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Clinical approach

D Gareth Jones
New technological developments have frequently had major consequences for anatomy education, and have raised ethical queries for anatomy educators. The advent of three-dimensional (3D) printing of human material is showing considerable promise as an educational tool that fits alongside cadaveric dissection, plastination, computer simulation, and anatomical models and images. At first glance its ethical implications appear minimal, and yet the more extensive ethical implications around clinical bioprinting suggest that a cautious approach to 3D printing in the dissecting room is in order...
December 15, 2018: Anatomical Sciences Education
Lorenzo Maggi, Pia Bernasconi, Adele D'Amico, Raffaella Brugnoni, Chiara Fiorillo, Matteo Garibaldi, Guja Astrea, Claudio Bruno, Filippo Maria Santorelli, Rocco Liguori, Giovanni Antonini, Amelia Evoli, Enrico Bertini, Carmelo Rodolico, Renato Mantegazza
Congenital myasthenic syndromes (CMS) are genetic disorders due to mutations in genes encoding proteins involved in the neuromuscular junction structure and function. CMS usually present in young children, but perinatal and adult onset has been reported. Clinical presentation is highly heterogeneous, ranging from mild symptoms to severe manifestations, sometimes with life-threatening respiratory episodes, especially in the first decade of life. Although considered rare, CMS are probably underestimated due to diagnostic difficulties...
December 15, 2018: Neurological Sciences
Anna Maria Formenti, Mauro Doga, Stefano Frara, Marco Ritelli, Marina Colombi, Giuseppe Banfi, Andrea Giustina
Ehlers-Danlos syndrome (EDS) is an emerging cause of skeletal fragility. Mechanism of bone damage are probably multifactorial in line with the different skeletal phenotypes that can be found in clinical practice. A structured approach to clinical management of bone metabolic complication in EDS is proposed.
December 15, 2018: Endocrine
Linpeng Wei, David W Roberts, Nader Sanai, Jonathan T C Liu
INTRODUCTION: 5-ALA-based fluorescence-guided surgery has been shown to be a safe and effective method to improve intraoperative visualization and resection of malignant gliomas. However, it remains ineffective in guiding the resection of lower-grade, non-enhancing, and deep-seated tumors, mainly because these tumors do not produce detectable fluorescence with conventional visualization technologies, namely, wide-field (WF) surgical microscopy. METHODS: We describe some of the main factors that limit the sensitivity and accuracy of conventional WF surgical microscopy, and then provide a survey of commercial and research prototypes being developed to address these challenges, along with their principles, advantages and disadvantages, as well as the current status of clinical translation for each technology...
December 15, 2018: Journal of Neuro-oncology
Rohit K Jain, Travis Snyders, Lakshminarayanan Nandgoapal, Rohan Garje, Yousef Zakharia, Shilpa Gupta
Checkpoint inhibitors have monumentally transformed the treatment of metastatic urothelial carcinoma. While the efficacy and safety of the different agents are similar in platinum-refractory metastatic urothelial carcinoma, pembrolizumab is the only agent that was superior to chemotherapy in a randomized phase III trial. Pembrolizumab and atezolizumab are also approved as first-line therapies in cisplatin-ineligible metastatic urothelial carcinoma. Several immunotherapy trials are ongoing in non-metastatic setting to maximize responses upfront...
December 15, 2018: Current Treatment Options in Oncology
Takerra Johnson, Lina Zhao, Gygeria Manuel, Herman Taylor, Dong Liu
Ischemic heart disease (IHD) is caused by the narrowing of arteries that work to provide blood, nutrients, and oxygen to the myocardial tissue. The worldwide epidemic of IHD urgently requires innovative treatments despite the significant advances in medical, interventional, and surgical therapies for this disease. Angiogenesis is a physiological and pathophysiological process that initiates vascular growth from pre-existing blood vessels in response to a lack of oxygen. This process occurs naturally over time and has encouraged researchers and clinicians to investigate the outcomes of accelerating or enhancing this angiogenic response as an alternative IHD therapy...
December 15, 2018: Journal of Molecular Medicine: Official Organ of the "Gesellschaft Deutscher Naturforscher und Ärzte"
G Elia
The importance of the Type-1 helper immune response in the development of Vitiligo (Vit), and of chemokine receptor (CXCR)3 receptor and its chemokine monokine induced by interferon (IFN)-γ(MIG) has been shown by several studies. MIG/ interferon (IFN)-γ-inducible protein 10 (IP10) /CXCR3 axis mediated T-cell recruitment into the skin in Vit is an early event in the progression of the disease. MIG and IP10 circulating levels are increased in progressive Vit. It has been suggested that MIG and CXCR3 could be novel targets of future therapeutical approaches...
