Scholar : Obstructive sleep apnea - νέα αποτελέσματα

[PDF] Obstructive Sleep Apnea and Obesity: Implications for Public Health

S Jehan, F Zizi, SR Pandi-Perumal, S Wall, E Auguste - Sleep Med Dis Int J, 2017

Abstract Obstructive sleep apnea (OSA) is a global disease with a rising incidence along
with its comorbidities, especially with metabolic syndrome. One of the main components
contributing to sleep apnea is obesity; as well as diabetes mellitus type 2 (T2DM),

Obstructive Sleep Apnea Assessed by Overnight Polysomnography in Patients With Keratoconus.

E Pedrotti, CL Demasi, A Fasolo, E Bonacci, T Brighenti… - Cornea, 2018

Abstract To determine the prevalence of obstructive sleep apnea (OSA) in patients with
keratoconus (KCN) and to evaluate the association between the severity of KCN and OSA.
OSA was diagnosed with an overnight home sleep apnea test. As estimated by home

Cardioventilatory Control in Preterm Born Children and the Risk of Obstructive Sleep Apnea

K Armoni Domany, MM Hossain, L Nava-Guerra… - American Journal of …, 2018

Rationale The contribution of ventilatory control to the pathogenesis of obstructive sleep
apnea (OSA) in preterm born children is unknown. Objectives To characterize phenotypes of
ventilatory control that are associated with the presence of OSA in preterm born children

Phenotyping Pharyngeal Pathophysiology Using Polysomnography in Patients with Obstructive Sleep Apnea

SA Sands, BA Edwards, PI Terrill… - American Journal of …, 2018

Rationale: Therapies for obstructive sleep apnea (OSA) could be administered based on a
patient's own phenotypic causes ("traits") if a clinically-applicable approach were available.
Here we present a novel approach to quantify two key contributors to OSA—pharyngeal

[HTML] Different effects of apnea during rapid eye movement period on peripheral arterial stiffness in obstructive sleep apnea

CY Lin, CS Ho, WC Tsai, JY Chen - Atherosclerosis, 2018

Methods This study recruited 275 patients who were referred for sleep apnea study. Arterial
stiffness was assessed by peripheral compliance index (CI) and central pulse wave velocity
derived from digital volume pulse (PWV DVP) by photoplethysmography. Overnight

A Pilot Study on the Biomechanical Assessment of Obstructive Sleep Apnea Pre and Post Bariatric Surgery

AM Al-Jumaily, S Ashaat, B Martin, R Pohle-Krauza… - Respiratory Physiology & …, 2018

Abstract Obesity is a major risk factor for obstructive sleep apnea patients. In obese patients
the severity of this risk can be reduced by bariatric surgery. This pilot study investigates the
perioperative effects of bariatric surgery on obstructive sleep apnea and on the physical and

Predicting response to oxygen therapy in obstructive sleep apnoea patients using a 10-minute daytime test

D Wang, KK Wong, L Rowsell, GW Don, BJ Yee… - European Respiratory …, 2018

Type D Personality and Sleep Quality in Coronary Artery Disease Patients With and Without Obstructive Sleep Apnea: Mediating Effects of Anxiety and Depression

A Juskiene, A Podlipskyte, A Bunevicius, G Varoneckas - International Journal of …, 2018

Abstract Purpose The study aimed to examine the association between type D personality
trait and sleep quality in coronary artery disease (CAD) patients with and without obstructive
sleep apnea (OSA) and to explore the mediating effects of anxiety and depression

FIBROTIC TISSUE STABILIZED BY CROSSLINKING FOR TREATMENT OF SNORING AND OBSTRUCTIVE SLEEP APNEA

ME Brown, TP Hedman - US Patent App. 15/180,552, 2017

Abstract: The present invention relates to administration or application of a crosslink
inducing agent to a subject following a stiffening procedure to the respiratory system. The
present invention has identified that such application or administration of a crosslinking

Neurological recovery after acute ischemic stroke with obstructive sleep apnea

T Kawada - Acta Neurologica Scandinavica, 2018

… Acta Neurologica Scandinavica: Previous article in issue: The HMGB1 is increased in CSF
of patients with an Anti-NMDAR encephalitis Previous article in issue: The HMGB1 is increased
in CSF of patients with an Anti-NMDAR encephalitis. View issue TOC Volume 137, Issue 2

 

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Scholar : ΚΑΡΚΙΝΩΜΑ - νέα αποτελέσματα

[PDF] Νοσηλευτική διαχείριση της εξαγγείωσης χημειοθεραπευτικών φαρμάκων.

Ε Τρουλλινού, Σ Σμαραγδάκη, E Troullinou… - 2018

… Η ονομασία της πάθησης αποδίδεται στον Ιπποκράτη περί το 400 π.Χ., που χρησιμοποίησε τον
όρο "καρκίνωμα", που προέρχεται από τη λέξη "καρκίνος" … υπηρετούσε στην Περσική Αυλή,
θεράπευσε τη γυναίκα του Βασιλιά Δαρείου, την Άτοσσα, από κάποιο καρκίνωμα του μαστού …

 

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Scholar : Θυρεοειδής - νέα αποτελέσματ

[PDF] Φαρμακευτικές μέθοδοι και θεραπεία με επιληψία

Ε Ζωγραφίδου - 2017

Page 1. ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΕΙΡΑΙΩΣ ΤΜΗΜΑ ΣΤΑΤΙΣΤΙΚΗΣ ΚΑΙ ΑΣΦΑΛΙΣΤΙΚΗΣ ΕΠΙΣΤΗΜΗΣ
ΜΕΤΑΠΤΥΧΙΑΚΟ ΠΡΟΓΡΑΜΜΑ ΣΠΟΥΔΩΝ ΣΤΗΝ ΕΦΑΡΜΟΣΜΕΝΗ ΣΤΑΤΙΣΤΙΚΗ
ΦΑΡΜΑΚΕΥΤΙΚΕΣ ΜΕΘΟΔΟΙ ΚΑΙ ΘΕΡΑΠΕΙΑ ΓΙΑ ΑΣΘΕΝΕΙΣ ΜΕ ΕΠΙΛΗΨΙΑ Ζωγραφίδου …

 

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Scholar : Laryngomalacia - νέα αποτελέσματα

[PDF] Anaesthetic Management of a Child with a Massive Mediastinal Mass

AÇ Tütüncü, P Kendigelen, G Kaya - Anaesthesiol Reanim, 2017

… During this period, her arterial pH was 7.37, PaCO2 was 42 mmHg and PaO2 was
98 mmHg. Because tra- cheomalacia or laryngomalacia were not detected, the patient
was referred to the clinic without any difficulty. Discussion …

[PDF] EXERCISE-INDUCED EPISODIC LARYNGEAL BREATHING DISORDERS: CLINICAL FEATURES AND MECHANISMS

A Shembel - 2018

Page 1. EXERCISE-INDUCED EPISODIC LARYNGEAL BREATHING DISORDERS: CLINICAL
FEATURES AND MECHANISMS by Adrianna C. Shembel Bachelor of Science, The Pennsylvania
State University, 2005 Masters of Arts, The University of Pittsburgh, 2008 …

 

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Scholar : ΑΛΛΕΡΓΙΑ - νέα αποτελέσματα

Οπτικοί ανοσοαισθητήρες για την ταυτόχρονη ανίχνευση αλλεργιογόνων ουσιών σε τρόφιμα

Μ Αγγελοπούλου - 2017

… Περίληψη. Η τροφική αλλεργία επηρεάζει μεγάλο ποσοστό των ανθρώπων παγκοσμίως … Ο
οπτικός ανοσοαισθητήρας που χρησιμοποιήθηκε ήταν πλήρως ολοκληρωμένο ... Η τροφική
αλλεργία επηρεάζει μεγάλο ποσοστό των ανθρώπων παγκοσμίως …

[PDF] Φαρμακευτικές μέθοδοι και θεραπεία με επιληψία

Ε Ζωγραφίδου - 2017

Page 1. ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΕΙΡΑΙΩΣ ΤΜΗΜΑ ΣΤΑΤΙΣΤΙΚΗΣ ΚΑΙ ΑΣΦΑΛΙΣΤΙΚΗΣ ΕΠΙΣΤΗΜΗΣ
ΜΕΤΑΠΤΥΧΙΑΚΟ ΠΡΟΓΡΑΜΜΑ ΣΠΟΥΔΩΝ ΣΤΗΝ ΕΦΑΡΜΟΣΜΕΝΗ ΣΤΑΤΙΣΤΙΚΗ
ΦΑΡΜΑΚΕΥΤΙΚΕΣ ΜΕΘΟΔΟΙ ΚΑΙ ΘΕΡΑΠΕΙΑ ΓΙΑ ΑΣΘΕΝΕΙΣ ΜΕ ΕΠΙΛΗΨΙΑ Ζωγραφίδου …

 

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Scholar : ΑΚΤΙΝΟΘΕΡΑΠΕΙΑ - νέα αποτελέ

[PDF] Νοσηλευτική διαχείριση της εξαγγείωσης χημειοθεραπευτικών φαρμάκων.

