Magnetic resonance imaging (MRI) has detected changes in pancreas volume and other characteristics in type 1 and type 2 diabetes. However, differences in MRI technology and approaches across ...locations currently limit the incorporation of pancreas imaging into multisite trials. The purpose of this study was to develop a standardized MRI protocol for pancreas imaging and to define the reproducibility of these measurements. Calibrated phantoms with known MRI properties were imaged at five sites with differing MRI hardware and software to develop a harmonized MRI imaging protocol. Subsequently, five healthy volunteers underwent MRI at four sites using the harmonized protocol to assess pancreas size, shape, apparent diffusion coefficient (ADC), longitudinal relaxation time (T1), magnetization transfer ratio (MTR), and pancreas and hepatic fat fraction. Following harmonization, pancreas size, surface area to volume ratio, diffusion, and longitudinal relaxation time were reproducible, with coefficients of variation less than 10%. In contrast, non-standardized image processing led to greater variation in MRI measurements. By using a standardized MRI image acquisition and processing protocol, quantitative MRI of the pancreas performed at multiple locations can be incorporated into clinical trials comparing pancreas imaging measures and metabolic state in individuals with type 1 or type 2 diabetes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Context
Participants with stage 1 or 2 type 1 diabetes (T1D) qualify for prevention trials, but factors involved in screening for such trials are largely unknown.
Objective
To identify ...factors associated with screening for T1D prevention trials.
Methods
This study included TrialNet Pathway to Prevention participants who were eligible for a prevention trial: oral insulin (TN-07, TN-20), teplizumab (TN-10), abatacept (TN-18), and oral hydroxychloroquine (TN-22). Univariate and multivariate logistic regression models were used to examine participant, site, and study factors at the time of prevention trial accrual.
Results
Screening rates for trials were: 50% for TN-07 (584 screened/1172 eligible), 9% for TN-10 (106/1249), 24% for TN-18 (313/1285), 17% for TN-20 (113/667), and 28% for TN-22 (371/1336). Younger age and male sex were associated with higher screening rates for prevention trials overall and for oral therapies. Participants with an offspring with T1D showed lower rates of screening for all trials and oral drug trials compared with participants with other first-degree relatives as probands. Site factors, including larger monitoring volume and US site vs international site, were associated with higher prevention trial screening rates.
Conclusions
Clear differences exist between participants who screen for prevention trials and those who do not screen and between the research sites involved in prevention trial screening. Participant age, sex, and relationship to proband are significantly associated with prevention trial screening in addition to key site factors. Identifying these factors can facilitate strategic recruitment planning to support rapid and successful enrollment into prevention trials.
IMPORTANCE: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, ...it is based on 3 small case series from the mid-1980s. OBJECTIVE: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. EVIDENCE REVIEW: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. FINDINGS: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. CONCLUSIONS AND RELEVANCE: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.
The feasibility of gastrointestinal (GI) microbiome work in a pediatric intensive care unit (PICU) to determine the GI microbiota composition of infants as compared to control infants from the same ...hospital was investigated. In a single-site observational study at an urban quaternary care children's hospital in Western Michigan, subjects less than 6 months of age, admitted to the PICU with severe respiratory syncytial virus (RSV) bronchiolitis, were compared to similarly aged control subjects undergoing procedural sedation in the outpatient department. GI microbiome samples were collected at admission (
= 20) and 72 h (
= 19) or at time of sedation (
= 10). GI bacteria were analyzed by sequencing the V4 region of the 16S rRNA gene. Alpha and beta diversity were calculated. Mechanical ventilation was required for the majority (
= 14) of study patients, and antibiotics were given at baseline (
= 8) and 72 h (
= 9). Control subjects' bacterial communities contained more
, and
(
= 0.004) than those of PICU infants. The ratio of
to
was greater in the control than the RSV infants (mean ± SD-1.27 ± 0.85 vs. 0.61 ± 0.75:
= 0.03). Bacterial communities of PICU infants were less diverse than those of controls with a loss of potentially protective populations.
Ticks attach to and penetrate their hosts' skin and inactivate multiple components of host responses in order to acquire a blood meal. Infestation loads with the cattle tick, Rhipicephalus microplus, ...are heritable: some breeds carry high loads of reproductively successful ticks, whereas in others, few ticks feed and reproduce efficiently.
