To evaluate efficacy of sclerotherapy with doxycycline versus sodium tetradecyl sulfate (STS) for treatment of macrocystic and mixed lymphatic malformations (LMs).
This single-center retrospective ...review identified 41 children (17 boys; 24 girls; age range, 1 month to 15.4 y) who underwent sclerotherapy with doxycycline (n = 32) or STS (n = 9) for macrocystic (n = 31) or mixed (n = 10) LMs. There were 114 treatments performed, averaging 2.8 treatments (range, 1-8 treatments) per patient. Average follow-up time was 10 months (range, 1-59 months). Clinical response was deemed excellent or moderate if > 90% or > 50% of LMs resolved based on visual estimate.
With doxycycline, 87% of patients (28 of 32) had excellent or moderate response with an average of 2.8 treatments (range, 1-7 treatments); 13% required subsequent resection. With 3% STS monotherapy, only 55% of patients (5 of 9) had excellent or moderate response with an average of 2.8 treatments (range, 1-8 treatments), and 33% required subsequent resection. Significantly fewer patients treated with STS responded well compared with patients treated with doxycycline (P = .03). Patients treated with STS had significantly longer follow-up than patients treated with doxycycline (27 months vs 6 months, P = .0001).
Doxycycline monotherapy resulted in a high rate of excellent clinical outcomes after a few treatments without increased need for subsequent operative resection. These results support use of doxycycline sclerotherapy as primary treatment for macrocystic and mixed LMs in children.
Patients have unprecedented online access to their medical records. More than 6 million Americans can now read their doctors' notes via patient portals, and continued rapid growth is likely. Sharing ...notes with patients may yield important health benefits, including increased patient empowerment and improved medication adherence. Seeing written information, including notes, helps patients remember the plan of care, reinforces patients' positive behaviors, and strengthens the patient-doctor alliance. In an effort to ease the transition to what they believe will be a widespread and ultimately beneficial practice, Klein et al draw on over 5 years of their clinical experience and conversations with clinicians around the country to offer suggestions for creating notes that can work for all concerned.
The aim of this study is to evaluate the usefulness of real-time elastography (RTE) in the diagnosis of graft interstitial fibrosis. We prospectively enrolled 50 patients clinically suspected of ...graft fibrosis. RTE was performed with a broadband linear transducer using a dedicated ultrasound machine. Tissue mean elasticity (TME) was calculated by two blinded operators. All patients underwent biopsy after RTE. To determine cortical fibrosis Banff score was used. The receiver operating characteristic curves analysis was performed to evaluate the accuracy of TME to discriminate between patients with mild fibrosis (F1) versus patients with moderate to severe fibrosis (F2-F3). Inverse correlation between TME values and the degree of fibrosis has been shown (p < 0.05). Patients with F1 had mean TME values significantly higher compared with TME in patients with F2 (p = 0.005) and F3 (p = 0.004). The diagnostic accuracy of TME measurement for F2-F3 evaluated by area under the curve-receiver operating characteristic analysis was 0.95. RTE was able to evaluate kidney fibrosis in a non-invasive way and could be used as complementary imaging during follow-up of renal transplant patients.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and ...pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.
Topical fluoride for caries prevention Weyant, Robert J., DMD, DrPH; Tracy, Sharon L., PhD; Anselmo, Theresa (Tracy), MPH, BSDH, RDH ...
The Journal of the American Dental Association (1939),
November 2013, Letnik:
144, Številka:
11
Journal Article
Recenzirano
Odprti dostop
ABSTRACT Background A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally ...applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies. Types of Studies Reviewed The authors conducted a search of MEDLINE and the Cochrane Library for clinical trials of professionally applied and prescription-strength topical fluoride agents—including mouthrinses, varnishes, gels, foams and pastes—with caries increment outcomes published in English through October 2012. Results The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research. Practical Implications The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.05 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from ”in favor“ to ”expert opinion for.“ As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 ...guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.
To develop a specialist-based consensus of cochlear contouring to be used in patients undergoing stereotactic radiosurgery (SRS) treatment for vestibular schwannoma.
Representative computed ...tomography (CT) and magnetic resonance imaging (MRI) were used for cochlear contouring. The semicircles, cochlea, vestibule, and internal acoustic meatus were delineated by 7 radiation oncology department physicians and reviewed by neuroradiologists. A total of 12 cases accrued from a single academic institution were studied for a similarity analysis by the Dice coefficient.
