in blood smear samples of our ARCI patients with PNPLA1 mutations. To investigate abnormal accumulation of LDs, we analyzed primary fibroblast cells of ARCI patients with PNPLA1 mutations (p.Y245del and p.D172 N). We hypothesized that PNPLA1 mutations might affect lipophagy-mediated regulation of LDs and cause intracellular lipid accumulation in ARCI patients.

Methods

LD accumulation was analyzed by fluorescence stainingwith BODIPY®493/503 in fibroblasts of patient cells and PNPLA1 siRNA transfected control fibroblast cells. The expression of PNPLA1 and its effects on the lipophagy-mediated degradation of LDs were analyzed by immunocytochemistry and immunoblotting.

Results

Our results showed that mutant or downregulated PNPLA1 protein cause abnormal intracellular LD accumulation. We found that PNPLA1 mutations affect neither the cellular localization nor expression levels of the protein in fibroblast cells. When we analyzed lipophagic degradation process, LC3 expression and the number of autophagosomes were significantly decreased in fibroblast cells of the patients. In addition, co-localization of LDs with autophagosomes and lysosomes were markedly less than that of the control group.

Conclusion

PNPLA1 mutations caused disturbances in both autophagosome formation and fusion of autophagosomes with lysosomes. Our results indicate a possible role for PNPLA1 protein in LD regulation via lipophagy-mediated degradation.

https://ift.tt/2EdaIjp

A Turkish girl with H syndrome: stunted growth and development of autoimmune insulin dependent diabetes mellitus in the 6th year of diagnosis

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2QbrBRQ

Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2RBkoqK

Natural Estrogen Receptor Modulators and Their Heterologous Biosynthesis

Publication date: Available online 4 December 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Jiali Yang, Lingrong Wen, Yueming Jiang, Bao Yang

Estrogen receptors (ERs) are transcription factors highly involved in physiological development and metabolism in the human body. They also play important roles in the treatment of cancer and metabolic diseases. Chemicals that interact with ERs can be used to treat diseases and maintain health. Phytoestrogens are natural chemicals that have been documented to possess significant ER modulatory activities. However, since phytoestrogens usually exist at low quantities in nature, heterologous biosynthesis techniques have quickly developed in recent years in order meet the demands for needed therapeutic amounts. In this review, the performance of phytoestrogens as ER modulators is described along with recent advances in biosynthesis techniques.

https://ift.tt/2StbWKb

Continuous degradation of Direct Red 23 by calcium pectate–bound Ziziphus mauritiana peroxidase: identification of metabolites and degradation routes

Abstract

In the present study, oxido-reductive degradation of diazo dye, Direct Red 23, has been carried out by Ziziphus mauritiana peroxidases (specific activity 17.6 U mg⁻¹). Peroxidases have been immobilized via simple adsorption and cross-linking by glutaraldehyde; adsorbed and cross-linked enzyme retained 94.28% and 91.23% of original activity, respectively. The stability of peroxidases was enhanced significantly upon immobilization; a marked widening in both pH and temperature activity profiles were observed. Adsorbed peroxidases exhibited similar pH and temperature optima as reported for the free enzyme. Thermal stability was significantly enhanced in case of cross-linked enzyme which showed 80.52% activity even after 2 h of incubation at 60 °C. Packed bed reactors containing adsorbed and cross-linked peroxidases were run over a period of 4 weeks; adsorbed peroxidases retained 52.86% activity whereas cross-linked peroxidases maintained over 77% dye decolorization ability at the end of the fourth week of its continuous operation. Gas chromatography coupled with mass spectrometry was used to analyze the degradation products; it showed the presence of four major metabolites. Degradation of dye starts with the 1-Hydroxybenzotriazole radical attack on the carbon atom of the phenolic ring bearing azo linkage, converting it into cation radical which underwent nucleophilic attack by a water molecule and results in cleavage of chromophore via symmetric and asymmetric cleavage pathways. Intermediates undergo spontaneous removal of nitrogen, deamination, and oxidation reactions to produce maleic acid as the final degradation product.

Graphical abstract

https://ift.tt/2E57NrQ

Institutional patient accrual volume and the treatment quality of I‑125 prostate seed implantation in a Japanese nationwide prospective cohort study

Abstract

Purpose

It is unclear whether experience at high-volume institute improves the treatment quality of prostate seed implantation. The aim of this study was to evaluate the effect of institutional experience on postimplant dosimetric parameters in a nationwide prospective cohort study.