November 2018: La Clinica Terapeutica
Yoshishiro Hiramatsu, Hiroya Takeuchi, Osamu Goto, Hirotoshi Kikuchi, Yuko Kitagawa
BACKGROUND: Recently, minimally invasive approaches such as endoscopic treatment or laparoscopic gastrectomy for early gastric cancer have made rapid progress. However, the extent of gastrectomy and lymphadenectomy in laparoscopic surgery is radical, similar to that of open gastrectomy for patients with early gastric cancer diagnosed as not indicated for endoscopic treatment. Since it is well known that lymph node metastasis is an important prognostic factor, the standard procedure of gastrectomy with radical lymph node dissection has been performed for the purpose of curative resection...
December 14, 2018: Digestion
Shiyue Li, Guangfa Wang, Changhui Wang, Xinglin Gao, Faguang Jin, Huaping Yang, Baohui Han, Rui Zhou, Chengshui Chen, Liangan Chen, Chunxue Bai, Huahao Shen, Felix J F Herth, Nanshan Zhong
BACKGROUND: Chronic obstructive pulmonary disease (COPD) has become a leading cause of morbidity and mortality in China, with tobacco smoke, air pollution, and occupational biohazards being the major risk factors. OBJECTIVES: The REACH trial is a multicenter, prospective, randomized controlled trial undertaken in China to assess the safety and effectiveness of the Spiration® Valve System (SVS) compared to standard medical care in COPD patients with severe emphysema...
December 14, 2018: Respiration; International Review of Thoracic Diseases
Javier Martín Broto
Multidisciplinary teams (MDTs) are necessary to deliver the best sarcoma care. Planning the optimal therapeutic strategy per patient requires input and expertise from several disciplines. Case/cohort studies have reported improved patient outcomes associated with treatment by MDTs and/or treatment in sarcoma centres. Many countries have established national networks of sarcoma reference centres and most have developed evidence-based clinical practice guidelines agreed using multidisciplinary expertise. In many countries, sarcoma networks are organised as cooperative groups...
2018: Oncology
Laura Cottey, S Jefferys, T Woolley, J E Smith
INTRODUCTION: Supplemental oxygen is a key element of emergency treatment algorithms. However, in the operational environment, oxygen supply poses a challenge. The lack of high-quality evidence alongside emerging technologies provides the opportunity to challenge current guidelines. The aim of this review was to appraise the evidence for the administration of oxygen in emergency patients and give recommendations for its use in clinical practice. METHODS: A critical review of the literature was undertaken to determine the evidence for emergency supplemental oxygen use...
December 15, 2018: Journal of the Royal Army Medical Corps
Asghar Fallah, Ali Sadeghinia, Houman Kahroba, Amin Samadi, Hamid Reza Heidari, Behzad Bradaran, Sirous Zeinali, Ommoleila Molavi
Angiogenesis is a critical step in the progression of almost all human malignancies and some other life-threatening diseases. Anti-angiogenic therapy is a novel and effective approach for treatment of angiogenesis-dependent diseases such as cancer, diabetic retinopathy, and age-related macular degeneration. In this article, we will review the main strategies developed for anti-angiogenic therapies beside their clinical applications, the major challenges, and the latest advances in the development of anti-angiogenesis-based targeted therapies...
December 13, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Nisha Sharma, Hans-Joachim Anders, Anil Bhanudas Gaikwad
Besides assisting the maintenance of blood pressure and sodium homeostasis, the renin-angiotensin system (RAS) plays a pivotal role in pathogenesis of acute kidney injury (AKI). The RAS is equipped with two arms i) the pressor arm composed of Angiotensin II (Ang II)/Angiotensin converting enzyme (ACE)/Angiotensin II type 1 receptor (AT1R) also called conventional RAS, and ii) the depressor arm consisting of Angiotensin (1-7) (Ang 1-7)/Angiotensin converting enzyme 2 (ACE2)/MasR known as non-conventional RAS...
December 13, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Caroline Havery
BACKGROUND: Increasing numbers of undergraduate nursing students speak English as an additional language. Clinical placements can be difficult for many of these students and their clinical facilitators. The causes of challenges are often reported to be students' lack of English language ability or, for some students, learning styles that are not suited to Western style education. OBJECTIVE: The purpose of this research was to investigate how clinical facilitators' pedagogic practices in hospital settings enabled or constrained the learning of students for whom English was an additional language...
