Effect of cosmetic chemical preservatives on resident flora isolated from healthy facial skin

Abstract

Background/Aims

Healthy skin harbors numerous microbes known to maintain its health and prevent attacks from external pathogens. The influence of chemical preservatives commonly used in cosmetic products on facial resident flora remains poorly characterized. In this study, we aimed to investigate the antibacterial activity of five such preservatives on in vitro cultivated skin‐resident bacteria.

Methods

Both Gram‐positive and Gram‐negative bacteria were isolated on blood agar, tryptic soy agar, and nutrient agar; Gram‐negative bacteria were then selected on Hank's balanced salt solution containing antibiotics and Reasoner's 2A. The minimum inhibitory concentrations (MICs) of methylisothiazolinone (MTI), iodopropynyl butylcarbamate (IPBC), ethylhexylglycerin (EHG), methylparaben (MP), and phenoxyethanol (PE) were estimated for nine facial resident bacteria, Escherichia coli, and Staphylococcus aureus using serial broth dilution in vitro.

Results

The maximum test concentrations coincided with the upper limits set by the "Cosmetic Safety and Technical Specification" (2015 edition, China). Nine facial resident bacteria were isolated from 14 healthy adults: Staphylococcus epidermidis, Staphylococcus capitis, Kocuria, Micrococcus luteus, Bacillus, Acinetobacter, Pseudomonas parafulva, Pseudomonas oleovorans, and Roseomonas cervicalis. MTI and IPBC displayed the strongest effect on all tested strains (MICs ≤0.01%), followed by EHG and MP (MICs ≤0.3%), and finally PE with the weakest effect (MIC ≤1%).

Conclusion

The five chemical preservatives assayed inhibited survival of the nine facial resident bacteria isolates, when tested at the maximum allowed limit. The corresponding MICs will provide a reference for the effective utilization of these compounds in product formulations.

https://ift.tt/2GeoCUf

Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review

Abstract

Botulinum Toxin Type A is a potent neurotoxin that is produced by a gram‐positive bacteria clostridium botulinum. Its utilization in the treatment of various medical condition has expanded over the years in both medical and esthetic uses. It is being preferred by most physicians due to its efficacy and lack of side effects. It can be used as monotherapy or combined therapy. The aim of this review study was to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids. The clear mechanisms underlying hypertrophic scars and keloids are still not clearly understood; however, the mechanism of action of Botulinum toxin type A has been shown to include action on wound tension, action on collagen, and action on fibroblasts. Different randomized controlled trials, double‐blind, and placebo‐controlled studies have been conducted to investigate its use in treatment and prevention of hypertrophic scars and keloids, and it still is one of the active areas of research in Dermatology and related fields. Method: In March 2018, we performed a literature search in PubMed for clinical studies, clinical trials, case reports, controlled trials, randomized controlled trials, and systemic reviews. The search terms we used were "BOTULINUM TOXIN" AND "HYPERTROPHIC SCARS" OR "KELOIDS" (from 1980). The search resulted in 1000 articles, out of these 35 articles met our inclusion exclusion criteria. Our inclusion criteria included relevant original articles relevant, critical systemic reviews, and crucial referenced articles, exclusion criteria included duplicates and articles not published in English language. We have reviewed these papers to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids.

https://ift.tt/2ryipbh

Molecular diagnosis of Helicobacter pylori infection in gastric biopsies: Evaluation of the Amplidiag® H. pylori + ClariR assay

Abstract

Background

Adapted treatments for Helicobacter pylori infection, guided by determining antimicrobial resistance, are associated with high eradication rates. We evaluated the performance of the Amplidiag^®H. pylori + ClariR PCR assay (Amplidiag^®) for detecting H. pylori and its clarithromycin resistance from gastric biopsies taken during endoscopy in comparison to culture and our "in‐house" PCR.

Materials and Methods

A total of 127 gastric biopsies were analyzed (98 adults; 29 children). Culture, PCR Amplidiag^®, and in‐house PCR were performed in parallel. The in‐house PCR combined amplification and sequencing of a 267‐bp fragment of the H. pylori 23S rRNA gene. Discrepancies were controlled by amplification of glmM gene.

Results

For detection of H. pylori, Amplidiag^® and the in‐house PCR were concordant in 118 of 127 of cases: 66 negative and 52 positive. Discrepancies were observed in nine cases, all with low bacterial load: Amplidiag^® did not detect seven biopsies positive on in‐house PCR but detected two positive biopsies that were negative on in‐house PCR. Among the 19 of 52 (36%) H. pylori cases resistant to clarithromycin, only four biopsies with mixed populations exhibited discordant results between the two PCR methods. The A2142T mutation was not detected by Amplidiag^®. With the in‐house PCR and amplified glmM gene as the reference method, the sensitivity and specificity of Amplidiag^® was 88.5% (95% confidence interval 83‐94.1) and 100%.

Conclusion

This study demonstrated the high sensitivity of the PCR‐based Amplidiag^®H. pylori test, especially with low H. pylori load, and the probability of its clarithromycin resistance analysis. For clinical use, a well‐designed trial with a large scale of samples may still be needed.

https://ift.tt/2EutMtw

Experimental exposure to gasohol impairs sperm quality with recognition of the classification pattern of exposure groups by machine learning algorithms

Abstract

Contamination caused by leakage at gas stations leads to possible exposure of the general population when in contact with contaminated water and soil. The present study aimed to evaluate the reproductive effects of exposure of adult male rats to gasohol and evaluate the performance of machine learning (ML) algorithms for pattern recognition and classification of the exposure groups. Rats were orally exposed to 0 (control), 16 (EA), 160 (EB), or 800 mg kg⁻¹ bw day⁻¹ of gasohol (EC), for 30 consecutive days. Sperm quality of the groups exposed to two higher doses was reduced in comparison to the control group. The sperm parameters decreased were: daily sperm production, sperm number in the caput/corpus epididymis, progressive motility, mitochondrial activity, and acrosomal membrane integrity. Sperm transit time in the epididymis cauda and sperm isolated head were increased in EB and EC. Sertoli cells number was decreased in these groups, but their support capacity was maintained. ML methods were used to identify patterns between samples of control and exposure groups. The results obtained by ML methods were very promising, obtaining about 90% of accuracy. It was concluded that the exposure of rats to different doses of gasohol impair spermatogenesis and sperm quality, with a recognizable classification pattern of exposure groups at ML.

https://ift.tt/2Pxge1q

Asymmetric lacrimal gland enlargement: an indicator for detection of pathological entities other than thyroid eye disease.

Related Articles

Asymmetric lacrimal gland enlargement: an indicator for detection of pathological entities other than thyroid eye disease.

Graefes Arch Clin Exp Ophthalmol. 2018 Nov 28;:

Authors: Ishikawa E, Takahashi Y, Valencia MRP, Ana-Magadia MG, Kakizaki H

Abstract
PURPOSE: To examine the clinicopathological characteristics of patients with thyroid eye disease (TED) who showed asymmetric lacrimal gland enlargement.
METHODS: Sixteen patients were included in this retrospective, observational case series. The following data were collected: sex, age, laterality, past medical history, laboratory results for thyroid function and other autoimmune disorders, pathological results, other systemic lesions related to lacrimal gland pathology, and the clinical course after treatment.
RESULTS: The results of pathological examinations were consistent with non-specific dacryoadenitis in seven patients, immunoglobulin G4-related dacryoadenitis in four patients, sarcoidosis in two patients, and xanthogranuloma in one patient, respectively. The remaining two patients were proven to be extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). One patient with sarcoidosis was noted to have another related systemic lesion. After treatment or observation, the lesions were either improved or stable in almost all patients, except for the two patients with MALT lymphoma.
CONCLUSIONS: Patients with TED who present with asymmetric lacrimal gland enlargement need to be further evaluated. Biopsy of the lacrimal gland and full systemic work-up should be considered as these may lead to detection of other pathological entities, especially malignancies, which could help in saving patients' lives.

PMID: 30488266 [PubMed - as supplied by publisher]

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The time point of completion thyroidectomy has no prognostic impact in patients with differentiated thyroid cancer

Summary

Background

After partial resection of the thyroid gland a second operation referred to as "completion thyroidectomy" may be required if histopathological analysis indicates the presence of differentiated thyroid cancer (DTC). Although there is little evidence it is assumed that the time point of completion thyroidectomy is not critical for oncological prognosis of patients with DTC. We assessed whether patients with total thyroidectomy (TTx) in a two‐step procedure have an equal long‐term prognosis with regard to disease‐specific survival compared to patients immediately undergoing total thyroidectomy in a one‐step procedure.

