Artificial intelligence could speed up colorectal #cancer detection during colonoscopy #weekchat @my_ueg … https://t.co/CppUyqsfT8

Artificial intelligence could speed up colorectal #cancer detection during colonoscopy #weekchat @my_ueg … https://t.co/CppUyqsfT8

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://twitter.com/ecancer/status/925014717239844865
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Dexamethasone attenuates methacholine-mediated aquaporin 5 downregulation in human nasal epithelial cells via suppression of NF-κB activation

Background

Cholinergic stimulation plays a major role in inflammatory airway diseases. However, its role in airway surface liquid homeostasis and aquaporin 5 (AQP5) regulation remains unclear. In this study we sought to determine the effects of methacholine and dexamethasone on AQP5 expression in human nasal epithelial cells (HNEpC).

Methods

HNEpC were cultured with methacholine or dexamethasone at 4 concentrations in vitro. The subcellular distribution of AQP5 was explored using immunocytochemistry. The pharmacologic effects of methacholine and dexamethasone on the expression of the phosphorylation of cyclic adenosine monophosphate–responsive element binding protein (p-CREB), AQP5, and nuclear factor-kappaB (NF-κB) were examined using Western blotting.

Results

AQP5 was found to be located in cell membrane and cytoplasm and present in every group without a statistically significant difference. Methacholine inhibited expression of AQP5 and p-CREB in HNEpC, whereas dexamethasone increased these protein levels dose-dependently in a statistically significant manner. In turn, HNEpC treated with methacholine and dexamethasone showed the same trends as those intervened separately with these 2 drugs. Moreover, dexamethasone had the ability to reverse the inhibitory effect of methacholine. Western blotting revealed that, after incubation with 10⁻⁴ mol/L methacholine, NF-κB increased significantly, by 186.67%, compared with the untreated control group. Again, such an increase could be significantly reversed after dexamethasone treatment.

Conclusion

NF-κB activation is important for inhibition of p-CREB/AQP5 expression after methacholine intervention, and dexamethasone adjusts it to the opposite side. This observation could provide additional insight into the anti-inflammatory effects of glucocorticoids that contribute to maintaining airway surface liquid and mucosal defense.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2ihA3uX
via IFTTT

Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery

Background

Functional endoscopic sinus surgery (FESS) is an effective treatment for chronic rhinosinusitis (CRS). Postoperative management strategies after FESS often vary from surgeon to surgeon. Recent data suggests that nasal saline irrigation following FESS is almost universally recommended; however, patient adherence has not been formally evaluated. The purpose of this study is to evaluate postoperative nasal irrigation practices and its effects on short-term outcomes in post-FESS patients.

Methods

Eighty-two patients were followed prospectively following FESS at a tertiary-academic medical institution for 3 postoperative visits. Patients were surveyed on their irrigation practices (start date, frequency, and volume per irrigation per side), and adherence to prescribed antibiotic and steroid regimens. At each visit, 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaires and endoscopic examinations were evaluated by the Lund-Kennedy Endoscopy Score (LKES). Factors evaluated include: patient demographics (age, sex, ethnicity), preoperative Lund-Mackay and SNOT-22 scores, comorbidities, extent of procedure, and use of nasal packing and/or spacers.

Results

Adherence to irrigation instructions was 82.9%. Factors significantly associated with compliance with irrigation instructions included younger age (p = 0.0022), prior irrigation (p < 0.0001), revision surgery (p = 0.0014), and non-native English language speaking (p = 0.0095). Patients were more likely to irrigate with larger volumes if they were younger (p = 0.0284), had prior irrigation (p < 0.0001), or had revision surgery (p = 0.0056).

Conclusion

Multiple factors are associated with patient compliance with nasal saline irrigation after FESS. Ethnic and cultural considerations, such as language barriers, should also be considered to improve outcomes. Identification of patients who may be noncompliant could potentially benefit from increased preoperative counseling to improve adherence rates.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2gOFTnu
via IFTTT

Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: a randomized, placebo-controlled, double-blind study

Background

Previous studies have shown controversial results of topical amphotericin B (AMB) nasal irrigation for chronic rhinosinusitis (CRS). The purpose of this study was to evaluate the efficacy of 200 μg/mL AMB nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery (FESS).