December 10, 2018: Nurse Education Today
Jiranuwat Sapudom, Liv Kalbitzer, Xiancheng Wu, Steve Martin, Klaus Kroy, Tilo Pompe
Extracellular matrix stiffening of breast tissues has been clinically correlated with malignant transformation and poor prognosis. An increase of collagen fibril diameter and lysyl-oxidase mediated crosslinking has been observed in advanced tumor stages. Many current reports suggest that the local mechanical properties of single fibrillar components dominantly regulate cancer cell behavior. Here, we demonstrate by an independent control of fibril diameter and intrafibrillar crosslinking of three-dimensional (3D) collagen matrices that fibril bending stiffness instructs cell behavior of invasive and non-invasive breast cancer cells...
December 10, 2018: Biomaterials
Jaskaran Singh Gosal, Satyadeo Pandey, Kuntal Kanti Das, Deepak Khatri, Kamlesh Rangari, Awadhesh Kumar Jaiswal, Sanjay Behari
BACKGROUND: Pathological laughter is inappropriate, involuntary and unmotivated laughter episodes which may or may not be associated with mirth or amusement. Though associated with many diffuse brain pathologies, its association with intracranial focal mass lesions causing ventrolateral brainstem compression like petroclival meningioma is very rare. The exact pathophysiology of this interesting and unusual clinical symptom is unknown but probably involves disinhibition and release of the so-called coordination center located in the upper brainstem due to compression by the tumor...
December 13, 2018: World Neurosurgery
Louis Beauté, Nathan McClenaghan, Sébastien Lecommandoux
The use of nanotechnology to improve treatment efficacy and reduce side effects is central to nanomedicine. In this context, stimuli-responsive drug delivery systems (DDS) such as chemical/physical gels or nanoparticles such as polymersomes, micelles or nanogels are particularly promising and are the focus of this review. Several stimuli have been considered but light as an exogenous trigger presents many advantages that are pertinent for clinical applications such as high spatial and temporal control and low cost...
December 13, 2018: Advanced Drug Delivery Reviews
Carolina Venditti, Antonella Vulcano, Silvia D'Arezzo, Cesare Ernesto Maria Gruber, Marina Selleri, Mario Antonini, Simone Lanini, Alessandra Marani, Vincenzo Puro, Carla Nisii, Antonino Di Caro
OBIECTIVES: Carbapenem-resistant (CR) Acinetobacter baumannii is a serious nosocomial pathogen able to cause a variety of serious, often life-threatening infections and outbreaks. We aimed to investigate the molecular epidemiology of clinical isolates of CR A. baumannii from an outbreak that occurred in the intensive care unit (ICU) of our hospital. METHODS: From January to April 2017, 13 CR A. baumannii isolates were collected from 7 patients treated in the ICU at the "L...
December 13, 2018: Journal of Global Antimicrobial Resistance
Cao Dai Phung, Hanh Thuy Nguyen, Tuan Hiep Tran, Han-Gon Choi, Chul Soon Yong, Jong Oh Kim
Immunotherapy is an important mode of cancer treatment. Over the past decades, immunotherapy has improved the clinical outcome for cancer patients. However, in many cases, mutations in cancer cells, lack of selectivity, insufficiency of tumor-reactive T cells, and host immunosuppression limit the clinical benefit of immunotherapy. Combination approaches in immunotherapy may overcome these obstacles. Accumulating evidence demonstrates that combination immunotherapy is the future of cancer treatment. However, designing safe and rational combinations of immunotherapy with other treatment modalities is critical...
December 13, 2018: Journal of Controlled Release: Official Journal of the Controlled Release Society
Masanori Yamamoto, Yusuke Watanabe, Norio Tada, Toru Naganuma, Motoharu Araki, Futoshi Yamanaka, Kazuki Mizutani, Minoru Tabata, Hiroshi Ueno, Kensuke Takagi, Akihiro Higashimori, Shinichi Shirai, Kentaro Hayashida
OBJECTIVES: We aimed to assess real-world clinical outcomes of transcatheter aortic valve replacement (TAVR) in Japan. BACKGROUND: Data are limited concerning procedural safety and valve performance following TAVR in Japanese. A program by an on-site proctor and procedure screening system was applied during TAVR introduction. METHODS: We consecutively enrolled 1613 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese registry, which consists of 14 centers...
December 4, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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