Ε Τρουλλινού, Σ Σμαραγδάκη, E Troullinou… - 2018

… 22 1.2.1 Ακτινοθεραπεία ..... 22 … Έχουν, επίσης, διαφορετική τάση εξάπλωσης
δια μέσου της κυκλοφορίας, και εμφανίζουν διαφορετική ανταπόκριση τόσο
στα φάρμακα όσο και στην ακτινοθεραπεία (Harrison, 1997) …

[DOC] Incidental diagnosis of uterine cancer on technetium-99m dimercaptosuccinic acid renal scintigraphy

O Kraft

… Ακολούθησε υστερεκτομή και αμφοτερόπλευρη οωθηκεκτομή. Ιστολογικά διαπιστώθηκε
μυωματώδης μήτρα με αδενοκαρκίνωμα μήτρας και αμφοτέρων των ωοθηκών.
Ακολούθησε εξωτερική ακτινοθεραπεία. Hell J Nucl Med 2005; 8(2) …

 

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Scholar : ΧΗΜΕΙΟΘΕΡΑΠΕΙΑ - νέα αποτελέ

[PDF] Νοσηλευτική διαχείριση της εξαγγείωσης χημειοθεραπευτικών φαρμάκων.

Ε Τρουλλινού, Σ Σμαραγδάκη, E Troullinou… - 2018

… 28 1.3 Η χημειοθεραπεία ..... 29 … Οι βασικές αρχές για την αντιμετώπιση του
καρκίνου είναι η χειρουργική θεραπεία, οι ακτινοβολίες, η χημειοθεραπεία, η
βιολογική θεραπεία και η ορμονοθεραπεία (Bestrong.org, 2013) …

[PDF] Η αναγκαιότητα καλλιέργειας της ψυχικής ανθεκτικότητας στην Ελλάδα της οικονομικής ύφεσης: μια συστηματική βιβλιογραφική επισκόπηση των ερευνών που …

Μ Μουστάκα - 2018

Page 1. ΣΧΟΛΗ ΚΟΙΝΩΝΙΚΩΝ, ΑΝΘΡΩΠΙΣΤΙΚΩΝ ΕΠΙΣΤΗΜΩΝ ΚΑΙ ΤΕΧΝΩΝ ΤΜΗΜΑ
ΕΚΠΑΙΔΕΥΤΙΚΗΣ ΚΑΙ ΚΟΙΝΩΝΙΚΗΣ ΠΟΛΙΤΙΚΗΣ ΠΡΟΓΡΑΜΜΑ ΜΕΤΑΠΤΥΧΙΑΚΩΝ
ΣΠΟΥΔΩΝ ΣΤΗ ΔΙΑ ΒΙΟΥ ΜΑΘΗΣΗ Μεταπτυχιακή Εργασία …

 

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Body composition and circulating estradiol are the main bone density predictors in healthy young and middle-aged men

Abstract

Purpose

Current fracture risk assessment options in men call for improved evaluation strategies. Recent research directed towards non-classic bone mass determinants have often yielded scarce and conflicting results. We aimed at investigating the impact of novel potential bone mass regulators together with classic determinants of bone status in healthy young and middle-aged men.

Methods

Anthropometric measurements, all-site bone mineral density (BMD) and body composition parameters assessed by dual-energy X-ray absorptiometry and also serum concentrations of (1) the adipokines leptin and resistin, (2) vitamin D and parathormone (PTH), (3) sex hormone binding globulin (SHBG), total testosterone and estradiol (free testosterone was also calculated) and (4) C-terminal telopeptide of type I collagen (CTx) were obtained from 30 apparently healthy male volunteers aged 20–65 years enrolled in this cross-sectional study.

Results

Only lean mass (LM) and total estradiol independently predicted BMD in men in multiple regression analysis, together explaining 49% (p ≤ 0.001) of whole-body BMD variance. Hierarchical regression analysis with whole-body BMD as outcome variable demonstrated that the body mass index (BMI) beta coefficient became nonsignificant when LM was added to the model. Adipokines, fat parameters, testosterone (total and free), SHBG, PTH and vitamin D were not independently associated with BMD or CTx.

Conclusions

The present study shows that LM and sex hormones—namely estradiol—are the main determinants of bone mass in young and middle-aged men. The effects of BMI upon BMD seem to be largely mediated by LM. Lifestyle interventions should focus on preserving LM in men for improved bone outcomes.

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Editorial Board

Publication date: February 2018
Source:Medical Image Analysis, Volume 44





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Reviewers -- An acknowledgement

Publication date: February 2018
Source:Medical Image Analysis, Volume 44





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Acrodermatitis acidaemica

Summary

Methylmalonic acidaemia (MMA) is an inborn error of amino acid metabolism that may be associated with cutaneous manifestations mimicking other diagnoses, including staphylococcal scalded skin syndrome (SSSS), psoriasis and acrodermatitis enteropathica. Whether this is due to the underlying metabolic disorder itself or occurs as a consequence of dietary restriction has yet to be elucidated. Skin biopsies typically show histological features shared by a number of other metabolic disorders and nutritional deficiency-associated diseases. Some presentations, especially SSSS-like eruptions, may be associated with acute metabolic decompensation. An underlying metabolic disorder, such as MMA, should be considered in a diagnosed adult or undiagnosed child presenting with skin eruptions that resemble those listed above, so that specialist management may be initiated early.

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Seasonal variation and source apportionment of PM 2.5 -bound trace elements at a coastal area in southwestern Taiwan

Abstract

The aim of this study is to investigate the seasonal variations and source apportionment on atmospheric fine particulate matter (PM_2.5) mass and associated trace element concentrations at a coastal area, in Chiayi County of southwestern Taiwan. Particle measurements were conducted in 2015. Twenty-three trace elements in PM_2.5 were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Multiple approaches of the enrichment factor (EF) analysis and positive matrix fraction (PMF) model were used to identify potential sources of PM_2.5-bound trace elements. Daily mean concentration of PM_2.5 in cold season (25.41 μg m⁻³) was higher than that in hot season (13.10 μg m⁻³). The trace elements contributed 11.02 and 10.74% in total PM_2.5 mass concentrations in cold season and hot season, respectively. The results of EF analysis confirmed that Sb, Mo, and Cd were the top three anthropogenic trace elements in the PM_2.5; furthermore, carcinogenic elements (Cr, Ni, and As) and other trace elements (Na, K, V, Cu, Zn, Sr, Sn, Ba, and Pb) were attributable to anthropogenic emissions in both cold and hot seasons; however, highly enriched Li and Mn were observed only in cold season. The PMF model identified four main sources: iron and steel industry, soil and road dust, coal combustion, and traffic-related emission. Each of these sources has an annual mean contribution of 8.2, 27.5, 11.2, and 53.1%, respectively, to PM_2.5. The relative dominance of each identified source varies with changing seasons. The highest contributions occurred in cold season for iron and steel industry (66.2%), in hot season for traffic-related emission (58.4%), soil and road dust (22.0%), and coal combustion (2.8%). These findings revealed that the PM_2.5 mass concentration, PM_2.5-bound trace element concentrations, and their contributions were various by seasons.

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Issue Information - Instructions for Authors

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Issue Information

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Is there an association of ABO blood groups and Rhesus factor with alopecia areata?

Summary

Background/Objectives

Alopecia areata (AA) is an autoimmune disease characterized by noncicatricial hair loss localized on hair, beard, mustache, eyebrow, eyelash, and sometimes on the body. Although etiopathogenesis is not fully understood, many studies show remarkable associations between various diseases and ABO blood groups. However, there is no study with AA and blood groups.

Methods

Healthy people and patients with AA were included in this study. A total of 155 patients with AA and 299 healthy controls were included in the study.

Results

ABO blood group distribution in patients with AA and distribution of healthy donors were similar. However, Rhesus factor positivity in the AA group was significantly higher than in healthy donors. The relationship between stress and AA was high as known. But, ABO blood group and Rhesus factor were not in a significant connection with stress.

Conclusion

We conclude that there was no association between ABO blood group and AA, but the observed distribution of Rhesus blood group differed slightly but significantly from that of the healthy population. The result of the study shows a small but statistically significant difference in the Rh blood group between patients with AA and the healthy population blood groups. This result is important because it suggests that genetic factors may influence the development of AA. The role of blood groups in the development of AA remains to be determined. We believe that the studies which will be carried out in other centers with wider series will be more valuable to support this hypothesis.

