Arthritic psoriasis during natalizumab treatment: a case report and review of the literature

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2y4khdU

Exercise Oscillatory Ventilation: Inter-reviewer Agreement and a Novel Determination.

Introduction: Determination of exercise oscillatory ventilation (EOV) is subjective and the inter-reviewer agreement has not been reported. The purpose of this study was, among patients with heart failure (HF): (1) determine the inter-reviewer agreement for EOV; and (2) describe a novel, objective, and quantifiable measure of EOV. Methods: This was a secondary analysis of the HEART Camp: Promoting Adherence to Exercise in Patients with Heart Failure study. EOV was determined through a blinded review by 6 individuals based on their interpretation of the EOV literature. Inter-reviewer agreement was assessed with Fleiss kappa ([kappa]). Final determination of EOV was based on agreement by 4 of the 6 reviewers. A new measure (ventilation dispersion index; VDI) was calculated for each test and its ability to predict EOV was assessed with the receiver operator characteristics curve (ROC). Results: Among 243 patients with HF (age=60+/-12 years; 45% women) the inter-reviewer agreement for EOV was fair ([kappa]=0.303) with 10-s discrete data averages and significantly better, but only moderate ([kappa]= 0.429) with 30-s rolling data averages. Prevalence of positive and indeterminate EOVs were 18% and 30% with the 10-s discrete averages and 14% and 13% with the 30-s rolling averages, respectively. VDI was strongly associated with EOV with area under the ROC= 0.852 to 0.890. Conclusions: Inter-reviewer agreement for EOV in patients with HF is fair to moderate which can negatively affect risk stratification. VDI has strong predictive validity with EOV; as such it might be a useful measure of prognosis in patients with HF. (C) 2017 American College of Sports Medicine

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjXRHT

The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.

Purpose: The aim of this study was to investigate the influence of foot-strike technique on longitudinal arch mechanics and intrinsic foot muscle function during running. Methods: 13 healthy participants ran barefoot on a force-instrumented treadmill at 2.8ms-1 with a forefoot (FFS) and rear-foot (RFS, habitual) running technique, while kinetic, kinematic and electromyographic (EMG) data from the intrinsic foot muscles were collected simultaneously. The longitudinal arch was modeled as a single "mid-foot" joint representing motion of the rear-foot (calcaneus) relative to the forefoot (metatarsals). An inverse dynamic analysis was performed to estimate joint moments generated about the mid-foot, as well as mechanical work and power. Results: The mid-foot was more plantar flexed (higher arch) at foot contact when running with a forefoot running technique (RFS 0.2 +/- 1.8o v FFS 6.9 +/- 3.0o, ES = 2.7), however there was no difference in peak mid-foot dorsiflexion in stance (RFS -11.6 +/- 3.0o v FFS -11.4 +/- 3.4o, ES = 0.63). When running with a forefoot technique, participants generated greater moments about the mid-foot (27% increase, ES = 1.1) and performed more negative work (240% increase, ES = 2.2) and positive work (42% increase, ES = 1.1) about the mid-foot. Average stance phase muscle activation was greater for Flexor Digitorum Brevis (20% increase, ES = 0.56) and Abductor Hallucis (17% increase, ES = 0.63) when running with a forefoot technique. Conclusion: Forefoot running increases loading about the longitudinal arch and also increases the mechanical work performed by the intrinsic foot muscles. These findings have substantial implications in terms of injury prevention and management for runners who transition from a rear-foot to a forefoot running technique. (C) 2017 American College of Sports Medicine

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fi7dtG

Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure

Abstract

Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary's Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep (p < 0.01), sleep duration (p < 0.05), number of awaking (p < 0.01), nap duration (p < 0.01), sleep quality (p < 0.05), and sleep satisfaction (p < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 (p < 0.01), and increase in sleep stage N2 (p < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjMXSw

Impact of pharmacological spasm provocation test in patients with a history of syncope

Abstract

Coronary artery spasm is involved in the pathogenesis of various cardiac disorders. We investigated patients with a history of syncope who underwent elective coronary angiography. We retrospectively analyzed 5781 consecutive patients who had diagnostic or follow-up angiography during a 26-year period. During this period, we found 95 patients with a history of syncope before elective coronary angiography. Pharmacological spasm provocation testing was performed in 64 patients with a history of syncope (<1 year). Positive pharmacological response was observed in 48 patients, while the remaining 16 patients had negative tests. Positive spasm was defined as a transient ≥90% narrowing with ischemic electrocardiographic changes. Among the 64 patients, definite coronary spastic angina (CSA) was found in 35 patients (54.7%) and suspected CSA was found in 13 patients (20.3%). Among the 35 patients with definite CSA, 22 patients (62.9%) had chest symptoms before syncope, but 13 (37.1%) had no chest symptom before syncope. No difference in clinical characteristics was observed between the two groups. Focal spasm during pharmacological spasm provocation tests was significantly higher in patients with chest symptoms than in those without chest symptoms before syncope (54.3 vs. 12.0%, p < 0.002). CSA was observed in 75.0% of patients with a history of syncope (<1 year). Thirteen patients with definite CSA had neither chest pain nor chest pressure before syncope. We should therefore investigate coronary artery spasm as a potential etiology in patients with a history of syncope.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fgP5jY

ADC-derived spatial features can accurately classify adnexal lesions

Background

The role of quantitative apparent diffusion coefficient (ADC) maps in differentiating adnexal masses is unresolved.

Purpose/Hypothesis

To propose an objective diagnostic method devised based on spatial features for predicting benignity/malignancy of adnexal masses in ADC maps.

Study Type

Prospective.

Population

In all, 70 women with sonographically indeterminate and histopathologically confirmed adnexal masses (38 benign, 3 borderline, and 29 malignant) were considered for this study.

Field Strength/Sequence

Conventional and diffusion-weighted magnetic resonance (MR) images (b-values = 50, 400, 1000 s/mm²) were acquired on a 3T scanner.