Methods

From July 2005 to June 2007, 2354 patients were registered in the Japanese Prostate Cancer Outcome Study of Permanent I‑125 Seed Implantation (J-POPS), and 1126 patients treated with seed implantation alone were evaluated. As a surrogate for institutional experience, we classified the J‑POPS institutions as high-volume (patient accrual volume was ≥120 patients per institution) or low-volume institutions (patient accrual volume was <120 patients per institution). To compare treatment quality between institutions, we evaluated the postimplant dosimetric parameters including D90, V100/150 (prostatic dose parameters), UD5/90, U200 (urethral dose parameters), and rectum R100/150 (rectal dose parameters).

Results

In the 5 high-volume institutions (n = 601 patients), most of the patients were treated with >144 Gy of D90, whereas in the 20 low-volume institutions (n = 525) some of the patients were treated with <144 Gy. The V100 of most of the high-volume institution patients were >90%, whereas in the low-volume institutions a considerable percentage of patients showed lower V100. Although there was no correlation between D90 and rectal dose parameters, UD90 had a moderate positive correlation with D90 in both the high- and low-volume institutions. U200 varied more widely in the low-volume institutions.

Conclusions

Our findings indicate that the institutional patient accrual volume is associated with the treatment quality of I‑125 prostate seed implantation.

https://ift.tt/2PiVSZz

Part I - Emerging Imaging Technologies in Dermatology: Basic Principles

Publication date: Available online 4 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Samantha L. Schneider, Indermeet Kohli, Iltefat H. Hamzavi, M. Laurin Council, Anthony M. Rossi, David M. Ozog

Abstract

Dermatologists rely primarily on clinical examination in combination with histopathology to diagnose conditions; however, clinical examination alone may not be sufficient for accurate diagnosis and skin biopsies have associated morbidity. With continued technological advancement, there are emerging ancillary imaging technologies available to dermatologists to aid in diagnosis and management. This two-part review article will discuss these emerging technologies including: digital photographic imaging, confocal microscopy, optical coherence tomography (OCT) and high frequency ultrasound (HFUS) as well as several additional modalities in development. In this first installment, authors will describe the breadth of technologies available and the science behind them. Then, in the second article, authors will discuss the applications and limitations of these technologies and future directions.

https://ift.tt/2G3KNw7

Part II - Emerging Imaging Technologies in Dermatology: Applications and Limitations

Publication date: Available online 4 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Samantha L. Schneider, Indermeet Kohli, Iltefat H. Hamzavi, M. Laurin Council, Anthony M. Rossi, David M. Ozog

Abstract

Clinical examination is critical for the diagnosis and identification of response to treatment. It is fortunate that technologies are continuing to evolve allowing for augmentation of the classical clinical examination with non-invasive imaging modalities. This article will discuss emerging technologies with a focus on digital photographic imaging, confocal microscopy, optical coherence tomography (OCT) and high frequency ultrasound (HFUS) and several additional developing modalities. The most readily adopted technologies to date include total body digital photography and dermoscopy with some practitioners beginning to use confocal microscopy. In this article, applications and limitations are addressed. For a detailed discussion of the principals involved in these technologies, please refer to the first part of this review article.

https://ift.tt/2rnDS70

Clinical features of Helicobacter pylori antibody‐positive junior high school students in Nagano Prefecture, Japan

Abstract

Background

Previously, we conducted an epidemiological study screening for Helicobacter pylori antibody positivity among Japanese junior high school students. In this study, we updated the epidemiological data and assessed the clinical features of H pylori antibody‐positive junior high school students.

Materials and methods

We assessed H pylori antibody‐positive subjects who were identified between 2012 and 2015 at four junior high schools in Nagano Prefecture, Japan. H pylori infection was confirmed by urea breath test (UBT) or endoscopic examination. Endoscopy was performed after obtaining consent from the subject and their guardians. Eradication therapy consisted of triple therapy with proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) or metronidazole (MNZ) for seven days. Eradication of H pylori was confirmed by UBT. We reviewed subjects' characteristics, endoscopic findings, histological findings, eradication regimes, outcomes, and adverse effects.

Results

The overall prevalence of H pylori antibody positivity was 3.2% (42/1298). We assessed thirteen H pylori antibody‐positive subjects. Eight subjects had a family history of H pylori infection. Six subjects had abdominal pain, and two subjects had iron deficiency anemia (IDA). Twelve subjects underwent endoscopy; one subject had duodenal ulcer, eleven subjects had antral nodular gastritis, and six subjects showed grade 2 closed type atrophic border according to the Kimura‐Takemoto classification. All subjects received eradication therapy; CAM was used in five subjects with CAM susceptibility as well as in three subjects with unknown information on CAM susceptibility, and MNZ was used in five subjects with CAM resistance. Eradication was successful in twelve subjects (one unconfirmed). There were three mild adverse effects (abdominal pain or diarrhea).

Conclusions

Helicobacter pylori test for junior high school students represents an opportunity to diagnose the peptic ulcer, iron deficiency anemia, and gastric atrophy.

https://ift.tt/2StA5k4