Addition of oral mini pulse dexamethasone to NBUVB phototherapy and topical steroids helps arrest disease activity in patients with vitiligo

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2M35d6g

“GENIPSO”: a French prospective study assessing instantaneous prevalence, clinical features and impact on quality of life of genital psoriasis among patients consulting for psoriasis

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2MVEWMj

Local interventions for actinic keratosis in organ transplant recipients: A systematic review

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wQYg2C

Benefit‐risk of tofacitinib in patients with moderate to severe chronic plaque psoriasis: Pooled analysis across 6 clinical trials

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2MVEVYL

A new clinical variant of acquired reactive perforating dermatosis‐like bullous pemphigoid

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wPZkUh

The effect of antioxidants on Helicobacter pylori eradication: A systematic review with meta‐analysis

Helicobacter, EarlyView.


https://ift.tt/2MRBna6

Oral Hedgehog Pathway Inhibition as a Means for Ocular Salvage in Locally Advanced Intraorbital Basal Cell Carcinoma

BACKGROUND Basal cell cancer is the most common cutaneous malignancy. It rarely presents with locally advanced or metastatic disease. Rare presentations such as intraorbital invasion remain a difficult clinical problem with significant potential morbidity. There is no review of sonic hedgehog pathway inhibitors (HPIs) for intraorbital basal cell cancer, and evidence regarding optimal management is limited. OBJECTIVE To evaluate the evidence for the management of intraorbital basal cell cancer with HPIs. METHODS A search to identify evidence for treatment intraorbital basal cell cancers with HPIs to date was performed in PubMed database and OVID using the phrases "basal cell cancer/carcinoma/BCC," "intraorbital," "orbital," "ocular," "periocular," "vismodegib," "GDC-0449," "sonidegib," and "LDE224," in various combinations with Boolean operators "AND" and "OR." RESULTS Rigorous clinical trials have previously reported the use of vismodegib and sonidegib in locally advanced and metastatic basal cell carcinoma (BCC). However, specific descriptions of treatment of intraorbital tumors are rarely presented in detail adequate for analysis. Twenty-two cases of intraorbital BCC treated with vismodegib have been described in the literature, and no cases using sonidegib were identified. These vary in quality, but highlight important questions regarding optimal treatment duration, follow-up, and adjunctive therapies. Reports describing locally advanced BCC in various facial and periocular locations, but without specific mention of intraorbital invasion, were excluded. CONCLUSION Vismodegib is an attractive eye and vision-sparing option in patients with locally advanced intraorbital basal cell cancer whose other options often include exenteration, radiation, or other radical surgery. Address correspondence and reprint requests to: Jason Mathis, Department of Dermatology, University of Utah, 30 North 1800 East 4A330, Salt Lake City, Utah 84132, or e-mail: jason.mathis@hsc.utah.edu The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2wRGLiz

Novel Fasciotomy Technique for the Keystone Flap

No abstract available

https://ift.tt/2MUHoTp

Repair of Apical Triangle Defects Using Melolabial Rotation Flaps

BACKGROUND The apical triangle of the upper cutaneous lip, also known as the alar-facial sulcus, is an anatomical structure bound medially by the nasal ala, laterally by the medial cheek, and inferiorly by the remainder of the upper cutaneous lip. During reconstruction, retaining the central concavity and the convex lateral and medial outlines of this location is required to maintain midfacial symmetry. OBJECTIVE This is a retrospective study of our use of the melolabial rotation flap for reconstruction of surgical defects of the apical triangle. METHODS AND MATERIALS Eighty-six surgical defects involving the apical triangle that were repaired with melolabial rotation flaps were included. All tumors were treated with Mohs micrographic surgery before reconstruction. Preoperative, intraoperative, and postoperative details of each case were analyzed. RESULTS Of the 86 defects included in the study, 68 (79%) were evaluated postoperatively. The apical triangle was preserved in all cases. Clinical asymmetry was noted in 3 patients (3.4%). No major complications were noted, and no patient required surgical revision. CONCLUSION Melolabial rotation flaps may be considered for single-stage reconstruction of surgical defects involving the apical triangle. Address correspondence and reprint requests to: Arash Kimyai-Asadi, MD, 7515 Main Street, Suite 240, Houston, TX 77030, or e-mail: akimyai@yahoo.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2O19E32