Methods

A database study using the Würzburg thyroid cancer database with 2258 patients with pT1a‐pT4b tumours DTC who were operated between 1980 and 2016 was carried out.

Results

277 patients with papillary microcarcinoma pT1aN0M0 were treated by hemithyroidectomy. TTx as one‐step procedure was performed in 1114 patients compared to 867 with TTx as a two‐step procedure. Patients with papillary thyroid cancer more frequently had a TTx as one step procedure than follicular thyroid cancer patients (59.4% vs. 47%; p<0.001). Compared to a one‐step thyroidectomy, overall complication rate was not different compared to patients undergoing a single operation. Multivariate analysis showed that the presence of distant metastases, T‐stage and age at diagnosis were the only independent determinants for DTC‐specific survival, regardless of a one‐ or two‐time thyroidectomy.

Conclusion

The present study on the largest of such patient collectives provides evidence that a delayed completion operation does not affect disease‐specific survival in DTC, nor does it lead to a significant increase in complication rates.

This article is protected by copyright. All rights reserved.

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Neurofibromatosis Type 1 Vasculopathy Presenting as Impending Central Retinal Artery Occlusion

No abstract available

https://ift.tt/2Bcc5uA

Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function Response

No abstract available

https://ift.tt/2UCOfRH

Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function Comment

No abstract available

https://ift.tt/2B9Mnqs

Optimizing the removal of nitrate from aqueous solutions via reduced graphite oxide – supported nZVI: synthesis, characterization, kinetics, and reduction mechanism

Abstract

Graphene has been considered an ideal absorbent and excellent carrier for nanoparticles. Reduced graphite oxide (rGO)–supported nanoscale zero-valent iron (nZVI@rGO) is an effective material for removing nitrate from water. nZVI@rGO nanocomposites were prepared by a liquid-phase reduction method and then applied for nitrate-nitrogen (NO₃⁻-N) removal in aqueous solution under anaerobic conditions. The experimental results showed that the stability and activity of the nZVI@rGO nanocomposites were enhanced compared with those of nZVI. The influence of the reaction conditions, including the initial concentration of NO₃⁻-N, coexisting anions, initial pH of the solution, and water temperature, on NO₃⁻-N removal was also investigated by batch experiments. In a neutral or slightly alkaline environment, 90% of NO₃⁻-N at a concentration less than 50 mg/L could be removed within 1 h, and nitrogen production was approximately 15%. The process of NO₃⁻-N removal by nZVI@rGO fits well with different reaction kinetics. In addition, magnetite was the main oxidation product. RGO-supported nZVI might become a promising filler in the permeable reactive barrier process for groundwater remediation.

https://ift.tt/2Ca8YVK

BRCA1/2 Functional Loss Defines a Targetable Subset in Leiomyosarcoma

AbstractBackground.Soft‐tissue sarcomas (STS) describe a heterogeneous group of mesenchymal tumors with limited treatment options. Targeted therapies exist for BRCA1/2 gene alterations, but their prevalence and role have not been fully described in STS. Here, we present the largest effort to characterize the frequency of homologous recombination (HR) DNA repair pathway alterations in STS subtypes and highlight the unique nature of leiomyosarcoma (LMS).Materials and Methods.DNA sequencing data were analyzed for HR pathway alterations for 1,236 patients with STS. DNA sequencing data from an additional 1,312 patients were used to confirm the prevalence of HR pathway alterations in LMS. Four uterine LMS (uLMS) patients with functional BRCA2 loss were evaluated for response to poly (ADP‐ribose) polymerase (PARP) inhibition.Results.In an unselected STS study population, BRCA2 alterations were identified in 15 (1%) patients, and homozygous BRCA2 loss was detected in 9 (<1%). However, subset analysis revealed that these BRCA2 alterations were concentrated in uLMS as compared with any other STS subtype. Notably, 10% of uLMS tumors had a BRCA2 alteration. We further report that PARP inhibitors had demonstrated durable clinical benefit in four uLMS patients with BRCA2 loss.Conclusion.HR pathway alterations are rare in most STS. However, we identify uLMS to be enriched for BRCA2 loss and report the positive outcomes of a series of patients treated with PARP inhibitors. Our data suggest that patients with uLMS should be considered for somatic BRCA2 profiling. Prospective trials are necessary to confirm the efficacy of PARP inhibition in uLMS.Implications for Practice.Soft‐tissue sarcomas are a highly morbid, diverse set of tumors with limited treatment options. This study identifies an increased prevalence of functional BRCA1/2 loss in patients with uterine leiomyosarcoma (uLMS). It also presents four patients with uLMS and BRCA2 loss who achieved durable clinical benefit from poly (ADP‐ribose) polymerase inhibition. These data suggest that patients with uLMS in particular should be screened for BRCA1/2 alterations and may benefit from treatment targeted to these alterations.

https://ift.tt/2SHCyYb

Biomarkers for Programmed Death‐1 Inhibition in Prostate Cancer

AbstractProstate cancer is the second leading cause of cancer death in American men. Despite the common nature of this disease, there is a poor understanding of biomarkers that predict responsiveness to immunotherapeutic agents such as the programmed death‐1 (PD‐1) and programmed death‐ligand 1 (PD‐L1) inhibitors. Herein we describe a case of complete remission with pembrolizumab therapy in a metastatic castrate‐resistant prostate cancer patient with a complex germline MSH2 alteration (Boland inversion) in association with a tumor demonstrating high microsatellite instability. Potential utility of high mutational burden assessed by an experimental circulating tumor DNA assay is also shown. The literature concerning biomarkers for PD‐1 inhibition is reviewed, including data for various mismatch repair gene deficiencies, microsatellite instability, tumor mutational burden, PD‐L1 3' untranslated region mutations, selected POLE mutations, and biallelic CDK12 mutations. Taken together, although prostate cancer is generally believed to be a tumor unresponsive to PD‐1 inhibition, careful dissection of tumor biology is able to provide an approach toward predictive biomarkers that has the potential for expanded clinical utility.Key Points. Biomarkers for anti‐PD1 and anti‐PDL1 therapy are poorly defined in prostate cancer.Recent advances are defining new important classes of responsive patients.

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FDA Approval Summary: Atezolizumab or Pembrolizumab for the Treatment of Patients with Advanced Urothelial Carcinoma Ineligible for Cisplatin‐Containing Chemotherapy

AbstractThe U.S. Food and Drug Administration (FDA) granted accelerated approval to atezolizumab and pembrolizumab in April and May 2017, respectively, for the treatment of patients with locally advanced or metastatic urothelial carcinoma who are not eligible for cisplatin‐containing chemotherapy. These approvals were based on efficacy and safety data demonstrated in the two single‐arm trials, IMvigor210 (atezolizumab) and KEYNOTE‐052 (pembrolizumab). The primary endpoint, confirmed objective response rate, was 23.5% (95% confidence interval [CI]: 16.2%–32.2%) in patients receiving atezolizumab and 28.6% (95% CI: 24.1%–33.5%) in patients receiving pembrolizumab. The median duration of response was not reached in either study and responses were seen regardless of PD‐L1 status. The safety profiles of both drugs were generally consistent with approved agents targeting PD‐1/PD‐L1. Two ongoing trials (IMvigor130 and KEYNOTE‐361) are verifying benefit of these drugs. Based on concerning preliminary reports from these trials, FDA revised the indications for both agents in cisplatin‐ineligible patients. Both drugs are now indicated for patients not eligible for any platinum‐containing chemotherapy or not eligible for cisplatin‐containing chemotherapy and whose tumors/infiltrating immune cells express a high level of PD‐L1. The indications for atezolizumab and pembrolizumab in patients who have received prior platinum‐based therapy have not been changed. This article summarizes the FDA thought process and data supporting the accelerated approval of both agents and the subsequent revision of the indications.Implications for Practice.The accelerated approvals of atezolizumab and pembrolizumab for cisplatin‐ineligible patients with advanced urothelial carcinoma represent the first approved therapies for this patient population. These approvals were based on single‐arm trials demonstrating reasonable objective response rates and favorable durations of response with an acceptable toxicity profile compared with available non‐cisplatin‐containing chemotherapy regimens. However, based on concerning preliminary reports from two ongoing phase III trials, the FDA revised the indication for both agents in cisplatin‐ineligible patients. Both are now indicated either for patients not eligible for any platinum‐containing chemotherapy or not eligible for cisplatin‐containing chemotherapy and whose tumors have high expression of PD‐L1.