Methods

Patients with CRS who had received FESS for treatment were recruited and assigned to 1 of 2 groups at random at 1 month postsurgery. In the AMB group patients received nasal irrigation with 200 μg/mL of AMB for 2 months on a daily basis. In the control group normal saline irrigation was given instead. Before FESS and before and after nasal irrigation, patients' sinonasal symptoms were assessed through a questionnaire that was a Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meati.

Results

A total of 73 patients completed the study between December 2014 and January 2017. Among them, 37 received nasal irrigation with AMB solution, and 36 with saline. In the AMB group, scores of TWSNOT-22 dropped significantly after irrigation compared with before (p = 0.005). In the control group, TWSNOT-22 scores did not changed after irrigation (p = 0.451). However, there were no significant differences in TWSNOT-22, endoscopic score, smell test, saccharine transit test, and bacterial culture rate after irrigation between 2 groups.

Conclusion

Our study showed that in post-FESS care, nasal irrigation with 200 μg/mL of AMB did not provide additional benefit compared with saline irrigation.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2ihzrFF
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A clinical predictive score for postoperative myasthenic crisis

ABSTRACT

Objective: Myasthenia gravis (MG) is an autoimmune disease mostly caused by autoantibodies against acetylcholine receptor (AChR) associated with thymus abnormalities. Thymectomy has been proven to be an efficacious treatment for patients with MG, but postoperative myasthenic crisis often occurs and is a major complication. We aimed to develop and validate a simple scoring system based on clinical characteristics in the preoperative status to predict the risk of postoperative myasthenic crisis.

Methods: We studied 393 patients with MG who underwent thymectomy at six tertiary centers in Japan (275 patients for derivation and 118 for validation). Clinical characteristics, such as gender, age at onset and operation, body mass index, disease duration, MG subtype, severity, symptoms, preoperative therapy, operative data, and laboratory data, were reviewed retrospectively. A multivariate logistic regression with LASSO penalties was used to determine the factors associated with postoperative myasthenic crisis and score was assigned. Finally, the predictive score was evaluated using bootstrapping technique in the derivation and validation group.

Results: Multivariate logistic regression identified three clinical factors for predicting postoperative myasthenic crisis risk: (1) vital capacity < 80%, (2) disease duration < 3 months, and (3) bulbar symptoms immediately before thymectomy. The postoperative myasthenic crisis predictive score, ranging from 0 to 6 points, had areas under the curve of 0.84 (0.66 – 0.96) in the derivation group and 0.80 (0.62 – 0.95) in the validation group.

Interpretation: A simple scoring system based on three preoperative clinical characteristics can predict the possibility of postoperative myasthenic crisis. This article is protected by copyright. All rights reserved.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2yXbw91
via IFTTT

Synthesis, structure and magnetic properties of a family of complexes, containing {CoII2DyIII} pivalate core, and pentanuclear CoII4DyIII derivative

A series of new CoII-DyIII complexes with metal-organic core {Co2Dy(NO3)(Piv)6} was prepared by self-assembly reactions or step-by-step assembling. [Co2Dy(NO3)(Piv)6(MeCN)2] was used as starting compound for synthesis of trinuclear analogue [Co2Dy(NO3)(Piv)6(py)2] and pentanuclear complex [{Co2Dy(NO3)(Piv)6}{CoL(Piv)(H2O)}2](NO3)2 (L = 2,6-bis(2-pyridyl)-4-(4-pyridyl)pyridine). Change of LnIII coordination polyhedra distortion depending on coordination environment and temperature was analyzed in a series of coordination compounds with MII2LnIII cores and close analogues. The distortion of the LnIII ion polyhedron depends both on the composition of the compound and temperature, temperature increase favors to D2d geometry of LnIII coordination polyhedron. Magnetic properties of the complexes with CoII2DyIII cores were analyzed taking into account anisotropy of CoII and DyIII ions. The compounds with similar polynuclear cores, containing diamagnetic LaIII and isotropic GdIII - [Co2Ln(Piv)6(NO3)(MeCN)2] (Ln = La, Gd) - were studied for evaluation of CoII magnetic anisotropy parameters in order to minimize overparametrization in magnetic properties fitting for Co2Dy systems. It was found that magnetic properties of all complexes in this study were mainly governed by the magnetic properties of isolated ions.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2yYvCgC
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Curative and palliative MRI-guided laser ablation for drug-resistant epilepsy

