To determine whether different doses and dosing regimens of intravitreal vascular endothelial growth factor (VEGF) Trap-Eye are superior to focal/grid photocoagulation in eyes with diabetic macular ...edema (DME).
Multicenter, randomized, double-masked, phase 2 clinical trial.
A total of 221 diabetic patients with clinically significant macular edema involving the central macula.
Patients were assigned to 1 of 5 treatment regimens: 0.5 mg VEGF Trap-Eye every 4 weeks; 2 mg VEGF Trap-Eye every 4 weeks; 2 mg VEGF Trap-Eye for 3 initial monthly doses and then every 8 weeks; 2 mg VEGF Trap-Eye for 3 initial monthly doses and then on an as-needed (PRN) basis; or macular laser photocoagulation. Assessments were completed at baseline and every 4 weeks thereafter.
Mean change in visual acuity and central retinal thickness (CRT) at 24 weeks.
Patients in the 4 VEGF Trap-Eye groups experienced mean visual acuity benefits ranging from +8.5 to +11.4 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters versus only +2.5 letters in the laser group (P ≤ 0.0085 for each VEGF Trap-Eye group vs. laser). Gains from baseline of 0+, 10+, and 15+ letters were seen in up to 93%, 64%, and 34% of VEGF Trap-Eye groups versus up to 68%, 32%, and 21% in the laser group, respectively. Mean reductions in CRT in the 4 VEGF Trap-Eye groups ranged from -127.3 to -194.5 μm compared with only -67.9 μm in the laser group (P = 0.0066 for each VEGF Trap-Eye group vs. laser). VEGF Trap-Eye was generally well tolerated. Ocular adverse events in patients treated with VEGF Trap-Eye were generally consistent with those seen with other intravitreal anti-VEGF agents.
Intravitreal VEGF Trap-Eye produced a statistically significant and clinically relevant improvement in visual acuity when compared with macular laser photocoagulation in patients with DME.
Background A gene expression profile (GEP) test able to accurately identify risk of metastasis for patients with cutaneous melanoma has been clinically validated. Objective We aimed for assessment of ...the prognostic accuracy of GEP and sentinel lymph node biopsy (SLNB) tests, independently and in combination, in a multicenter cohort of 217 patients. Methods Reverse transcription polymerase chain reaction (RT-PCR) was performed to assess the expression of 31 genes from primary melanoma tumors, and SLNB outcome was determined from clinical data. Prognostic accuracy of each test was determined using Kaplan-Meier and Cox regression analysis of disease-free, distant metastasis–free, and overall survivals. Results GEP outcome was a more significant and better predictor of each end point in univariate and multivariate regression analysis, compared with SLNB ( P < .0001 for all). In combination with SLNB, GEP improved prognostication. For patients with a GEP high-risk outcome and a negative SLNB result, Kaplan-Meier 5-year disease-free, distant metastasis–free, and overall survivals were 35%, 49%, and 54%, respectively. Limitations Within the SLNB-negative cohort of patients, overall risk of metastatic events was higher (∼30%) than commonly found in the general population of patients with melanoma. Conclusions In this study cohort, GEP was an objective tool that accurately predicted metastatic risk in SLNB-eligible patients.
Not all patients with complement deposition of the heart have developed hemodynamic instability at the time of diagnosis, suggesting that immunoprotective mechanisms reside within grafts. We ...hypothesized that decay-accelerating factor (DAF) could provide a first-line defense against complement injury, thus explaining the discrepancy in hemodynamics. Thus, we examined the role of DAF in the clinical presentation of antibody-mediated cardiac allograft rejection.
Endomyocardial biopsies from C4d(+)/C3d(+) patients were immunoflourescently stained for DAF, and its expression was compared in patients who did (n = 5) and did not (n = 4) exhibit allograft dysfunction.
Endomyocardial biopsies of patients without allograft dysfunction displayed intense staining of endothelial bound DAF expression at the time of antibody-mediated cardiac allograft rejection. Conversely, biopsies of patients with allograft dysfunction showed no evidence of DAF at that time.
Expression of DAF on cardiac allografts may provide an immunoprotective mechanism against the deleterious effects of complement deposition in patients with antibody-mediated cardiac allograft rejection.
Ackerman's Tumor Rodríguez-Gutiérrez, René; Rodarte-Shade, Mario; Gonzalez-Saldivar, Gloria ...
The American journal of the medical sciences
349, Številka:
5
Journal Article
Resistant hypertension: coarctation of the aorta Rodríguez-Gutiérrez, René; Ortiz-Corona, José de Jesús; Gonzalez-Saldivar, Gloria ...
The American journal of the medical sciences,
2014-November, Letnik:
348, Številka:
5
Journal Article
Massive barium aspiration Rodríguez-Gutiérrez, René; Mendoza-Garcia, Alejandra; Gonzalez-Saldivar, Gloria ...
The American journal of the medical sciences,
2014-September, Letnik:
348, Številka:
3
Journal Article
Bergman's triad: fat embolism syndrome Rodríguez-Gutiérrez, René; Rodarte-Shade, Mario; González-González, José Gerardo ...
The American journal of the medical sciences,
2015-February, Letnik:
349, Številka:
2
Journal Article
Buschke-Lowenstein tumor Rodríguez-Gutiérrez, René; Rodarte-Shade, Mario; González-Saldivar, Gloria ...
The American journal of the medical sciences,
2015-January, Letnik:
349, Številka:
1
Journal Article
Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management ...can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety.
The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed.
This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
Herpes zoster ophthalmicus masked by hymenoptera stings Rodríguez-Gutiérrez, René; Eichelmann-Herrera, Kristian; Ocampo-Candiani, Jorge ...
The American journal of the medical sciences,
2014-January, Letnik:
347, Številka:
1
Journal Article