The suggested guideline is an easily reproductive tool that allows radiation oncologists to accurately contour the vestibulocochlear system to avoid toxicity due to inadequate dosimetry of organs at risk. This could be a useful tool even for non-vestibular schwannoma radiation therapy. The Dice coefficient suggests reproducible results as long as the following contouring recommendations are observed.
The template for vestibulocochlear delineation may be useful for an adequate organs at risk definition. Future studies are required to find specific constraints for each segment of the vestibulocochlear system, and to mitigate interobserver variations.
To determine whether regular performance of adapted sports is associated with long-term changes in carotid atherosclerosis in subjects with spinal cord injury (SCI).
Prospective observational study.
...Academic medical center.
Men with chronic (>1y) SCI and no preserved motor function below the injury level were evaluated in 2007 and 2012 (N=17). Nine subjects did not perform physical activity between the studied time points (control group), whereas 8 subjects entered competitive upper-body sports programs (rugby: n=5, basketball: n=1, jiu-jitsu: n=1, and tennis: n=1) after baseline and were regularly training at the time of the second evaluation (sports group).
Not applicable.
Clinical, laboratory, hemodynamic, and carotid ultrasonography analysis.
The studied groups showed no differences in all studied variables at baseline. After 5 years of follow-up, the control group showed increases in heart rate (87.0±3.1 vs 74.7±3.8 beats per minute; P=.004), but the participants had no significant changes in carotid intima-media thickness (IMT) (.65±.05 vs .67±.03mm; P=.73) or IMT/diameter (.118±.007 vs .136±.013; P=.24). In contrast, the sports group showed long-term decreases in carotid IMT (.56±.05 vs .74±.05mm; P=.001) and IMT/diameter (.097±.006 vs .141±.009; P<.001), but the participants did not show any variation in the other studied variables at follow-up.
Regular upper-body sports activities are associated with long-term reductions in carotid atherosclerosis in subjects with SCI and might be a potential prevention strategy aiming to reduce cardiovascular risk in this population.
Citral (3,7-dimethyl-2,6-octadienal) is the main component of Cymbopogon citratus (DC) Stapf, an herb with analgesic properties. Arthritic pain is the main unpleasant component of rheumatoid ...arthritis. The pharmacological approaches used to treat arthritic pain are often accompanied by adjuvant drugs or non-pharmacological treatments, showing a constant need in identifying new efficient analgesic drugs.
To test the hypothesis that citral, which is a monoterpenoid compound with therapeutic properties, reduces nociception, spinal pro-nociceptive and pro-inflammatory signaling, and systemic oxidative stress in arthritic rats.
Complete Freund's adjuvant (CFA) was administrated in the left knee joint of rats. Oral treatment with citral was performed during eight days and mechanical allodynia was monitored during the period of treatment to evaluate the analgesic effect of citral. We assessed the levels of serotonin (5-hydroxytryptamine, 5-HT) in the lumbar dorsal horn of the spinal cord (DHSC) and the profiles of expression of the glycogen synthase kinase-3β (GSK3β), which is a 5-HT-regulated intracellular protein, and of the stress-activated protein kinase (SAPK)/jun N-terminal kinase (JNK) in the DHSC. Plasma levels of superoxide dismutase (SOD) were assessed as an indicator of oxidative stress.
Administration of CFA induced mechanical allodynia associated with reduced spinal GSK3β phosphorylation, increased spinal SAPK/JNK phosphorylation, and increased plasma SOD levels. Oral administration of citral reversed mechanical allodynia, increased endogenous spinal 5-HT levels, reduced spinal SAPK/JNK phosphorylation, and reduced plasma SOD levels.
Citral shows anti-nociceptive effects in an animal model of arthritic pain by modulating spinal nociceptive signaling.