Epilepsy is a common neurological disorder occurring in 3% of the US adult population. It is characterised by seizures resulting from aberrant hypersynchronous neural activity. Approximately one-third of newly diagnosed epilepsy cases fail to become seizure-free in response to antiseizure drugs. Optimal seizure control, in cases of drug-resistant epilepsy, often requires neurosurgical intervention targeting seizure foci, such as the temporal lobe. Advances in minimally invasive ablative surgical approaches have led to the development of MRI-guided laser interstitial thermal therapy (LITT). For refractory epilepsy, this surgical intervention offers many advantages over traditional approaches, including real-time lesion monitoring, reduced morbidity, and in some reports increased preservation of cognitive and language processes. We review the use of LITT for epileptic indications in the context of its application as a curative (seizure freedom) or palliative (seizure reduction) measure for both lesional and non-lesional forms of epilepsy. Furthermore, we address the use of LITT for a variety of extratemporal lobe epilepsies. Finally, we describe clinical outcomes, limitations and future applications of LITT for epilepsy.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2gP3e8r
via IFTTT

Early intravenous immunoglobulin treatment in paraneoplastic neurological syndromes with onconeural antibodies

Introduction

Paraneoplastic neurological syndromes (PNS) are immune-mediated complications of cancer, characterised by relentless progression. The mainstay of PNS treatment is the achievement of tumour remission,1 while immunotherapy provides only little additional benefit.2 3 However, in historical series, immunotherapy was initiated over 6 months after neurological onset and, at that stage, neuronal loss is already extensive and irreversible.

Among available immunotherapies, intravenous immunoglobulin (IVIg) has been used in single cases4 and in one retrospective series,3 showing some efficacy when administered timely.4 Based on these findings, we designed a prospective study to assess the efficacy and safety of early IVIg treatment in patients with PNS.

MethodsStudy design

This prospective, multicentre, non-comparative, phase II clinical study was performed by the 'Centre de Reference Francais des Syndromes Neurologiques Paranéoplasiques'. Written informed consent was obtained from all participants. This trial is registered at ClinicalTrials.gov (NCT02343211).

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2ig6UQO
via IFTTT

Monitoring disease progression with plasma creatinine in amyotrophic lateral sclerosis clinical trials

Objectives

Plasma creatinine is a predictor of survival in amyotrophic lateral sclerosis (ALS). It remains, however, to be established whether it can monitor disease progression and serve as surrogate endpoint in clinical trials.

Methods

We used clinical trial data from three cohorts of clinical trial participants in the LITRA, EMPOWER and PROACT studies. Longitudinal associations between functional decline, muscle strength and survival with plasma creatinine were assessed. Results were translated to trial design in terms of sample size and power.

Results

A total of 13 564 measurements were obtained for 1241 patients. The variability between patients in rate of decline was lower in plasma creatinine than in ALS functional rating scale–Revised (ALSFRS-R; p<0.001). The average rate of decline was faster in the ALSFRS-R, with less between-patient variability at baseline (p<0.001). Plasma creatinine had strong longitudinal correlations with the ALSFRS-R (0.43 (0.39–0.46), p<0.001), muscle strength (0.55 (0.51–0.58), p<0.001) and overall mortality (HR 0.88 (0.86–0.91, p<0.001)). Using plasma creatinine as outcome could reduce the sample size in trials by 21.5% at 18 months. For trials up to 10 months, the ALSFRS-R required a lower sample size.

