Scholar : ΑΠΝΟΙΑ - νέα αποτελέσματα

[PDF] Νεογνικός ίκτερος και νοσηλευτικές παρεμβάσεις

Γ Μπακογιάννη, Ι Πάππου - 2018

Page 1. ΑΝΩΤΑΤΟ ΤΕΦΝΟΛΟΓΙΚΟ ΙΔΡΥΜΑ Τ.Ε.Ι. ΗΠΕΙΡΟΥ ΢ΧΟΛΗ
ΕΠΑΓΓΕΛΜΑΣΩΝ ΤΓΕΙΑ΢ & ΠΡΟΝΟΙΑ΢ "ΣΜΗΜΑ ΝΟ΢ΗΛΕΤΣΙΚΗ΢"
ΠΣΤΥΙΑΚΗ ΓΡΓΑ΢ΙΑ ΘΓΜΑ: ΝΓΟΓΝΙΚΟ΢ ΙΚΣΓΡΟ΢ ΚΑΙ ΝΟ΢ΗΛΓΤΣΙΚΓ΢ …

 

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Scholar : Εμφυτευματα - νέα αποτελέσμα

[PDF] Το θεατρικό παιχνίδι στην προσχολική ηλικία

Ε Γκόγκου, Α Γκουτζιομήτρου, Γ Θεοχάρη… - 2018

Page 1. ΤΕΙ ΗΠΕΙΡΟΥ ΣΧΟΛΗ ΕΠΑΓΓΕΛΜΑΤΩΝ ΥΓΕΙΑΣ ΚΑΙ ΠΡΟΝΟΙΑΣ ΠΡΟΣΧΟΛΙΚΗΣ
ΑΓΩΓΗΣ ΠΤΥΧΙΑΚΗ ΕΡΓΑΣΙΑ «ΤΟ ΘΕΑΤΡΙΚΟ ΠΑΙΧΝΙΔΙ ΣΤΗΝ ΠΡΟΣΧΟΛΙΚΗ ΗΛΙΚΙΑ»
Ονοματεπώνυμο φοιτητή: Ειρήνη Γκόγκου:Α.Μ 15081 Ανθή Γκουντζιομήτρου: Α.Μ 14526 …

 

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Scholar : Undersea "Hyperbaric Medicine" - νέα αποτελέσματα

Relating Hyperbaric Oxygen Therapy and Barotraumatism Occurrence: A Linear Model Approach

MF Teodoro, SS Teles, MC Marques, FG Guerreiro - International Conference on …, 2018

… United States Undersea and Hyperbaric Medical Society (UHMS) [10], and
in 1971 the European Underwater Baromedical Society (EUBS) was created
in Europe with the aim of contributing to the advancement of science in the …

OTI–Ossigenoterapia iperbarica: definizione scientifica e bibliografia

M MENU

… Med Sub Hyp 1984; 3:100-4. 2. Thom SR. Effects of hyperoxia on neutrophil adhesion.
Undersea Hyperb Med 2004; 31:123-31. 3 … enhancement. In: Wattel F, ed. Handbook
of Hyperbaric Medicine. Milan: Springer-Verlag, 1996:485-597 …

 

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Scholar : ΔΥΣΠΝΟΙΑ - νέα αποτελέσματα

[PDF] Καρκίνος ουροδόχου κύστεως και νοσηλευτικές παρεμβάσεις.

Μ Δρόσος - 2018

Page 1. ΤΕΧΝΟΛΟΓΙΚΟ ΕΚΠΑΙΔΕΥΤΙΚΟ ΙΔΡΥΜΑ ΗΠΕΙΡΟΥ ΣΧΟΛΗ
ΕΠΑΓΓΕΛΜΑΤΩΝ ΥΓΕΙΑΣ ΚΑΙ ΠΡΟΝΟΙΑΣ ΤΜΗΜΑ ΝΟΣΗΛΕΥΤΙΚΗΣ "Καρκίνος
Ουροδόχου Κύστεως και Νοσηλευτικές Παρεμβάσεις" Φοιτητής: Μάριος …

 

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Scholar : ΨΕΥΔΟΜΟΝΑΔΑ - νέα αποτελέσμα

[PDF] Μελέτη σύγχρονων μη θερμικών τεχνολογιών επεξεργασίας και συντήρησης τροφίμων

Μ Χάμου - 2018

Page 1. Αθήνα, 2018 Γεωπονικό Πανεπιστήμιο Αθηνών Τμήμα Επιστήμης & Διατροφής
του Ανθρώπου Εργαστήριο Μηχανικής Τροφίμων, Επεξεργασίας & Συντήρησης
Γεωργικών Προϊόντων Πρόγραμμα Μεταπτυχιακών Σπουδών …

 

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Scholar : ΑΚΤΙΝΟΘΕΡΑΠΕΙΑ - νέα αποτελέ

[PDF] Καρκίνος ουροδόχου κύστεως και νοσηλευτικές παρεμβάσεις.

Μ Δρόσος - 2018

… ουροδόχου κύστης, με ή χωρίς λεμφαδενικό καθαρισμό και πιθανά σε συμπληρωματική
χημειοθεραπεία ή ακτινοθεραπεία … Ακτινοβολία της πυέλου Οι γυναίκες που
υπεβλήθησαν σε ακτινοθεραπεία για καρκίνο του τραχήλου της …

 

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Scholar : ΦΩΝΗΤΙΚΕΣ ΧΟΡΔΕΣ - νέα αποτελέσματα

[PDF] Το θεατρικό παιχνίδι στην προσχολική ηλικία

Ε Γκόγκου, Α Γκουτζιομήτρου, Γ Θεοχάρη… - 2018

Page 1. ΤΕΙ ΗΠΕΙΡΟΥ ΣΧΟΛΗ ΕΠΑΓΓΕΛΜΑΤΩΝ ΥΓΕΙΑΣ ΚΑΙ ΠΡΟΝΟΙΑΣ ΠΡΟΣΧΟΛΙΚΗΣ
ΑΓΩΓΗΣ ΠΤΥΧΙΑΚΗ ΕΡΓΑΣΙΑ «ΤΟ ΘΕΑΤΡΙΚΟ ΠΑΙΧΝΙΔΙ ΣΤΗΝ ΠΡΟΣΧΟΛΙΚΗ ΗΛΙΚΙΑ»
Ονοματεπώνυμο φοιτητή: Ειρήνη Γκόγκου:Α.Μ 15081 Ανθή Γκουντζιομήτρου: Α.Μ 14526 …

[PDF] Καινοτόμος Μουσική Αγωγή. Η περίπτωση της διαδικτυακής εφαρμογής.«Design your own opera" Hansel & Gretel"».

Π Καποδίστρια - 2018

… Η δημιουργική έκφραση του παιδιού μέσα από τη μουσική. • Η απόκτηση δεξιοτήτων
μουσικής έκφρασης μέσα από τη χρήση του σώματος, της φωνής και των μουσικών
οργάνων … Ο Dalcroze έδωσε έμφαση σε ακουστικές και φωνητικές ασκήσεις και στο τραγούδι …

 

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Scholar : ΠΡΟΣΩΠΙΚΟ ΝΕΥΡΟ - νέα αποτελέσματα

[PDF] Καρκίνος ουροδόχου κύστεως και νοσηλευτικές παρεμβάσεις.