Neurochemical mechanisms involved in citral-induced analgesia in arthritis. (A) Complete Freund's adjuvant (CFA)-induced arthritis reduces spinal serotonin metabolism in the lumbar dorsal horn of the spinal cord ipsilateral to the injured joint, as indicated by the reduction in the spinal levels of the main metabolite of serotonin (5-HT), 5-hydroxyindole-3-acetic acid (5-HIAA). Moreover, there is a reduction in glycogen synthase kinase-3β (GSK3β) phosphorylation, which is a 5-HT-regulated intracellular protein, and an increase in stress-activated protein kinase (SAPK)/jun N-terminal kinase (JNK) phosphorylation. Systemically, arthritis increases plasma superoxide dismutase levels, which indicate an increase in plasma reactive oxygen species (ROS). Together, the alteration of the molecules described and certainly many other aspects contribute to a scenario of increased central sensitization and chronic arthritic pain. (B) During arthritis, chronic treatment with citral increases spinal 5-HT and regulates spinal 5-HT metabolism (i.e., 5-HIAA levels), prevents CFA-induced increase in spinal GSK3β phosphorylation and reduces CFA-induced increase in SAPK/JNK phosphorylation, and reduces plasma ROS. Here, we propose that the increase in 5-HT signaling in the spinal cord combined with the reduction of spinal SAPK/JNK phosphorylation and the reduction of systemic oxidative stress are the anti-nociceptive mechanisms by which citral causes analgesia. Display omitted
•Citral reversed mechanical allodynia in arthritic rats.•Citral increased endogenous levels of spinal 5-HT in arthritic rats.•Citral reduced spinal SAPK/JNK phosphorylation in arthritic rats.•Citral prevented CFA-induced increase in systemic oxidative stress.
Risk allele Minor allele frequency Association tests Spanish Sardinian Italian Japanese Individual studiesOR (95% CI)low *; P value Meta-analysisOR (95% CI)low *; P value Control subjects (n = 1271) ...Casesdagger (n= 139) Control subjects (n = 460) Cases (n = 139) Control subjects (n = 278) Cases (n = 67) Control subjects (n = 639) Cases (n = 391) Spanishdouble dagger Sardinian Italian Japanese§ Europeans All samples§ rs1732887 A 0.26 0.21     0.10 0.09 1.28 (0.96-1.72); .082   1.06 (0.78-1.43); .725  1.18 (0.95-1.46); .1420 rs2701653 T 0.09 0.13     0.41 0.43 1.49 (1.03-2.14); .034   1.05 (0.87-1.25); .620  1.11 (0.95-1.31); .1791 rs1732886 A 0.26 0.21 0.21 0.16     1.32 (0.98-1.75); .061 1.40 (0.98-2.00); .106   1.36 (1.08-1.72); .0105  rs1882200 T 0.33 0.38 0.34 0.46     1.25 (0.97-1.61); .105 1.65 (1.26-2.17); .001   1.42 (1.18-1.71); .0002  rs11465955 T 0.33 0.39 0.35 0.46 0.34 0.43   1.28 (0.99-1.64); .058 1.56 (1.18-2.04); .001 1.48 (1.01-2.18); .029  1.42 (1.2-1.68); .0001  rs2293657 T 0.29 0.35 0.34 0.46   0.12 0.15 1.32 (1.01-1.71); .010 1.65 (1.26-2.17); .001  1.07 (0.82-1.39); .180 1.47 (1.22-1.77); .0001 1.31 (1.13-1.53); .0004 rs1152888 A 0.08 0.11     0.40 0.40 1.46 (0.98-2.17); .07   0.96 (0.81-1.15); .839  1.03 (0.87-1.21); .3719 rs1821777 T 0.34 0.39 0.36 0.46     1.22 (0.94-1.57); .088 1.54 (1.17-2.02); .001   1.36 (1.13-1.63); .0013  rs1624395 A 0.39 0.48 0.42 0.51 0.40 0.53   1.40 (1.09-1.79); .007 1.46 (1.11-1.91); .002 1.68 (1.15-2.46); .004  1.47 (1.25-1.74); 5.7 x 10-6  rs1370128 T 0.42 0.49 0.43 0.54 0.41 0.55   1.46 (1.14-1.87); .001 1.53 (1.16-2.00); .001 1.76 (1.21-2.58); .002  1.54 (1.31-1.82); 2.9 x 10-7  rs10716217 delA 0.42 0.49     0.54 0.55 1.50 (1.17-1.92); .001   1.04 (0.87-1.24); .685  1.17 (1.02-1.36); .0295 Table E6 Meta-analysis of IRAK3 SNPs in unrelated case-control samples  Coverage (%) SNP array HapMap CEU Resequencing Affymetrix 500K 63 29 Affymetrix Genome-Wide Human SNP Array 6.0 93 71 Illumina HumanHap300dagger 77 19 Illumina HumanHap550double dagger 83 35 Illumina HumanHap650Y 83 42 Illumina 1M-Duo 97 65 Table E7 Coverage of SNPs from the IRAK3 gene with MAFs of 5% or greater on commercial arrays used in asthma GWASs in samples of European ancestrylow * CEU, Ancestry from northern and western Europe.
PDF