Assessment

For each patient, two radiologists in consensus manually delineated lesion borders in whole ADC map volumes, which were consequently analyzed using spatial models (first-order histogram [FOH], gray-level co-occurrence matrix [GLCM], run-length matrix [RLM], and Gabor filters). Two independent radiologists were asked to identify the attributed (benign/malignant) classes of adnexal masses based on morphological features on conventional MRI.

Statistical Tests

Leave-one-out cross-validated feature selection followed by cross-validated classification were applied to the feature space to choose the spatial models that best discriminate benign from malignant adnexal lesions. Two schemes of feature selection/classification were evaluated: 1) including all benign and malignant masses, and 2) scheme 1 after excluding endometrioma, hemorrhagic cysts, and teratoma (14 benign, 29 malignant masses). The constructed feature subspaces for benign/malignant lesion differentiation were tested for classification of benign/borderline/malignant and also borderline/malignant adnexal lesions.

Results

The selected feature subspace consisting of RLM features differentiated benign from malignant adnexal masses with a classification accuracy of ∼92%. The same model discriminated benign, borderline, and malignant lesions with 87% and borderline from malignant with 100% accuracy. Qualitative assessment of the radiologists based on conventional MRI features reached an accuracy of 80%.

Data Conclusion

The spatial quantification methodology proposed in this study, which works based on cellular distributions within ADC maps of adnexal masses, may provide a helpful computer-aided strategy for objective characterization of adnexal masses.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2017.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xYyPek

Quantitative evaluation of breast cancer response to neoadjuvant chemotherapy by diffusion tensor imaging: Initial results

Background

Diffusion tensor imaging (DTI) yields several parameters that have not been tested in response evaluation to neoadjuvant chemotherapy (NAC).

Purpose

To evaluate and compare in reference to histopathology findings the ability of DTI and dynamic contrast-enhanced (DCE) MRI to monitor response to NAC.

Study Type

Retrospective.

Population

Twenty patients treated with neoadjuvant chemotherapy.

Field Strength/Sequence

1.5T MRI axial, bilateral T₂-weighted, DTI, and DCE-MRI.

Assessment

A standardized blinded image analysis at pixel resolution generated color-coded maps of DTI and DCE parameters

Statistical Tests

Pearson's correlation analysis and Bland–Altman plots of the DTI and DCE size changes and of the pathological final residual tumor diameter and DCE or DTI final diameter, from pre- to post-NAC. Spearman coefficient of rank correlation between the DTI and DCE size changes from pre- to post-NAC and Miller and Payne (M&P) pathological response grading. Receiver operating characteristic curve analyses to differentiate between responders to nonresponders on the basis of the DTI and DCE percent size changes and the changes in DTI parameters.

Results

DTI and DCE changes in the cancers' diameter and volume from pre- to post-NAC exhibited high and significant Pearson correlation (r = 0.82 P = 1.2 × 10⁻⁵). The DTI volume changes exhibited a significant Spearman coefficient rank correlation (0.68, P = 0.001) with the pathological M&P grading and differentiated between responders and nonresponders with area-under-the-curve (AUC) of 0.83 ± 0.10. A similar AUC for differentiating responders from nonresponders was exhibited by the changes in the highest diffusion coefficient (0.84 ± 0.11) and the mean diffusivity (0.83 ± 0.11). The DTI residual-tumor-diameter showed a high and significant Pearson correlation (r = 0.87 P = 1.2 × 10⁻⁶) to pathology tumor diameter.

Data Conclusion

DTI monitors changes in cancer size and diffusion tensor parameters in response to NAC with an accuracy equivalent to that of DCE, enabling differentiation of responders from nonresponders and assessment of residual tumor size in high congruence with pathology.

Level of Evidence: 1

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2017.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2h1GAgz

Clinically insignificant prostate cancer suitable for active surveillance according to Prostate Cancer Research International: Active surveillance criteria: Utility of PI-RADS v2

Background

Active surveillance (AS) is an important treatment strategy for prostate cancer (PCa). Prostate Imaging-Reporting and Data System (PI-RADS) v2 has been addressed, but few studies have reported the value of PI-RADS v2 for assessing risk stratification in patients with PCa, especially on selecting potential candidates for AS.

Purpose

To investigate the utility of PI-RADS v2 and apparent diffusion coefficient (ADC) in evaluating patients with insignificant PCa, who are suitable for AS.

Study Type

Retrospective.

Subjects

In all, 238 patients with PCa who met the Prostate Cancer Research International: Active Surveillance criteria underwent radical prostatectomy.

Field Strength/Sequence

3.0T, including T₂-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging.

Assessment

Insignificant cancer was defined histopathologically as an organ-confined disease with a tumor volume <0.5 cm³ without Gleason score 4–5. Patients were divided into two groups based on the PI-RADS v2 and tumor ADC: A, PI-RADS score ≤3 and ADC ≥1.095 × 10⁻³mm²/s; and B, PI-RADS score 4–5 or ADC <1.095 × 10⁻³mm²/s. Preoperative clinical and imaging variables were evaluated regarding the associations with insignificant cancer.

Results

Of the 238 patients, 101 (42.8%) were diagnosed with insignificant cancer on pathological findings. The number of positive cores, prostate-specific antigen density (PSAD), PI-RADS v2 and tumor ADC were significantly associated with insignificant cancer on univariate analysis (P < 0.05). However, multivariate analysis indicated tumor ADC (odds ratio [OR] = 4.57, P < 0.001) and PI-RADS v2 (OR = 3.60, P < 0.001) were independent predictors of insignificant cancer. Area under the receiver operating characteristics curve (AUC) reached 0.803 when PI-RADS v2 (AUC = 0.747) was combined with tumor ADC (AUC = 0.786).

Data Conclusion

The PI-RADS v2 together with tumor ADC may be a useful marker for predicting patients with insignificant PCa when considering AS.