Correction to: Facile synthesis of carbon-coated layered double hydroxide and its comparative characterisation with Zn–Al LDH: application on crystal violet and malachite green dye adsorption—isotherm, kinetics and Box-Behnken design

The original publication of this paper contains an error. The correct Figure 8 is shown in this paper.

https://ift.tt/2NrdhCo

Synthesis of mesoporous core-shell TiO 2 microstructures with coexposed {001}/{101} facets: enhanced intrinsic photocatalytic performance

Abstract

TiO₂ microstructures were synthesized via a facile one-step route for enhanced intrinsic photocatalytic performance. The prepared TiO₂ microstructures are featured by both mesoporous core-shell structures and coexposed {001}/{101} facets. Their intrinsic photocatalytic performance were remarkably enhanced due to their high specific surface area, coexposed {001}/{101} facets, and promoted separation of photogenerated carriers. Furthermore, the origin and detailed mechanism for diethylenetriamine (DETA) that served as a high efficient stabilizer of TiO₂ {001} facet have been theoretically investigated. Finally, a new DETA-modified Ostwald ripening mechanism was originally proposed when studying the growth mechanism of the mesoporous core-shell TiO₂ spherical microstructures with coexposed {001}/{101} facets.

https://ift.tt/2NT9Y3T

Minimal Increase in Survival Throughout the Years in Patients with Soft Tissue Sarcoma with Synchronous Metastases: Results of a Population‐Based Study

AbstractBackground.Treatment options for patients with metastatic soft tissue sarcoma (STS) have increased in the last decade. We aimed to examine whether this is associated with improved overall survival (OS) in patients with STS with synchronous metastases.Patients and Methods.Patients diagnosed with STS and synchronous metastases from 1989 to 2014 were queried from The Netherlands Cancer Registry. Trends in OS were assessed by the Kaplan‐Meier method and log‐rank test in time intervals of 5 years, for the whole study population and in subgroups for liposarcomas, leiomyosarcoma, and other STS subtypes. A multivariable Cox regression analysis was performed to identify characteristics prognostic for OS.Results.Median OS of the 1,393 identified patients did not improve significantly over the years from 5.8 months in 1989–1994 to 8.1 months in 2010–2014, but there was an evident trend. Median OS was prolonged in the subgroups of liposarcomas (3.6 to 9.3 months), leiomyosarcomas (11.3 to 14.6 months), and other STS subtypes (5.7 to 6.3 months), although there were no significant improvements in OS over the years. Primary tumor site in one of the extremities and surgery in an academic center had a favorable effect on OS, whereas significant negative predictors were no treatment, elderly age, STS subtype other than liposarcoma or leiomyosarcoma, high or unknown grade, and nodal involvement.Conclusion.Although overall survival of patients with STS with synchronous metastases in this nationwide and "real‐life" population has improved over the years, the improvement was not statistically significant, despite new treatment options.Implications for Practice.Treatment of patients with metastatic soft tissue sarcoma (STS) has changed in the past years, with new drugs such as trabectedin (2007) and pazopanib (2012) becoming available. By using data from the nationwide Netherlands Cancer Registry, the impact of these changes in treatment policies on survival is analyzed in a "real‐life" population of patients with STS with synchronous metastases, rather than in a strictly selected trial population. Unfortunately, overall survival improved only minimally and not significantly for these patients diagnosed from 1989 to 2014. Hopefully, the advent of novel treatment options, such as eribulin and olaratumab, will further improve the outcome of this patient group.

https://ift.tt/2Q9pA4V

An Open Label Phase Ib Dose Escalation Study of TRC105 (Anti‐Endoglin Antibody) with Axitinib in Patients with Metastatic Renal Cell Carcinoma