Conclusions

Plasma creatinine is an inexpensive and easily accessible biomarker that exhibits less variability between patients with ALS over time and is predictive for the patient's functional status, muscle strength and mortality risk. Plasma creatinine may, therefore, increase the power to detect treatment effects and could be incorporated in future ALS clinical trials as potential surrogate outcome.

from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2gMrbNz
via IFTTT

Dexamethasone attenuates methacholine-mediated aquaporin 5 downregulation in human nasal epithelial cells via suppression of NF-κB activation

Background

Cholinergic stimulation plays a major role in inflammatory airway diseases. However, its role in airway surface liquid homeostasis and aquaporin 5 (AQP5) regulation remains unclear. In this study we sought to determine the effects of methacholine and dexamethasone on AQP5 expression in human nasal epithelial cells (HNEpC).

Methods

HNEpC were cultured with methacholine or dexamethasone at 4 concentrations in vitro. The subcellular distribution of AQP5 was explored using immunocytochemistry. The pharmacologic effects of methacholine and dexamethasone on the expression of the phosphorylation of cyclic adenosine monophosphate–responsive element binding protein (p-CREB), AQP5, and nuclear factor-kappaB (NF-κB) were examined using Western blotting.

Results

AQP5 was found to be located in cell membrane and cytoplasm and present in every group without a statistically significant difference. Methacholine inhibited expression of AQP5 and p-CREB in HNEpC, whereas dexamethasone increased these protein levels dose-dependently in a statistically significant manner. In turn, HNEpC treated with methacholine and dexamethasone showed the same trends as those intervened separately with these 2 drugs. Moreover, dexamethasone had the ability to reverse the inhibitory effect of methacholine. Western blotting revealed that, after incubation with 10⁻⁴ mol/L methacholine, NF-κB increased significantly, by 186.67%, compared with the untreated control group. Again, such an increase could be significantly reversed after dexamethasone treatment.

Conclusion

NF-κB activation is important for inhibition of p-CREB/AQP5 expression after methacholine intervention, and dexamethasone adjusts it to the opposite side. This observation could provide additional insight into the anti-inflammatory effects of glucocorticoids that contribute to maintaining airway surface liquid and mucosal defense.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ihA3uX
via IFTTT

Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery

Background

Functional endoscopic sinus surgery (FESS) is an effective treatment for chronic rhinosinusitis (CRS). Postoperative management strategies after FESS often vary from surgeon to surgeon. Recent data suggests that nasal saline irrigation following FESS is almost universally recommended; however, patient adherence has not been formally evaluated. The purpose of this study is to evaluate postoperative nasal irrigation practices and its effects on short-term outcomes in post-FESS patients.

Methods

Eighty-two patients were followed prospectively following FESS at a tertiary-academic medical institution for 3 postoperative visits. Patients were surveyed on their irrigation practices (start date, frequency, and volume per irrigation per side), and adherence to prescribed antibiotic and steroid regimens. At each visit, 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaires and endoscopic examinations were evaluated by the Lund-Kennedy Endoscopy Score (LKES). Factors evaluated include: patient demographics (age, sex, ethnicity), preoperative Lund-Mackay and SNOT-22 scores, comorbidities, extent of procedure, and use of nasal packing and/or spacers.

Results

Adherence to irrigation instructions was 82.9%. Factors significantly associated with compliance with irrigation instructions included younger age (p = 0.0022), prior irrigation (p < 0.0001), revision surgery (p = 0.0014), and non-native English language speaking (p = 0.0095). Patients were more likely to irrigate with larger volumes if they were younger (p = 0.0284), had prior irrigation (p < 0.0001), or had revision surgery (p = 0.0056).

Conclusion

Multiple factors are associated with patient compliance with nasal saline irrigation after FESS. Ethnic and cultural considerations, such as language barriers, should also be considered to improve outcomes. Identification of patients who may be noncompliant could potentially benefit from increased preoperative counseling to improve adherence rates.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2gOFTnu
via IFTTT

Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: a randomized, placebo-controlled, double-blind study

Background

Previous studies have shown controversial results of topical amphotericin B (AMB) nasal irrigation for chronic rhinosinusitis (CRS). The purpose of this study was to evaluate the efficacy of 200 μg/mL AMB nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery (FESS).