Level of Evidence: 4

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2017.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xYyNDe

Diagnostic performance of CT, gadoxetate disodium-enhanced MRI, and PET/CT for the diagnosis of colorectal liver metastasis: Systematic review and meta-analysis

Background

Imaging studies, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), have an essential role in the detection and localization of colorectal liver metastasis (CRLM).

Purpose

To systematically determine the diagnostic accuracy of multidetector row CT (MDCT), gadoxetate disodium-enhanced MRI, and PET/CT for diagnosing CRLM and the sources of heterogeneity between the reported results.

Study Type

Systematic review and meta-analysis.

Subjects

In all, 2151 lesions in CT studies, 2301 lesions in MRI studies, 1846 lesions in PET/CT studies,

Field Strength

1.5T and 3.0T.

Assessment

We identified research studies that investigated MDCT, gadoxetate disodium-enhanced MRI, and PET/CT to diagnose CRLM by performing a systematic search of PubMed MEDLINE and EMBASE. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

Statistical Tests

According to the types of imaging tests, study heterogeneity and the threshold effect were analyzed and the meta-analytic summary of sensitivity and specificity were estimated. Meta-regression analysis was performed to further investigate study heterogeneity.

Results

Of the 860 articles screened, we found 36 studies from 24 articles reporting a diagnosis of CRLM (11 CT studies, 12 MRI studies, and 13 PET/CT studies). The meta-analytic summary sensitivity for CT, MRI, and PET/CT were 82.1% (95% confidence interval [CI], 74.0–88.1%), 93.1% (95% CI, 88.4–96.0%), and 74.1% (95% CI, 62.1–83.3%), respectively. The meta-analytic summary specificity for CT, MRI, and PET/CT were 73.5% (95% CI, 53.7–86.9%), 87.3% (95% CI, 77.5–93.2%), and 93.9% (95% CI, 83.9–97.8%), respectively. There was no threshold effect in any of the imaging tests. Neoadjuvant chemotherapy significantly decreased the sensitivity of CT and MRI (P < 0.01), although it did not significantly affect the sensitivity of PET/CT. The study design, type of reference standard, and study quality also affected the diagnostic performances of imaging studies.

Data Conclusion

Despite the heterogeneous accuracy between studies, gadoxetate disodium-enhanced MRI showed the highest sensitivity, and gadoxetate disodium-enhanced MRI and PET/CT had similar specificities for diagnosing CRLM.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2017.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2gZkn2C

RadCases: Head and neck imaging Gaurang Shah, Jeffrey Wesolowski, Jeanie Choi, and Elliott R. Friedman, New York: Thieme; 2016. $59.99; 224 pages; 361 illustrations.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xYwikn

Sonographie in der Nachsorge bei Kopf- und Halskarzinomen

Zusammenfassung

In Deutschland ist die hochauflösende Sonographie mit Verwendung von Farbduplexverfahren neben der Computertomographie (CT) ein gängiges und bewährtes Verfahren im Rahmen der Therapiekontrolle („restaging") nach der Primärtherapie von Kopf-Hals-Karzinomen (HNSCC). Im internationalen Kontext existieren für HNSCC keine evidenzbasierten Leitlinien für das Re-Staging oder die Tumornachsorge. Entscheidungen für und wider eine „neck dissection" (ND) nach primärer Radiochemotherapie (RCT) werden in den Tumorkonferenzen häufig individuell getroffen und unterliegen damit einer Variabilität. Anders als in Großbritannien oder den USA besteht in Deutschland eine hohe Expertise in der Anwendung des Ultraschalls in Kombination mit der CT zum routinemäßigen Re-Staging von HNSCC nach RCT. Mittels der hochauflösenden Sonographie (B-Mode und Farbdoppler) sind morphologische Veränderungen von Halslymphknoten hervorragend darstellbar. Ein weiterer wichtiger Aspekt ist die genaue und standardisierte Dokumentation von Befunden und deren Dynamik im Verlauf. Zusammen mit der klinischen Präsentation ermöglicht die Sonographie eine konkrete Entscheidungsfindung und „Therapie aus einer Hand".

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2h0LkCZ

The role of the neural niche in brain metastasis

Abstract

Cancers with neurologic metastasis are a burdensome affliction. As primary cancer care improves, the incidence of metastatic cancer increases as a result of prolonged survival time. Because of this, advances in the understanding of the mechanisms of metastasis are important for the development of continuing management strategies. Knowing how metastatic tumor cells engage, survive, and proliferate in the central nervous system (CNS) is an important first step in developing treatment paradigms. The neural niche is the soil of the CNS that accommodates tumor cells, is a microenvironment of cell signaling that exists between the tumor cell and the native neural cellular network. Elements of the neural niche have been identified as acquaintances for metastatic tumor growth. As more is known about the neural niche, treatment strategies can be developed to target these networks of metastatic tumor progression.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2woXmYS

Preliminary result with incisional negative pressure wound therapy and pectoralis major muscle flap for median sternotomy wound infection in a high-risk patient population

ABSTRACT

Deep sternal wound infection (DSWI) represents a dangerous complication that can follow open-heart surgery with median sternotomy access. Muscle flaps, such as monolateral pectoralis major muscle flap (MPMF), represent the main choices for sternal wound coverage and infection control. Negative pressure incision management system has proven to be able to reduce the incidence of these wounds' complications. Prevena^TM represents one of these incision management systems and we aimed to evaluate its benefits. A total of 78 patients with major risk factors that presented post-sternotomy DSWI following cardiac surgery was selected. Thrity patients were treated with MPMF and Prevena^TM (study group). Control group consisted of 48 patients treated with MPMF and conventional wound dressings. During the follow-up period, 4 (13%) adverse events occurred in the study group, whereas 18 complications occurred (37·5%) in the control group. Surgical revision necessity and mean postoperative time spent in the intensive care unit were both higher in the control group. Our results evidenced Prevena^TM system's ability in improving the outcome of DSWI surgical treatment with MPMF in a high-risk patient population.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2joMM2C