Μ Δρόσος - 2018

… Αιματώνεται από την άνω, μέση και κατώτερη κυστική αρτηρία, παροχετεύεται από πολλές
φλέβες και λεμφαγγεία και νευρώνεται από κλάδους του τρίτου και τέταρτου ιερού νεύρου
του υπογάστριου πλέγματος. Εικόνα 6. Ανατομία της ουροδόχου κύστης …

 

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Brazilin induces FOXO3A-dependent autophagic cell death by disturbing calcium homeostasis in osteosarcoma cells

Abstract

Purpose

Osteosarcoma is a common primary malignant bone tumour, and its cure rate has stagnated over the past 25–30 years. Brazilin, a purified natural product from sappan wood (Caesalpinia sappan L.), has been proved to possess potent anti-cancer effects. In this study, we investigated the anti-cancer effect of brazilin on human osteosarcoma and elucidated the underlying mechanisms.

Methods

We exposed MG-63 cells to different concentrations of brazilin (5, 10 and 20 µM) for 24 h. Western blotting, immunocytofluorescence, luciferase reporter assays, and RT-PCR were used to evaluate whether brazilin activates FOXO family-dependent autophagy.

Results

Brazilin increased autophagic flux in the human osteosarcoma cell line MG-63, as evidenced by the upregulation of LC3-II and the downregulation of P62/SQSTM1. Moreover, the pharmacological or genetic blockade of autophagy decreased brazilin-induced cell death, indicating that brazilin triggered autophagic cell death in MG-63 cells. Specifically, brazilin induced FOXO3A(Ser7) phosphorylation, activated FOXO3A nuclear translocation and increased FOXO3A reporter activity, which contributed to the expression of autophagy-related genes and subsequently initiated autophagic cell death in MG-63 cells. Importantly, the increased expression and nuclear translocation of FOXO3A were tightly related to the disturbance of calcium homeostasis, which could be prevented by chelating intracellular calcium.

Conclusions

Taken together, these data demonstrate that brazilin induces osteosarcoma cell death by inducing excessive autophagy, which is mediated through the Ca²⁺-FOXO3A pathway. Our study provides a new anti-tumour mechanism for brazilin treatment in osteosarcoma patients.

https://ift.tt/2L0qGjE

Efficacy and safety of liposome-paclitaxel and carboplatin based concurrent chemoradiotherapy for locally advanced lung squamous cell carcinoma

Abstract

Objective

The aim of this study was to evaluate the efficacy and toxicities of liposome-paclitaxel and carboplatin concurrent with radiotherapy for locally advanced lung squamous cell carcinoma (LSCC).

Methods

The clinical data of 38 patients with locally advanced LSCC treated with liposome-paclitaxel based concurrent chemoradiotherapy were collected and reviewed. The overall response, toxicities, progression-free survival and overall survival were analyzed with SPSS software.

Result

The efficacy of treatment was classified as complete remission in 4 cases (10.5%), partial remission in 22 cases (57.9%) and stable disease in 12 cases (31.6%). The objective response rate was 68.4% (26/38). The most common types of hematological toxicities were anemia (65.7%) and leukopenia (57.9%), but all the events were transient. No paclitaxel-induced allergic reactions occurred during the treatment. The median PFS and OS time were 17.0 and 29.0 months.

Conclusions

Liposome-paclitaxel and carboplatin concurrent with radiotherapy showed a significant antitumor effect to LSCC with manageable toxicities. Further clinical investigation are warranted to evaluate the efficacy of this regimen.

https://ift.tt/2L6YVTD

A phase I study of panobinostat in pediatric patients with refractory solid tumors, including CNS tumors

Abstract

Purpose

This was an open label, phase I (3 + 3 design), multi-centre study evaluating panobinostat in pediatric patients with refractory solid tumors.

Methods

Primary endpoints were to establish MTD, define and describe associated toxicities, including dose limiting toxicities (DLT) and to characterize its pharmacokinetics (PK). Secondary endpoints included assessing the anti-tumour activity of panobinostat, and its biologic activity, by measuring acetylation of histones in peripheral blood mononuclear cells.

Results

Nine patients were enrolled and treated with intravenous panobinostat at a dosing level of 15 mg/m² which was tolerated. Six were evaluable for adverse events. Two (33%) patients experienced Grade 3–4 thrombocytopenia, 1 (17%) experienced Grade 3 anemia, and 2 (33%) experienced Grade 3 neutropenia. Grade 4 drug related pain occurred in 2 (33%) of the patients studied. Two (33%) patients experienced a Grade 2 QTcF change (0.478 ± 0.006 ms). One cardiac DLT (T wave changes) was reported. PK values for 15 mg/m² (n = 9) dosing were: T_max 0.8 h, C_max 235.2 ng/mL, AUC_0–t 346.8 h ng/mL and t_1/2 7.3 h. Panobinostat significantly induced acetylation of histone H3 and H4 at all time points measured when compared to pre-treatment samples (p < 0.05). Pooled quantitative Western blot data confirmed that panobinostat significantly induced acetylation of histone H4 at 6 h (p < 0.01), 24 h (p < 0.01) and 28–70 h (p < 0.01) post dose.

Conclusion

A significant biological effect of panobinostat, measured by acetylation status of histone H3 and H4, was achieved at a dose of 15 mg/m². PK data and drug tolerability at 15 mg/m² was similar to that previously published.

https://ift.tt/2KYoklh

Randomized, prospective, comparative study on the effects and safety of sorafenib vs. hepatic arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein tumor thrombosis

Abstract

Background/aims

Treatment responses of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remain unacceptably low and treatment modalities are limited. We compared the efficacy and safety of sorafenib and hepatic arterial infusion chemotherapy (HAIC).

Methods

In this randomized, prospective, comparative study, data on 58 patients with advanced HCC with PVTT, with Child–Turcotte–Pugh (CTP) scores of 5–7, were collected from six university hospitals between January 2013 and October 2015. Twenty-nine patients were treated with sorafenib and twenty-nine with HAIC.

Results

The median overall survival (OS) and time to progression (TTP) were significantly longer in the HAIC group than in the sorafenib group (14.9 vs.7.2 months, p = 0.012 and 4.4 vs. 2.7 months, p = 0.010). The objective response (OR) rates were 27.6 and 3.4% in the HAIC and sorafenib groups, respectively (p = 0.001). In univariate analysis, sex, main portal vein invasion and treatment modality were significant prognostic factors of OS (p = 0.044, 0.040, 0.015), whereas cause of HCC, tumor number, tumor location and treatment modality were significant prognostic factors of TTP (p = 0.040, 0.002, 0.034, 0.014). In multivariate analysis, sex and treatment modality were significant prognostic factors of OS (p = 0.008, 0.005), whereas cause of HCC, tumor number, tumor location and treatment modality were significant prognostic factors of TTP (p = 0.038, 0.038, 0.015, 0.011). Major complications included hyperbilirubinemia (44.8%), AST elevation (34.5%), ascites (13.8%) and catheter-related complications (3.4%) in the HAIC group and hyperbilirubinemia (34.5%), hand-foot syndrome (31.0%) and AST elevation (27.6%) in the sorafenib group.