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Implications of Antimicrobial Usage to Prevent Bacteremia for Periodontal Therapy

Abstract

Purpose of Review

This review examines the current literature on periodontal treatment, bacteremia and prophylactic antibiotic usage to prevent the systemic adverse outcomes.

Recent Findings

Currently, it is not clear whether prophylactic antibiotic administration prevents bacterial endocarditis in patients with high risk.

Summary

Recent publications have resulted in significant changes in the concept of antibiotic prophylaxis. Available evidence does not support the previously published guidelines recommending prophylactic antibiotic usage prior to dental treatment. Potential harms and costs of antibiotic administration should be weighed against expected benefits. Clinicians are advised to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before prescription.

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Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with Demodex and increased IL-17 levels? Reply from authors

Abstract

In studies in atopic dermatitis (AD), dupilumab has been associated with higher rates of conjunctivitis compared with placebo. Consistent with previous studies, in LIBERTY AD CAFÉ (NCT02755649), all cases but one were mild or moderate, most (62–89%) were recovered/resolved or recovering/resolving by end of treatment, and no patients permanently discontinued study treatment because of conjunctivitis.¹ No patients reported atopic keratoconjunctivitis in this study.

This article is protected by copyright. All rights reserved.

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Treatment of Subclinical Atrial Fibrillation: Does One Plus One Always Equal Two?.

Author: Gold, Michael R. MD, PhD

Page: 217-218

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Confusion Around Therapeutic Temperature Management Hypothermia After In-Hospital Cardiac Arrest?.

Author: Polderman, Kees H. MD, PhD; Varon, Joseph MD, PhD

Page: 219-221

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Phenotypic Consequences of a Genetic Predisposition to Enhanced Nitric Oxide Signaling.

Author: Emdin, Connor A. DPhil; Khera, Amit V. MD; Klarin, Derek MD; Natarajan, Pradeep MD; Zekavat, Seyedeh M. BSc; Nomura, Akihiro MD; Haas, Mary PhD; Aragam, Krishna MD; Ardissino, Diego MD; Wilson, James G. MD; Schunkert, Heribert MD; McPherson, Ruth MD; Watkins, Hugh MD, PhD; Elosua, Roberto MD, PhD; Bown, Matthew J. MD; Samani, Nilesh J. FRCP; Baber, Usman MD; Erdmann, Jeanette PhD; Gormley, Padhraig PhD; Palotie, Aarno MD, PhD; Stitziel, Nathan O. MD, PhD; Gupta, Namrata PhD; Danesh, John DPhil; Saleheen, Danish MBBS, PhD; Gabriel, Stacey PhD; Kathiresan, Sekar MD

Page: 222-232

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Nitric Oxide Signaling and Atherothrombosis Redux: Evidence From Experiments of Nature and Implications for Therapy.

Author: Loscalzo, Joseph MD, PhD

Page: 233-236

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Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Adults in the United States: National Health and Nutrition Examination Survey, 2014.

Author: Jackson, Sandra L. PhD; Cogswell, Mary E. DrPH; Zhao, Lixia PhD; Terry, Ana L. MS; Wang, Chia-Yih PhD; Wright, Jacqueline DrPH; Coleman King, Sallyann M. MD; Bowman, Barbara PhD; Chen, Te-Ching PhD; Merritt, Robert MS; Loria, Catherine M. PhD

Page: 237-246

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Sodium and Potassium Intake in US Adults.

Author: Whelton, Paul K. MB, MD, MSc

Page: 247-249

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Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study.

Author: Nazerian, Peiman MD; Mueller, Christian MD; Soeiro, Alexandre de Matos MD; Leidel, Bernd A. MD; Salvadeo, Sibilla Anna Teresa MD; Giachino, Francesca MD; Vanni, Simone MD, PhD; Grimm, Karin MD; Oliveira, Mucio Tavares Jr MD, PhD; Pivetta, Emanuele MD, MSc; Lupia, Enrico MD, PhD; Grifoni, Stefano MD; Morello, Fulvio MD, PhD; for the ADvISED Investigators; Capretti, Elisa; Castelli, Matteo; Gualtieri, Simona; Trausi, Federica; Battista, Stefania; Bima, Paolo; Carbone, Federica; Tizzani, Maria; Veglio, Maria G.; Badertscher, Patrick; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael

Page: 250-258

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Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection.

Author: Wang, Yuan PhD, MD; Tan, Xin PhD; Gao, Hai PhD, MD; Yuan, Hui MD; Hu, Rong PhD, MD; Jia, Lixin PhD, MD; Zhu, Junming MD; Sun, Lizhong MD; Zhang, Hongjia MD; Huang, Lianjun MD; Zhao, Dong PhD, MD; Gao, Pei PhD *,; Du, Jie PhD *,,

Page: 259-269

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Biomarker-Assisted Diagnosis of Acute Aortic Dissection.

Author: Suzuki, Toru MD, PhD; Eagle, Kim A. MD

Page: 270-272

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Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment-Elevation Myocardial Infarction After Cardiac Arrest.

Author: Bascom, Karen E. MBChB; Dziodzio, John BA; Vasaiwala, Samip MD, MSc; Mooney, Michael MD; Patel, Nainesh MD; McPherson, John MD; McMullan, Paul MD; Unger, Barbara RN; Nielsen, Niklas MD, PhD; Friberg, Hans MD, PhD; Riker, Richard R. MD; Kern, Karl B. MD; Duarte, Christine W. PhD; Seder, David B. MD; for the International Cardiac Arrest Registry (INTCAR); May, Teresa DO; Sunde, Kjetil MD; Rubertsson, Sten MD; Smid, Ondrej MD; Soreide, Eldar MD; Hand, Robert MD; Rundgren, Malin MD; Valsson, Felix MD; Sadaka, Farid MD; Bekkers, Bas MD; Wanscher, Michael MD; Lindell, Eva-Lotta MD; Guldbrand, Pehr MD; Torstensson, Anders MD; Dybkowska, Krystyna MD; Israelsson, Johan MD; Skram, Ulrik MD; Guzowski, Michelle MD; Hopf, Hans-Bernd MD; Persson, Stefan MD; Chang, Ira MD; Samuelsson, Line MD; Oddby, Eva MD; Savolainen, Kristina MD; Zatterman, Richard MD; Rodriguez, Daniel MD; Mayer, Stephan MD; Fodisch, Markus MD; Oscarsson, Beata MD; Scheer, Hakan MD; Sarbinowski, Roman MD; Hyddmark, Ulf MD; Deye, Nicolas MD; Lindbom, Anna MD; Armani, Claudia MD; Forsberg, Sune MD; Ericsson, Anders B. MD

Page: 273-282

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Identifying Candidates for Advanced Hemodynamic Support After Cardiac Arrest.

Author: Bartos, Jason A. MD, PhD; Doonan, Aaron L. MD; Yannopoulos, Demetris MD

Page: 283-285

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Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure: An Individual Patient Data Meta-Analysis.

Author: Aimo, Alberto MD; Januzzi, James L. Jr MD; Vergaro, Giuseppe MD, PhD; Ripoli, Andrea EngD; Latini, Roberto MD; Masson, Serge PhD; Magnoli, Michela BSc; Anand, Inder S. MD, PhD; Cohn, Jay N. MD; Tavazzi, Luigi MD; Tognoni, Gianni MD; Gravning, Jorgen MD, PhD; Ueland, Thor PhD; Nymo, Stale H. MD; Brunner-La Rocca, Hans-Peter MD; Genis, Antoni Bayes MD, PhD; Lupon, Josep MD; de Boer, Rudolf A. MD; Yoshihisa, Akiomi MD, PhD; Takeishi, Yasuchika MD; Egstrup, Michael MD, PhD; Gustafsson, Ida MD, PhD; Gaggin, Hanna K. MD, MPH; Eggers, Kai M. MD, PhD; Huber, Kurt MD; Tentzeris, Ioannis MD; Tang, Wai H.W. MD; Grodin, Justin BSc; Passino, Claudio MD; Emdin, Michele MD, PhD

Page: 286-297

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Costly Medications Add Urgency to Physician-Patient Affordability Discussions.

Author: Kuehn, Bridget M.

Page: 298-299

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Young Male With Incessantly Wide Complex Tachycardia: What Is the Substrate of the Arrhythmia?.

Author: Miranda-Arboleda, Andres F. MD; Correa, Rafael MD; Saenz, Gloria MD; Agudelo, Juan F. MD; Ramirez, Juan D. MD

Page: 300-302

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Electronic Cigarette Smoking Increases Arterial Stiffness and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette: An Acute and Chronic Study.