Differences in Energy Consumption in Electric Vehicles: An Exploratory Real-World Study in Beijing

Electric vehicles (EVs) are widely regarded as a promising solution to reduce air pollution in cities and key to a low carbon mobility future. However, their environmental benefits depend on the temporal and spatial context of actual usage (journey energy efficiency) and the rolling out of EVs is complicated by issues such as limited range. This paper explores how the energy efficiency of EVs is affected and shaped by driving behavior, personal driving styles, traffic conditions, and infrastructure design in the real world. Tests have been conducted with a Nissan LEAF under a typical driving cycle on the Beijing road network in order to improve understanding of variations in energy efficiency among drivers under different urban traffic conditions. Energy consumption and operation parameters were recorded in both peak and off-peak hours for a total of 13 drivers. The analysis reported in this paper shows that there are clear patterns in energy consumption along a route that are in part related to differences in infrastructure design, traffic conditions, and personal driving styles. The proposed method for analyzing time series data about energy consumption along routes can be used for research with larger fleets of EVs in the future.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jmGQaI

Design strategies for improved velocity-selective pulse sequences

Publication date: December 2017
Source:Magnetic Resonance Imaging, Volume 44
Author(s): Gerald B. Matson
Over the years, a variety of MRI methods have been developed for visualizing or measuring blood flow without the use of contrast agents. One particular class of methods uses flow-encoding gradients associated with an RF pulse sequence to distinguish spins in flowing blood from stationary spins. While a strength of these particular methods is that, in general, they can be tailored to capture a desired range of blood flow, such sequences either do not provide a sharp transition from stationary spins to flowing spins, or else are long, generating relaxation losses and undesirable SAR, and have limited immunity to resonance offsets and to RF inhomogeneity. This article provides design methods for improving these longer RF pulse sequences, especially to provide improved immunity to RF inhomogeneity, and also to improve immunity to resonance offsets, as well as to minimize RF sequence length. These design methods retain the flexibility to capture a desired range of blood flow, with sharp transitions between stationary spins and flowing blood. These improvement strategies are demonstrated through Bloch equations simulations of examples of these new sequences in the presence of blood flow. Examples of improved sequences that should prove suitable for use at 3.0Tesla are presented.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jndxoh

The role of the neural niche in brain metastasis

Abstract

Cancers with neurologic metastasis are a burdensome affliction. As primary cancer care improves, the incidence of metastatic cancer increases as a result of prolonged survival time. Because of this, advances in the understanding of the mechanisms of metastasis are important for the development of continuing management strategies. Knowing how metastatic tumor cells engage, survive, and proliferate in the central nervous system (CNS) is an important first step in developing treatment paradigms. The neural niche is the soil of the CNS that accommodates tumor cells, is a microenvironment of cell signaling that exists between the tumor cell and the native neural cellular network. Elements of the neural niche have been identified as acquaintances for metastatic tumor growth. As more is known about the neural niche, treatment strategies can be developed to target these networks of metastatic tumor progression.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2woXmYS

Hydraulic performance and fouling characteristics of a membrane sequencing batch reactor (MSBR) for landfill leachate treatment under various operating conditions

Abstract

This study investigates the hydraulic performance and the fouling characteristics of a bench-scale membrane sequencing batch reactor (MSBR), treating mature landfill leachate under various time-based operating conditions. The MSBR system operated initially under a high-flux condition (Period 1) which resulted in a rapid trans-membrane pressure (TMP) rise due to intense fouling. Following the characterization of Period 1 as super-critical, the system was subsequently operated under a near-critical condition (Period 2). The overall filtration resistance analysis showed that cake layer formation was the dominant fouling mechanism during Period 1, contributing to 85.5% of the total resistance. However, regarding the MSBR operation during Period 2, adsorption was found to also be a dominant fouling mechanism (Days 1 to 47), contributing to 29.1% of the total resistance. Additionally, the irregular total resistance variation, which was observed during the subsequent operation (Days 48 to 75), and the respective filtration resistance analysis suggested also the formation of an initial sludge cake layer on the membrane surface, contributing to the 47.7% of the total resistance.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2x0cHm0

Evaluation of the efficacy and safety of oral isotretinoin versus topical isotretinoin in the treatment of plane warts: a randomized open trial

Abstract

Background

Plane warts are a common therapeutic problem. Our aim was to assess the efficacy and safety of oral versus topical isotretinoin in the treatment of plane warts.

Methods

Forty patients with multiple plane warts were randomized into two groups. Group A was treated with oral isotretinoin capsules in the dose of 0.5 mg/kg/d and Group B with topical isotretinoin 0.05% in gel formulation once daily at night. Treatment was given to the patients for 3 months or until the complete clearance of lesions, whichever was earlier. Patients with complete response were followed up monthly for 4 months to record the relapse rate.

Results

Results were analyzed in 16 patients of Group A and 13 patients of Group B. At the end of 3 months of therapy, 11 (69%) patients in Group A had complete remission whereas five (31%) had partial remission. In Group B, at the end of study, five (38%) patients had complete remission and six (46%) had partial remission, whereas two patients had no remission. The difference was statistically significant between two groups; P < 0.0001. The most common side effect in Group A was cheilitis. In Group B, five patients had to be dropped because they developed severe erythema and scaling.