Methods

Patients with CRS who had received FESS for treatment were recruited and assigned to 1 of 2 groups at random at 1 month postsurgery. In the AMB group patients received nasal irrigation with 200 μg/mL of AMB for 2 months on a daily basis. In the control group normal saline irrigation was given instead. Before FESS and before and after nasal irrigation, patients' sinonasal symptoms were assessed through a questionnaire that was a Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meati.

Results

A total of 73 patients completed the study between December 2014 and January 2017. Among them, 37 received nasal irrigation with AMB solution, and 36 with saline. In the AMB group, scores of TWSNOT-22 dropped significantly after irrigation compared with before (p = 0.005). In the control group, TWSNOT-22 scores did not changed after irrigation (p = 0.451). However, there were no significant differences in TWSNOT-22, endoscopic score, smell test, saccharine transit test, and bacterial culture rate after irrigation between 2 groups.

Conclusion

Our study showed that in post-FESS care, nasal irrigation with 200 μg/mL of AMB did not provide additional benefit compared with saline irrigation.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ihzrFF
via IFTTT

Curative and palliative MRI-guided laser ablation for drug-resistant epilepsy

Epilepsy is a common neurological disorder occurring in 3% of the US adult population. It is characterised by seizures resulting from aberrant hypersynchronous neural activity. Approximately one-third of newly diagnosed epilepsy cases fail to become seizure-free in response to antiseizure drugs. Optimal seizure control, in cases of drug-resistant epilepsy, often requires neurosurgical intervention targeting seizure foci, such as the temporal lobe. Advances in minimally invasive ablative surgical approaches have led to the development of MRI-guided laser interstitial thermal therapy (LITT). For refractory epilepsy, this surgical intervention offers many advantages over traditional approaches, including real-time lesion monitoring, reduced morbidity, and in some reports increased preservation of cognitive and language processes. We review the use of LITT for epileptic indications in the context of its application as a curative (seizure freedom) or palliative (seizure reduction) measure for both lesional and non-lesional forms of epilepsy. Furthermore, we address the use of LITT for a variety of extratemporal lobe epilepsies. Finally, we describe clinical outcomes, limitations and future applications of LITT for epilepsy.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2gP3e8r
via IFTTT

Monitoring disease progression with plasma creatinine in amyotrophic lateral sclerosis clinical trials

Objectives

Plasma creatinine is a predictor of survival in amyotrophic lateral sclerosis (ALS). It remains, however, to be established whether it can monitor disease progression and serve as surrogate endpoint in clinical trials.

Methods

We used clinical trial data from three cohorts of clinical trial participants in the LITRA, EMPOWER and PROACT studies. Longitudinal associations between functional decline, muscle strength and survival with plasma creatinine were assessed. Results were translated to trial design in terms of sample size and power.

Results

A total of 13 564 measurements were obtained for 1241 patients. The variability between patients in rate of decline was lower in plasma creatinine than in ALS functional rating scale–Revised (ALSFRS-R; p<0.001). The average rate of decline was faster in the ALSFRS-R, with less between-patient variability at baseline (p<0.001). Plasma creatinine had strong longitudinal correlations with the ALSFRS-R (0.43 (0.39–0.46), p<0.001), muscle strength (0.55 (0.51–0.58), p<0.001) and overall mortality (HR 0.88 (0.86–0.91, p<0.001)). Using plasma creatinine as outcome could reduce the sample size in trials by 21.5% at 18 months. For trials up to 10 months, the ALSFRS-R required a lower sample size.