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Low Prevalence of the Four Common Colombian Founder Mutations in BRCA1 and BRCA2 in Early‐Onset and Familial Afro‐Colombian Patients with Breast Cancer

AbstractBackground.Inherited mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (BRCA1/2) confer high risks of breast and ovarian cancer. In Colombian Hispanic families, four common BRCA1/2 founder mutations have previously been identified. Because nothing is known about the contribution of BRCA1/2 germline mutations to early‐onset and hereditary breast and/or ovarian cancer in Afro‐Colombians, we conducted the first study on 60 patients with early‐onset and familial breast cancer in this population.Materials and Methods.Screening for the four Colombian founder mutations BRCA1/c.3331_3334delCAAG, BRCA1/c.5123C > A, BRCA2/c.2806_2809delAAAC, and BRCA2/c.1763_1766delATAA was performed using mismatch polymerase chain reaction (PCR) analysis, PCR‐based restriction fragment length polymorphism analysis, and qualitative real‐time PCR. Mutations were confirmed by direct DNA sequencing.Results.The BRCA1 founder mutation c.5123C > A was identified in one family with breast and ovarian cancer (1/60, 1.7%). Three women were diagnosed with breast cancer, including one with bilateral disease at the ages of 30, 30/33, and 52 years and one woman with ovarian cancer at the age of 60 years.Conclusion.Our data showed a low prevalence of the BRCA1/2 founder mutations in Colombians of African descent, implying that these mutations should not be recommended for genetic screening programs in the Afro‐Colombian population.Implications for Practice.(a) Risk reduction intervention programs for women who are found to carry a BRCA1/2 mutation. (b) Implementation of prevention programs in inherited breast cancer. (c) Treatment addressing in patients with BRCA1/2 mutations.

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Higher Serum Uric Acid is a Risk Factor of Reduced Muscle Mass in Men with Type 2 Diabetes Mellitus

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0805-2197

Objective Sarcopenia has been recognized as a diabetic complication, and hyperuricemia is often accompanied by type 2 diabetes mellitus (T2DM). However, it is unknown whether serum uric acid (UA) levels are associated with reduced muscle mass in T2DM. Methods We conducted a cross-sectional study to investigate the association of serum UA with muscle mass in 401 subjects with T2DM (209 men and 192 postmenopausal women). The relative skeletal muscle mass index (RSMI) was evaluated using whole-body dual-energy x-ray absorptiometry. Results Multiple regression analyses adjusted for body weight, age, serum creatinine, hemoglobin A1c (HbA1c), and duration of T2DM showed that serum UA was negatively associated with RSMI in all subjects and men with T2DM (β=−0.13, p=0.001 and β=−0.17, p=0.003, respectively). Moreover, logistic regression analyses adjusted for these confounding factors showed that a higher serum UA level was significantly associated with low RSMI in men with T2DM [odds ratio (OR)=1.94, 95% confidence interval (CI)=1.10–3.45 per SD increase, p=0.023]. In addition, higher serum UA levels were significantly associated with low RSMI after additional adjustment for age, duration of T2DM, HbA1c level, serum creatinine level, and sex in all subjects with T2DM [OR=1.80, 95% CI=1.20–2.72 per SD increase, p=0.005]. Conclusions The present study showed for the first time that higher serum UA is an independent risk factor of reduced muscle mass in men with T2DM.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2RUry9S

Alternate anti‐leprosy therapy for “Refractory Leprosy”!

https://ift.tt/2GePp2J

Vulval Crohn disease: A case series of 26 patients

Abstract

Vulval Crohn disease is rare and likely under‐reported, leading to difficulty in diagnosis and delay in treatment. In this case series, we report the clinical features and discuss therapy in 26 consecutive patients with vulval Crohn disease, with or without documented gastrointestinal disease, presenting between January 2016 and July 2018. We highlight the need for treatment that is in some cases more aggressive than the requirement to manage the patient's gastrointestinal involvement.

https://ift.tt/2QMapC2

Charcoal pocket hand warmers – a rare cause of BCC carcinogenesis?

https://ift.tt/2SJP7lA

Collision tumour of extramammary Paget disease and melanoma

https://ift.tt/2Li9qUY

Keystone flap used on the legs: case series

https://ift.tt/2C6JvfK

Recurrence of periocular basal and squamous cell carcinoma after Mohs Micrographic Surgery: a retrospective cohort study

Abstract

Background

Despite the widespread use of Mohs Micrographic Surgery (MMS) for periocular basal and squamous cell carcinoma (together called keratinocyte carcinoma (KC)), follow‐up data regarding recurrences are limited.

Objectives

To investigate the recurrence rate for periocular KCs after MMS and describe experience with interdisciplinary collaborations.

Methods

Patients with periocular KCs treated with MMS between 2006 and 2016 in a tertiary MMS referral hospital were included in this retrospective cohort study. Descriptive statistics were used to describe the MMS procedure related characteristics. By follow‐up data from the electronic patient records and linkage with the Dutch nationwide network and registry of histopathology and cytopathology (PALGA) June 30^th 2017, the recurrence rate was evaluated and calculated by using a cumulative incidence curve.

Results

In total, 683 (93·7%) periocular basal cell carcinomas (BCCs) and 46 (6·3%) squamous cell carcinomas (SCCs) were treated with MMS. Three‐quarters (n=549) were primary tumours and the majority was located at the medial canthus or lower eyelid (n=649, 89·0%). In 505 MMS procedures (69%) an oculoplastic surgeon participated and in 63 patients (8·6%) a plastic surgeon performed the reconstruction. After a median follow‐up of 46 months the recurrence rate is 3·0%, based on 22 recurrences (20 BCCs and 2 SCCs).

Conclusions

MMS is an excellent treatment option for periocular KCs with a low recurrence rate. Due to its specific location an interdisciplinary approach should pre‐eminently be considered.

This article is protected by copyright. All rights reserved.

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Variability in the Diagnosis of Surgical Site Infections After Full‐Thickness Skin Grafting: An International Survey

Abstract

Background

Diagnosis of a surgical site infection (SSI) in dermatologic surgery can be entirely based on a subjective assessment according to the 4^th criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control (CDC).

Objectives

To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.

Methods

An international electronic photographic survey with eight photographs of wounds 1 week after full‐thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds.

Results

A total of 393 dermatologists from 27 countries enrolled. Most respondents were from the United States (25%), followed by Sweden (24%) and the United Kingdom (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board‐certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03), and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than US physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.

Conclusion

This study reveals a broad inter‐rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PwGWHu

How often are bath emollients prescribed to children with atopic eczema in primary care in England? A cross‐sectional study

Abstract

Atopic eczema is one of the most burdensome skin diseases across the globe and affects up to 20% of children in the UK. The mainstay of treatment is regular use of emollients including leave‐on emollients, soap substitutes and emollient bath additives. However, the lack of evidence to support the use of bath additives has led some to question their role in atopic eczema management. A recently published, independent, randomised controlled trial has provided robust evidence that bath emollients provide no meaningful benefit in addition to standard care (regular use of leave‐on emollients and avoidance of soap.

This article is protected by copyright. All rights reserved.

https://ift.tt/2zW4LTX

Efficacy of topical dithranol (Dithrocream®) in the treatment of alopecia areata: a retrospective case series

Abstract

Topical dithranol is an alternative therapy to topical diphencyprone for extensive AA, with the advantage that it can be applied at home. It is also safe in children and has low risk for use during pregnancy. Its precise mechanism of action is unknown, but it is plausible that the local cytokine profile induced by its irritant effect "compete" with the inflammatory milieu incited during the inflammatory cell attack on hair follicles.

This article is protected by copyright. All rights reserved.