Author: Ikonomidis, Ignatios MD, PhD; Vlastos, Dimitrios MD; Kourea, Kallirrhoe MD, PhD; Kostelli, Gavriela MD; Varoudi, Maria MD; Pavlidis, George MD, PhD; Efentakis, Panagiotis MD; Triantafyllidi, Helen MD, PhD; Parissis, John MD, PhD; Andreadou, Ioanna PhD; Iliodromitis, Efstathios MD, PhD; Lekakis, John MD, PhD

Page: 303-306

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Effect of Intravenous Fentanyl on Ticagrelor Absorption and Platelet Inhibition Among Patients Undergoing Percutaneous Coronary Intervention: The PACIFY Randomized Clinical Trial (Platelet Aggregation With Ticagrelor Inhibition and Fentanyl).

Author: McEvoy, John W. MBBCh, MEHP, MHS; Ibrahim, Khalil MD; Kickler, Thomas S. MD; Clarke, William A. PhD; Hasan, Rani K. MD, MHS; Czarny, Matthew J. MD; Keramati, Ali R. MD; Goli, Rakesh R. BA; Gratton, Travis P. MD; Brinker, Jeffrey A. MD; Chacko, Matthews MD; Hwang, Chao-Wei MD, PhD; Johnston, Peter V. MD; Miller, Julie M. MD; Trost, Jeffrey C. MD; Herzog, William R. MD; Blumenthal, Roger S. MD; Thiemann, David R. MD; Resar, Jon R. MD; Schulman, Steven P. MD

Page: 307-309

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Letter by Madias Regarding Article, "Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement".

Author: Madias, John E. MD

Page: 310-311

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Response by Glaser et al to Letter Regarding Article, "Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement".

Author: Glaser, Natalie MD; Jackson, Veronica MD, PhD; Holzmann, Martin J. MD, PhD; Franco-Cereceda, Anders MD, PhD; Sartipy, Ulrik MD, PhD

Page: 312-313

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Letter by Jin-shan and Xue-bin Regarding Article, "Prospective Study of Adenosine on Atrioventricular Nodal Conduction in Pediatric and Young Adult Patients After Heart Transplantation".

Author: Jin-shan, He MD; Xue-bin, Li MD

Page: 314

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Letter by Ye et al Regarding Article, "Prospective Study of Adenosine on Atrioventricular Nodal Conduction in Pediatric and Young Adult Patients After Heart Transplantation".

Author: Ye, Ziliang MD; Su, Qiang MD, PhD; Li, Lang MD, PhD

Page: 315-316

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Clinical Thyroidology for the Public – Highlighted Article

From Clinical Thyroidology for the Public: Severe thyroid disease is associated with cognitive deficits that could be misdiagnosed as dementia. The association of milder forms of these thyroid conditions and cognitive deficits is less well understood.  Read More….

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Mass balance of arsenic fluxes in rivers impacted by gold mining activities in Paracatu (Minas Gerais State, Brazil)

Abstract

Arsenic (As) is a dangerous and carcinogenic element and drinking water is its main pathway of human exposure. Gold mines are widely recognized as important sources of As pollution. This work proposes the assessment of As distribution along watersheds surrounding "Morro do Ouro" gold mine (Paracatu, southeastern Brazil). A balance approach between filtered As fluxes (As < 0.45 μm) and suspended particulate material (AsSPM) in different river segments was applied. Ultrafiltration procedure was used to categorize As into the following classes: particulate > 0.1 μm, colloidal < 0.1 μm to > 10 kDa, dissolved < 10 kDa to > 1 kDa, and truly dissolved < 1 kDa. By applying this approach, arsenic contributions from mining facilities were quantified in order to identify critical fluvial segments and support decision makers in actions of remediation. The mass balance indicated the occurrence of a decreasing gradient from upstream to downstream: (i) of the As concentrations higher than the limit established by Brazilian law (10 μg L⁻¹); (ii) of the ratio between specific fluxes (g As km⁻² day⁻¹) and those determined using an uncontaminated watershed (a proxy for estimating the anthropic contribution), from 103 to 101; (iii) of the specific fluxes As < 0.45 μm and AsSPM from 102 to 100; and (iv) of the negative balance output minus input for each river segment that suggests As accumulation in sediments along the rivers in both urban and rural areas, mainly due to SPM sedimentation and sorption by Fe oxyhydroxides. Ultrafiltration shattering showed concentrations of decreasing As with particle size; the SPM load (> 0.1 μm) was almost one order higher to dissolved load (< 1 kDa).

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Silicone Migration after Buttock Augmentation

Summary: We present the case of a 30-year-old woman who presented with enlarged inguinal lymph nodes and sacral hyperpigmentation 4 months after gluteal augmentation with silicone implants. Inguinal lymph node biopsy revealed granulomatous lymphadenitis due to foreign material. Upon right buttock implant revision, a 1.5-cm-thick capsule was noted with the absence of peri-implant inflammatory fluid and no macroscopic implant defects. Analysis of the implant by the manufacturer revealed a microscopic silicone leak. The patient's recovery was uneventful, and her symptoms resolved shortly after her reoperation.

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Cardiovascular Mortality Reduction With Empagliflozin in Patients With Type 2 Diabetes and Cardiovascular Disease

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Imaging the Intersection of Oxidative Stress, Lipids, and Inflammation: Progress Toward Personalized Care of Atherosclerosis

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Myocardial Inflammation Predicts Remodeling and Neuroinflammation After Myocardial Infarction

AbstractBackground

The local inflammatory tissue response after acute myocardial infarction (MI) determines subsequent healing. Systemic interaction may induce neuroinflammation as a precursor to neurodegeneration.

Objectives

This study sought to assess the influence of MI on cardiac and brain inflammation using noninvasive positron emission tomography (PET) of the heart-brain axis.

Methods

After coronary artery ligation or sham surgery, mice (n = 49) underwent serial whole-body PET imaging of the mitochondrial translocator protein (TSPO) as a marker of activated macrophages and microglia. Patients after acute MI (n = 3) were also compared to healthy controls (n = 9).

Results

Infarct mice exhibited elevated myocardial TSPO signal at 1 week versus sham (percent injected dose per gram: 8.0 ± 1.6 vs. 4.8 ± 0.9; p < 0.001), localized to activated CD68⁺ inflammatory cells in the infarct. Early TSPO signal predicted subsequent left ventricular remodeling at 8 weeks (r_partial = –0.687; p = 0.001). In parallel, brain TSPO signal was elevated at 1 week (1.7 ± 0.2 vs. 1.4 ± 0.2 for sham; p = 0.017), localized to activated microglia. After interval decline at 4 weeks, progressive heart failure precipitated a second wave of neuroinflammation (1.8 ± 0.2; p = 0.005). TSPO was concurrently up-regulated in remote cardiomyocytes at 8 weeks (8.8 ± 1.7, p < 0.001) without inflammatory cell infiltration, suggesting mitochondrial impairment. Angiotensin-converting enzyme inhibitor treatment lowered acute inflammation in the heart (p = 0.003) and brain (p = 0.06) and improved late cardiac function (p = 0.05). Patients also demonstrated elevation of cardiac TSPO signal in the infarct territory, paralleled by neuroinflammation versus controls.

Conclusions

The brain is susceptible to acute MI and chronic heart failure. Immune activation may interconnect heart and brain dysfunction, a finding that provides a foundation for strategies to improve heart and brain outcomes.

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JACC Instructions for Authors

http://ift.tt/2FHSIej

Imaging Dynamic Heart-Brain Interactions: Getting to the Heart of the Matter, Gray and White

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Antithrombotic Therapy in Peripheral Artery Disease: Generating and Translating Evidence Into Practice

Abstract

Atherosclerotic cardiovascular (CV) disease remains a major health concern affecting more than 200 million adults worldwide, and lower extremity peripheral artery disease (PAD) is associated with significant morbidity and mortality. Treatment strategies to reduce the burden of major adverse CV events and limb events have mainly involved the use of antiplatelet and statin medications. Unlike other types of atherosclerotic CV disease, the evidence base is not well developed for therapies in patients with PAD. Recently, studies from subgroups of patients with PAD and a large clinical trial of PAD patients have been published, signaling a burgeoning interest in studying this higher risk population. This review outlines the inherent CV risks of patients with PAD, risk reduction strategies, emerging clinical trial data, and opportunities for the CV community to generate evidence in real-world settings and translate evidence into practice as new therapies become available.

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Autosomal Recessive Hypercholesterolemia: Long-Term Cardiovascular Outcomes

AbstractBackground

Autosomal recessive hypercholesterolemia (ARH) is a rare lipid disorder characterized by premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data for clinical management and cardiovascular outcomes in ARH.