Conclusion

Oral isotretinoin showed better and earlier response than topical isotretinoin. Oral isotretinoin should definitely be given a trial particularly in cases of multiple facial warts before trying various destructive procedures.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xYEdho

Strong emphasis on collaboration to tackle health challenges

Sweden holds a strong position in the field of life science. While at the same time we are facing serious health challenges and need to adapt to changes in the world around us, not least rapid digitalisation. Players in the Life Science sector met for an afternoon at Karolinska Institutet to discuss the need for interaction to be able to meet the challenges. "One of the biggest challenges is how research and education are to keep pace with the extensive changes that are taking place, not only in Stockholm but around the world. That challenge is enormous and requires us to cooperate in order for our society to have the beast health services and health and medical care in the future," said Karolinska Institutet's new vice-chancellor Ole Petter Ottersen as he welcomed participants to the seminar on health and life science in the Samuelsson Hall on September 6th. The seminar is part of a nationwide series of seminars on societal challenges based on the research policy bill that the government put forward in 2016. Helene Hellmark Knutsson, Minister for Higher Education and Research, attends the seminars where concerned players from academia, trade and industry and other parts of society come together to discuss how the initiatives in the bill can be translated into practice and do the most good.  Ole Petter Ottersen said that Karolinska Institutet has listed six main points in the university's strategies for interaction: development of university healthcare, regional and national cooperation, more interaction with trade and industry, incentives for and financing of innovation, strategic cooperation with trade and industry, and international collaborations. The major infrastructural changes currently taking place at Karolinska Institutet need well-developed forms of interaction with, among others, Stockholm County Council, Sweden's trade and industry and other prominent universities, both in Sweden and in other countries. Professor Ottersen emphasised that all the ongoing initiatives and investments are taking place in interaction with the health and medical care services in order to further integrate research with clinical operations and activities.  The research policy bill turned into practical action In her introduction to the seminar, Helene Hellmark Knutsson emphasised that now is the time to turn the research policy into practical action. The new research funds and research programmes have just been set in motion and it is time to implement the research policy in reality. "It feels good to see so many of those who are to help us tackle societal challenges participating here," Hellmark Knutsson told her audience. She emphasised that Sweden has traditionally been a country that has invested in research, which is for example evident in the Times Higher Education's ranking of universities around the world where three Swedish universities can be found among the world's top 100. The research policy bill's starting point is to tackle societal challenges through collaboration, she went on. In order to achieve this, basic appropriations are being raised and particular initiatives will be put into effect with among other things ten-year research programmes and measures to promote collaboration and innovation. She emphasised, however, that more research funding does not always mean higher quality of the research results. "We must announce more career-development positions in international competition. Well-defined, transparent career paths are important in order to attract the best researchers. Today, many have time-limited positions and too many are recruited internally. We have traditionally favoured 'home-grown sons', that is to say men from one's own university," Helena Hellmark Knutsson said. More research linkage in education programmes, better conditions for doctoral students and quality assurance also of research are further examples from the research policy bill that Helena Hellmark Knutsson emphasised. "We have world-leading research in some areas of Life Science. We have health and medical care that covers all patients. We have good registers and bio-banks. All of these could put us even further ahead. I look forward to collaborating with you all to make Sweden a leading research nation in Life Science." Helena Hellmark Knutsson also emphasised her support for the proposal that the European Medicines Agency should be located in Sweden, before handing over to moderator Göran Stiernstedt, senior lecturer and member of the University Senate Council at Karolinska Institutet. Research projects with social linkages Seminar participants then watched presentations on the theme of health challenges from four researchers at Karolinska Institutet. Professor Kristina Johnell, Division Head of the Aging Research Center, spoke about the challenges of drug treatment in elderly people. Among other things she said that elderly people are often excluded from clinical trials and that sensitivity to drugs increases the older we become. Ylva Trolle Lagerros, senior lecturer at the Department of Medicine, described how digital technology can be used to promote health. We can among other things use our smartphones to register the amount of exercise we do, share exercise data with our care provider and together set common goals for better health. "The exciting thing about this is that 70 percent of the participants in the research project are older men, a group that is usually difficult to reach when it comes to health promoting research. And the digital care plan makes a difference. Almost all take that extra evening walk to reach their goal," she said. Christian Giske, senior lecturer at the Department of Laboratory Medicine, spoke about resistant intestinal bacteria and showed worrying figures of the proportion of resistant intestinal bacteria in various parts of the world. He pointed out, however, the importance of not scaring people and exaggerating the risks, which he said the media, among others, contributed to. Professor Jan-Olov Höög from the Department of Medical Biochemistry and Biophysics gave his views on how university education programmes in Life Science should be designed to equip students for the future. Karolinska Institutet offers for example global master's programmes that are taught in English and free university courses via the Internet (MOOC). Professor Höög also emphasised the need for innovations in the health sector and said that programmes and courses must meet the particular skills needs and the possible clashes of culture that may occur between a medical and a technical organisation as technical innovations increasingly pervade health and medical care.  The seminar ended with a panel discussion on how interaction can be effective and what thresholds and obstacles can make successful interaction difficult, in which Ole Petter Ottersen, Eric Vänerlöv, secretary of the National Coordination for Life Science study, Anna Sandström, Science Relations Director at AstraZeneca, Jenni Nordborg, director and head of the Health Department at Vinnova, and Malin Frenning, County Council Director for Stockholm County Council, took part.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fiiryD

The role of the neural niche in brain metastasis

Abstract

Cancers with neurologic metastasis are a burdensome affliction. As primary cancer care improves, the incidence of metastatic cancer increases as a result of prolonged survival time. Because of this, advances in the understanding of the mechanisms of metastasis are important for the development of continuing management strategies. Knowing how metastatic tumor cells engage, survive, and proliferate in the central nervous system (CNS) is an important first step in developing treatment paradigms. The neural niche is the soil of the CNS that accommodates tumor cells, is a microenvironment of cell signaling that exists between the tumor cell and the native neural cellular network. Elements of the neural niche have been identified as acquaintances for metastatic tumor growth. As more is known about the neural niche, treatment strategies can be developed to target these networks of metastatic tumor progression.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2woXmYS