Conclusions

Plasma creatinine is an inexpensive and easily accessible biomarker that exhibits less variability between patients with ALS over time and is predictive for the patient's functional status, muscle strength and mortality risk. Plasma creatinine may, therefore, increase the power to detect treatment effects and could be incorporated in future ALS clinical trials as potential surrogate outcome.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2gMrbNz
via IFTTT

A clinical predictive score for postoperative myasthenic crisis

ABSTRACT

Objective: Myasthenia gravis (MG) is an autoimmune disease mostly caused by autoantibodies against acetylcholine receptor (AChR) associated with thymus abnormalities. Thymectomy has been proven to be an efficacious treatment for patients with MG, but postoperative myasthenic crisis often occurs and is a major complication. We aimed to develop and validate a simple scoring system based on clinical characteristics in the preoperative status to predict the risk of postoperative myasthenic crisis.

Methods: We studied 393 patients with MG who underwent thymectomy at six tertiary centers in Japan (275 patients for derivation and 118 for validation). Clinical characteristics, such as gender, age at onset and operation, body mass index, disease duration, MG subtype, severity, symptoms, preoperative therapy, operative data, and laboratory data, were reviewed retrospectively. A multivariate logistic regression with LASSO penalties was used to determine the factors associated with postoperative myasthenic crisis and score was assigned. Finally, the predictive score was evaluated using bootstrapping technique in the derivation and validation group.

Results: Multivariate logistic regression identified three clinical factors for predicting postoperative myasthenic crisis risk: (1) vital capacity < 80%, (2) disease duration < 3 months, and (3) bulbar symptoms immediately before thymectomy. The postoperative myasthenic crisis predictive score, ranging from 0 to 6 points, had areas under the curve of 0.84 (0.66 – 0.96) in the derivation group and 0.80 (0.62 – 0.95) in the validation group.

Interpretation: A simple scoring system based on three preoperative clinical characteristics can predict the possibility of postoperative myasthenic crisis. This article is protected by copyright. All rights reserved.

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2yXbw91
via IFTTT

Synthesis, structure and magnetic properties of a family of complexes, containing {CoII2DyIII} pivalate core, and pentanuclear CoII4DyIII derivative

A series of new CoII-DyIII complexes with metal-organic core {Co2Dy(NO3)(Piv)6} was prepared by self-assembly reactions or step-by-step assembling. [Co2Dy(NO3)(Piv)6(MeCN)2] was used as starting compound for synthesis of trinuclear analogue [Co2Dy(NO3)(Piv)6(py)2] and pentanuclear complex [{Co2Dy(NO3)(Piv)6}{CoL(Piv)(H2O)}2](NO3)2 (L = 2,6-bis(2-pyridyl)-4-(4-pyridyl)pyridine). Change of LnIII coordination polyhedra distortion depending on coordination environment and temperature was analyzed in a series of coordination compounds with MII2LnIII cores and close analogues. The distortion of the LnIII ion polyhedron depends both on the composition of the compound and temperature, temperature increase favors to D2d geometry of LnIII coordination polyhedron. Magnetic properties of the complexes with CoII2DyIII cores were analyzed taking into account anisotropy of CoII and DyIII ions. The compounds with similar polynuclear cores, containing diamagnetic LaIII and isotropic GdIII - [Co2Ln(Piv)6(NO3)(MeCN)2] (Ln = La, Gd) - were studied for evaluation of CoII magnetic anisotropy parameters in order to minimize overparametrization in magnetic properties fitting for Co2Dy systems. It was found that magnetic properties of all complexes in this study were mainly governed by the magnetic properties of isolated ions.

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2yYvCgC
via IFTTT

Early intravenous immunoglobulin treatment in paraneoplastic neurological syndromes with onconeural antibodies

Introduction

Paraneoplastic neurological syndromes (PNS) are immune-mediated complications of cancer, characterised by relentless progression. The mainstay of PNS treatment is the achievement of tumour remission,1 while immunotherapy provides only little additional benefit.2 3 However, in historical series, immunotherapy was initiated over 6 months after neurological onset and, at that stage, neuronal loss is already extensive and irreversible.

Among available immunotherapies, intravenous immunoglobulin (IVIg) has been used in single cases4 and in one retrospective series,3 showing some efficacy when administered timely.4 Based on these findings, we designed a prospective study to assess the efficacy and safety of early IVIg treatment in patients with PNS.

