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Clinical approach

Tae Won Ha, Hyun Soo Kang, Tae-Hee Kim, Ji Hyun Kwon, Hyun Kyu Kim, Aeli Ryu, Hyeji Jeon, Jaeseok Han, Hal E Broxmeyer, Yongsung Hwang, Yun Kyung Lee, Man Ryul Lee
Improved approaches for promoting umbilical cord blood (CB) hematopoietic stem cell (HSC) homing are clinically important to enhance engraftment of CB-HSCs. Clinical transplantation of CB-HSCs is used to treat a wide range of disorders. However, an improved understanding of HSC chemotaxis is needed for facilitation of the engraftment process. We found that ectopic overexpression of miR-9 and antisense-miR-9 respectively down- and up-regulated C-X-C chemokine receptor type 4 (CXCR4) expression in CB-CD34⁺ cells as well as in 293T and TF-1 cell lines...
October 31, 2018: International Journal of Stem Cells
Amir Mari, Fadi Abu Backer, Hana Amara, Mahmud Mahamid
Achalasia is a rare idiopathic disease, associated with significant morbidity and negative impact on life quality. The disorder is characterized by impairments in the esophageal motility and loss of the lower esophageal sphincter (LES) relaxation. Achalasia symptoms include dysphagia, regurgitations, chest pain, vomiting and weight loss. Diagnosis of achalasia is based on an appropriate clinical presentation and typical findings on complementary tests. These tests include endoscopy showing a dilated esophageal lumen containing fluid or food, High-resolution manometry (HRM) shows evidence of obstruction at the gastro-esophageal junction and motility failure, and barium swallow shows esophageal dilation and distal narrowing...
October 2018: Harefuah
Anroop Nair, Mohamed Aly Morsy, Shery Jacob
Preclinical Research & Development Appropriate translation and determination of the maximum recommended starting dose in human is a vital task in new drug development and research. Allometric scaling is the most frequently used approach for dose extrapolation based on normalization of dose-to-body surface area. Misinterpretation of allometric dose conversion and safety factor application can lead to major problems in calculating maximum recommended safe starting dose in first-in-human clinical trials. Therefore, dose translation always necessitates careful consideration of body surface area, pharmacological, physiological and anatomical factors, pharmacokinetic parameters, metabolic function, receptor, and life span...
October 21, 2018: Drug Development Research
C Chillemi, L Dei Giudici, M Mantovani, M Osimani, S Gumina
BACKGROUND: Tear recurrence is considered the main complication of a rotator cuff repair. The best arthroscopic technique has not yet been established. The aim of the present study was to evaluate, from a clinical and a radiological standpoint, the all-arthroscopic transosseous rotator cuff repair with cortical lateral augmentation, performed in the setting of a revision surgery. MATERIALS AND METHODS: Eleven consecutive cases were prospectively followed up for a minimum of 12 month after a rotator cuff repair with a novel all-arthroscopic transosseous rotator cuff repair...
October 2018: Musculoskeletal Surgery
Nathalie Khoury, Jing Xu, Samuel D Stegelmann, Charles W Jackson, Kevin B Koronowski, Kunjan R Dave, Juan I Young, Miguel A Perez-Pinzon
Neuroprotective agents administered post-cerebral ischemia have failed so far in the clinic to promote significant recovery. Thus, numerous efforts were redirected toward prophylactic approaches such as preconditioning as an alternative therapeutic strategy. Our laboratory has revealed a novel long-term window of cerebral ischemic tolerance mediated by resveratrol preconditioning (RPC) that lasts for 2 weeks in mice. To identify its mediators, we conducted an RNA-seq experiment on the cortex of mice 2 weeks post-RPC, which revealed 136 differentially expressed genes...