Conclusions

For managing advanced HCC with PVTT, HAIC may be a valuable treatment modality.

https://ift.tt/2L4542I

An open-label, multicenter, phase Ib study investigating the effect of apalutamide on ventricular repolarization in men with castration-resistant prostate cancer

Abstract

Purpose

Phase Ib study evaluating the effect of apalutamide, at therapeutic exposure, on ventricular repolarization by applying time-matched pharmacokinetics and electrocardiography (ECG) in patients with castration-resistant prostate cancer. Safety of daily apalutamide was also assessed.

Methods

Patients received 240 mg oral apalutamide daily. Time-matched ECGs were collected via continuous 12-lead Holter recording before apalutamide (Day − 1) and on Days 1 and 57 (Cycle 3 Day 1). Pharmacokinetics of apalutamide were assessed on Days 1 and 57 at matched time points of ECG collection. QT interval was corrected for heart rate using Fridericia correction (QTcF). The primary endpoint was the maximum mean change in QTcF (ΔQTcF) from baseline to Cycle 3 Day 1 (steady state). Secondary endpoints were the effect of apalutamide on other ECG parameters, pharmacokinetics of apalutamide and its active metabolite, relationship between plasma concentrations of apalutamide and QTcF, and safety.

Results

Forty-five men were enrolled; 82% received treatment for ≥ 3 months. At steady state, the maximum ΔQTcF was 12.4 ms and the upper bound of its associated 90% CI was 16.0 ms. No clinically meaningful effects of apalutamide were reported for heart rate or other ECG parameters. A concentration-dependent increase in QTcF was observed for apalutamide. Most adverse events (AEs) (73%) were grade 1–2 in severity. No patients discontinued due to QTc prolongation or AEs.

Conclusion

The effect of apalutamide on QTc prolongation was modest and does not produce a clinically meaningful effect on ventricular repolarization. The AE profile was consistent with other studies of apalutamide.

https://ift.tt/2KWi7Xe

Metabolite profiling of the novel anti-cancer agent, plitidepsin, in urine and faeces in cancer patients after administration of 14 C-plitidepsin

Abstract

Purpose

Plitidepsin absorption, distribution, metabolism and excretion characteristics were investigated in a mass balance study, in which six patients received a 3-h intravenous infusion containing 7 mg ¹⁴C-plitidepsin with a maximum radioactivity of 100 µCi.

Methods

Blood samples were drawn and excreta were collected until less than 1% of the administered radioactivity was excreted per matrix for two consecutive days. Samples were pooled within-patients and between-patients and samples were screened for metabolites. Afterwards, metabolites were identified and quantified. Analysis was done using Liquid Chromatography linked to an Ion Trap Mass Spectrometer and offline Liquid Scintillation Counting (LC-Ion Trap MS-LSC).

Results

On average 4.5 and 62.4% of the administered dose was excreted via urine over the first 24 h and in faeces over 240 h, respectively. Most metabolites were found in faeces.

Conclusion

Plitidepsin is extensively metabolised and it undergoes dealkylation (demethylation), oxidation, carbonyl reduction, and (internal) hydrolysis. The chemical formula of several metabolites was confirmed using high resolution mass data.

https://ift.tt/2JbAClp

A phase 1 study of ADI-PEG 20 and modified FOLFOX6 in patients with advanced hepatocellular carcinoma and other gastrointestinal malignancies

Abstract

Purpose

Arginine depletion interferes with pyrimidine metabolism as well as DNA damage repair pathways. Preclinical data indicates that pairing pegylated arginine deiminase (ADI-PEG 20) with fluoropyrimidines or platinum enhances cytotoxicity in vitro and in vivo in arginine auxotrophs.

Methods

This is a single-center, open-label, phase 1 trial of ADI-PEG 20 and modified FOLFOX6 (mFOLFOX6) in treatment-refractory hepatocellular carcinoma (HCC) and other advanced gastrointestinal tumors. A 3 + 3 dose escalation design was employed to assess safety, tolerability, and determine the recommended phase 2 dose (RP2D) of ADI-PEG 20. A RP2D expansion cohort for patients with HCC was employed to define the objective response rate (ORR). Secondary objectives were to estimate progression-free survival (PFS), overall survival (OS), and to explore pharmacodynamics and immunogenicity. Eligible patients were treated with mFOLFOX6 intravenously biweekly at standard doses and ADI-PEG-20 intramuscularly weekly at 18 (Cohort 1) or 36 mg/m² (Cohort 2 and RP2D expansion).

Results

Twenty-seven patients enrolled—23 with advanced HCC and 4 with other gastrointestinal tumors. No dose-limiting toxicities were observed in cohort 1 or 2. The RP2D for ADI-PEG 20 was 36 mg/m² weekly with mFOLFOX6. The most common any grade adverse events (AEs) were thrombocytopenia, neutropenia, leukopenia, anemia, and fatigue. Among the 23 HCC patients, the most frequent treatment-related Grade ≥ 3 AEs were neutropenia (47.8%), thrombocytopenia (34.7%), leukopenia (21.7%), anemia (21.7%), and lymphopenia (17.4%). The ORR for this group was 21% (95% CI 7.5–43.7). Median PFS and OS were 7.3 and 14.5 months, respectively. Arginine levels were depleted with therapy despite the emergence of low levels of anti-ADI-PEG 20 antibodies. Arginine depletion at 4 and 8 weeks and archival tumoral argininosuccinate synthetase-1 levels did not correlate with response.

Conclusions

Concurrent mFOLFOX6 plus ADI-PEG-20 intramuscularly at 36 mg/m² weekly shows an acceptable safety profile and favorable efficacy compared to historic controls. Further evaluation of this combination is warranted in advanced HCC patients.

https://ift.tt/2KWuUsF

Interactions of lean soft-tissue and chemotherapy toxicities in patients receiving anti-cancer treatments

Abstract

Use of cross-sectional imaging to identify whole-body lean soft-tissue mass has recently emerged as an attractive prognostic factor for chemotherapy toxicities. Beyond that, there is increasing interest in use of lean soft-tissue mass as a more accurate method for dosing chemotherapy, as compared to body surface area. In this review, we summarize the current evidence that supports interactions between skeletal muscle and chemotherapy, the role of lean soft tissue in predicting chemotherapy toxicities and potential use of an alternate method of chemotherapeutic dosing, all based on quantification of skeletal muscle mass by computed tomography.

https://ift.tt/2J9V5Y2

Bioequivalence study of single-dose lenalidomide capsule vs. Revlimid ® capsule in healthy Chinese males

Abstract

Objective

Lenalidomide is a 4-amino-glutaryl derivative of thalidomide and belongs to a new generation of immunomodulatory agents for the treatment of patients with myelodysplastic syndrome and multiple myeloma. The aim of this study is to evaluate the bioequivalence and safety of a capsule containing 25 mg of a test formulation of lenalidomide and a 25 mg Revlimid^® capsule in healthy, Chinese adult males for good quality anti-cancer medicine with lower costs.