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Significant therapeutic response to cysteamine cream in a melasma patient resistant to Kligman's formula

Summary

L‐Cysteamine is a biological antioxidant produced during the coenzyme A metabolism cycle and is naturally present in all mammalian cells. The efficacy of topical cysteamine for the treatment of melasma has been recently shown in two double‐blind, randomized, and placebo‐controlled clinical trials. Herein, we report a 44‐year‐old patient with melasma resistant to Kligman's formula (Pigmanorm cream), who was successfully treated with topical cysteamine as a new depigmenting agent. Skin colorimetric measurements, MASI score determination, and standard photographies after 2 and 4 months of once daily application of cysteamine cream showed a marked improvement of the hyperpigmented lesions. Telangiectasia and perilesional hypopigmentation improved rapidly after the discontinuation of Kligman's formula and starting the treatment with topical cysteamine. After 4 months, the therapeutic results were maintained through a biweekly application regimen of cysteamine cream. The use of cysteamine cream was well tolerated and did not induce any side effects during the 3‐year follow‐up of the patient. Cysteamine is a natural molecule with an excellent safety profile and known antimutagenic, antimelanoma, and anticarcinogenic effects. Considering the high efficacy of cysteamine cream, it is possible that it could replace mutagenic and carcinogenic depigmenting agents such as hydroquinone in near future.

https://ift.tt/2zXk0wd

Brown adipose tissue thermogenesis in polycystic ovary syndrome

Summary

Objective

Polycystic ovary syndrome (PCOS) is associated with increased obesity with a greater propensity to weight gain and a lack of sustainable lifestyle interventions. Altered brown adipose tissue (BAT) thermogenesis is a potential contributor to obesity in PCOS. BAT activity and modulation has not been studied in PCOS. This observational study explored BAT thermogenesis and its associations in women with and without PCOS.

Participants and methods

Cutaneous temperature was recorded from supraclavicular (indicator of BAT activity) and upper arm regions using Dataloggers (SubCue, Calgary, Canada) in a cross sectional sub‐study, nested within a randomized control trial, of community recruited pre‐menopausal women with (n=47, Rotterdam diagnostic criteria) and without (n=11) PCOS.

Results

Complete temperature data were available in 44 PCOS (mean age: 30.0±6.2, mean BMI: 29.3±5.5) and 11 non‐PCOS (mean age: 33.0±7.0, mean BMI: 25±3) women. Women with PCOS had lower supraclavicular skin temperature compared to controls overall (33.9±0.7 vs 34.5±1, p < 0.05) and during sleep (34.5±0.6 vs 35.2±0.9, p < 0.001). In the PCOS group, supraclavicular skin temperature overall and over sleep and waking hours correlated inversely with testosterone (r= ‐ 0.41 p <0.05, r= ‐0.485 p <0.01 and r= ‐0.450 p <0.01 respectively). Testosterone levels explained approximately 15%, 30% and 20% of the variability in supraclavicular skin temperature overall and over sleep and waking hours in women with PCOS, respectively.

Conclusion

Women with PCOS have lower BAT activity compared to controls. BAT thermogenesis is negatively associated with androgen levels in PCOS.

This article is protected by copyright. All rights reserved.

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Nephrectomy for Metastatic Kidney Tumor in Patients with Differentiated Thyroid Cancer: A Report of Two Cases.

Related Articles

Nephrectomy for Metastatic Kidney Tumor in Patients with Differentiated Thyroid Cancer: A Report of Two Cases.

Case Rep Endocrinol. 2018;2018:7842792

Authors: Yamazaki H, Kishida T, Noguchi G, Iwasaki H, Suganuma N, Masudo K, Nakayama H, Yamashita T, Yamanaka T, Sugawara Y, Matsubara Y, Kohagura K, Rino Y, Masuda M

Abstract
The occurrence of renal tumors originating from thyroid cancer is extremely rare with a few effective treatments for renal metastases. Here, we report the cases of two patients with differentiated thyroid cancer who underwent nephrectomy for a metastatic kidney tumor. Case 1 was a 74-year-old man who was diagnosed with right kidney tumor 10 years after initial surgery for papillary thyroid cancer (PTC). Right nephrectomy was performed, and the pathology was metastatic PTC. Case 2 was a 68-year-old woman who was diagnosed with left kidney tumor 24 years after surgery for follicular thyroid carcinoma (FTC). Left nephrectomy was performed, and the pathology was metastatic FTC. Nephrectomy for single renal metastasis could be considered a treatment option if the patients' general condition is positive.

PMID: 30534449 [PubMed]

https://ift.tt/2UBeZC6

Equilibrium radionuclide ventriculography: still a clinically useful method for the assessment of cardiac function?

Related Articles

Equilibrium radionuclide ventriculography: still a clinically useful method for the assessment of cardiac function?

Hell J Nucl Med. 2018 Sep-Dec;21(3):213-220

Authors: Sachpekidis C, Sachpekidis V, Moralidis E, Arsos G

Abstract
18 The non-invasive assessment of left ventricular function with simple indices, such as left ventricular volumes and ejection fraction (LVEF), offers significant diagnostic and prognostic implications in the entire spectrum of cardiac diseases. Equilibrium radionuclide ventriculography (RNV) is a well validated technique for this purpose. Based on the principle that the amount of radioactivity emitted by technetium-99m (99mTc)-pertechnate labeled erythrocytes in the cardiac chambers is proportional to the amount of bloodcontained, reproducible and accurate LVEF measurements can be obtained, with practically no geometric assumptions regarding heart shape. However, the development of other imaging techniques, mostly echocardiography and secondarily cardiac magnetic resonance has led to a decline in the use of RNV. This is due to easiness, cost and availability issues and also because competitive modalities can offer reliable anatomic and functional information and hence they can address a variety of clinical scenarios in one session. Nevertheless, RNV still remains a reliable method in clinical conditions, in which the detection of small changes in LVEF may be important in clinical decision-making, such as in patients undergoing cardiotoxic chemotherapy, when the images of different methods are of suboptimal quality or unobtainable, or there is discordance between clinical judgment and imaging results. In this respect the more recently introduced gated single photon emission tomography (SPET) myocardial perfusion imaging has not demonstrated equivalent reliability, in terms of independence from a variety of factors and accuracy of measurements on a per-patient basis. The purpose of this review is to present the features of RNV, and to define its role in the evaluation of cardiac function in the current era of medical imaging.

PMID: 30534636 [PubMed - in process]

https://ift.tt/2rAviBC

Unsuspected reduced radiochemical purity of the 18F-FDG may decrease image resolution, SUV reliability and diagnostic accuracy.

Related Articles

Unsuspected reduced radiochemical purity of the 18F-FDG may decrease image resolution, SUV reliability and diagnostic accuracy.

Hell J Nucl Med. 2018 Sep-Dec;21(3):186-190

Authors: Kim ST, Yong CS, Han EO

Abstract
OBJECTIVE: Our aim was to identify the conditions required to stably maintain the radiochemical purity of fluorine-18-fluorodeoxyglucose (18F-FDG) above the Korean Pharmacology (KP) and United States Pharmacology (USP) standards for expiration time (time from the end of synthesis (EOS), 8h even at a high radioactive concentration exceeding 7.4GBq/mL.
SUBJECTS AND METHODS: The changes in the radiochemical purity of 18F-FDG were assessed according to the changes in radioactive concentration, ethanol (EtOH) concentration, amount of water for dilution storage temperature, and storage volume.
RESULTS: Controlling the radioactive concentration as much as possible during the production of 18F-FDG is necessary to improve the radiochemical purity of 18F-FDG. In the production of 18F-FDG, a radioactive concentration <7.4GBq/mL was sufficient to maintain the radiochemical purity above the KP and USP standards for 10h after the EOS. If the radioactive concentration exceeded 7.4GBq/mL during synthesis, the addition of EtOH to 18F-FDG is essential to maintain the radiochemical purity above the KP and USP standards. To minimize residual solvent EtOH production, the addition of 0.1% EtOH to the 18F-FDG is the ideal combination.
CONCLUSION: Increasing the radiochemical purity of the 18F-FDG increases the quality of images, the reliabity of the SUV during PET scanning and consequently increases the accuracy of diagnosis. Furthermore, 18F-FDG can be synthesized at a high radioactive concentration in large volume, and its effective date could also be prolonged.

PMID: 30534635 [PubMed - in process]

https://ift.tt/2GdD6U6

New Insights into Human Nostril Microbiome from the Expanded Human Oral Microbiome Database (eHOMD): a Resource for the Microbiome of the Human Aerodigestive Tract.