October 20, 2018: Molecular Neurobiology
Carlos Blanco, John C Markowitz, David J Hellerstein, Arthur M Nezu, Melanie Wall, Mark Olfson, Ying Chen, Jon Levenson, Maika Onishi, Cindy Varona, Mayumi Okuda, Dawn L Hershman
PURPOSE: Breast cancer (BC) is a risk factor for major depressive disorder (MDD), yet little research has tested the efficacy of different psychotherapies for depressed women with BC. This study, the largest to date, compared outcomes of three evidence-based, 12-week therapies in treating major depressive disorder among women with breast cancer. METHODS: This randomized trial compared interpersonal psychotherapy (IPT), problem solving therapy (PST), and brief supportive psychotherapy (BSP)...
October 20, 2018: Breast Cancer Research and Treatment
Giacomina Brunetti, Gabriele D'Amato, Mariangela Chiarito, Apollonia Tullo, Graziana Colaianni, Silvia Colucci, Maria Grano, Maria Felicia Faienza
BACKGROUND: Bone remodeling is a lifelong process due to the balanced activity of osteoclasts (OCs), the bone-reabsorbing cells, and osteoblasts (OBs), and the bone-forming cells. This equilibrium is regulated by numerous cytokines, but it has been largely demonstrated that the RANK/RANKL/osteoprotegerin and Wnt/β-catenin pathways play a key role in the control of osteoclastogenesis and osteoblastogenesis, respectively. The pro-osteoblastogenic activity of the Wnt/β-catenin can be inhibited by sclerostin and Dickkopf-1 (DKK-1)...
October 20, 2018: World Journal of Pediatrics: WJP
Kardelen Gencer-Atalay, Ekim Can Ozturk, Ilker Yagci, Pinar Ata, Kenan Delil, Zerrin Ozgen, Gulseren Akyuz
Fibrodysplasia ossificans progressiva (FOP), is a rare autosomal dominant connective tissue disease with a prevalence of 1 in 2 million. It is characterized by congenital foot deformities and multiple heterotopic ossifications in fibrous tissue. It usually starts with painful soft tissue swellings occurring with attacks at the ages of three or four. The attacks develop spontaneously or after minor trauma, and gradually turn into heterotopic ossifications that cause joint limitations, growth defects, skeletal deformities and chronic pain...
October 20, 2018: Rheumatology International
Shin-Ting Wu, Wallace Souza Loos, Dayvid Leonardo de Castro Oliveira, Fernando Cendes, Clarissa L Yasuda, Enrico Ghizoni
PURPOSE: Visualizing a brain in its native space plays an essential role during neurosurgical planning because it allows the superficial cerebral veins and surrounding regions to be preserved. This paper describes the use of a visualization tool in which single gadolinium contrast-enhanced T1-weighted magnetic resonance imaging was applied in nondefective and nonresective skulls to promote visualization of important structures. METHODS: A curvilinear reformatting tool was applied on the supratentorial compartment to peel the tissues to the depth of the dura mater and thereby revealing cortical and vascular spatial relationships...
October 20, 2018: International Journal of Computer Assisted Radiology and Surgery
Robert Reid, Evelyn Rising, Arthur Kaufman, Amanda Bassett, Martha Cole McGrew, Helene Silverblatt, Michael Haederle
An unlikely partnership between a private, place-based foundation and the University of New Mexico's Office for Community Health resulted in an innovative approach for addressing a critical shortage of health professionals in an isolated, rural setting in the southeastern corner of New Mexico. Many place-based private foundations are focused locally and are naturally disinclined to engage distally located public universities for local projects. Large public universities do not often focus resources on small communities located far from their campuses...
October 20, 2018: Journal of Community Health
Kayla L Del Valle, Marie E McDonnell
PURPOSE OF REVIEW: Formalized chronic care management has the potential to improve the quality and cost-effectiveness of complex diabetes management in adults, but has historically not been sustainably supported by health care systems. This review discusses the application of the chronic care model in the care of complex diabetes and its translation in the current reimbursement structure designed by Centers for Medicare and Medicaid Services (CMS). RECENT FINDINGS: Following the introduction of Wagner's Chronic Care Model (CCM) in the late 1990s, evidence gathered over the past 2 decades has supported the shift in focus of health care systems from acute to chronic disease management and proactive care...