Methods

This was a single-center, randomized, open-label, single-dose, two-period, crossover pharmacokinetic study. Forty-eight healthy, adult Chinese males were administered a test lenalidomide or Revlimid^® capsule, 24 in a fasted and 24 in a fed state, followed by crossover to the other capsule.

Results

Twenty-four subjects in the fasting group and 23 in the postprandial group completed the clinical trial. Subjects administered test lenalidomide and Revlimid^® capsules in the fasting state had a C_max of 564 ± 153 and 609 ± 121 ng/mL, respectively; an AUC_0−t of 1660 ± 211 and 1660 ± 235 h ng/mL, respectively; and an AUC_0−∞ of 1670 ± 210 and 1670 ± 237 h ng/mL, respectively. In the fed state, the subjects had a C_max of 389 ± 105 and 383 ± 101 ng/mL, respectively; an AUC_0−t of 1770 ± 314 and 1740 ± 360 h ng/mL, respectively; and an AUC_0−∞ of 1800 ± 316 and 1760 ± 362 h ng/mL, respectively. Both capsules were well tolerated, with no serious adverse events observed.

Conclusion

According to the criteria for bioequivalence, the test formulation of lenalidomide and Revlimid^® was determined to be bioequivalent.

https://ift.tt/2KWiaCo

Role of toll-like receptor 4 (TLR4)-mediated interleukin-6 (IL-6) production in chemotherapy-induced mucositis

Abstract

Despite significant advances in our ability to treat cancer, cytotoxic chemotherapy continues to be the mainstay treatment for many solid tumours. Chemotherapy is commonly associated with a raft of largely manageable adverse events; however, gastrointestinal (GI) toxicity (also termed mucositis) remains a significant challenge with little in the way of preventative and therapeutic options. The inability to manage GI complications likely reflects our incomplete understanding of its aetiology and the idiosyncrasies of each chemotherapeutic agent. This review highlights aims to provide a narrative for the involvement of Toll-like receptor (TLR4) in the development of chemotherapy-induced GI mucositis, an already emerging theme within this field. Particular focus will be placed upon the signalling interaction between TLR4 and interleukin (IL)-6. This parallels recent preclinical findings showing that TLR4 knockout mice, which are protected from developing severe GI mucositis, completely lack an IL-6 response. As such, we suggest that this signalling pathway presents as a novel mechanism with potential for therapeutic intervention.

https://ift.tt/2J6j7TH

Reduced dose pegfilgrastim is associated with less bone pain without increased neutropenia: a retrospective study

Abstract

Background

Chemotherapy for breast cancer is associated with a high risk of neutropenia. Pegfilgrastim reduces the risk of neutropenic fever but commonly causes bone pain.

Objective

Evaluate whether a reduced dose of pegfilgrastim (3 mg) reduced the frequency of bone pain without compromising efficacy.

Methods

Records reviewed from breast cancer patients who received at least one 3 mg dose of pegfilgrastim, white blood count (WBC), and absolute granulocyte counts (AGC) were collected. Musculoskeletal pain scale was collected at each visit.

Results

265 treatments from 36 women were analyzed. There was no difference in post-treatment AGC between 3 versus 6 mg. Leukocytosis (WBC > 20,000 cells/cu mm) was more likely for those treated with 6 mg (chi-square 5.265, p = 0.0215). There was higher change in bone pain in patients who received 6 mg doses compared to none or 3 mg.

Limitations

In this retrospective, non-randomized study, we found the majority of patients received the reduced 3 mg dose after intolerance to the 6 mg dose. It is unknown if smaller or larger doses than 3 mg would achieve similar results or whether 3 mg dose would be effective as an initial therapy or for patients receiving different chemotherapy regimens. Pain is observed despite premedication with naproxen and/or loratidine.

Conclusion

Reduced dose of pegfilgrastim 3 mg was less likely to cause bone pain. The reduced dose was not associated with a significant difference in post-treatment AGC or rate of serious infection.

https://ift.tt/2L0JlvG

Timing is everything: intraperitoneal chemotherapy after primary or interval debulking surgery for advanced ovarian cancer

Abstract

Purpose

To evaluate the outcomes of intraperitoneal chemotherapy (IP) compared with those of intravenous chemotherapy (IV) in patients with advanced ovarian cancer after neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) or primary debulking surgery (PDS).

Methods

Patients with advanced epithelial ovarian carcinoma treated with PDS or NACT and IDS from 2006 to 2015 were identified. Comparative statistics were used to evaluate covariates, and survival rates were calculated using the Kaplan–Meier method and compared with log-rank tests.

Results

Sixty-six patients received NACT followed by IDS with residual disease of ≤ 1 cm; 42 of these patients (63.6%) received IP therapy; and 24 patients (36.3%) had IV therapy only after IDS. The median progression-free survival (PFS) was 16.0 months in the IP group and 13.5 months in the IV group (p = 0.13). The estimated median overall survival (OS) was 64.0 months with IP and 50.0 months with IV (p = 0.44). During the same study period, 149 patients underwent optimal PDS after which 93 patients (62.4%) received IP and 56 patients (37.6%) were given IV chemotherapy. Patients after IP demonstrated improved survival outcomes when compared to patients after IV therapy. The median PFS was 28.0 months after IP and 16.5 months after IV (p = 0.0006), and the median OS was not reached for IP and 50.0 months after IV (p < 0.0001).

Conclusions

Although IP chemotherapy after PDS is associated with improved survival, IP therapy after NACT and IDS, despite high rates of completion, may not have the same degree of survival advantage over IV therapy.

https://ift.tt/2vRyI8b

Comparison of tumor size assessments in tumor growth inhibition-overall survival models with second-line colorectal cancer data from the VELOUR study

Abstract

Purpose

To compare lesion-level and volumetric measures of tumor burden with sum of the longest dimensions (SLD) of target lesions on overall survival (OS) predictions using time-to-growth (TTG) as predictor.

Methods

Tumor burden and OS data from a phase 3 randomized study of second-line FOLFIRI ± aflibercept in metastatic colorectal cancer were available for 918 patients out of 1216 treated (75%). A TGI model that estimates TTG was fit to the longitudinal tumor size data (nonlinear mixed effect modeling) to estimate TTG with: SLD, sum of the measured lesion volumes (SV), individual lesion diameters (ILD), or individual lesion volumes (ILV). A parametric OS model was built with TTG estimates and assessed for prediction of the hazard ratio (HR) for survival.

Results

Individual lesions had consistent dynamics within individuals. Between-lesion variability in rate constants was lower (typically < 27% CV) than inter-patient variability (typically > 50% CV). Estimates of TTG were consistent (around 12 weeks) across tumor size assessments. TTG was highly significant in a log-logistic parametric model of OS (median over 12 months). When individual lesions were considered, TTG of the fastest progressing lesions best predicted OS. TTG obtained from the lesion-level analyses were slightly better predictors of OS than estimates from the sums, with ILV marginally better than ILD. All models predicted VELOUR HR equally well and all predicted study success.