AbstractBackground.TRC105 is an IgG1 endoglin monoclonal antibody that potentiates VEGF inhibitors in preclinical models. We assessed safety, pharmacokinetics, and antitumor activity of TRC105 in combination with axitinib in patients with metastatic renal cell carcinoma (mRCC).Subjects, Materials, and Methods.Heavily pretreated mRCC patients were treated with TRC105 weekly (8 mg/kg and then 10 mg/kg) in combination with axitinib (initially at 5 mg b.i.d. and then escalated per patient tolerance to a maximum of 10 mg b.i.d.) until disease progression or unacceptable toxicity using a standard 3 + 3 phase I design.Results.Eighteen patients (median number of prior therapies = 3) were treated. TRC105 dose escalation proceeded to 10 mg/kg weekly without dose‐limiting toxicity. Adverse event characteristics of each drug were not increased in frequency or severity when the two drugs were administered concurrently. TRC105 and axitinib demonstrated preliminary evidence of activity, including partial responses (PR) by RECIST in 29% of patients, and median progression‐free survival (11.3 months). None of the patients with PR had PR to prior first‐line treatment. Lower baseline levels of osteopontin and higher baseline levels of TGF‐β receptor 3 correlated with overall response rate.Conclusion.TRC105 at 8 and 10 mg/kg weekly was well tolerated in combination with axitinib, with encouraging evidence of activity in patients with mRCC. A multicenter, randomized phase II trial of TRC105 and axitinib has recently completed enrollment (NCT01806064).Implications for Practice.TRC105 is a monoclonal antibody to endoglin (CD105), a receptor densely expressed on proliferating endothelial cells and also on renal cancer stem cells that is implicated as a mediator of resistance to inhibitors of the VEGF pathway. In this Phase I trial, TRC105 combined safely with axitinib at the recommended single agent doses of each drug in patients with renal cell carcinoma. The combination demonstrated durable activity in a VEGF inhibitor‐refractory population and modulated several angiogenic biomarkers. A randomized Phase II trial testing TRC105 in combination with axitinib in clear cell renal cell carcinoma has completed accrual.

https://ift.tt/2CrkNJ9

“I need to know what makes somebody tick …”: Challenges and Strategies of Implementing Shared Decision‐Making in Individualized Oncology

AbstractBackground.Shared decision‐making (SDM) has been advocated as an ethical framework for decision‐making in cancer care. According to SDM, patients make decisions in light of their values and based on the available evidence. However, SDM is difficult to implement in cancer care. A lack of applicability in practice is often reported. This empirical‐ethical study explores factors potentially relevant to current difficulties in translating the concept of SDM into clinical practice.Methods.This study was conducted with nonparticipant observation of the decision‐making process in patients with gastrointestinal cancers for whom the benefit of adjuvant chemotherapy was uncertain according to clinical guidelines. Triangulation of qualitative data analysis was conducted by means of semistructured interviews subsequent to the observation. Observation notes and interview transcripts were analyzed according to the principles of grounded theory.Results.Deviating from the concept of SDM, oncologists initiated a process of eliciting values and medical information prior to conveying information. The purpose of this approach was to select and individualize information relevant to the treatment decision. In doing so, the oncologists observed used two strategies: "biographical communication" and a "metacommunicative approach." Both strategies could be shown to be effective or to fail depending on patients' characteristics such as their view of the physicians' role and the relevance of value‐related information for medical decision‐making.Conclusion.In contrast to the conceptual account of SDM, oncologists are in need of patient‐related information prior to conveying information. Both strategies observed to elicit such information are in principle justifiable but need to be adapted in accordance with patient preferences and decision‐making styles.Implications for Practice.This study showed that knowledge of patients' values and preferences is very important to properly adapt the giving of medical information and to further the process of shared decision‐making. Shared decision‐making (SDM) trainings should consider different strategies of talking about values. The right strategy depends largely on the patient's preferences in communication. To be aware of the role of values in SDM and to be able to switch communicative strategies might prove to be of particular value. A more systematic evaluation of the patient's decision‐making preferences as part of routine procedures in hospitals might help to reduce value‐related barriers in communication.