Objectives

Evaluation of changes in lipid management, achievement of low-density lipoprotein cholesterol (LDL-C) goals and cardiovascular outcomes in ARH.

Methods

Published ARH cases were identified by electronic search. All corresponding authors and physicians known to treat these patients were asked to provide follow-up information, using a standardized protocol.

Results

We collected data for 52 patients (28 females, 24 males; 31.1 ± 17.1 years of age; baseline LDL-C: 571.9 ± 171.7 mg/dl). During a mean follow-up of 14.1 ± 7.3 years, there was a significant increase in the use of high-intensity statin and ezetimibe in combination with lipoprotein apheresis; in 6 patients, lomitapide was also added. Mean LDL-C achieved at nadir was 164.0 ± 85.1 mg/dl (–69.6% from baseline), with a better response in patients taking lomitapide (–88.3%). Overall, 23.1% of ARH patients reached LDL-C of <100 mg/dl. During follow-up, 26.9% of patients had incident ASCVD, and 11.5% had a new diagnosis of aortic valve stenosis (absolute risk per year of 1.9% and 0.8%, respectively). No incident stroke was observed. Age (≥30 years) and the presence of coronary artery disease at diagnosis were the major predictors of incident ASCVD.

Conclusions

Despite intensive treatment, LDL-C in ARH patients remains far from targets, and this translates into a poor long-term cardiovascular prognosis. Our data highlight the importance of an early diagnosis and treatment and confirm the fact that an effective treatment protocol for ARH is still lacking.

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Myocardial Dysfunction Following Brain Death

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Learning From Patients With Ultrarare Conditions: Cholesterol Hoof Beats

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PET/MR Imaging of Malondialdehyde-Acetaldehyde Epitopes With a Human Antibody Detects Clinically Relevant Atherothrombosis

AbstractBackground

Oxidation-specific epitopes (OSEs) are proinflammatory, and elevated levels in plasma predict cardiovascular events.

Objectives

The purpose of this study was to develop novel positron emission tomography (PET) probes to noninvasively image OSE-rich lesions.

Methods

An antigen-binding fragment (Fab) antibody library was constructed from human fetal cord blood. After multiple rounds of screening against malondialdehyde-acetaldehyde (MAA) epitopes, the Fab LA25 containing minimal nontemplated insertions in the CDR3 region was identified and characterized. In mice, pharmacokinetics, biodistribution, and plaque specificity studies were performed with Zirconium-89 (⁸⁹Zr)-labeled LA25. In rabbits, ⁸⁹Zr-LA25 was used in combination with an integrated clinical PET/magnetic resonance (MR) system. ¹⁸F-fluorodeoxyglucose PET and dynamic contrast-enhanced MR imaging were used to evaluate vessel wall inflammation and plaque neovascularization, respectively. Extensive ex vivo validation was carried out through a combination of gamma counting, near infrared fluorescence, autoradiography, immunohistochemistry, and immunofluorescence.

Results

LA25 bound specifically to MAA epitopes in advanced and ruptured human atherosclerotic plaques with accompanying thrombi and in debris from distal protection devices. PET/MR imaging 24 h after injection of ⁸⁹Zr-LA25 showed increased uptake in the abdominal aorta of atherosclerotic rabbits compared with nonatherosclerotic control rabbits, confirmed by ex vivo gamma counting and autoradiography. ¹⁸F-fluorodeoxyglucose PET, dynamic contrast-enhanced MR imaging, and near-infrared fluorescence signals were also significantly higher in atherosclerotic rabbit aortas compared with control aortas. Enhanced liver uptake was also noted in atherosclerotic animals, confirmed by the presence of MAA epitopes by immunostaining.

Conclusions

⁸⁹Zr-LA25 is a novel PET radiotracer that may allow noninvasive phenotyping of high-risk OSE-rich lesions.

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Cardiovascular Risk and Statin Eligibility of Young Adults After an MI: Partners YOUNG-MI Registry

AbstractBackground

Despite significant progress in primary prevention, the rate of MI has not declined in young adults.

Objectives

The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age.

Methods

The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation.

Results

Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001).

Conclusions

The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.

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Implications of Underlying Mechanisms for the Recognition and Management of Diabetic Cardiomyopathy

Abstract

Heart failure is a complex clinical syndrome, the incidence and prevalence of which is increased in diabetes mellitus, pre-diabetes, and obesity. Although this may arise from underlying coronary artery disease, it often occurs in the absence of significant major epicardial coronary disease, and most commonly manifests as heart failure with preserved ejection fraction. Despite epidemiological evidence linking diabetes to heart failure incidence and outcome, the presence of a distinct primary "diabetic" cardiomyopathy has been difficult to prove, because the link between diabetes and heart failure is confounded by hypertension, microvascular dysfunction, and autonomic neuropathy. Nonetheless, several mechanistic associations at systemic, cardiac, and cellular/molecular levels explain different aspects of myocardial dysfunction, including impaired cardiac relaxation, compliance, and contractility. This review seeks to describe recent advances and limitations pertinent to integrating molecular mechanisms, clinical screening, and potential therapeutic avenues for this condition.

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Identifying and Treating Young Patients at Risk for Cardiovascular Events

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Inorganic Nitrite Selectively Dilates Epicardial Coronary Arteries

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Impaired Recovery of Left Ventricular Function in Patients With Cardiomyopathy and Left Bundle Branch Block

AbstractBackground

Patients with left bundle branch block (LBBB) often respond to cardiac resynchronization therapy (CRT) with left ventricular ejection fraction (LVEF) improvement. Guideline-directed medical therapy (GDMT), not CRT, is first-line therapy for patients with reduced LVEF with LBBB. However, there are little data on how patients with reduced LVEF and LBBB respond to GDMT.

Objectives

This study examined patients with cardiomyopathy and sought to assess rates of LVEF improvement for patients with LBBB compared to other QRS morphologies.

Methods

Using data from the Duke Echocardiography Laboratory Database, the study identified patients with baseline electrocardiography and LVEF ≤35% who had a follow-up LVEF 3 to 6 months later. The study excluded patients with severe valve disease, a cardiac device, left ventricular assist device, or heart transplant. QRS morphology was classified as LBBB, QRS duration <120 ms (narrow QRS duration), or a wide QRS duration ≥120 ms but not LBBB. Analysis of variance testing compared mean change in LVEF among the 3 groups with adjustment for significant comorbidities and GDMT.

Results

There were 659 patients that met the criteria: 111 LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%). Adjusted mean increase in LVEF over 3 to 6 months in the 3 groups was 2.03%, 5.28%, and 8.00%, respectively (p < 0.0001). Results were similar when adjusted for interim revascularization and myocardial infarction. Comparison of mean LVEF improvement between patients with LBBB on GDMT and those not on GDMT showed virtually no difference (3.50% vs. 3.44%). The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB.

Conclusions

LBBB is associated with a smaller degree of LVEF improvement compared with other QRS morphologies, even with GDMT. Some patients with LBBB may benefit from CRT earlier than guidelines currently recommend.

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Left Ventricular Systolic Dysfunction in Transplantation Donor Hearts: Another Takotsubo Phenotype?

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Cardiomyopathy and Left Bundle Branch Block: A Farewell to Drugs?

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Reply: Transient Wall Motion Abnormalities in Donor Hearts With Improved Left Ventricular Systolic Dysfunction: Takotsubo Revisited?

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Measurement of warping angle in human rib graft; Experimental study

To determine the warping angle of the costal cartilage in vivo. A nasal framework reconstruction with a rib graft was performed in a total of 130 patients. After the cartilage specimens were prepared, the remaining grafts were used for the experimental study. The angle of warping in all grafts was measured at 0, 30, and 60 minutes, after 24 hours and after one week. In this study, 8 subgroups of graft thicknesses from central and peripheral groups, which were determined according to the perichondral distance of the grafts, were evaluated, and the warping angles of a total of 48 osteochondral and chondral grafts were individually measured. Three-way analysis of variance was used to compare the change in warping over time to detect differences in the grafts. Significant differences were not observed in the 1-3 mm thick grafts of peripheral and central origin before 30 minutes(P>0.05), although significant differences were observed in these groups for all time periods after 30 minutes(P0.05). In the central origin grafts thinner than 1 mm, significant differences were not observed in the warping angle for all time periods(P>0.05), although significant differences were observed in the same grafts of peripheral origin(P

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Improved Long-term Volume Retention of SVF-gel Grafting with Enhanced Angiogenesis and Adipogenesis