Conclusion

This analysis revealed consistent TGI profiles across all tumor size assessments considered. TTG predicted VELOUR HR when based on any of the tumor size measures.

https://ift.tt/2HvufcA

Late-Onset Facial Papular Elastorrhexis

Abstract: Papular elastorrhexis, a rare defect of dermal elastic fibers of unknown origin, usually involves the trunk and extremities of children or young adults. We report the case of a 62-year-old woman with multiple soft, skin-colored facial papules with histological findings characteristic of papular elastorrhexis. Awareness of this entity may allow for its proper identification outside the usual clinical setting. Correspondence: Carlos Santonja, MD, Anatomía Patológica Fundación Jiménez, Díaz Departamento de Anatomía Patológica, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain (e-mail: csantonja@fjd.es). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2znFeVX

Squamoid Eccrine Ductal Carcinoma: An Aggressive Mimicker of Squamous Cell Carcinoma

Abstract: Squamoid eccrine ductal carcinoma (SEDC) is an uncommon cutaneous adnexal malignancy that has the potential for an aggressive clinical course. The authors present a case of SEDC that resulted in widespread metastases and death. The clinical, histological, and immunohistochemical features of SEDC and several entities on the differential diagnosis are reviewed. Correspondence: Sterling S. Mckissack, MD, 1100 Wilford Hall Loop, Building 4554, JBSA Lackland, TX 78236 (e-mail: sterling.s.mckissack.mil@mail.mil). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u6FnrS

Cutaneous Metastasis of Choriocarcinoma in 2 Male Patients: A Rare Presentation of an Aggressive Malignancy That Dermatopathologists Must Recognize

Abstract: Testicular choriocarcinoma needs to be considered in the differential diagnosis of cutaneous metastases in young adult men because of its propensity for early hematogenous dissemination. Furthermore, the diagnosis may not be suspected in many cases in which there is clinically no testicular enlargement. This highly aggressive germ cell tumor typically metastasizes to the liver, lungs, and brain. Skin metastasis is exceedingly rare with only 22 cases previously reported in the world literature. We herein report 2 additional cases: a 25-year-old man and a 32-year-old man, both of whom were treated for mixed germ cell tumors and developed multiple cutaneous metastases to the head. Correspondence: Robert E. LeBlanc, MD, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 (e-mail: Robert.E.LeBlanc@hitchcock.org). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ujLQ25

Periungual Finger-Like Projections: Challenge

No abstract available

https://ift.tt/2u8xUZf

Trichoblastic Carcinosarcoma of the Skin: A Case Report and Literature Review

Abstract: An 83-year-old man presented to the dermatology department for an ulcerated skin lesion of the back that had been increasing in size during the past 11 years. The physical examination revealed a well-defined, fleshy, reddish plaque measuring 10 × 20 cm in diameter with erosions and black areas on the surface. The patient underwent surgical excision with margins of 10 mm followed by a skin graft. Histologic section showed a lesion composed of 2 intimately intermingled epithelial and mesenchymal components associated with a basal cell carcinoma (BCC). Immunohistochemical examination showed epithelial cells that were positive for CK AE1/AE3 and p53, whereas stromal cells were positive for vimentin, CD10, and p53. BCC was positive for CD10. On the basis of these findings, a diagnosis of trichoblastic carcinosarcoma associated with BCC was made. Given the scarcity of data available in the literature regarding this diagnosis, no standard of care exists. No adjuvant treatment was provided and after 1 year of follow-up, the patient did not experience recurrence. Correspondence: Ilona Okhremchuk, MD, Department of Pathology, Hôpital d'Instruction des Armées Sainte-Anne, 2 Boulevard Sainte-Anne, 83000 Toulon, France (e-mail: ilonaokh@hotmail.fr). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zp4KKx

Impact of Dermoscopy and Reflectance Confocal Microscopy on the Histopathologic Diagnosis of Lentigo Maligna/Lentigo Maligna Melanoma

Background: Equivocal pigmented lesions of the head are usually biopsied to avoid inappropriate treatment. Clinical approach has evolved from simple visual examination to sophisticated techniques for selecting the biopsy sites. Objective: This study aimed to retrospectively evaluate the efficiency of dermoscopy (DE) and reflectance confocal microscopy (RCM) in sampling a histopathologically representative focus of lentigo maligna/lentigo maligna melanoma. Methods: Punch biopsies and surgical excisions of 72 patients, 37 men and 35 women (median age 70.6 years, range 39–90 years), affected by lentigo maligna/lentigo maligna melanoma of the head, sent from a single dermatology clinic, were reviewed for the presence of 5 histopathologic criteria: atypical junctional melanocytes, increased junctional melanocytes, follicular colonization, pagetoid spread and melanocytic junctional nests, plus other minor features. Forty-two patients were biopsied under DE and 30 under RCM guidance. Results: Accuracy of the 2 techniques in sampling a representative tissue overlapped in most cases, although RCM selected sites to biopsy with more histopathologic criteria, in particular pagetoid spread and melanocytic nests. Interestingly, with RCM, inflammation and melanophages were observed more in biopsy than in excision. False positive cases were not registered. Conclusion: Compared with the sampling at naked eye, our results show that DE and RCM help selecting the most appropriate areas for biopsies, thus allowing not only more robust histopathologic diagnoses, but also a more accurate microstaging of tumor. Correspondence: Anna M. Cesinaro, MD, Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria Policlinico di Modena, via del Pozzo 71, 41125 Modena, Italy (e-mail: cesinaro.annamaria@policlinico.mo.it). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u6EYFS

Muir–Torre Syndrome: A Case Report in a Woman Without Personal Cancer History

Abstract: We report a case of a 68-year-old white woman presenting with 5 sebaceous neoplasms, ranging from sebaceous adenoma to sebaceoma on histopathology. Despite the lack of a personal cancer history, her multiple sebaceous neoplasms and a paternal history of colon cancer prompted testing her sebaceous adenomas for microsatellite instability (MSI) by immunohistochemistry. The results showed retained nuclear expressions of MLH1 and PMS2 while MSH2 and MSH6 proteins were absent. The tumor infiltrating lymphocytes expressed both MSH2 and MSH6, providing reliable internal positive controls. Having a high probability for MSI, she was found to be heterozygous for a germline point mutation in MSH2 gene, where a pathologic variant, c.1165C > T (p.Arg389*), determined by sequencing confirmed Muir–Torre syndrome (MTS). On further genetic counseling recommendations, one of her 2 sons was found to have colon cancer in the context of his MTS. In this article, we highlight and review the implications of MSI testing by both immunohistochemistry and sequencing as they relate to confirming the diagnosis of a suspected case of MTS. Correspondence: Kristin Torre, BS, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06032 (e-mail: torre@uchc.edu). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ulrnJU

Osteoma Cutis Arising in Common Blue Nevus (Blue Osteonevus): A Clinicopathologic, Immunohistochemical, and Dermoscopic Study