Related Articles

New Insights into Human Nostril Microbiome from the Expanded Human Oral Microbiome Database (eHOMD): a Resource for the Microbiome of the Human Aerodigestive Tract.

mSystems. 2018 Nov-Dec;3(6):

Authors: Escapa IF, Chen T, Huang Y, Gajare P, Dewhirst FE, Lemon KP

Abstract
The expanded Human Oral Microbiome Database (eHOMD) is a comprehensive microbiome database for sites along the human aerodigestive tract that revealed new insights into the nostril microbiome. The eHOMD provides well-curated 16S rRNA gene reference sequences linked to available genomes and enables assignment of species-level taxonomy to most next-generation sequences derived from diverse aerodigestive tract sites, including the nasal passages, sinuses, throat, esophagus, and mouth. Using minimum entropy decomposition coupled with the RDP Classifier and our eHOMD V1-V3 training set, we reanalyzed 16S rRNA V1-V3 sequences from the nostrils of 210 Human Microbiome Project participants at the species level, revealing four key insights. First, we discovered that Lawsonella clevelandensis, a recently named bacterium, and Neisseriaceae [G-1] HMT-174, a previously unrecognized bacterium, are common in adult nostrils. Second, just 19 species accounted for 90% of the total sequences from all participants. Third, 1 of these 19 species belonged to a currently uncultivated genus. Fourth, for 94% of the participants, 2 to 10 species constituted 90% of their sequences, indicating that the nostril microbiome may be represented by limited consortia. These insights highlight the strengths of the nostril microbiome as a model system for studying interspecies interactions and microbiome function. Also, in this cohort, three common nasal species (Dolosigranulum pigrum and two Corynebacterium species) showed positive differential abundance when the pathobiont Staphylococcus aureus was absent, generating hypotheses regarding colonization resistance. By facilitating species-level taxonomic assignment to microbes from the human aerodigestive tract, the eHOMD is a vital resource enhancing clinical relevance of microbiome studies. IMPORTANCE The eHOMD (http://www.ehomd.org) is a valuable resource for researchers, from basic to clinical, who study the microbiomes and the individual microbes in body sites in the human aerodigestive tract, which includes the nasal passages, sinuses, throat, esophagus, and mouth, and the lower respiratory tract, in health and disease. The eHOMD is an actively curated, web-based, open-access resource. eHOMD provides the following: (i) species-level taxonomy based on grouping 16S rRNA gene sequences at 98.5% identity, (ii) a systematic naming scheme for unnamed and/or uncultivated microbial taxa, (iii) reference genomes to facilitate metagenomic, metatranscriptomic, and proteomic studies and (iv) convenient cross-links to other databases (e.g., PubMed and Entrez). By facilitating the assignment of species names to sequences, the eHOMD is a vital resource for enhancing the clinical relevance of 16S rRNA gene-based microbiome studies, as well as metagenomic studies.

PMID: 30534599 [PubMed]

https://ift.tt/2QHCz11

Methicillin-resistant Staphylococcus aureus tracking spread among health-care workers and hospitalized patients in critical wards at a university hospital, Tehran, Iran.

Related Articles

Methicillin-resistant Staphylococcus aureus tracking spread among health-care workers and hospitalized patients in critical wards at a university hospital, Tehran, Iran.

New Microbes New Infect. 2019 Jan;27:29-35

Authors: Pourramezan N, Ohadian Moghadam S, Pourmand MR

Abstract
Health-care workers may serve as a reservoir for dissemination of methicillin-resistant Staphylococcus aureus (MRSA) to patients in hospital settings. The present study aimed to screen MRSA in nasal swabs of health-care workers and clinical specimens from patients and investigate the possible relationship between these isolates at a university hospital in Tehran, Iran. Additionally, we aimed to identify potential risk factors for MRSA colonization in health-care workers. Staphylococcus aureus strains were isolated from health-care workers and inpatients who completed a questionnaire on risk factors. Cefoxitin disc diffusion test was also used for detection of MRSA. Moreover, all of the MRSA isolates were subjected to pulsed-field gel electrophoresis (PFGE). Colonization rate of MRSA among health-care workers was 22.5%. Furthermore, out of 24 S. aureus isolates obtained from patients, nine (37.5%) were MRSA. Regarding risk factors, the prevalence of nasal MRSA carriage among hospital personnel who used masks was significantly lower than in those without masks (p 0.007). Using PFGE, 10 clusters and 14 singletons were identified among the MRSA isolates. In this regard, most of the MRSA isolates recovered from health-care carriers and patients in intensive care wards, especially general intensive care units, were grouped in certain clusters, indicating intra-ward transmission of the mentioned isolates in these restricted areas. We concluded that screening and decolonization of carriers, contact precautions, prudent use of antibiotics and implementation of active surveillance are recommended strategies for the prevention and control of MRSA transmission in hospital settings.

PMID: 30534385 [PubMed]

https://ift.tt/2SKBinc

Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series.

Related Articles

Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series.

J Bone Jt Infect. 2018;3(5):241-244

Authors: Medina F, Meyssonnier V, Zeller V, Heym B, Ziza JM, Marmor S

Abstract
Introduction: Prosthetic joint infections (PJIs) can be acquired hematogenously from a distant site or device. Notably, 30%-40% of patients with PJIs have Staphylococcus aureus bacteremia. No case reports or series of PJIs acquired from totally implantable venous-access device (TIVAD) infection or colonization have been published. This study was undertaken to describe epidemiological, clinical, microbiological and radiological characteristics of such PJIs, their treatments and outcomes. Methods: This retrospective study included all patients, identified in a prospective French Bone-and-Joint Infections Referral Center cohort treated between 2004 and 2017, with PJI secondary to TIVAD infection, with the same microbiologically documented microorganism isolated from both. Results: We describe six consecutive hematogenous PJIs (4 women, 2 men; median age: 66.5 years) acquired from TIVAD primary infections. The main infection risk factors were malignancy (n=5) and prior septic arthritis (n=2). Four participants' TIVADs were implanted for chemotherapy, preceding the prosthesis for one patient. The median TIVAD-implantation-to-symptom-onset interval was 12 months. Microorganisms were Staphylococcus epidermidis (n=4), Staphylococcus capitis (n=1) and Staphylococcus aureus (n=1). All TIVADs were removed. Five participants received curative treatment, with a median of 12 weeks of antibiotics. After median follow-up of 42 months, none have relapsed. Conclusions: When PJI occurs in a patient with a TIVAD, the latter must be tested as a potential source of the prosthesis infection. Conversely, PJIs must sought in all patients with bacteremia.

PMID: 30533344 [PubMed]

https://ift.tt/2QQ8OuN

Mannitol-fermenting methicillin-resistant staphylococci (MRS) in pig abattoirs in Cameroon and South Africa: A serious food safety threat.

Related Articles

Mannitol-fermenting methicillin-resistant staphylococci (MRS) in pig abattoirs in Cameroon and South Africa: A serious food safety threat.

Int J Food Microbiol. 2018 Nov 20;285:50-60

Authors: Founou LL, Founou RC, Essack SY, Djoko CF

Abstract
Food animals can be reservoirs of methicillin-resistant staphylococci (MRS) and are involved in their zoonotic transmission through the food chain. In Africa, there is a dearth of information about the food safety issues associated with their dissemination in the farm-to-plate continuum. This study sought to determine and compare the carriage, antimicrobial resistance profiles and clonal relatedness of circulating MRS strains among pigs and exposed workers in Cameroon and South Africa. A total of 288 nasal and rectal pooled samples collected from 432 pigs as well as nasal and hand swabs from 82 humans were cultured on mannitol salt agar supplemented with 6 mg/l cefoxitin. Presumptive MRS were screened for methicillin resistance using the cefoxitin disc test and confirmed with the VITEK 2 system. Selected isolates underwent genomic fingerprinting via REP-PCR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for MRS carriage in humans from a questionnaire survey among slaughterhouse workers. Overall, 75% and 70% of nasal and rectal pooled samples were respectively positive for MRS. The MRS prevalence in all pooled pig samples from Cameroon was higher than that of South Africa. MRS prevalence of carriage (nasal and hand) was higher in Cameroonian exposed workers compared to those from South Africa, with high statistical significance. Nasal MRS colonization was highly statistically associated with hand MRS (31.58% vs 86.21%; p = 0.000; OR = 13.54; 95% CI 3.99-45.95; p = 0.015). Recent antibiotic use, previous hospitalization, occupation of relatives, years in the employment and contact with poultry were the main risk factors identified in the emergence and spread of MRS. MRS are emerging as serious foodborne pathogens and present a food safety threat. There is an urgent need to implement stringent and effective prevention and containment measures to curb antibiotic resistance in the farm-to-plate continuum in Cameroon and South Africa.

PMID: 30025249 [PubMed - indexed for MEDLINE]

https://ift.tt/2SIn2v3

Subgingival lipid A profile and endotoxin activity in periodontal health and disease

Abstract

Objectives

Regulation of lipopolysaccharide (LPS) chemical composition, particularly its lipid A domain, is an important, naturally occurring mechanism that drives bacteria-host immune system interactions into either a symbiotic or pathogenic relationship. Members of the subgingival oral microbiota can critically modulate host immuno-inflammatory responses by synthesizing different LPS isoforms. The objectives of this study were to analyze subgingival lipid A profiles and endotoxin activities in periodontal health and disease and to evaluate the use of the recombinant factor C assay as a new, lipid A-based biosensor for personalized, point-of-care periodontal therapy.