Background The apoptosis of mature adipocytes after fat grafting can result in chronic inflammation, absorption, and fibrosis, leading to unpredictable outcomes. Selective elimination of mature adipocytes may result in better outcomes and a different underlying retention mode. We previously developed a mature-adipocyte-free product, SVF-gel, derived from lipoaspirate, which eliminates adipocytes while preserving the stromal vascular fraction. This study investigated the retention and regeneration mode of SVF-gel grafting. Methods Nude mice were grafted with human-derived SVF-gel or Coleman fat. Detailed cellular events over 3 months were investigated histologically and immunohistochemically. Results The retention rate 90 days after grafting was significantly higher for SVF-gel grafts than for standard Coleman fat (82% ± 15% vs. 42% ± 9%, P

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Cheek Volumization and Nasolabial folds

The impression that cheek filling results in longitudinal shortening ("lift") of the skin and elevation of the nasolabial crease(NLC) or nasolabial fold (NLF) has become common within the facial injection community, but remains unsubstantiated. In this study, seventy-seven patients were evaluated pre and post-injection injection of the cheeks with an Hyaluronic Acid filler using a 3-dimensional camera system. A constant pattern of skin expansion away from the center of the injection and perpendicular to the surface of the skin was observed. A subgroup of 37 patients without differences in their pre and post-injection facial expression were analyzed by direct comparison and failed to demonstrate lateral traction (or "pull") on the intervening skin from the cheek injection site to the nasolabial crease. Further, there was no photographic difference in the nasolabial fold or nasolabial crease. The only patients who demonstrated photographic improvement of the medial face were those who had filler placed directly in the transition between the lateral nasolabial fold and cheek (nasojugal crease). It is likely that expanding the nasojugal crease is the direct visual cue that leads to perceived improvement in the nasolabial fold. No disclosures Corresponding author Val Lambros, MD , Clinical professor of Plastic Surgery, University of California Irvine, 2121 E Coast Highway #200, Corona Del Mar Ca 92925, Lambrosone@aol.com ©2018American Society of Plastic Surgeons

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Consequences of the F.D.A. Directed Moratorium on Silicone Gel Breast Implants – 1992-2006

The FDA silicone gel breast implant moratorium occurred 25 years ago. The immediate and long-term consequences of the moratorium are reviewed and assessed. Financial Disclosure Statement: Nothing to disclose. Corresponding Author: Norman M. Cole, M.D., 2208 Lake Ridge Drive, Belmont, NC 28012 USA ©2018American Society of Plastic Surgeons

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Commentary on Norm Cole’s “Moratorium Consequences.”

No abstract available

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“A fresh cadaver study on indocyanine green fluorescence lymphography: A new whole body imaging technique for investigating the superficial lymphatics.”

Background: Identification of the lymphatic system in cadavers is painstaking because lymphatic vessels have very thin walls and are transparent. Selection of appropriate contrast agents is a key factor for successfully visualizing the lymphatics. In this study, we introduce a new imaging technique of lymphatic mapping in whole body of fresh cadavers. Methods: Ten fresh human cadavers were used for this study. We injected 0.1 mL of indocyanine green fluorescence (ICG) solution subcutaneously at multiple spots along the watershed lines between lymphatic territories and hand and foot regions. After the body was scanned by the near infrared camera system, fluorescent tissues were harvested and histological examination was performed under the microscope equipped with the infrared camera system to confirm they were the lymphatics. Results: Subcutaneously injected ICG was immediately transported into the lymphatic vessels after gentle massage on the injection points. Sweeping massage along the lymphatic vessels facilitated ICG transport inside the lymphatic vessel to move towards the lymph nodes. The lymphatic system was visualized well in the whole body. Histological examinations confirmed that ICG was detected in the lymphatic lumens specifically, even when located far from the injected points. Conclusions: The lymphatic system could be visualized in whole body fresh cadavers, as in living bodies, using ICG fluorescence lymphography. Compatibility of ICG lymphography would be open to use cadaveric specimens for macro and microscopical analysis. Financial Disclosure Statement: The authors have no financial interest to declare in relation to the content of this article. Acknowledgments: This work was supported by the Japan Society for the Promotion of Science via Grants-in-Aid for Scientific Research (KAKENHI Award Number: 16K20358) and Research Foundation for the Electrotechnology of Chubu. Corresponding author: Akira Shinaoka, Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, 700-8558, Japan. Email: a-shinaoka@okayama-u.ac.jp ©2018American Society of Plastic Surgeons

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The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics

Background: Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most common causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers. Methods: This was a retrospective cross-sectional analysis and chart review at the departments of ophthalmology and neurology at the University Hospital Zurich (USZ), University of Zürich, Switzerland, and the University of Utah (UU), USA. Data were analyzed from January 2012 to December 2013. We included patients aged 18 years or older presenting with eye pain as a major complaint. Results: Two thousand six hundred three patient charts met inclusion criteria; 742 were included from USZ and 1,861 were included from UU. Of these, 2,407 had been seen in an ophthalmology clinic and 196 had been seen in a neurology clinic. Inflammatory eye disease (conjunctivitis, blepharitis, keratitis, uveitis, dry eye, chalazion, and scleritis) was the underlying cause of eye pain in 1,801 (69.1%) of all patients analyzed. Although only 71 (3%) of 2,407 patients had migraine diagnosed in an ophthalmology clinic as the cause of eye pain, migraine was the predominant cause of eye pain in the neurology clinics (100/196; 51%). Other causes of eye pain in the neurology clinics included optic neuritis (44 patients), trigeminal neuralgia, and other cranial nerve disorders (8 patients). Conclusions: Eye pain may be associated with a number of different causes, some benign and others sight- or life-threatening. Because patients with eye pain may present to either a neurology or an ophthalmology clinic and because the causes of eye pain may be primarily ophthalmic or neurologic, the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties. Address correspondence to Kathleen B. Digre, MD, Johan A Moran Eye Center, University of Utah Health Sciences Center, 65 N Mario Capecchi Drive, Salt Lake City, UT 84132; E-mail: Kathleen.digre@hsc.utah.edu This investigation was supported by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. Presented at the Annual Meeting of the North American Neuro-Ophthalmology Society, March 1, 2016, Tucson, AZ; Annual Scientific Meeting of the American Headache Society, June 11, 2016, San Diego, CA. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (http://ift.tt/2BFTkP1). R. C. Bowen and J. Koeppel contributed equally to the manuscript and should both be recognized as first authors. © 2018 by North American Neuro-Ophthalmology Society

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Invited Commentary: Evaluation of Horner Syndrome in the MRI Era

This Invited Commentary discusses the following article: Sadaka A, Schockman SL, Golnik KC. Evaluation of Horner syndrome in the MRI era. J Neuroophthalmol. 2017;37:268–272. Background: To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging. Methods: A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Imaging was obtained based on pharmacologic localization and/or clinical evaluation. The etiology of HS and the yield of imaging were determined in all subgroups. Results: Imaging showed causative lesions in 24 of 179 (12.84%) imaged patients with HS, and 13 (69.0%) were determined "idiopathic." Of the patients who underwent testing with hydroxyamphetamine drops (132 patients), 86 had a postganglionic localization with an imaging yield of 8.1%, and 46 had preganglionic cause with an imaging yield of 21.7%. Fifty-three patients (26.5%) never noticed ptosis/anisocoria before examination, and the imaging yield in this subgroup was 2.8%. Eighteen of the 200 patients (9.0%) had serious pathology, including carotid artery dissection, brain, or neck mass, and 6 of these (31.6%) had acute symptoms and/or pain. Conclusion: HS is most often idiopathic with serious pathology being relatively infrequent. When determining etiology, the absence of symptoms is not predictive of the pathology. However, acute onset of symptoms and/or pain are possible indicators for serious pathology. Localizing the lesion using hydroxyamphetamine drops whenever obtainable and available is still an efficient way to target imaging evaluation. Address correspondence to Aki Kawasaki, MD, Department of Neuro-Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules Gonin, Avenue de France 15, Lausanne, 1004, Lausanne, Switzerland; E-mail: aki.kawasaki@fa2.ch The author reports no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

BACKGROUND Prasugrel is a thienopyridine that inhibits platelet aggregation more rapidly and effectively than clopidogrel, with an increased bleeding risk. OBJECTIVE The current study aimed to evaluate the efficacy of three nonspecific haemostatic drugs – recombinant activated factor VII (rFVIIa), tranexamic acid and desmopressin (DDAVP) – to limit blood loss after administration of prasugrel in a rabbit model of bleeding while also evaluating any prothrombotic effects. DESIGN Randomised, placebo-controlled study. SETTING Faculty of Medicine, University of Geneva, Switzerland, in 2013. ANIMALS Anaesthetised and artificially ventilated rabbits (n=56). INTERVENTIONS Animals were randomly allocated to one of five groups: control (placebo–placebo), prasugrel–placebo, rFVIIa (prasugrel–rFVIIa 150 μg kg−1), tranexamic acid (prasugrel–tranexamic acid 20 mg kg−1) or DDAVP (prasugrel–DDAVP 1 μg kg−1). Two hours after an oral prasugrel loading dose (4 mg kg−1), a stenosis and an injury were inflicted on the carotid artery to induce cyclic flow reductions (CFRs) due to thrombosis. Haemostatic drugs were administered during the ensuing observation period. MAIN OUTCOME MEASURES Standardised hepatosplenic sections were performed to evaluate the primary endpoint of blood loss, monitored for 15 min. Ear-immersion bleeding time and incidence of CFRs were secondary endpoints. RESULTS Prasugrel decreased ADP-induced platelet aggregation (light transmission method) from 66 ± 4% (mean ± SD) to 41 ± 7% (P 