Abstract: Osteonevus of Nanta is a rare histopathologic variant of melanocytic nevus that results from ossification of the dermis between dermal nests of melanocytes. Most cases described in the literature have been associated with long-standing intradermal nevi and were often located in the upper part of the body. We report a lesion on the shoulder of an elderly man showing the association of a common blue nevus and osteoma cutis, an exceptional feature which has been previously reported in 2 instances. We also describe for the first time the dermoscopic appearance of this "blue osteonevus." Correspondence: Luis Requena, MD, Department of Dermatology, Fundación Jiménez Díaz, Av. Reyes Católicos 2, 28040 Madrid, Spain (e-mail: lrequena@fjd.es). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u9stcB

Juvenile-Onset Early-Stage Mycosis Fungoides–Associated Follicular Mucinosis: A Case Report

Abstract: We report a juvenile case of mycosis fungoides with prominent follicular mucinosis (FM). The patient was a 9-year old boy who presented with a 2-month history of enlarging alopecic patch with fine scales on the scalp. Dermatologic examination revealed orange-tan slightly palpable plaques with follicular prominence on his trunk. The patient and his family were not aware of these asymptomatic truncal plaques. Histopathologic examination of both—scalp and trunk—lesions revealed folliculotropic lymphocytic infiltration with mucin. Immunohistochemical study showed that lymphocytic infiltration was CD4 dominant. Flow cytometry analyses of peripheral blood were normal. Any abnormal populations and Sézary cells were not observed on blood smear. Polymerase chain reaction testing showed monoclonality for the T-cell receptor4-[Latin Small Letter Rams Horn] gene. Our patient had the clinical and histopathological diagnosis of follicular mycosis fungoides–associated follicular mucinosis. Reprints: Pinar Incel Uysal, MD, Talatpasa Bulvari, Ankara Numune Training and Research Hospital, Altındag, Ankara 06100, Turkey (e-mail: pinarincel@hotmail.com). The authors declare no conflicts of interest. The written informed consent form was obtained from parents. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zpDQSP

Periadnexal Nerve Hyperplasia: A Reactive Histopathological Feature and an Incidental Finding After Surgical Excision and Scar Formation

Abstract: Cutaneous nerve hyperplasia is characterized by the presence of increased and hypertrophic myelinated and unmyelinated nerve fibers in the dermis. We report a case of periadnexal nerve hyperplasia as an asymptomatic and infrequent reactive histopathological change, with no associated risk of malignancy that can be seen in scars, in patients with no syndromic stigmata. Correspondence: Alejandro Lobato-Berezo, MD, Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain (e-mail: allobe@hotmail.es). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u6IsYW

A Young Woman With Multiple Painful Subungual Nodules

No abstract available

https://ift.tt/2zqynv5

Primary Visceral Merkel Cell Carcinoma: A Case Report and Review of the Literature

Abstract: A 63-year-old white man with no significant previous medical or surgical history presented with painless jaundice after 3 weeks of dark urine, yellow stools, and a 9-pound weight loss. Bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase were elevated, and a computed tomography scan detected a 10-cm, ill-defined mass at the porta hepatis compressing the common bile duct. He underwent endoscopic retrograde cholangiopancreatography with stenting and ultrasound-guided biopsies. Histologic sections showed a neoplastic population of small ovoid cells with a high N:C ratio, nuclear hyperchromasia, "smoky" chromatin and abundant mitotic figures, and characteristic of high-grade neuroendocrine carcinoma (HGNECA). Immunohistochemistry showed synaptophysin, chromogranin, golgi pattern CK20 reactivity, and strong diffuse expression of Merkel cell polyomavirus, supporting a diagnosis of Merkel cell carcinoma (MCC). A metastatic workup, including complete skin examination and positron emission tomography scan, revealed no other site of disease. Although this patient fits the classic demographic pattern for MCC, he lacks cutaneous involvement and significant risk factors for MCC including immunosuppression and concurrent or previous malignancy. Histologically, the differential diagnosis in this anatomical site is primary or occult metastatic organ-based small-cell HGNECA. Although pure nodal MCC accounts for a minute subset of MCC, it is almost exclusively described in superficial and extremity-draining nodal basins (eg, axillary or inguinal regions). Primary visceral nodal MCC accounts for fewer than 5 cases ever reported. This case illustrates the importance of recognizing the morphologic features characteristic of MCC, regardless of anatomical location, and the value of immunohistochemistry in diagnosis, which aid in differentiating it from non-MCC mimics. Development of targeted therapy has made distinction between MCC and non-MCC HGNECA increasingly important. This patient initially responded to PD-L1 inhibitor therapy but ultimately died with disease 10 months after diagnosis. Correspondence: Bonnie Balzer, MD, PhD, Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048 (e-mail: bonnie.balzer@cshs.org). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u64hHU

“Pigmented Extramammary Paget Disease”—A Potential Mimicker of Malignant Melanoma and a Pitfall in Diagnosis: A Case Report and Review of the Literature

Abstract: Extramammary Paget disease (EMPD) is a rare intraepithelial carcinoma and an uncommon variant of Paget disease affecting areas of the apocrine-rich skin of the perineum, vulva, and less commonly, axilla. Women in their sixth to eighth decades are commonly affected. It is exceedingly rare for EMPD to present on the face, chest, abdomen, or other nonapocrine sites and even more unusual for EMPD to present as a pigmented lesion. The relationship between Paget cells in pigmented extramammary Paget disease (PEMPD) and reactive proliferation and colonization by melanocytes has been poorly explored. The relevance of this rare entity resides in its potential to be misdiagnosed clinically and histopathologically as malignant melanoma in situ. Therefore, application of a panel of immunostains and careful analysis and interpretation of these findings are essential to arrive at the correct diagnosis. We report a new case of PEMPD on a nonapocrine site. The specimen was examined by routine microscopy including hematoxylin and eosin stain as well as immunostains. Histologic examination revealed characteristic features of PEMPD confirmed with immunohistochemical stains. Correspondence: Katrin Kiavash, MD, Wayne State University School of Medicine, Detroit Medical Center, Harper Professional Building, 4160 John R Street, Detroit, MI 48201 (e-mail: kiavashkatrin@yahoo.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ukC4fU

A Man With Fever and Bullous Plaques on the Thigh: Challenge

No abstract available

https://ift.tt/2u6EQWU

Pigmented Lesion on the Buttock: Challenge

No abstract available

https://ift.tt/2ukBTRM

Primary Cutaneous Follicle Center Lymphoma Clear Cell Variant: Expanding the Spectrum of Cutaneous Clear Cell Neoplasms