October 20, 2018: Current Diabetes Reports
Francesca Palandri, Elena Sabattini, Margherita Maffioli
Myelofibrosis (MF) is a Philadelphia chromosome-negative myeloproliferative neoplasm associated with bone marrow fibrosis, splenomegaly, a high symptom burden, and poor prognosis. Treatment is based on a risk-adapted approach, with treatment guidelines generally recommending allogeneic stem cell transplant or drug-based therapy for patients with higher-risk or more advanced disease and recommending observation or the "watch-and-wait" strategy for those with lower-risk or early-stage MF. With the advent of targeted therapies, such as the Janus kinase inhibitors, many patients have experienced substantial clinical benefits, including reduction in splenomegaly and symptoms and, in some instances, improvement or stabilization of bone marrow fibrosis and reduction of JAK2 V617F allele burden...
October 20, 2018: Annals of Hematology
Hans-Peter Müller, Federica Agosta, Martin Gorges, Rebecca Kassubek, Edoardo Gioele Spinelli, Nilo Riva, Albert C Ludolph, Massimo Filippi, Jan Kassubek
BACKGROUND: After the demonstration of a corticoefferent propagation pattern in amyotrophic lateral sclerosis (ALS) by neuropathological studies, this concept has been used for in vivo staging of individual patients by diffusion tensor imaging (DTI) techniques, both in `classical` ALS and in restricted phenotypes such as primary lateral sclerosis (PLS). OBJECTIVE: The study was designed to investigate that microstructural changes according to the neuropathologically defined ALS alteration pattern in PLS patients could be confirmed to be identical to ´classical´ ALS patients...
October 9, 2018: NeuroImage: Clinical
Ying Shi, Yanjiao Pang, Ning Huang, Chaoqun Sun, Yadi Pan, Yuan Cheng, Yijuan Long, Huzhi Zheng
Dopamine (DA), a catecholamine neurotransmitter, is considered to be an important indicator for mental diseases detection in the clinic. In this study, a novel fluorescent sensing platform consisting of the ficin-H2 O2 -tyramine system for determining DA in cerebrospinal fluids (CSF) was established. The proposed method is based on the fact that ficin, a mimetic peroxidase, can catalyze H2 O2 decomposition into OH radicals, which can oxidize non-fluorescent tyramine into fluorescent dityramine. When DA was introduced, DA can compete with tyramine for OH and resulting in the oxidation reaction of tyramine inhibited along with the fluorescence intensity of the system decreased, which provides a unique strategy for fluorescence detection of DA...
October 16, 2018: Spectrochimica Acta. Part A, Molecular and Biomolecular Spectroscopy
Max L Senders, Sophie Hernot, Giuseppe Carlucci, Jan C van de Voort, Francois Fay, Claudia Calcagno, Jun Tang, Amr Alaarg, Yiming Zhao, Seigo Ishino, Anna Palmisano, Gilles Boeykens, Anu E Meerwaldt, Brenda L Sanchez-Gaytan, Samantha Baxter, Laura Zendman, Mark E Lobatto, Nicolas A Karakatsanis, Philip M Robson, Alexis Broisat, Geert Raes, Jason S Lewis, Sotirios Tsimikas, Thomas Reiner, Zahi A Fayad, Nick Devoogdt, Willem J M Mulder, Carlos Pérez-Medina
OBJECTIVES: This study sought to develop an integrative positron emission tomography (PET) with magnetic resonance imaging (MRI) procedure for accurate atherosclerotic plaque phenotyping, facilitated by clinically approved and nanobody radiotracers. BACKGROUND: Noninvasive characterization of atherosclerosis remains a challenge in clinical practice. The limitations of current diagnostic methods demonstrate that, in addition to atherosclerotic plaque morphology and composition, disease activity needs to be evaluated...