The role of the neural niche in brain metastasis

Abstract

Cancers with neurologic metastasis are a burdensome affliction. As primary cancer care improves, the incidence of metastatic cancer increases as a result of prolonged survival time. Because of this, advances in the understanding of the mechanisms of metastasis are important for the development of continuing management strategies. Knowing how metastatic tumor cells engage, survive, and proliferate in the central nervous system (CNS) is an important first step in developing treatment paradigms. The neural niche is the soil of the CNS that accommodates tumor cells, is a microenvironment of cell signaling that exists between the tumor cell and the native neural cellular network. Elements of the neural niche have been identified as acquaintances for metastatic tumor growth. As more is known about the neural niche, treatment strategies can be developed to target these networks of metastatic tumor progression.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2woXmYS

Arthritic psoriasis during natalizumab treatment: a case report and review of the literature

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2y4khdU

Cognitive reactions of nurses exposed to cancer patients' traumatic experiences: A qualitative study to identify triggers of the onset of compassion fatigue

ConclusionsThis study identified important components of cognitive reactions of nurses who encounter the traumatic experiences of cancer patients in Japan. This information can contribute to the understanding of the onset of compassion fatigue and provide the foundation for nurses in cancer care to avoid and recover from compassion fatigue. (Source: Psycho-Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2wZIqUs

Her2 positive subtype and breast cancer brain metastasis: any effect of anti-Her2 targeted therapy?

(Source: Journal of Neuro-Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jnrZg0

Spatial discrimination of glioblastoma and treatment effect with histologically-validated perfusion and diffusion magnetic resonance imaging metrics

AbstractThe goal of this study is to spatially discriminate tumor from treatment effect (TE), within the contrast-enhancing lesion, for brain tumor patients at all stages of treatment. To this end, the diagnostic accuracy of MRI-derived diffusion and perfusion parameters to distinguish pure TE from pure glioblastoma (GBM) was determined utilizing spatially-correlated biopsy samples. From July 2010 through June 2015, brain tumor patients who underwent pre-operative DWI and DSC-MRI and stereotactic image-guided biopsy were considered for inclusion in this IRB-approved study. MRI-derived parameter maps included apparent diffusion coefficient (ADC), normalized cerebral blood flow (nCBF), normalized and standardized relative cerebral blood volume (nRCBV, sRCBV), peak signal-height (PSR) and per...

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2x0pp4e

Low blood cell counts: Side effect of cancer treatment

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/1vLZYd2

Dew formation and its variation in Haloxylon ammodendron plantations at the edge of a desert oasis, northwestern China

Publication date: 15 December 2017
Source:Agricultural and Forest Meteorology, Volume 247
Author(s): Yanli Zhuang, Wenzhi Zhao
Dewfall may be a critical source of moisture in desert environments and may determine sustainability of sand-stabilizing planted vegetation. However, little is known about factors responsible for dew formation, the relative importance of dew as a source of water, and its variability in plantations. During June and October of 2013, the dew amounts and duration were estimated by using the Bowen ratio energy budget technique (BREB), and the dew variability on sand dunes planted with Haloxylon ammodendron 5, 20, and 40 years before were measured by microlysimeter. We quantified dew formation characteristics in a sand-stabilizing H. ammodendron plantation at the edge of a desert oasis, northwestern China. The results indicated that the average daily amount of dew in the H. ammodendron plantations during the observation period based on BREB was 0.13mm, and the dew duration lasted from 1 to 9.5h. Dew occurred on 77% of growing season days, the number of days with dew amounts of >0.03mm comprised 95% of the total dewfall days, and the cumulative amount of dew for those days was 16.1mm. Air temperature, relative humidity, the difference between air temperature and dew point, and wind speed had significant effects on dew formation. The thresholds of the dew formation were RH >50% and wind speed <4.27m/s. As a result of larger canopy area and lower Sky View Factors to 20- and 40-year-old H. ammodendron, the accumulated amount of dew was always significantly greater, and its night-time variability was almost 3 times greater for 5-year-old than for 20- and 40-year-old shrubs. In addition, near-ground dew amounts at the inter-space of three ages of H. ammodendron exhibited higher values than that under the canopy, while dew formation lagged and the maximum cumulative amount of dew was observed 2h later under the canopy of shrubs. The Bowen ratio method estimated actual dew reasonably well. It is concluded that dew may be a frequent and stable water resources in H. ammodendron plantations at the edge of a desert oasis, and there is a mutually reinforcing effect between dewfall and the sand-fixing vegetation system.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjA2jh

Iberian atmosferic dynamics and large forest fires in mainland Portugal

Publication date: 15 December 2017
Source:Agricultural and Forest Meteorology, Volume 247
Author(s): F. Ferreira-Leite, N. Ganho, A. Bento-Gonçalves, F. Botelho
In Portugal the natural cycle of fire has been reduced, fires have become recurrent, their intensity and expansion have increased, and they have taken on catastrophic proportions.From 2003 to 2012, were accounted, for Portuguese mainland territory, 31 "large forest fires" (LFF) larger than 5000ha (12 of them with an area exceeding 10,000ha), and these always occurred in the months from July to September.Although the relationship between atmospheric dynamics, certain synoptic situations and the occurrence of LFF is already known in Portugal, several authors tried to identify the most favorable, in the new fire reality, that can even configure the existence of a new fire regime in Portugal, it is essential to identify synoptic patterns associated with LFF (5000ha above), which could be an important meteorological tool in the management of wildfires.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fhX4NL

Sustained Growth of a University-Based Endocrine Surgery Program Over 10 Years

ConclusionsEstablishment of an academic ESP can lead to sustained clinical growth and a fundamental shift in regional referral patterns. The nation 's continued need for skilled high-volume endocrine surgeons represents opportunities for medical centers to institute their own dedicated endocrine surgery programs. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fgT53M

Impact of Sustained Virological Response to Interferon Therapy on Recurrence of Hepatitis C Virus-Related Hepatocellular Carcinoma

ConclusionAchievement of SVR may reduce postoperative recurrence after hepatic resection. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjFZww

Usefulness of Mapping Biopsy in the Treatment of Penoscrotal Extramammary Paget ’s Disease

ConclusionsMapping biopsy is beneficial to reduce local recurrence in penoscrotal EMPD. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fgJw4W

Reappraisal of Staging Laparoscopy for Patients with Pancreatic Adenocarcinoma: A Contemporary Analysis of 1001 Patients

ConclusionThe rate for unnecessary laparotomy among patients with PDAC has decreased in contemporary times, but unnecessary laparotomy still occurs for 1 in 4 patients. Using our scoring system, a cutoff of 4 allows 76% of radiographically occult metastases to be predicted, thereby selecting high-risk patients for laparoscopic biopsy and potentially avoiding a non-therapeutic laparotomy. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjPYlt

Survival Rates for Patients with Resected Gastric Adenocarcinoma Finally have Increased in the United States

ConclusionThis analysis demonstrated for the first time that gastric cancer survival rates have significantly improved in the United States during the past 2  decades. This observation likely reflects improved adherence to cancer treatment guidelines, including adequate lymph node evaluation and delivery of adjuvant treatment more consistently. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fgJpq2

Targeted Therapy and Local Control: The Dynamic Duo

(Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjPQT1

Optimal Lymphadenectomy for Duodenal Adenocarcinoma: Does the Number Alone Matter?

ConclusionThe pancreaticoduodenal lymph node station was the most commonly involved lymph node in DA, and PD should be the standard operation for DA. Segmental resection should only be reserved for patients with distal DA who are physically unfit for PD. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fgJkTg

2017 Update on the Querleu –Morrow Classification of Radical Hysterectomy

ConclusionStudies evaluating radicality in the surgical management of cervical cancer should be based on precise, universally accepted descriptions. The authors ' updated classification presents standardized, universally applicable descriptions of different types of hysterectomies performed worldwide, categorized according to degree of radicality, independently of theoretical considerations. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjDj22

Impact of Patient Age on the Postoperative Survival in Pancreatic Head Cancer

ConclusionsPatient age influenced the survival after pancreatoduodenectomy for pancreatic cancer. (Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fgJcDg

Usefulness of Mapping Biopsy in the Treatment of Penoscrotal Extramammary Paget ’s Disease

(Source: Annals of Surgical Oncology)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjPGLp

Risk factors for postoperative pneumonia after microsurgery for vestibular schwannoma

Publication date: November 2017
Source:Clinical Neurology and Neurosurgery, Volume 162
Author(s): Chenghong Wang, Tengfei Li, Shaozhou Tang, Yuekang Zhang
ObjectivesPostoperative complications occurred in about 30% patients after vestibular schwannoma (VS) microsurgical excision. Although many specific complications have been extensively studied, postoperative pneumonia (POP) has received little attention. This study was designed to identify the risk factors for POP after microsurgery for VS.Patients and methodsPatients undergoing VS microsurgical resection (n=244) between December 2014 and November 2016 at West China Hospital of Sichuan University were retrospectively assessed for POP. Univariate and multivariate analyses were performed to identify the risk factors for POP.ResultsPOP (Clavien–Dindo grade II or higher) was diagnosed in 29 (11.9%) patients. Univariate analysis revealed that age (≥60years; p=0.013), diabetes mellitus (DM; p=0.040) and Koos grade IV (p=0.017) were significantly associated with POP. Multivariate analysis revealed that these factors were all independent risk factors for POP. Association between POP and prolonged postoperative hospitalization was also revealed. However, no risk factor associated with severity of POP was found in this study.ConclusionOlder age, DM and Koos grade IV were identified as independent risk factors for POP after microsurgery for VS Moreover, POP caused a prolonged hospital stay.



from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xvycwA

Do Patients with Advanced NSCLC Doing Well on an Immune Checkpoint Inhibitor Reach a Point of Diminishing Returns after a Fixed Duration of Treatment? (BMIC-008)

Dr. Jack West reviews the important, clinically relevant results of the CheckMate-153 trial that asks whether there is a value in continuing an immune checkpoint inhibitor in patients with advanced NS... Author: BeaconMedIC Added: 09/12/2017 (Source: Oncology Tube)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2jlSiDc

The FLAURA Trial: Practice-Changing Results for Patients with EGFR Mutation-Positive NSCLC (BMIC-007)

Dr. Jack West summarizes the likely practice-changing results of the FLAURA trial of osimertinib vs. standard of care EGFR TKI therapy (gefitinib or erlotinib) as first line treatment for patients wit... Author: BeaconMedIC Added: 09/10/2017 (Source: Oncology Tube)

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2wVlQdW

Differential involvement of L- and T-type Ca2+ channels, store-operated calcium channel (TRPC) and Rho-kinase signaling pathway(s) in PGF2α-induced contractions in myometrium of non-pregnant and pregnant buffaloes (Bubalus bubalis)

Publication date: Available online 12 September 2017
Source:Prostaglandins & Other Lipid Mediators
Author(s): Abhishek Sharma, Udayraj P. Nakade, Pooja Jaitley, Vipin Sharma, Soumen Choudhury, Satish Kumar Garg
This study unravels the differential involvement of calcium signaling pathway(s) in PGF2α-induced contractions in myometrium of non-pregnant and pregnant buffaloes. Compared to the myometrium of pregnant animals, myometrium of non-pregnant buffaloes was more sensitive to PGF2α–induced contractile effect as manifested by the changes in mean integral tension (MIT) and tonicity. However, phasic contraction was significantly more in myometrium of pregnant animals. The uterotonic effect of PGF2α was dependent on extracellular Ca²⁺ and its influx through nifedipine-sensitive L-type Ca²⁺ channels both in non-pregnant and pregnant animals, but T-type Ca²⁺ channels play an additional role during pregnancy. Entry of extracellular Ca²⁺ is triggered by enhanced functional involvement of Pyr3-sensitive TRPC3 channels and Rho-kinase pathways to regulate uterotonic action of PGF2α in myometrium of non-pregnant buffaloes while these are down-regulated during pregnancy as there was significantly reduced expression of Rho-A proteins in myometrium of pregnant buffaloes and down-regulation of these facilitate uterine quiescence. Intracellular Ca²⁺ plays minor role in myometrium of both the non-pregnant and pregnant buffaloes.