Abstract: Primary cutaneous follicle center lymphoma is the most frequent cutaneous B-cell lymphoma despite the fact that is an uncommon disease. Mild biological behavior and good prognosis characterized this neoplasm with a low aggressiveness compared with classic nodal follicular lymphoma (FL). Rare histological variants have been described. We present the case of a 72-year-old man who underwent surgery for a cutaneous nodule on his left scapula. The biopsy showed a dermal clear cell proliferation arranged in a nodular and diffuse pattern. The cells stained positive for CD20 and Bcl-6 supporting B-cell follicular differentiation. The final diagnosis was "primary cutaneous follicle center lymphoma" with "clear cell changes" according to the 2016 World Health Organization classification of lymphoid neoplasms. Additional tests to rule out a systemic involvement were performed. The prognosis was favorable with a disease-free survival of 7 years after complete surgical excision. It has been assumed that cutaneous tumors composed of clear cells may have an epithelial, melanocytic, adnexal, mesenchymal, or metastatic origin. The correct histopathological diagnosis required immunohistochemistry and even molecular techniques. To the best of our knowledge, this is the first report of a cutaneous clear cell lymphoma and of a FL with clear cell features. Our findings provide evidence that the heterogeneity of FL is greater than previously thought and expand the spectrum of differential diagnosis in cutaneous clear cell neoplasms. Dermatopathologists should be aware of this entity and should comprise a PanB marker in their first- or second-line immunohistochemistry for the correct diagnosis of a dermal clear cell proliferation. Correspondence: Angelo Cassisa, MD, Pathology Unit, Carlo Poma Hospital of Mantova, Str. Lago Paiolo, n. 10, 46100 Mantova, Italy (e-mail: angelo.cassisa@asst-mantova.it). Internal funding from Department of Clinical Services has been used in part for study-related facilities. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u70fiv

Indeterminate Dendritic Cell Tumor: A Report of 2 New Cases Lacking the ETV3-NCOA2 Translocation and a Literature Review

Abstract: Indeterminate dendritic cell tumor (IDCT) is a cutaneous proliferation of histiocytes that share morphologic and immunophenotypic properties with Langerhans cells. IDCT was recently included in the updated WHO classification of tumors of hematopoietic and lymphoid tissues. Recent studies have shown that some cases of IDCT demonstrate an ETV3-NCOA2 translocation, supporting the idea that IDCT is a clonal neoplasm. We report 2 new cases of IDCT at our institution lacking the ETV3-NCOA2 translocation. We also present a comprehensive review of reported cases of IDCT in the medical literature. Eighty-five cases of IDCT were reported in the literature between 1985 and 2016. The median age at diagnosis was 45 years. In contrast to Langerhans cell histiocytosis, IDCT is limited to the skin in the majority of cases (88%) and generally follows an indolent clinical course. Most reported lesions are cured with complete excision. However, the histologic features of IDCT and langerhans cell histiocytosis are similar. Conjoint immunostaining for CD1a and langerin is necessary for optimal classification. The authors have no relevant financial or ethical conflicts of interests to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ukQU6b

Vulvar Tuberculosis Cutis Orificialis Concomitant to Pulmonary Tuberculosis: A Case Report

Abstract: Tuberculosis (TB) is a common condition with increasing incidence worldwide. Cutaneous TB represents a small portion of extrapulmonary TB. Health care professionals must be aware of cutaneous forms of TB to avoid delay in diagnosis and treatment. We present a case of a 59-year-old woman with vulvar TB cutis orificialis in association with pulmonary TB without any other involvement of genitourinary system. We discuss epidemiological aspects, classification, treatment, range of histopathological patterns, and use of ancillary techniques for diagnosis. Correspondence: Thiago Jeunon, MD, Departments of Dermatology and Pathology, Hospital Federal de Bonsucesso, Rua General Roca 778/1005, Saens Peña, Rio de Janeiro—RJ, CEP: 20521-070, Brazil (e-mail: thiago.jeunon@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u6PA7x

Self-healing Cutaneous Mucinosis in Adulthood: The Adult Counterpart of the Juvenile Variant of the Disease?

Abstract: Self-healing cutaneous mucinosis (SHCM) is an idiopathic localized cutaneous mucinosis mainly described in children and characterized clinically by an acute onset of papules and nodules that exhibit a spontaneous resolution in a period ranging from weeks to few months. Histologically, a diffuse mucin deposition in the dermis and/or hypodermis associated with a proliferation of spindle-shaped cells and some large epithelioid gangliocyte-like mononuclear cells is usually observed. An uncommon adult variant of SHCM has also been reported; however, the clinicopathological features described in these patients are extremely heterogeneous and differ significantly from the juvenile variant of the disease, often showing exclusively dermal involvement. We report a case of a 37-year-old female patient with multiple asymptomatic nodules located on the legs and arms that resolved spontaneously in a period of 2 years, showing the typical subcutaneous features of the juvenile variant of SHCM at the histological examination (ie, mucinous areas associated with dense bands of fibrosis containing arborizing thin-walled vessels, spindle-shaped fibroblasts, and some gangliocyte-like cells). To the best of our knowledge, this is the first report of SHCM showing the classic pattern of deep-seated subcutaneous involvement of the disease in an adult patient. We also review the cases of adult-onset SHCM reported in the literature. Correspondence: Gustavo Deza, MD, Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Passeig Marítim, 25-29, 08003 Barcelona, Spain (e-mail: gustavo.deza@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ugFLmU

Histopathological Findings and Increased D-Dimer Are Predictive Factors of Systemic Thromboses in Eosinophilic Granulomatosis With Polyangiitis

Abstract: Eosinophilic granulomatosis with polyangiitis (EGPA; ie, Churg–Strauss syndrome) is one of the antineutrophil cytoplasmic antibody–associated vasculitis syndromes. Although extravascular granulomatoses are a well-known histopathological feature, the diverse histopathologic spectrum of cutaneous lesions has not been described in detail. Thus, this study sought to investigate the possible correlation between the clinical features and histopathology of cutaneous lesions in EGPA cases, focusing on systemic thrombogenic conditions, such as visceral infarction and deep vein thrombosis. Fourteen cases of EGPA diagnosed at the Department of Dermatology in Asahikawa Medical University from 1977 to 2017 were clinically and histopathologically reviewed. In 6 (43%) cases, skin lesions were the initial manifestation of EGPA. Among the cutaneous lesions, purpura and erythema were the most common. Persistent proteinuria and macrohematuria were observed in only 2 myeloperoxidase–antineutrophil cytoplasmic antibody–positive cases. Systemic thrombotic symptoms, such as cerebral infarction and deep vein thrombosis, were detected in 5 (36%) cases, and, in 3 of those cases, thromboses in dermal or subcutaneous vessels were observed histopathologically. Elevation of plasma D-dimer level (>2.5 μg/mL) was significantly correlated with concomitant systemic thrombotic symptoms (P = 0.0152, Fischer exact test). The histopathological finding of thrombotic features and increased plasma D-dimer were predictive factors of EGPA accompanied with systemic thromboses, such as deep vein thromboses and cerebral infarction. Correspondence: Kyoko Kanno, MD, Department of Dermatology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan (e-mail: k-kanno@asahikawa-med.ac.jp). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2u9pb97

Current Concepts in Carious Tissue Removal

Abstract

Purpose of Review

To summarize current concepts in carious tissue removal.