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Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases

BACKGROUND Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery. DESIGN Retrospective cohort study. SETTING The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013. MAIN OUTCOME MEASURES Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications. RESULTS A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%). CONCLUSION Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories. Correspondence to Andrie C. Westerkamp, MD, PhD, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Box 30.001, 9700 RB Groningen, The Netherlands Tel: +31 50 3613155; fax: +31 50 3613763; e-mail: ac.westerkamp@umcg.nl © 2018 European Society of Anaesthesiology

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Prevalence of metabolic syndrome in children with moderate to severe psoriasis treated with TNF inhibitors in comparison to conventional agents

Abstract

Association of childhood psoriasis with metabolic syndrome has not been studied well. TNF-alfa contributes to the inflammation seen in metabolic syndrome, and recently etanercept has shown to reduce the levels of inflammatory markers. Assessment of prevalence of metabolic syndrome in juvenile psoriasis patients in Kuwait. We included 236 patients with moderate to severe psoriasis below 18 years treated for at least 24 weeks with TNF inhibitors (Group A), and equal number of age and sex matched cases treated with conventional medications (Group B). The metabolic syndrome (MBS) was defined according to the International Diabetes Foundation (IDF 2007 criteria for children). Increased waist circumference was seen in 56.77% of cases in Group A. Triglyceridemia was less frequent in Group A. MBS was higher in Group B [41·52% vs. 50·42%, odds ratio (OR) 1·76, 95% CI 1.19–2.41; p = .005]. Psoriasis is associated with higher prevalence of metabolic syndrome in children. Six months of anti TNF treatment showed lesser association with metabolic syndrome. With fasting blood glucose, and serum TG seen in significantly lesser number of patients in this group.

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Clinical evaluation of a novel fractional radiofrequency device for hair growth: Fractional radiofrequency for hair growth stimulation

Abstract

AGA is a common disorder. Different treatments are available to prevent hair loss and achieve hair growth with variable results. The purpose of the present study was to evaluate the efficacy and safety of a novel fractional radiofrequency (RF) device (HairLux, Innogen Technologies Ltd., Yokneam, Israel), to prevent hair loss and induce hair growth. Twenty-five patients received 10 fractional RF treatments every 2 weeks, and were followed up 2 months after the last treatment. All patients were evaluated by global photography. In 10 patients, blinded manual hair counts were performed. Patients demonstrated less hair shedding, fuller hair, and faster hair growth. There was an average increase of 31.6% in hair density (based on hair counts) and 18% increase in hair shaft thickness. All subjects tolerated the treatments well. The HairLux device is effective and safe for hair growth stimulation in AGA. Ten treatment sessions are recommended to maximize results.

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Ring Ring Ring! Characterising Telephone Interruptions During Radiology Reporting and How to Reduce These

Publication date: Available online 11 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Christopher Watura, Dominic Blunt, Dimitri Amiras
BackgroundTelephone calls remain one of the most frequent interruptions in radiology reporting rooms, despite modern electronic order communication systems. A call received by a radiology trainee during the hour before completing a report may increase the chance of a discrepancy by 12%.AimTo characterise telephone calls to radiology reporting rooms and identify ways to reduce these interruptions.Methods and MaterialsAn observational study over five working days (10 programmed activity reporting sessions equivalent) was conducted across two large acute teaching hospital reporting rooms. Radiologists were requested to record all calls between 9a.m–5p.m on a pre-prepared Excel proforma and indicate their initial rating of call appropriateness.Results288 calls recorded, 92% (266/288) interrupted reporting. Reasons for calls were 48% (139/288) ask for a request to be vetted, 17% (50/288) ask for a study to be reported, 17% (45/288) 'other′, 7% (19/288) discuss choice of study, 6% (16/288) review a report, 3% (9/288) wrong number, 2% (7/288) returning a bleep and 1% (3/288) provide further explanation in addition to the electronic request form.ConclusionRadiologists and referrers remain over reliant on telephone interruptions for their workflow. Attempts to educate referrers previously reduced calls to a CT reporting room by 28%. Our recommendations include (i) defining protected activities, (ii) adhering to fully electronic requesting and vetting processes, other than in time critical or exceptional circumstances, (iii) electronic critical report alerts and review of report priority triaging to reduce calls for reports, (iii) revising duty radiologist timetables to tackle non-reporting responsibilities, (iv) improving new doctor induction in the organisation to improve radiology request practice.



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CT Imaging of Non-Neoplastic and Neoplastic Benign Gastric Disease

Publication date: Available online 11 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Maria Zulfiqar, Anup Shetty, Vilaas Shetty, Christine Menias




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Online Interactive Case-based Instruction in Prostate MRI Interpretation using PI-RADS Version 2: Impact for Novice Readers

Publication date: Available online 10 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Andrew B. Rosenkrantz, Jovan Begovic, Antonio Pires, Eugene Won, Samir S. Taneja, James S. Babb
PurposeTo assess the impact on reader performance of an interactive case-based online tutorial for prostate MRI interpretation using PI-RADS.MethodsAn educational website was developed incorporating scrollable multi-parametric prostate MRI examinations with annotated solutions based on PI-RADS version 2. Three second-year radiology residents evaluated a separate set of 60 prostate MRI examinations both before and after review of the online case material, identifying and scoring dominant lesions. These 60 examinations included 30 benign cases and 30 cases with a dominant lesion demonstrating Gleason score ≥3+4 tumor on fusion-targeted biopsy. The readers′ pooled performance was compared between the two sessions using logistic regression and Wilcoxon signed rank tests.ResultsAll readers completed the online material within four-hours. Review of the online material significantly improved sensitivity (from 57.8% to 73.3%, p=0.003) and negative predictive value (from 69.2% to 78.2%, p=0.049), but not specificity (from 70.0% to 67.8%, p=0.692) or positive predictive value (from 59.6% to 64.7%, p=0.389). Reader confidence (1–10 scale; 10=maximal confidence) also improved significantly (from 5.6±2.7 to 6.3±2.6, p0.026). However, accuracy of assigned PI-RADS scores did not improve significantly (from 45.5% to 53.3%, p=0.149).ConclusionAn online interactive case-based website in prostate MRI interpretation improved novice readers′ sensitivity and NPV for tumor detection, as well as readers′ confidence. This online material may serve as a resource complementing existing traditional methods of instruction by providing a more flexible educational experience among a larger volume of learners. However, further more targeted educational initiatives regarding the proper application of PI-RADS remain warranted.



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Male Breast MRI: When is it Helpful? Our Experience over the Last Decade

Publication date: Available online 10 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Kyungmin Shin, Sarah Martaindale, Gary J. Whitman
Currently, there are no clear indications or guidelines for performing breast MRI in male patients diagnosed with primary breast cancer. The literature is also very limited on the utilization of breast MRI in male patients. Although it is not common or recommended as a routine clinical practice to perform breast MRI in male patients even in the setting of a diagnosis of breast cancer, there are few instances where MRI may help clinicians and surgeons. With a comprehensive review of cases that was performed at our institution over the last 10 years, the readers may achieve better understanding of when it may be helpful to perform breast MRI in male patients.



