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Treatment algorithms

Myung Han Hyun, Young-Sun Lee, Ji Hoon Kim, Chan Uk Lee, Young Kul Jung, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon, Kwan Soo Byun
According to the American Association for the Study of Liver Disease treatment guidelines for hepatocellular carcinoma (HCC), the role of surgery has been expanded beyond the Barcelona Clinic Liver Cancer (BCLC) algorithm. We compared primary hepatectomy (PH) with transarterial chemoembolization (TACE) in patients with intermediate to advanced (BCLC stage-B/C) stage HCC to determine the current evidence. Through database search, we included 18 high-quality studies (1 randomized controlled trial [RCT], 5 propensity-score matching non-randomized comparative trials [NRCT], and 12 NRCTs) that compared survival outcomes of 5,986 patients after PH and TACE...
March 15, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Fernando Yepes-Calderon, Marvin D Nelson, J Gordon McComb
The picture archiving and communications system (PACS) is currently the standard platform to manage medical images but lacks analytical capabilities. Staying within PACS, the authors have developed an automatic method to retrieve the medical data and access it at a voxel level, decrypted and uncompressed that allows analytical capabilities while not perturbing the system's daily operation. Additionally, the strategy is secure and vendor independent. Cerebral ventricular volume is important for the diagnosis and treatment of many neurological disorders...
2018: PloS One
Rensheng Cao, Mingyi Fan, Jiwei Hu, Wenqian Ruan, Xianliang Wu, Xionghui Wei
Highly promising artificial intelligence tools, including neural network (ANN), genetic algorithm (GA) and particle swarm optimization (PSO), were applied in the present study to develop an approach for the evaluation of Se(IV) removal from aqueous solutions by reduced graphene oxide-supported nanoscale zero-valent iron (nZVI/rGO) composites. Both GA and PSO were used to optimize the parameters of ANN. The effect of operational parameters (i.e., initial pH, temperature, contact time and initial Se(IV) concentration) on the removal efficiency was examined using response surface methodology (RSM), which was also utilized to obtain a dataset for the ANN training...
March 15, 2018: Materials
I Yu Lisitskiy, A M Kiselev, S E Kiselev
Pathological processes in the craniovertebral region (CVR) are usually accompanied by dislocation complications leading to gross neurological disorders. One of the diseases that affect the CVR and lead to atlanto-axial dislocation (AAD) is rheumatoid arthritis. Errors in the diagnosis of rheumatoid disease and in the choice of a treatment approach may cause adverse outcomes. OBJECTIVE: To define the approach for surgical treatment of AAD associated with rheumatoid disease of the CVR, with allowance for the rigidity of deformity...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
V A Shaimova, T B Shaimov, R B Shaimov, A Yu Galin, Zh A Goloshchapova, P K Ryzhkov, A V Fomin
PURPOSE: To develop methods for evaluating effectiveness of YAG-laser vitreolysis of vitreous floaters. MATERIAL AND METHODS: The study included 144 patients (173 eyes) who had underwent YAG-laser vitreolysis and were under observation from 01.09.16 to 31.01.18. The patients were 34 to 86 years old (mean age 62.7±10.2 years), 28 (19.4%) patients were male, 116 (80.6%) - female. All patients underwent standard and additional examination: ultrasonography (Accutome B-scan plus, U...
2018: Vestnik Oftalmologii
Matheus Roque, Sandro C Esteves
Varicocele, the leading cause of male infertility, can impair sperm quality and fertility via various oxidative stress mechanisms. An imbalance between excessive reactive oxygen species production and antioxidant protection causes alterations in nuclear and mitochondrial sperm DNA, thus rendering a subset of varicocele men less fertile. In particular, sperm DNA fragmentation is usually elevated in men with clinical varicocele in both abnormal and normal semen parameters by the current World Health Organization criteria...
March 14, 2018: International Urology and Nephrology
Keisuke Usui, Keisuke Sasai, Koichi Ogawa
This study aimed to verify the validity of generating treatment plans for volumetric arc therapy (VMAT) for prostate cancer using magnetic resonance (MR) imaging with a dose calculation algorithm in Acuros XB (Eclipse version 13.6; Varian Medical Systems, Palo Alto, CA, USA) based on deterministically solving the linear Boltzmann transport equations. Four different classes were applied to prostate MR images: MRW (all water equivalent); MRW+B (water and bone); MRS+B (soft tissue and bone); and MRS+B+G (soft tissue, bone, and rectal gas)...