Materials and methods

Subgingival plaque samples were collected from healthy individuals and chronic periodontitis patients before and after periodontal therapy. Chemical composition of subgingival lipid A moieties was determined by ESI-Mass Spectrometry. Endotoxin activity of subgingival LPS extracts was assessed using the recombinant factor C assay, and their inflammatory potential was examined in THP-1-derived macrophages by measuring TNF-α and IL-8 production.

Results

Characteristic lipid A molecular signatures, corresponding to over-acylated, bi-phosphorylated lipid A isoforms, were observed in diseased samples. Healthy and post-treatment samples were characterized by lower m/z peaks, related to under-acylated, hypo-phosphorylated lipid A structures. Endotoxin activity levels and inflammatory potentials of subgingival LPS extracts from periodontitis patients were significantly higher compared to healthy and post-treatment samples.

Conclusions

This is the first study to consider structure-function-clinical implications of different lipid A isoforms present in the subgingival niche and sheds new light on molecular pathogenic mechanisms of subgingival biofilm communities.

Clinical relevance

Subgingival endotoxin activity (determined by lipid A chemical composition) could be a reliable, bacterially derived biomarker and a risk assessment tool for personalized periodontal care.

https://ift.tt/2PyM7q9

Anticaries activity of egg ovalbumin in an experimental caries biofilm model on enamel and dentin

Abstract

Objectives

Limited evidence suggests a putative inhibitory effect of dietary proteins on demineralization during the carious process. The aim was to explore a potential anticaries activity of the egg protein ovalbumin on a relevant in vitro approach.

Materials and methods

Biofilms of Streptococcus mutans UA159 were formed on saliva-coated enamel and dentin bovine slabs. Biofilms were challenged with 10% sucrose followed by either a 200 μg/mL solution of ovalbumin or 1:10, 1:100, and 1:1000 (v/v) serial dilutions of that ovalbumin solution, for the entire length of the experiment. Biofilms exposed to 10% sucrose followed only by 0.9% NaCl served as caries-positive control. Once completed the experimental phase, biofilms were analyzed for biomass, viable bacteria, and polysaccharide formation. Final surface hardness (SH) was obtained to calculate %SH loss (demineralization). Two independent experiments were conducted, in triplicate. Data were analyzed by ANOVA and a post hoc test at the 95% confidence level.

Results

A reduction (p < 0.05) in biomass and extracellular polysaccharide formation, but not in the number of viable cells, was observed for both dental substrates. All ovalbumin concentrations tested showed lower demineralization than the positive control (p < 0.05), in a dose-dependent manner. The highest concentration showed a reduction in the %SH loss of about 30% for both enamel and dentin.

Conclusion

Egg ovalbumin presented to sucrose-challenged biofilms of Streptococcus mutans seems to reduce cariogenicity of a biofilm-caries model.

Clinical relevance

Ovalbumin may counteract the cariogenic effect of sugars. If these findings are clinically confirmed, novel preventive approaches for caries are warranted.

https://ift.tt/2zX9W68

Characteristics of salt contents in soils under greenhouse conditions in China

Abstract

Greenhouse cultivation is expanding in China due to high production efficiency and greater economic benefits. Although the accumulation of soil salinity and nutrients has been observed in greenhouse cultivation areas, the linkage between soil salinity, soil major ions, and farm practices is not clear in China. Few studies have examined soil salinity accumulated in soil layers; thus, a broad investigation is needed in order to understand the potential causes of soil salinity in greenhouse soil. In this study, a short review was given to show the salt contents and the major ion under greenhouse conditions in China. Then, we analyzed a total of 132 soil samples from different parts of China in terms of their soil major ions and nutrient components and investigated the relevant farm practices. Based on survey data from three different types of cultivation areas (open farmland, plastic greenhouses, and multispan greenhouses), we found that cultivation in both greenhouse types resulted in a significant increase in salt content and a decrease in soil pH values, a pattern not shown in open farmland. The linkage between soil salinity and cultivation type was confirmed by soil salinity classification. The proportion of each ion in the soil salt differs significantly between the different management methods, but the variation range of the main ions ranged from − 23.3 to 225.6% for multispan greenhouses and − 22.6 to 430.5% for plastic greenhouses. In addition, the salt source in greenhouses is not unique to those methods, suggesting that different growing practices cause the differences in ion concentration. Removing greenhouse covers during the rainy season can avoid further accumulations of salt, but the subsequent rinsing of soil can lead to the deeper salt accumulations. In addition, increasing salt content may lead to decreasing pH once the natural salt balance is altered. These results show that the soil salinization produced by greenhouse cultivation cannot be ignored.

https://ift.tt/2rAnzn6

Monitoring haemodynamic response to fluid-challenge in ICU: Comparison of pressure recording analytical method and oesophageal Doppler

BACKGROUND The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts. OBJECTIVE Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM). DESIGN Prospective, observational study. SETTING Hôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017. PATIENTS Critically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure. INTERVENTION ΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line. MAIN OUTCOME MEASURE Polar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined. RESULTS Sixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8 (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03). CONCLUSION When compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias. TRIAL REGISTRATION IRB 00010254-2016-033. Correspondence to Romain Barthélémy, MD, Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital, AP-HP, 2 Rue Ambroise Paré, 75475 Paris Cedex 10, France E-mail: romain.barthelemy@aphp.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

https://ift.tt/2LdQJ4P

Comparison of rocuronium requirement in children with continuous infusion versus intermittent bolus: A randomised controlled trial

BACKGROUND Minimising rocuronium administration during paediatric surgery helps to reduce the incidence of residual muscular blockade. OBJECTIVE To determine whether intermittent bolus injection (Bolus group) or continuous infusion (group) requires the lesser amount of rocuronium. DESIGN A prospective, randomised, single-blind controlled trial. SETTING A single university hospital from March to June 2017. PATIENTS Sixty-six children undergoing general anaesthesia. INTERVENTIONS Dose of rocuronium for maintenance of muscle relaxation in either Bolus or continuous infusion group. Train-of-four (TOF) count of two was maintained during surgery. When TOF count reached three, 0.1 mg kg−1 of rocuronium was administered in Bolus group or infused at an increased rate of 0.1 mg kg−1 h−1 in continuous infusion group. MAIN OUTCOME MEASURES Primary outcome was the dose of rocuronium given (μg kg−1 min−1). The recovery time from the TOF count four to TOF 0.7 (RT0.7), and 0.9 (RT0.9) were recorded. All adverse events were recorded up to 30 min after extubation. RESULTS Mean (SD) rocuronium dose in the Bolus group was 6.1 (0.9), [95% confidence interval (95% CI) 5.7 to 6.4] μg kg−1 min−1 and 4.9 (1.0), (95% CI 4.6 to 5.3) μg kg−1 min−1 in the continuous infusion group (P = 0.001). RT0.7 was 24.0 (13.7), 95% CI 19.3 to 28.7) min in the Bolus group, and 25.7 (16.0), (95% CI 20.2 to 31.2) min in the continuous infusion group (P = 0.73). RT0.9 was 30.7 (17.1), (95% CI 24.9 to 36.5) min in the Bolus group, and 30.0 (17.6), (95% CI 24.0 to 36.0) min in the continuous infusion group (P  = 0.91). The incidence of adverse events was not significantly different between two groups. CONCLUSION In children undergoing general anaesthesia, the dose of rocuronium given by continuous administration was less than that with intermittent bolus. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03060707). Correspondence to Hee-Soo Kim, MD, PhD, Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, #101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea Tel: +82 2 2072 3659; fax: +82 2 747 5639; e-mail: dami0605@snu.ac.kr © 2018 European Society of Anaesthesiology

https://ift.tt/2C8BSFU

Orthostatic intolerance following hip arthroplasty: Incidence, risk factors and effect on length of stay a prospective cohort study