https://ift.tt/2Q5yTTz

Regorafenib for Patients with Metastatic Colorectal Cancer Who Progressed After Standard Therapy: Results of the Large, Single‐Arm, Open‐Label Phase IIIb CONSIGN Study

AbstractBackground.In the phase III CORRECT trial, regorafenib significantly improved survival in treatment‐refractory metastatic colorectal cancer (mCRC). The CONSIGN study was designed to further characterize regorafenib safety and allow patients access to regorafenib before market authorization.Methods.This prospective, single‐arm study enrolled patients in 25 countries at 186 sites. Patients with treatment‐refractory mCRC and an Eastern Cooperative Oncology Group performance status (ECOG PS) ≤1 received regorafenib 160 mg once daily for the first 3 weeks of each 4‐week cycle. The primary endpoint was safety. Progression‐free survival (PFS) per investigator assessment was the only efficacy evaluation.Results.In total, 2,872 patients were assigned to treatment and 2,864 were treated. Median age was 62 years, ECOG PS 0/1 was 47%/53%, and 74% had received at least three prior regimens for metastatic disease. Median treatment duration was three cycles. Treatment‐emergent adverse events (TEAEs) led to dose reduction in 46% of patients. Regorafenib‐related TEAEs led to treatment discontinuation in 9%. Grade 5 regorafenib‐related TEAEs occurred in <1%. The most common grade ≥3 regorafenib‐related TEAEs were hypertension (15%), hand–foot skin reaction (14%), fatigue (13%), diarrhea (5%), and hypophosphatemia (5%). Treatment‐emergent grade 3–4 laboratory toxicities included alanine aminotransferase (6%), aspartate aminotransferase (7%), and bilirubin (13%). Ongoing monitoring identified one nonfatal case of regorafenib‐related severe drug‐induced liver injury per DILI Working Group criteria. Median PFS (95% confidence interval [CI]) was 2.7 months (2.6–2.7).Conclusion.In CONSIGN, the frequency and severity of TEAEs were consistent with the known safety profile of regorafenib. PFS was similar to reports of phase III trials. ClinicalTrials.gov: NCT01538680.Implications for Practice.Patients with metastatic colorectal cancer (mCRC) who fail treatment with standard therapies, including chemotherapy and monoclonal antibodies targeting vascular endothelial growth factor or epidermal growth factor receptor, have few treatment options. The multikinase inhibitor regorafenib was shown to improve survival in patients with treatment‐refractory mCRC in the phase III CORRECT (N = 760) and CONCUR (N = 204) trials. However, safety data on regorafenib for mCRC in a larger number of patients were not available. The CONSIGN trial, carried out prospectively in more than 2,800 patients across 25 countries, confirmed the safety profile of regorafenib from the phase III trials and reinforced the importance of using treatment modifications to manage adverse events.

https://ift.tt/2Crm8jp

A Pioneer in Neuroendocrinology

Exp Clin Endocrinol Diabetes 2018; 126: 534-535
DOI: 10.1055/a-0658-1185

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2M5It5B

Most Innovative Paper Award

Exp Clin Endocrinol Diabetes 2018; 126: 471-471
DOI: 10.1055/a-0696-9405

Dear Readers,It is our – and the publisher's – conviction that a scientific journal's mission is not only to provide its readers with the most relevant and interesting papers available, but also to further scientific research and to reward and honour those whose contributions to the advancement of science are truly remarkable. We are thus especially delighted to announce that from this year onward, we – the Editors-in-Chief together with the publisher Georg Thieme Verlag- will again officially award the most innovative paper published in Experimental and Clinical Endocrinology & Diabetes. Eligible are all original papers within the fields of endocrinology and diabetes published the two years previously, i. e. the prize awarded in 2019 will consider papers published in 2017 and 2018.Of course, true to the title of the journal, the prize – worth € 4,000 – will alternate between endocrinology and diabetes and will be awarded either during the DGE or the DDG conference. Endocrinology will make a start in 2019 and we are looking forward to our first winners on stage during the DGE conference 20–22 March 2019.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2oNZKqM