In order to elucidate the mechanisms that result in the different outcomes of infestations with cattle ticks, we examined global gene expression and inflammation induced by tick bites in skins from one resistant and one susceptible breed of cattle that underwent primary infestations with larvae and nymphs of R. microplus. We also examined the expression profiles of genes encoding secreted tick proteins that mediate parasitism in larvae and nymphs feeding on these breeds.
Functional analyses of differentially expressed genes in the skin suggest that allergic contact-like dermatitis develops with ensuing production of IL-6, CXCL-8 and CCL-2 and is sustained by HMGB1, ISG15 and PKR, leading to expression of pro-inflammatory chemokines and cytokines that recruit granulocytes and T lymphocytes. Importantly, this response is delayed in susceptible hosts. Histopathological analyses of infested skins showed inflammatory reactions surrounding tick cement cones that enable attachment in both breeds, but in genetically tick-resistant bovines they destabilized the cone. The transcription data provided insights into tick-mediated activation of basophils, which have previously been shown to be a key to host resistance in model systems. Skin from tick-susceptible bovines expressed more transcripts encoding enzymes that detoxify tissues. Interestingly, these enzymes also produce volatile odoriferous compounds and, accordingly, skin rubbings from tick-susceptible bovines attracted significantly more tick larvae than rubbings from resistant hosts. Moreover, transcripts encoding secreted modulatory molecules by the tick were significantly more abundant in larval and in nymphal salivary glands from ticks feeding on susceptible bovines.
Compared with tick-susceptible hosts, genes encoding enzymes producing volatile compounds exhibit significantly lower expression in resistant hosts, which may render them less attractive to larvae; resistant hosts expose ticks to an earlier inflammatory response, which in ticks is associated with significantly lower expression of genes encoding salivary proteins that suppress host immunity, inflammation and coagulation.
Background
Inductive reasoning via the Clinical Presentation (CP) Model is an innovative approach to medical education delivery. Moving the locus of training from the medical school campus to a ...community health center (CHC) or CHC-affiliated site for the second, third, and fourth year is equally innovative.
Methods
We investigated student impressions of the CP Curriculum, inductive reasoning process and the early contextual learning experience. An electronic survey of 10 questions was sent to 194 third and fourth year SOMA students. Of the 194 registered students, 146 (75.3%) responded.
Results
Greater than 80% of all respondents rated their experience at the contextual learning campuses as having a positive impact on their ability to perform in their clerkship years. The majority of students (60.3%) rated their level of understanding of the CP Model highly as well as their understanding of how to actually use the CP Model to arrive at a diagnosis (50.7%). Respondents rated their perceptions of their understanding of inductive vs. deductive reasoning with less confidence (39.0%).
Conclusions
Overall, student assessment of the CP Curriculum and early clinical experiences was positive. Third year students rated the CP Model higher than their fourth year counterparts as a positive method to organize and learn medical knowledge. The majority of students reported some degree of adjustment period regarding communicating the CP Model to their trainers.
Background
The Clinical Presentation (CP) Model and inductive reasoning process is an innovative approach to undergraduate medical education delivery used at A.T. Still University School of ...Osteopathic Medicine in Arizona (ATSU-SOMA). Embedding cohorts of students into community campus settings during the second, third and fourth year is equally as innovative and a unique model for training future physicians that fosters contextual learning.
Methods
We investigated faculty impressions of the CP Curriculum (CPC), inductive reasoning process and the early contextual learning experience. Electronic surveys were sent to 36 Mesa campus faculty and 23 Regional Directors of Medical Education (RDME) at each of the 11 National Association of Community Health Centers (NACHC) affiliated Community Health Campuses (CHC’s) in nine states.
1
A total of 40 respondents (68%) completed the survey.
Results
Seventy percent of faculty respondents indicated that they “Completely Understand or “Understand Very Well” the CP Model as a teaching tool. Ninety-five percent of respondents stated they understand the application of “inductive vs. deductive” processes as they apply to medicine, and 88% expressed that they understood at least “Somewhat” how to use the CP Model to arrive at a diagnosis in “real life”. More than half (53%) indicated that placing the medical student in the contextual learning campus beginning in year 2 is the “right idea that is implemented at the right time”.
Conclusions
Since about half of faculty surveyed indicated that they understand the inductive reasoning aspect of the CP Model very well or well, additional faculty development training is warranted. In the classroom, 70% reported including clinical presentation schemes 80–100% of the time during instruction. Clinical faculty were statistically significantly more likely to indicate that placing the medical students in the community health clinic settings at the beginning of their second year is the right idea at the right time.
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