MethodsStudy design

This prospective, multicentre, non-comparative, phase II clinical study was performed by the 'Centre de Reference Francais des Syndromes Neurologiques Paranéoplasiques'. Written informed consent was obtained from all participants. This trial is registered at ClinicalTrials.gov (NCT02343211).

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2ig6UQO
via IFTTT

Monitoring disease progression with plasma creatinine in amyotrophic lateral sclerosis clinical trials

Objectives

Plasma creatinine is a predictor of survival in amyotrophic lateral sclerosis (ALS). It remains, however, to be established whether it can monitor disease progression and serve as surrogate endpoint in clinical trials.

Methods

We used clinical trial data from three cohorts of clinical trial participants in the LITRA, EMPOWER and PROACT studies. Longitudinal associations between functional decline, muscle strength and survival with plasma creatinine were assessed. Results were translated to trial design in terms of sample size and power.

Results

A total of 13 564 measurements were obtained for 1241 patients. The variability between patients in rate of decline was lower in plasma creatinine than in ALS functional rating scale–Revised (ALSFRS-R; p<0.001). The average rate of decline was faster in the ALSFRS-R, with less between-patient variability at baseline (p<0.001). Plasma creatinine had strong longitudinal correlations with the ALSFRS-R (0.43 (0.39–0.46), p<0.001), muscle strength (0.55 (0.51–0.58), p<0.001) and overall mortality (HR 0.88 (0.86–0.91, p<0.001)). Using plasma creatinine as outcome could reduce the sample size in trials by 21.5% at 18 months. For trials up to 10 months, the ALSFRS-R required a lower sample size.

Conclusions

Plasma creatinine is an inexpensive and easily accessible biomarker that exhibits less variability between patients with ALS over time and is predictive for the patient's functional status, muscle strength and mortality risk. Plasma creatinine may, therefore, increase the power to detect treatment effects and could be incorporated in future ALS clinical trials as potential surrogate outcome.

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2gMrbNz
via IFTTT

The clinical response to omalizumab in CSU patients is linked to and predicted by IgE levels and their change

Abstract

Background

Omalizumab is an effective and well-tolerated treatment for chronic spontaneous urticaria (CSU). Markers and predictors of response are largely unknown, but needed to optimize omalizumab treatment. Omalizumab targets IgE, and IgE levels may be linked to the effects of treatment. We evaluated if response rates to treatment with omalizumab in patients with CSU are linked to their baseline IgE levels, their IgE levels after omalizumab treatment, and the ratio of on treatment IgE and baseline IgE levels.

Methods

CSU patients (n=113) were treated with omalizumab 300 mg/4 weeks for 12 weeks, when their treatment responses, i.e. no, partial, or complete response, were assessed by use of the urticaria activity score, physician and patient visual analog scale, and treatment effectiveness score. Total IgE levels were measured before treatment (bIgE) with omalizumab and 4 weeks thereafter (w4IgE).

Results

Non-responders to omalizumab had significantly lower bIgE levels (17.9IU/ml, 17.0-55.0IU/ml) than partial responders (82.0IU/ml, 46.2-126.5IU/ml, p=0.008) and complete responders (73.7IU/ml, 19.45-153.8IU/ml, p=0.032). Non-responders also had lower w4IgE levels and lower ratios of w4IgE/bIgE levels than partial and complete responders (p<0.001). Non-response to omalizumab was best predicted by patients' w4IgE/bIgE ratios, significantly better than by bIgE levels (p=0.016).

Conclusions

In CSU, total IgE levels and their change predict the response to treatment with omalizumab. The assessment of pre- and post-treatment IgE levels and their ratio may help to improve the management of CSU in patients who require omalizumab treatment.

This article is protected by copyright. All rights reserved.

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2yeiKpv
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Psychological Roots of Palliative Care Benefit in Cancer Psychological Roots of Palliative Care Benefit in Cancer

Early palliative care can improve coping strategies, which in turn are associated with subsequent improved quality of life and reduced depression.Medscape Medical News (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from ! Medicine by Alexandros G. Sfakianakis via alwin on Inoreader http://ift.tt/2zjwC1N
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