March 14, 2018: Radiological Physics and Technology
Hideki Miwa, Nobuhiro Tanabe, Takayuki Jujo, Fumiaki Kato, Rie Anazawa, Keiko Yamamoto, Akira Naito, Hajime Kasai, Rintaro Nishimura, Rika Suda, Toshihiko Sugiura, Seiichiro Sakao, Keiichi Ishida, Masahisa Masuda, Koichiro Tatsumi
BACKGROUND: Several new treatments for chronic thromboembolic pulmonary hypertension (CTEPH) have appeared in recent years, which have led to changes in the treatment algorithm. Changes in survival rates and prognostic factors, however, have not been estimated so far.Methods and Results:Two hundred and eighty patients were diagnosed with CTEPH at Chiba University Hospital between June 1986 and June 2016. Survival rate was investigated by date of treatment initiation (group 1, 1986-1998; group 2, 1999-2008; group 3, 2009-2016)...
March 13, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Henry Zhao, Lauren Pesavento, Skye Coote, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, Leonid Churilov, Nawaf Yassi, Stephen M Davis, Bruce C V Campbell
BACKGROUND AND PURPOSE: Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. METHODS: The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen...
March 14, 2018: Stroke; a Journal of Cerebral Circulation
Michelle Livne, Jens K Boldsen, Irene K Mikkelsen, Jochen B Fiebach, Jan Sobesky, Kim Mouridsen
BACKGROUND AND PURPOSE: Stroke imaging is pivotal for diagnosis and stratification of patients with acute ischemic stroke to treatment. The potential of combining multimodal information into reliable estimates of outcome learning calls for robust machine learning techniques with high flexibility and accuracy. We applied the novel extreme gradient boosting algorithm for multimodal magnetic resonance imaging-based infarct prediction. METHODS: In a retrospective analysis of 195 patients with acute ischemic stroke, fluid-attenuated inversion recovery, diffusion-weighted imaging, and 10 perfusion parameters were derived from acute magnetic resonance imaging scans...
March 14, 2018: Stroke; a Journal of Cerebral Circulation
Efstratios Kardalas, Stavroula A Paschou, Panagiotis Anagnostis, Giovanna Muscogiuri, Gerasimos Siasos, Andromachi Vryonidou
Hypokalaemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalaemia requires urgent medical attention. The aim of this review is to present updated information regarding: 1) the definition and prevalence of hypokalaemia, 2) the physiology of potassium homeostasis, 3) the various causes leading to hypokalaemia, 4) the diagnostic steps for the assessment of hypokalaemia and 5) the appropriate treatment of hypokalaemia depending on the cause...
March 14, 2018: Endocrine Connections
Víctor Vinuesa, Rafael Borrás, María Luisa Briones, María Ángeles Clari, Vicenta Cresencio, Estela Giménez, Carmen Muñoz, Rosa Oltra, Emilio Servera, Talia Scheelje, Carlos Tornero, David Navarro
The potential impact of routine real-time PCR testing of respiratory specimens from patients with presumptive tuberculosis in terms of diagnostic accuracy and time to tuberculosis treatment inception in low-prevalence settings remains largely unexplored. We conducted a prospective intervention cohort study. Respiratory specimens from 1,020 patients were examined by acid-fast bacilli smear microscopy, tested by the real-time Mycobacterium tuberculosis complex PCR assay (Abbott RealTi me MTB PCR) and cultured in mycobacterial media...
March 14, 2018: Journal of Clinical Microbiology
Sherrie L Kelly, Rowan Martin-Hughes, Robyn M Stuart, Xiao F Yap, David J Kedziora, Kelsey L Grantham, S Azfar Hussain, Iyanoosh Reporter, Andrew J Shattock, Laura Grobicki, Hassan Haghparast-Bidgoli, Jolene Skordis-Worrall, Zofia Baranczuk, Olivia Keiser, Janne Estill, Janka Petravic, Richard T Gray, Clemens J Benedikt, Nicole Fraser, Marelize Gorgens, David Wilson, Cliff C Kerr, David P Wilson
BACKGROUND: To move towards ending AIDS by 2030, HIV resources should be allocated cost-effectively. We used the Optima HIV model to estimate how global HIV resources could be retargeted for greatest epidemiological effect and how many additional new infections could be averted by 2030. METHODS: We collated standard data used in country modelling exercises (including demographic, epidemiological, behavioural, programmatic, and expenditure data) from Jan 1, 2000, to Dec 31, 2015 for 44 countries, capturing 80% of people living with HIV worldwide...