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Radiographic Cobb Angle: A Feature of Congenital Lumbar Spine Stenosis

Publication date: Available online 11 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Falgun H. Chokshi, Nadja Kadom, Nishant Dwivedi, Suprateek Kundu, Ahmed Y. Moussa, Chadi Tannoury, Tony Tannoury
PurposeA low cost, reproducible radiographic method of diagnosing congenital lumbar spinal stenosis (CLSS) is lacking. We hypothesized that the Cobb angle for lumbar lordosis would be smaller in patients with CLSS, based on observations in our spine clinic patient population. Here, we compared lumbar lordosis Cobb angles with the radiographic ratio method in patients with normal spine imaging, degenerative spinal stenosis, and with CLSS.Materials & MethodsOrthopedic surgeons categorized patients with low back pain as "Normal", "Degenerative spinal stenosis", and "CLSS" based on clinical presentation and findings on lumbar magnetic resonance imaging (MRI). We included 30 patients from each cohort who had undergone lateral lumbar spine radiographs and lumbar MRI. For each lateral radiograph, two measurement methods were used: 1) 4-line lumbosacral Cobb angle between L2-S1 and 2) the ratio of the anteroposterior (AP) vertebral body (VB) diameter and spinal canal AP diameter at the L3 level. We performed logistic regression analyses of CLSS prediction by Cobb angle vs. the ratio method in all three cohorts. Covariates included age, gender, and body mass index (BMI).ResultsThe radiographic Cobb angles were smaller in CLSS patients when compared to the Degenerative Disease and Normal cohorts: A smaller radiographic Cobb angle showed higher odds ratio (OR) of predicting CLSS diagnosis compared to the radiographic ratio when compared with Degenerative Disease (OR 0.28, 95% CI 0.11–0.78, p=0.01) and when compared with the Normal cohort (OR 0.46, 95% CI 0.24–0.92, p=0.03). Radiographic ratio measurements showed no difference between the three cohorts (p=0.12). CLSS was associated with male gender (p=0.04), younger age (p=0.01), and higher BMI (p=0.01).ConclusionThe radiographic Cobb angle method for lumbar lordosis may be useful for raising the possibility of CLSS as the diagnosis.



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Issue Information

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Surgical stress response and promotion of metastasis in colorectal cancer: a complex and heterogeneous process

Abstract

Surgery remains the curative treatment modality for colorectal cancer in all stages, including stage IV with resectable liver metastasis. There is emerging evidence that the stress response caused by surgery as well as other perioperative therapies such as anesthesia and analgesia may promote growth of pre-existing micro-metastasis or potentially initiate tumor dissemination. Therapeutically targeting the perioperative period may therefore reduce the effect that surgical treatments have in promoting metastases, for example by combining β-adrenergic receptor antagonists and cyclooxygenase-2 (COX-2) inhibitors in the perioperative setting. In this paper, we highlight some of the mechanisms that may underlie surgery-related metastatic development in colorectal cancer. These include direct tumor spillage at the time of surgery, suppression of the anti-tumor immune response, direct stimulatory effects on tumor cells, and activation of the coagulation system. We summarize in more detail results that support a role for catecholamines as major drivers of the pro-metastatic effect induced by the surgical stress response, predominantly through activation of β-adrenergic signaling. Additionally, we argue that an improved understanding of surgical stress-induced dissemination, and more specifically whether it impacts on the level and nature of heterogeneity within residual tumor cells, would contribute to the successful clinical targeting of this process. Finally, we provide a proof-of-concept demonstration that ex-vivo analyses of colorectal cancer patient-derived samples using RGB-labeling technology can provide important insights into the heterogeneous sensitivity of tumor cells to stress signals. This suggests that intra-tumor heterogeneity is likely to influence the efficacy of perioperative β-adrenergic receptor and COX-2 inhibition, and that ex-vivo characterization of heterogeneous stress response in tumor samples can synergize with other models to optimize perioperative treatments and further improve outcome in colorectal and other solid cancers.

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A photonumeric scale for the assessment of atrophic facial photodamage

Summary

Background

Photonumeric scales have consistently shown superiority over descriptive equivalents. They have the advantage of providing a consistent visual frame of reference by minimising variability in perception and subjectivity. A photonumeric scale to assess hypertrophic facial photodamage already exists. However, there is currently no objective measure for atrophic facial photodamage. To address this, we have devised a nine-point photonumeric standardised scale.

Objectives

To design, test and validate a photonumeric scale for the assessment of atrophic facial photodamage against a descriptive scale for the same indication.

Methods

A pool of 393 facial photographs (en face and 45º oblique) from 131 individuals with atrophic facial photodamage was created. Five photographic standards were selected and assigned grades 0 through 8, where 0 is no photodamage and 8 is severe atrophic photodamage, thus making a nine-point scale. Twenty photographs spanning the entire range of values were selected to test the scale. Testing was performed alongside a descriptive equivalent. A panel of 10 dermatologists, 10 non-dermatology clinicians and 14 dermatology scientists marked the two scales; marking was repeated one week later.

Results

There was a significantly greater agreement between the graders using the photonumeric scale than the descriptive scale (kappa values 0.71 and 0.37 with standardised errors of 0.57 and 0.17 respectively) with no significant difference in repeatability between the two methods (p < 0.05).

Conclusions

The study describes a new photonumeric scale for atrophic photodamage. This would be a useful adjunct in both the clinical and research settings.

This article is protected by copyright. All rights reserved.

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Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with demodex and increased IL-17 levels?

Abstract

de Bruin-Weller et al., reported alarmingly high rates of unspecified and allergic conjunctivitis in trial patients with moderate-to-severe atopic dermatitis (AD) who underwent treatment with dupilumab; an antibody that inhibits signaling of IL-4 and IL-13.¹ Importantly, the exact pathogenic mechanism behind incident conjunctivitis in dupilumab-treated patients is unclear. While all, but one case, were considered to be of mild or moderate severity, and most resolved after treatment discontinuation, ocular complications may ultimately deprive AD patients from effective treatment with dupilumab. For these reasons, the medical community needs to rapidly identify the pathogenic mechanism.

This article is protected by copyright. All rights reserved.

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Foreign body removal assisted by an intraoral ultrasound probe

Abstract

Ultrasonography has recently been applied to the field of oral and maxillofacial surgery because of its noninvasiveness and ease of use. However, traditional transducers are not used in the intraoral area because of their large size. A novel intraoral transducer was introduced with size, volume, and axis modifications. This new transducer allows the surgeon to approach the intraoral region during dental procedures. This report describes a case of successful removal of a foreign body using the newly developed intraoral ultrasound probe. Precise localization and minimally invasive removal of the foreign body using the intraoral transducer were simultaneously conducted. Because of its many advantages, this intraoral ultrasound transducer has the potential to be applied in oral and maxillofacial surgery.

http://ift.tt/2r6vP11

Agricultural non-point source pollution management in a reservoir watershed based on ecological network analysis of soil nitrogen cycling

Abstract

The Miyun Reservoir plays a pivotal role in providing drinking water for the city of Beijing. In this research, ecological network analysis and scenario analysis were integrated to explore soil nitrogen cycling of chestnut and Chinese pine forests in the upper basin of the Miyun Reservoir, as well as to seek favorable fertilization modes to reduce agricultural non-point source pollution. Ecological network analysis results showed that (1) the turnover time was 0.04 to 0.37 year in the NH₄⁺ compartment and were 15.78 to 138.36 years in the organic N compartment; (2) the Finn cycling index and the ratio of indirect to direct flow were 0.73 and 11.92 for the chestnut forest model, respectively. Those of the Chinese pine forest model were 0.88 and 29.23, respectively; and (3) in the chestnut forest model, NO₃⁻ accounted for 96% of the total soil nitrogen loss, followed by plant N (2%), NH₄⁺ (1%), and organic N (1%). In the Chinese pine forest, NH₄⁺ accounted for 56% of the total soil nitrogen loss, followed by organic N (34%) and NO₃⁻ (10%). Fertilization mode was identified as the main factor affecting soil N export. To minimize NH₄⁺ and NO₃⁻ outputs while maintaining the current plant yield (i.e., 7.85e0 kg N/year), a fertilization mode of 162.50 kg N/year offered by manure should be adopted. Whereas, to achieve a maximum plant yield (i.e., 3.35e1 kg N/year) while reducing NH₄⁺ and NO₃⁻ outputs, a fertilization mode of 325.00 kg N/year offered by manure should be utilized. This research is of wide suitability to support agricultural non-point source pollution management at the watershed scale.

http://ift.tt/2DdtDuj

Pustular psoriasis and related pustular skin diseases

Summary

Patients with pustular psoriasis or related pustular diseases may have genetic abnormalities impairing the function of key players of the innate skin immune system. Recently, identification of these abnormalities has changed the paradigm of several of these diseases. These include generalized pustular psoriasis, palmoplantar pustular psoriasis and acrodermatitis continua of Hallopeau, and also drug-induced acute exanthematous generalized pustular eruption. Identified mutations in IL36RN, CARD14 and AP1S3 in different groups of patients lead to enhanced inflammatory cascade in several cellular subtypes including keratinocytes, and to the recruitment and activation of neutrophils and macrophages. These insights have unveiled pathophysiological features that shift the existing paradigms and emphasize the autoinflammatory nature of skin pustular disorders. They also highlight the crucial role of the innate immune system across entities belonging to the psoriasis disease spectrum, allowing identification of new appealing therapeutic targets.

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Vitiligo-like lesions and immune checkpoint inhibition therapy: is it truly an adverse event exclusive to patients with melanoma?

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