“The validity of the EQ-5D-5L in measuring quality of life benefits of breast reconstruction”

The EuroQol EQ-5D-5L instrument is the most widely-used quality of life measure in health economic evaluations. It is unclear whether such a generic instrument is valid enough to estimate the benefits of breast reconstruction (BR), given the specific changes observed in quality of life after BR. Hence, we aimed to evaluate the validity of EQ-5D-5L in patients who had undergone postmastectomy BR.

https://ift.tt/2oTsIFT

Aggregation, sedimentation, and dissolution of CuO and ZnO nanoparticles in five waters

Abstract

With the accelerated application of copper oxide (CuO) and zinc oxide (ZnO) nanoparticles (NPs) in commercial products, concerns about the potential impacts on the environment have been growing. Environmental behaviors of NPs are expected to significantly influence their fate and ecological risk in the aquatic environment. In this study, the environmental behaviors of two metallic NPs (CuO and ZnO NPs), including aggregation, sedimentation, and dissolution, were systematically evaluated in five representative waters (pool water, lake water, rainwater, tap water, and wastewater) with varying properties. Remarkable aggregation, sedimentation, and dissolution were observed for both metallic NPs, among which ZnO NPs exhibited greater influence. CuO (ZnO) NPs aggregated to 400 (500) nm, 500 (900) nm, and 800 (1500) nm in lake water, wastewater, and tap water, respectively. The sedimentation rates of CuO and ZnO NPs in the five waters were ranked as tap water > wastewater > lake water > pool water > rainwater. The dissolution of CuO and ZnO NPs in waters follows a first-order reaction rate model and is affected by ionic type, ionic strength (IS), and NOM (natural organic matter) concentrations. Redundancy analysis (RDA) indicated that the aggregation and sedimentation of NPs have a strong correlation, insofar as the sedimentation rates increase with increasing aggregation rates. The aggregation and dissolution of NPs have a negative correlation, insofar as the dissolution rates reduce with increasing aggregation rates. The aggregation, sedimentation, and dissolution of NPs can be influenced by ionic types, IS, and TOC in waters, among which, TOC may the dominant factor.

https://ift.tt/2wOMV3M

Interactions between hypothalamic pituitary thyroid axis and other pituitary dysfunctions

Abstract

Central hypothyroidism is defined as low circulating free thyroxine (free T4) with inappropriately low circulating thyrotropin (TSH), in context of a hypothalamic pituitary pathology. Rare cases of idiopathic central hypothyroidism caused by a functional defect may occur, and the condition is often overlooked due to difficulty in achieving the correct diagnosis, sparse symptomatology of the condition and a high risk of misinterpretion of the biochemical changes in central hypothyroidism. Central hypothyroidism is mainly seen in patients with hypothalamic–pituitary pathology due to one of many possible aetiologies, where other hormone deficiencies often co-exist, and both the presence of other deficiencies and their replacement have a strong influence on the measurement of the thyroid-related hormones and thereby interpretation of the thyroid function variables in relation to the clinical impact of thyroid hormone substitution therapy. Conversely, lack of thyroid hormone has a similar strong influence on the interpretation of other pituitary hormone axes, as well as their replacement. Undertreating patients with central hypothyroidism may have serious metabolic consequences with a potentially increased risk of cardiovascular morbidity. The present review thus aims at describing central hypothyroidism, by an overview of interactions of hypothyroidism with other pituitary hormones, diagnosing/testing for central hypothyroidism, and focusing on consequences of undertreatment. Finally, it is mentioned how to deal with new diagnostic settings with lower a priori likelihood of hypopituitarism, particularly in view of the importance of stringent diagnostic testing in order to avoid overdiagnosing central hypothyroidism.

https://ift.tt/2MUaXVi