March 9, 2018: Lancet HIV
Tazeen H Jafar, Ngiap Chuan Tan, John C Allen, Eric A Finkelstein, Paul Goh, Peter Moey, Joanne Hui Min Quah, Siew Wai Hwang, Juliana Bahadin, Anandan Gerard Thiagarajah, Jason Chan, Gary Kang, Agnes Koong
BACKGROUND: Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics. METHODS/DESIGN: The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care...
March 14, 2018: Trials
Gin S Malhi, Tim Outhred, Grace Morris, Philip M Boyce, Richard Bryant, Paul B Fitzgerald, Malcolm J Hopwood, Bill Lyndon, Roger Mulder, Greg Murray, Richard J Porter, Ajeet B Singh, Kristina Fritz
In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on bipolar disorder. It is intended as an aid to the management of this complex disorder for primary care physicians working in collaboration with psychiatrists to implement successful long term management...
March 19, 2018: Medical Journal of Australia
Albert J Czaja
Autoimmune hepatitis lacks a quantifiable biomarker that is close to its pathogenic mechanisms and that accurately reflects inflammatory activity, correlates with treatment response, and ensures inactive disease before treatment withdrawal. Areas covered: Micro-ribonucleic acids, programmed death-1 protein and its ligands, macrophage migration inhibitory factor, soluble CD163, B cell activating factor, and metabolite patterns in blood were considered the leading candidates as therapeutic biomarkers after search of PubMed from August 1981 to August 2017 using the search words "biomarkers of autoimmune hepatitis"...
March 14, 2018: Expert Review of Gastroenterology & Hepatology
Thomas C Sauter, Balthasar Eberle, Walter A Wuillemin, Thomas Thiele, Anne Angelillo-Scherrer, Aristomenis K Exadaktylos, Gabor Erdös, Adam Cuker, Michael Nagler
Antithrombotic treatment puts patients at risk of major bleeding. Fast and adequate response to anticoagulant-associated bleeding may not only stop the bleeding but prevent severe complications. However, practical treatment algorithms to guide physicians in emergency situations are lacking. Important principles that arise from management of bleeding in general are (a) implementation of an in-house algorithm, (b) rapid identification and treatment of the bleeding source, (c) adequate fluid resuscitation, (d) consideration of the application of tranexamic acid and (e) appropriate coagulation testing...
March 14, 2018: Swiss Medical Weekly
Miriam Eddyani, Ghislain E Sopoh, Gilbert Ayelo, Luc V C Brun, Jean-Jacques Roux, Yves Barogui, Dissou Affolabi, William R Faber, Marleen Boelaert, Annelies Van Rie, Françoise Portaels, Bouke C de Jong
Background: The diagnosis of the neglected tropical skin and soft tissue disease Buruli ulcer (BU) is made on clinical and epidemiological grounds, after which treatment with BU-specific antibiotics is initiated empirically. Given the current decline in BU incidence, clinical expertise in the recognition of BU is likely to wane and laboratory confirmation of BU becomes increasingly important. We therefore aimed to determine the diagnostic accuracy of clinical signs and microbiological tests in patients presenting with lesions clinically compatible with BU...
March 10, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Christopher Klifto, Austin Ramme, Anthony Sapienza, Nader Paksima
Scaphoid nonunions are challenging injuries to manage and the optimal treatment algorithm continues to be debated. Most scaphoid fractures heal when appropriately treated; however, when nonunions occur, they require acute treatment to prevent future complications like scaphoid nonunion advanced collapse. Acute nonunion treatment technique depends on nonunion location, vascular status of the proximal pole, fracture malalignment, and pre-existing evidence of arthrosis. Bone grafting and vascular grafts are common in nonunion management...
March 2018: Bulletin of the Hospital for Joint Diseases
Robin De Roover, Wouter Crijns, Kenneth Poels, Ronald Peeters, Cédric Draulans, Karin Haustermans, Tom Depuydt
PURPOSE: Liquid fiducial markers have shown to be a promising alternative to solid gold markers in terms of imaging artifact reduction, patient comfort and compatibility with different imaging modalities. This study aims to investigate the performance of the novel BioXmark® liquid marker for state-of-the-art multi-modal imaging used in prostate cancer (PCa) radiotherapy, encompassing kV CT/CBCT, multi-parametric MRI and kV X-ray imaging. In addition, automatic detection of the liquid markers in X-ray imaging for prostate motion monitoring during treatment was investigated...
March 14, 2018: Medical Physics
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