Recent Findings

Traditionally, caries has been seen as an infectious disease and was treated by attempted complete removal of all cariogenic bacteria. The logical traditional aim of carious tissue removal—removing all bacteria from carious lesions—no longer applies. The contemporary aim of carious tissue removal is to maximize restoration longevity, without unnecessarily removing sound or remineralizable dentin. This is based on recent perspectives that dental caries is a biofilm-based and lifestyle-mediated disorder. In shallow lesions, as much carious tissue as possible should be removed, with removal until hard dentin is felt around the periphery of a cavity (to maximize restoration survival and seal the cavity) while centrally firm dentin is left (to retain remineralizable dentin). For deep lesions in teeth with vital pulps (without irreversible pulpitis or pulp necrosis), maintaining pulp vitality is the priority. Dentists should aim to avoid pulp exposure and accept leaving soft or leathery dentin in areas close to the dental pulp, while at the periphery, carious tissue should be removed until hard tissue is felt, ensuring that any remaining bacteria are sealed and inactivated and that the restoration has sufficient mechanical support against masticatory forces. An alternative for deep lesions is stepwise removal. Carious tissue strategies where no carious tissue removal at all is performed include sealing using plastic materials or stainless steel crowns, or non-restorative cavity control.

Summary

A range of carious tissue removal strategies are available and should be applied according to lesion characteristics, pulp vitality, and other patient related factors. Always striving to remove carious tooth tissue until hard dentin remains is not in line with current evidence and not recommended.

https://ift.tt/2uiN6Cl

Recent Trends in Tricalcium Silicates for Vital Pulp Therapy

Abstract

Purpose of Review

Tricalcium silicates are considered as materials of choice for vital pulp therapy. Recent development improved their mechanical and bioactive properties and broadened their clinical application fields. Incorporating resins to tricalcium silicates further decreased the setting time and simplified clinical procedures but raised questions about their potential toxicity.

Recent Findings

Tricalcium silicates represent an added value in vital pulp therapy. This is ascribed to the pulp high regeneration potential, material byproducts production upon hydration and growth factor release from target cells. Adding resins to tricalcium silicates decreases their hydration and subsequently leads to pulp toxicity.

Summary

Tricalcium silicates can be successfully used for vital pulp therapy in a broad range of clinical applications. Although long-term clinical studies are still required with these new materials, adding resins to tricalcium silicates is responsible for pulp disorganization and toxicity and cannot be recommended for direct pulp capping.

https://ift.tt/2m57lzO

The Future of Payment for Dental Care

Abstract

Purpose of Review

To examine the literature on dental reimbursement methods, with emphasis on paying for value (e.g., health care outcomes) rather than procedure. To make recommendations that would facilitate the expansion of access to dental care for those most in need and improve the oral health of the US population.

Recent Findings

Although the health care system is moving toward paying for performance and outcomes, dentistry lags behind. We review publications that identify obstacles to payment for outcomes in oral health as well as moving away from traditional fee-for-service reimbursement.

Summary

Payment for value in dentistry is a long way from becoming a reality; however, the testing of models within Medicaid that set aside a small percentage of the fee for a procedure to be reimbursed based on the improved oral health of the patient and/or the population of the practice may facilitate its adoption. A similar set aside in capitation-based programs could ensure the delivery of essential services and avoid the underutilization traditionally associated with this type of reimbursement system. Similar incentives could be tested in group practices and perhaps even community health centers. Widespread adoption of diagnostics code, missing in dental records, would enable better tracking of met needs. Educational systems that foster intra- and interprofessional teamwork and the appropriate use of personnel operating at the top of their competency would increase efficiency while adding value at the same or lower cost.

https://ift.tt/2zsa3cc

Smear Layer-Deproteinization: Improving the Adhesion of Self-Etch Adhesive Systems to Caries-Affected Dentin

Abstract

Purpose of review

This paper reviews a new method of dentin surface modification, smear layer-deproteinization for self-etch adhesive systems, particularly in relation to improving the adhesion to caries-affected dentin.

Recent Findings

Remnants of smear debris, which forms hybridized smear layer with self-etch adhesives, can prevent monomer infiltration and interfere with the chemical interaction of adhesive monomers and the underlying dentin. The hybridized smear layer weakens the physical and chemical properties of the resin-dentin hybridized complex both immediately and over time. Smear layer-deproteinization with NaOCl and HOCl solutions can improve the quality of resin-dentin interface of self-etch adhesives through elimination of the hybridized smear layer, development of monomer infiltration, and enhancement of the chemical interaction of adhesive monomers with hydroxyapatite due to an increase in the mineral/organic ratio on the dentin surface. These positive effects are influenced by the types of oxidizing solution and their application time and also depend upon the adhesive materials used because compromising effects of residual oxidized-byproducts at the dentin surface on the polymerization behavior of the adhesives are different between the materials. However, applying antioxidant/reducing agents can eliminate this problem.

Summary

Smear layer-deproteinization is more effective for improving the bonding efficacy of self-etch adhesives to caries-affected dentin than normal dentin because caries-affected dentin produces a thicker organic-rich smear layer. Smear layer-deproteinization with HOCl solution, which has a rapid and broad-spectrum antimicrobial activity with less irritating and sensitizing properties, along with the subsequent application of antioxidant/reducing agents could enhance the longevity of composite restoration with self-etch adhesives.

https://ift.tt/2m3oIkC

Fracture Toughness Testing of Dental Restoratives: a Critical Evaluation

Abstract

Purpose of Review

We intend by this short critical review to highlight important aspects regarding the mechanical testing of fracture toughness. The final aim is to increase the awareness to the test sensitivity, ultimately increasing the quality and reliability of reported testing results.

Recent Findings

In a well-intended attempt to facilitate testing procedures or provide alternatives for testing material interfaces, authors are resorting to adaptation of testing methodologies without proper theoretical and experimental validation. The assumption of validity in such cases endangers the perpetration of testing strategies that are not safeguarded by sound theoretical bases. The use of improper statistical treatments based on extreme-value distributions further aggravates this scenario.

Summary

We supply here some directions for authors concerning method selection, interpretation of data scatter, statistical treatment, and possibilities for test validation.

https://ift.tt/2L0hqfo

Beyond JAAD - October 2018

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Andrew Bronin, Robert Phelps, Robert Sidbury

https://ift.tt/2N1x7jO

Methotrexate for alopecia areata: a systematic review and meta-analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kevin Phan, Vignesh Ramachandran, Deshan Frank Sebaratnam

Abstract

Background

Methotrexate has been used both as an adjunct for low-risk maintenance therapy after initiation with corticosteroids for alopecia areata (AA) and as standalone therapy in some investigations, based on a lack of definitive evidence/guidelines.

Objective

To (1) determine the efficacy and risks associated with methotrexate therapy for AA (2) determine differences efficacy of combination with corticosteroids versus standalone treatment, and (3) determine relative efficacy of methotrexate in adult versus pediatric populations.

Methods

A systematic review and meta-analysis was performed according to recommended PRISMA guidelines.

Results

Methotrexate has reasonable effectiveness in patients with severe AA, and that adults appear to be more responsive to methotrexate treatment compared to pediatric cases. Methotrexate in conjunction with corticosteroids result in higher good/complete response rates compared to those treated with methotrexate alone. A large proportion of recurrence rates occurred in the setting of tapering treatment. Complication rates were acceptable and similar between adults and pediatric cases.

Limitations

Studies reviewed were retrospective observational studies with heterogeneity between centers in terms of dosages/protocols for methotrexate use in AA, and adjunctive treatments with a lack of data beyond one year.

Conclusion

Methotrexate is an effective monotherapy or adjunct to corticosteroid in the treatment of severe AA.

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