Graphical abstract

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2fhpjfn

Natriuretic peptides in the control of lipid metabolism and insulin sensitivity

Summary

Natriuretic peptides have long been known for their cardiovascular function. However, a growing body of evidence emphasizes the role of natriuretic peptides in human substrate and energy metabolism, thereby connecting the heart with several insulin-sensitive organs like adipose tissue, skeletal muscle and liver. Obesity may be associated with an impaired regulation of the natriuretic peptide system, also indicated as a natriuretic handicap. Evidence points towards a contribution of this natriuretic handicap to the development of obesity, type 2 diabetes mellitus and cardiometabolic complications, although the causal relationship is not fully understood. Nevertheless, targeting the natriuretic peptide pathway may improve metabolic health in obesity and type 2 diabetes mellitus. This review will focus on current literature regarding the metabolic roles of natriuretic peptides with emphasis on lipid metabolism and insulin sensitivity. Furthermore, it will be discussed how exercise and lifestyle intervention may modulate the natriuretic peptide-related metabolic effects.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xxea4U

AICAR Administration Attenuates Hemorrhagic Hyperglycemia and Lowers Oxygen Debt in Anesthetized Male Rabbits

Yi Huang, Paul H. Ratz, Amy S. Miner, Victoria A. Locke, Grace Chen, Yang Chen, Robert W. Barbee

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2xjNRyi

Molecular Mechanisms Underlying Renin-Angiotensin-Aldosterone System Mediated Regulation of BK Channels

Zhen-Ye Zhang, Ling-Ling Qian, Ru-Xing Wang

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2x0kfWf

Reflected vision in surgical practice – A novel method to circumvent posture related Musculo-skeletal disorders

Musclulo-skeletal disorders (MSD) rank very high among the occupational hazards that plague dentists including oral and maxillofacial surgeons. This has been attributed to abnormal posture while operating, with the severity being directly proportional to the duration of procedures. The prevalence of neck & back pain is found to be as high as 81% among practicing dentists 1. A questionnaire based study involving 5305 practising oral & maxillofacial surgeons in the United States of America revealed that 45% of the surgeons had undergone treatment for MSD, with 8% needing a surgical intervention.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2y4bJUm

Enzalutamide-warfarin interaction necessitating warfarin dosage adjustment: A case report of successful clinical management

Summary

What is known and objectives

Enzalutamide package labeling recommends avoiding concurrent warfarin use due to potential reductions in warfarin concentrations via enzalutamide-associated hepatic enzyme induction. A case of successful management of this interaction via warfarin adjustments is reported.

Case description

A 77-year-old Caucasian male, previously relatively stable on warfarin 42-45 mg weekly, reported to clinic after the recent start of enzalutamide and subsequent hospitalization with a subtherapeutic International Normalized Ratio (INR). A 50% increase in weekly warfarin dose resulted in a therapeutic INR. Enzalutamide was temporarily discontinued, and a 33% weekly warfarin dose decrease resulted in two therapeutic INRs.

What is new and conclusion

This is the first case to highlight the clinical significance of this interaction, noting that patients taking enzalutamide may require approximately 30%-50% adjustment in their warfarin dosage to maintain a therapeutic INR.

Enzalutamide is a moderate CYP2C9 inducer, which can reduce the plasma concentrations of warfarin via metabolism induction when given concurrently. Although not always clinically feasible, enzalutamide package labeling recommends to avoid this combination due to the narrow therapeutic index of warfarin and the risk of significant INR fluctuations. Our case illustrates that patients receiving this combination can be successfully managed in clinical practice and may require warfarin dosage adjustments of 30-50% to maintain a therapeutic INR.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2x06THU

Lymph node-positive prostate cancer after robotic prostatectomy and extended pelvic lymphadenectomy

Abstract

Optimal management of node-positive prostate cancer patients after prostatectomy remains a challenge. We evaluated clinically localized patients who demonstrated node positivity and identified predictors for secondary treatment. From 2010 to 2015, clinically localized prostate cancer patients who underwent robot prostatectomy with extended lymphadenectomy and node-positive disease on pathologic analysis were identified. Clinical N1, M1 or salvage cases were excluded. Patients were stratified based on secondary treatments. Kaplan–Meier method was used to determine the time to biochemical and metastatic recurrence. Multivariate logistic regression was used to identify predictors for additional treatment. 145 patients (45 no additional therapy, 47 adjuvant, 53 salvage) had a median follow-up of 31.2 months. Salvage patients had higher median pre-operative prostate-specific antigen (10.8 vs. 9.7 vs. 8.2, p = 0.1), higher percentage of pathologic Gleason ≥8 (50.9 vs. 38.3% and 22.2%, p < 0.01), and higher median-positive nodes (3 vs. 1 and 1, p < 0.0001) compared to adjuvant and no treatment groups, respectively. Pathologic Gleason ≥8 (OR = 3.5, p = 0.007) and positive nodes ≥2 (OR = 3.3, p = 0.006) were associated with additional therapy. In the no treatment group, two-year estimated BCRFS was 74.3%. Two-year metastatic recurrence-free rates for no treatment, adjuvant and salvage groups were 100, 87.5, and 80.9%, respectively (p = 0.01). Observation is a viable alternative for low metastatic burden patients. In the largest series of node-positive patients from robotic prostatectomy and extended lymphadenectomy, those with pathologic Gleason ≥8 and positive lymph nodes ≥2 were more likely to receive additional treatment.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2wVLcev