BACKGROUND Early postoperative mobilisation is important for enhanced recovery, but can be hindered by orthostatic intolerance, characterised by dizziness, nausea, vomiting, feeling of heat, blurred vision and ultimately syncope. Although the incidence of orthostatic intolerance following total hip arthroplasty has been identified, few studies have yet investigated potential risk factors for developing orthostatic intolerance after hip arthroplasty. OBJECTIVES The aim of this study was to assess the incidence of orthostatic intolerance on the first postoperative day after total hip arthroplasty, potential predisposing risk factors for developing orthostatic intolerance and its effect on length of stay. DESIGN A prospective observational study. SETTING Tertiary hospital, Auckland, New Zealand, May to September 2015. PATIENTS One hundred and seventeen consecutive patients undergoing unilateral total hip arthroplasty. Patients were excluded if they had revision surgery. MAIN OUTCOME MEASURES Incidence of orthostatic intolerance during mobilisation on the first postoperative day. Significant peri-operative risk factors for developing orthostatic intolerance were identified using logistic regression. Length of stay was compared between orthostatic intolerant and orthostatic tolerant patients using the Mann–Whitney U-test. RESULTS On the first postoperative day, 22% of patients failed mobilisation due to orthostatic intolerance. Factors independently associated with orthostatic intolerance were female sex; OR (95% CI), 3.11 (1.01 to 9.57), postoperative use of gabapentin; OR 3.55 (1.24 to 10.15) and high peak pain levels (≥5/10) during mobilisation; OR 4.05 (1.30 to 12.61). Overall, 78% of patients were correctly identified. The model was more accurate at predicting those who would not get orthostatic intolerance (89% correct), compared with those who did have orthostatic intolerance (39% correct). Length of stay was longer in patients with orthostatic intolerance (P = 0.019). CONCLUSION Orthostatic intolerance is common after total hip arthroplasty. Optimising pain control prior to mobilisation and limiting gabapentin use may modify the risk of developing postoperative orthostatic intolerance. Although personalised recovery pathways appear attractive, at present, the ability to predict at-risk individuals is still limited. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Correspondence to Dr David A. Rice, Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand E-mail: david.rice@aut.ac.nz Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

https://ift.tt/2LbkNhp

Use of tracheal ultrasound combined with clinical parameters to select left double-lumen tube size: A prospective observational study

BACKGROUND Left double-lumen tubes (LDLTs) are used in thoracic surgery to allow one-lung ventilation. Their size is usually chosen on the basis of clinical parameters (height, sex). Double-lumen endobronchial tubes are frequently undersized/oversized, risking tube displacement or tracheal trauma. A correlation between ultrasound tracheal diameter and left main bronchus dimension has been demonstrated. OBJECTIVES We hypothesised that the insertion of undersized/oversized double-lumen tubes is frequent when the size is selected using standard criteria, and that the use of ultrasound to estimate tracheal diameter may help to reduce the frequency of insertion of oversized tubes. DESIGN Two-step prospective observational study. SETTING The operating room of a French University hospital from January 2016 to February 2017. PATIENTS We enrolled 102 and 50 consecutive patients undergoing elective thoracic surgery in Steps 1 and 2 (males 63.7 and 60.0%, age 63 (13) and 63 (11) years, height 170 (13) and 169 (9) cm, respectively). INTERVENTION In Step 1, the size of the LDLT inserted was selected on the basis of clinical parameters. Ultrasound data about tracheal diameter were collected to determine cut-off points associating height and tracheal diameter. Cut-off values for ultrasound tracheal diameter were applied retrospectively to test their capability to reduce the insertion rate of oversized tube. In Step 2, the LDLT size was chosen according to the determined combined cut-off values. MAIN OUTCOME MEASURE LDLT size was considered adequate if the bronchial cuff volume required for isolation of the lung (i.e. no difference between inspiratory and expiratory lung volumes) was 0.5 to 2.5 ml of air; undersized and oversized tubes required more than 2.5 ml and less than 0.5 ml, respectively. RESULTS In Step 1, LDLT size was appropriate/undersized/oversized in 40 (39.2%)/23 (22.6%)/39 (38.6%) of patients. Cut-off values derived from ultrasound measurements would have reduced the use of oversized tubes by 20.6% (P 

https://ift.tt/2C7dynz

Impact of Nasoseptal Flap Harvest Technique on Olfaction Following Endoscopic Transsphenoidal Pituitary Surgery

Conditions:   Pituitary Tumor;   Surgery;   Olfactory Nerve Injuries
Intervention:   Procedure: Electrocautery versus scalpel
Sponsor:   St. Michael's Hospital, Toronto
Not yet recruiting

https://ift.tt/2EfV99D

Comparison of Aramchol Concentrations With Once or Twice Daily Dosing

Condition:   Healthy
Intervention:   Drug: Aramchol
Sponsors:   Galmed Pharmaceuticals Ltd;   Hammersmith Medicines Research (HMR);   Analyst Research Laboratories;   Diamond PV Services Ltd
Not yet recruiting

https://ift.tt/2EeGyeO

Irinotecan-based Triplet (FOLFOXIRI) as Perioperative Treatment in Resectable Gastric and Gastroesophageal Junction Adenocarcinoma.

Condition:   Resectable Gastric and Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Fluorouracil;   Drug: Oxaliplatin;   Drug: Irinotecan
Sponsor:   Lund University Hospital
Not yet recruiting

https://ift.tt/2EuaaFG

Anti-liver cancer effect and the mechanism of arsenic sulfide in vitro and in vivo

Abstract

Purpose

This study aimed at investigating the anti-tumor effect of arsenic sulfide (As₂S₂) against liver cancer both in vivo and in vitro and to elucidate its underlying mechanisms.

Methods

Cell viability of the human hepatocellular carcinoma cell lines SMMC-7721, BEL-7402, HepG2 were measured by CCK-8 assay. The effects of As₂S₂ on cell proliferation and apoptosis of SMMC-7721 cells were investigated using Calcein-AM and PI staining, Hoechst 33258 staining, crystal violet staining, and JC-1 staining. Cell cycle and Annexin V/PI assay were analyzed via flow cytometry. The expression of apoptosis-related proteins, phosphorylation of PI3K and AKT were detected by Western blotting. H22-bearing mice model was established to evaluate the anti-tumor effect of As₂S₂ in vivo. HE staining, PCNA was observed via immunohistochemistry, and TUNEL assay was used to assess the anti-proliferation and pro-apoptotic effects of As₂S₂.

Results

As₂S₂ significantly inhibited the growth of human hepatoma cells SMMC-7721, BEL-7402 and HepG2. As₂S₂ inhibited cell proliferation effectively by inducing G0/G1 cell cycle arrest in SMMC-7721 cells. As₂S₂ could increase Bax/Bcl-2 ratio, decrease mitochondrial membrane potential, promote the release of cytochrome c, increase the levels of cleaved caspase-3 and PARP, indicating that As₂S₂ induced apoptosis in SMMC-7721 cells via mitochondrial-mediated apoptosis pathway. Further research showed that As₂S₂ inhibited the PI3K/AKT signaling pathway leading to apoptotic cell death. In addition, As₂S₂ significantly inhibited tumor growth in H22-bearing mice and induced apoptosis by deactivating PI3K/AKT pathway, which was consistent with the in vitro results.

Conclusion

These findings suggested that As₂S₂ could induce apoptosis of liver cancer cells in vitro and in vivo, which was related to PI3K/AKT-mediated mitochondrial pathway and may provide a novel promising therapeutic agent for liver cancer treatment.

https://ift.tt/2PxzAU3

Cannabinoids: Potential Role in Inflammatory and Neoplastic Skin Diseases

Abstract

The endocannabinoid system is a complex and nearly ubiquitous network of endogenous ligands, enzymes, and receptors that can also be stimulated by exogenous compounds such as those derived from the marijuana plant, Cannabis sativa. Recent data have shown that the endocannabinoid system is fully functional in the skin and is responsible for maintaining many aspects of skin homeostasis, such as proliferation, differentiation, and release of inflammatory mediators. Because of its role in regulating these key processes, the endocannabinoid system has been studied for its modulating effects on both inflammatory disorders of the skin and skin cancer. Although legal restrictions on marijuana as a Schedule I drug in the USA have made studying cannabinoid compounds unfavorable, an increasing number of studies and clinical trials have focused on the therapeutic uses of cannabinoids. This review seeks to summarize the current, and rapidly expanding field of research on the broad potential uses of cannabinoids in inflammatory and neoplastic diseases of the skin.

https://ift.tt/2GdoaFG

Basic chemical peeling—superficial and medium-depth peels

Publication date: Available online 11 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kachiu C. Lee, Carlos G. Wambier, Seaver L. Soon, J.Barton Sterling, Marina Landau, Peter Rullan, Harold J. Brody, International Peeling Society(IPS)

Abstract

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.