October 12, 2018: JACC. Cardiovascular Imaging
Yihan Li, Xin Wang, Deli Wang, Walter Offen
Multiplicity adjustment plays a critical role for testing multiple endpoints and/or multiple doses in clinical trials. Under the clinical trial setting, multiple hypotheses are usually grouped into primary and secondary families and hierarchically ordered between and within families. The determination of the order and grouping of the hypotheses depends on the objectives of the trial. In such scenarios, strong control of the family-wise error rate (FWER) can be achieved via either gatekeeping procedures or the graphical approach to sequential testing procedures...
October 18, 2018: Contemporary Clinical Trials
Andrew E Grulich, Rebecca Guy, Janaki Amin, Fengyi Jin, Christine Selvey, Jo Holden, Heather-Marie A Schmidt, Iryna Zablotska, Karen Price, Bill Whittaker, Kerry Chant, Craig Cooper, Scott McGill, Barbara Telfer, Barbara Yeung, Gesalit Levitt, Erin E Ogilvie, Nila J Dharan, Mohamed A Hammoud, Stefanie Vaccher, Lucy Watchirs-Smith, Anna McNulty, David J Smith, Debra M Allen, David Baker, Mark Bloch, Rohan I Bopage, Katherine Brown, Andrew Carr, Christopher J Carmody, Kym L Collins, Robert Finlayson, Rosalind Foster, Eva Y Jackson, David A Lewis, Josephine Lusk, Catherine C O'Connor, Nathan Ryder, Emanuel Vlahakis, Phillip Read, David A Cooper
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is highly effective in men who have sex with men (MSM) at the individual level, but data on population-level impact are lacking. We examined whether rapid, targeted, and high-coverage roll-out of PrEP in an MSM epidemic would reduce HIV incidence in the cohort prescribed PrEP and state-wide in Australia's most populous state, New South Wales. METHODS: The Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) study is an implementation cohort study of daily co-formulated tenofovir disoproxil fumarate and emtricitabine as HIV PrEP...
October 17, 2018: Lancet HIV
M Le Hanneur, A Cambon-Binder, Z Belkheyar
Our aims were to study the anatomical feasibility of triceps brachii long head (TBLH) transfer to the extensor digitorum communis (EDC) and extensor pollicis longus (EPL) tendons through a medial route, and to report on its first clinical application. Dissections were conducted on 10 fresh-frozen cadaver specimens. Using a posteromedial approach, the TBLH was separated from the remaining triceps and extended distally with a fascia lata strip. This strip was then tunneled through a medial route and secured distally to the EDC and EPL tendons...
October 18, 2018: Hand Surgery and Rehabilitation
Vassiliki Sinopoulou, Morris Gordon, Paul Rutter
BACKGROUND: Increases in patients seeking advice at pharmacies has led to pharmacy staff engaging in diagnostic behaviours. Approaches to diagnosis include using mnemonics and clinical reasoning. OBJECTIVES: The primary aim of this review was to assess the degree to which the criteria researchers use to evaluate diagnostic performance in pharmacy consultations, in studies that have simulated patients or vignettes, conform with a clinical reasoning and a mnemonic framework...
October 11, 2018: Research in Social & Administrative Pharmacy: RSAP
Jean-Louis Wémeau, Marc Klein, Jean-Louis Sadoul, Claire Briet, Fritz-Line Vélayoudom-Céphise
Graves' disease is the most frequent cause of hyperthyroidism. Many questions remain about the choice of diagnostic evaluations and treatment strategy according to clinical context (age, gender, pregnancy, etc.) and about the best management of the main extrathyroidal complication that is Graves orbitopathy. The exact pathogenic mechanisms are not fully clear. They associate genetic factors, interactions between endogenous and environmental factors, and immune system dysregulation. Graves' orbitopathy is one of the consequences of this partial understanding...
September 11, 2018: Annales D'endocrinologie
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