Chemical peeling is the controlled wounding of the epidermis and dermis for medical and aesthetic improvement. Although the use of chemical peels dates to ancient Egyptian times, our understanding of the science behind chemical peeling is still evolving.1 Recent scientific studies investigating the histologic and long-term effects of peels provide data to support the clinical observations. This first part of the two-part chemical peels CME discusses superficial and medium depth peels, with a description of the histological effects and treatment indications of these peels.

https://ift.tt/2QoWDpv

Tezepelumab, an anti-TSLP monoclonal antibody, in the treatment of moderate to severe atopic dermatitis: A randomized phase 2a clinical trial

Publication date: Available online 12 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Eric L. Simpson, Jane R. Parnes, Dewei She, Sarah Crouch, William Rees, May Mo, René van der Merwe

Abstract

Background

Tezepelumab (AMG 157/MEDI9929), a first-in-class monoclonal antibody, targets thymic stromal lymphopoietin, a cytokine implicated in atopic dermatitis (AD) pathogenesis.

Objective

Evaluate efficacy and safety of tezepelumab in adults with moderate to severe AD.

Methods

In this phase 2a study (NCT02525094), 113 patients were randomized 1:1 to subcutaneous tezepelumab 280 mg or placebo every 2 weeks, plus Class 3 topical corticosteroids (TCS). The primary endpoint was the Week-12 response rate for a ≥50% reduction in Eczema Area and Severity Index (EASI50). Secondary endpoints including EASI75, Investigator's Global Assessment, Scoring of Atopic Dermatitis (SCORAD) 50, SCORAD75, pruritus numeric rating and 5-D itch scales, and exploratory endpoints (including EASI90) were assessed at Week 12, and Week 16 (post hoc).

Results

A numerically greater percentage of tezepelumab plus TCS-treated patients achieved EASI50 (64.7%) versus placebo plus TCS (48.2%; P = .091). Numerical improvements over placebo were demonstrated for Week 12 secondary and exploratory endpoints, with further improvements at Week 16. Treatment-emergent adverse events were similar between treatment groups.

Limitations

Greater than expected response rates in placebo-treated patients were possibly attributable to TCS.

Conclusion

Although not statistically significant, numerical improvements over placebo for all Week 12 endpoints were demonstrated, with greater Week 16 responses.

https://ift.tt/2QvEsi5

Access to Dermatology Services at Free Medical Clinics, A Nationwide Cross-sectional Survey

Publication date: Available online 12 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Victoria Madray, Sarvani Ginjupalli, Osama Hashmi, Richard W. Sams, J.Aaron Johnson, Benjamin Stoff

https://ift.tt/2RZovNO

Happy Holidays

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Season's Greetings

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Gemcitabine and metabolite pharmacokinetics in advanced NSCLC patients after bronchial artery infusion and intravenous infusion

Abstract

Purpose

We investigated the safety, pharmacokinetics, and efficacy of gemcitabine administered via bronchial artery infusion (BAI) and IV infusion in advanced NSCLC patients.

Methods

Patients were eligible if they had received at least two prior cytotoxic chemotherapy regimens. Gemcitabine was administered via BAI as 600 mg/m² on day one of cycle one, followed by IV as 1000 mg/m² on day eight of cycle one, and IV on days one and eight of all subsequent cycles. Pharmacokinetics for gemcitabine and dFdU metabolite in plasma, and dFdCTP active metabolite in peripheral blood mononuclear cells (PBMC) were evaluated. Intensive pharmacokinetic sampling was performed after BAI and IV infusions during cycle one.

Results

Three male patients (age range 59–68 years) were evaluated. All patients responded with stable disease or better. One PR was observed after cycle three, and the remaining had SD. C_max (mean ± SD) following BAI for gemcitabine, dFdCTP, and dFdU were 7.71 ± 0.13, 66.5 ± 40.6, and 38 ± 6.27 µM and following IV infusion, 17 ± 2.36, 50.8 ± 3.61, and 83.2 ± 12.3 µM, respectively. The AUCinf (mean ± SD) following BAI for gemcitabine, dFdCTP, and dFdU were 6.89 ± 1.2, 791.1 ± 551.2, and 829.9 ± 217.8 µM h and following IV infusion, 12.5 ± 3.13, 584 ± 86.6, and 1394.64 ± 682.2 µM h, respectively. The AUC and Cmax of dFdCTP after BAI were higher than IV. The median OS was 6.27 months. No grade 3 or 4 toxicity was observed. The most common side effects were all grade ≤ 2 involving nausea, vomiting, rigor, thrombocytopenia, and anemia.

Conclusions

Systemic exposure to dFdCTP was higher after BAI than IV in two out of three patients.

https://ift.tt/2BfYdzl

Predicting the appropriate size of the uncuffed nasotracheal tube for pediatric patients: a retrospective study

Abstract

Objectives

The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively.

Materials and methods

The 1–12-year patients underwent dental procedures under general anesthesia intubated nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed tube sizes were calculated. In addition, we compared the relationships between the predicted tube size and actually the intubated tube size.

Results

The tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for tube size. The correspondence rates for the tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size tube were intubated actually; 56% and 70%. When the predicted tube size was 4.0-mm ID, 0.5 mm larger size tube was intubated actually; 66%.

Conclusions

The formula by height could be most suitable for the selection of size for pediatric nasotracheal intubation. When the predicted tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial.

Clinical relevance

The present data indicate that the selection of nasotracheal tube using the formula by height might be useful.

https://ift.tt/2GeB862

Effects of neonicotinoids on the emergence and composition of chironomids in the Prairie Pothole Region

Abstract

The use of neonicotinoid pesticides is widespread throughout agricultural regions, including the Prairie Pothole Region of North America. The occurrence of these pesticides to the abundant adjacent wetlands can result in impacts on nontarget insects, and cascading effects through wetland ecosystems. In the current study, field-based mesocosms were used to investigate the effects of multiple pulses of the neonicotinoid imidacloprid on the emergence and chironomid community composition, in an effort to simulate episodic rain events to Prairie Pothole Wetlands. Sediments from two local wetlands were placed into the mesocosm tanks and three imidacloprid pulses added, each 1 week apart at nominal concentrations of 0.2, 2.0, and 20 μg/L. Overall, a significant decrease in the emergence of adult chironomids was observed within the 2.0 μg/L and greater concentrations, with the subfamilies Chironominae and Tanypodinae showing a greater sensitivity than the members of the subfamily Orthocladiinae. The chironomid community also had a dose-related response, followed by a recovery of the community composition near the end of the experiment. Our results provide additional evidence that repeated pulses of imidacloprid may have effects on chironomids and other sensitive aquatic insects living within Prairie Pothole Wetlands, resulting in reduced food availability. We stress the need for continued monitoring of US surface waters for neonicotinoid compounds and the continuation of additional experiments looking into the impacts on aquatic communities.

https://ift.tt/2SIubeK

Clinical outcomes of oral metronomic vinorelbine in advanced non-small cell lung cancer: correlations with pharmacokinetics and MDR1 polymorphisms

Abstract

Purpose

This study investigated correlations of the clinical outcomes of oral metronomic vinorelbine (VNR) with VNR pharmacokinetics and MDR1 polymorphisms.

Methods

Eighty-two patients with metastatic non-small cell lung cancer (NSCLC) unfit for standard chemotherapy were treated with VNR at the oral doses of 20–30 mg every other day or 50 mg three times a week. They had a performance status (PS) ≤ 3, were > 70-year-old and drug-naïve or cisplatin-pretreated. MDR1 2677G > T and 3435C > T polymorphisms were analysed and blood concentrations of VNR and desacetyl-VNR (dVNR: active metabolite) assayed. Overall survival (OS), treatment duration and drug-related toxicity were the main endpoints.

Results

Median OS and treatment duration were 27 weeks (range 1.3–183) and 15 weeks (range 1.3–144), respectively. OS was directly correlated with the duration of VNR treatment and number of therapy lines after VNR treatment (multiple linear regression: adjusted r² = 0.71; p < 0.00001). Neither MDR1 genotypes nor VNR/dVNR concentrations predicted OS. VNR blood levels were positively correlated with platelet counts (r² = 0.12; p = 0.0036). Patients who had long-term benefit (treated for ≥ 6 month without toxicity) showed lower VNR concentrations than those who had not. Twelve patients stopped therapy due to grade 3–4 toxicity. Toxicity was associated with blood concentrations of VNR ≥ 1.57 ng/mL and dVNR ≥ 3.04 ng/mL, but not with MDR1 polymorphisms.

Conclusions

Neither pharmacokinetic nor pharmacogenetic monitoring seem useful to predict OS. On the other hand, high VNR and dVNR blood levels were associated with severe toxicity.

https://ift.tt/2PAHqMC