An unorthodox pathophysiology of severe cases of COVID-19 the weak heme hypothesis

xlomafota13 shared this article with you from Inoreader An unorthodox pathophysiology of severe cases of COVID-19 the weak heme hypothesis Via American Journal of Blood Research Am J Blood Res. 2020 Dec 15;10(6):305-310. eCollection 2020. ABSTRACT Important amount of severe cases is the main concern in COVID-19 pandemic. It could be the running cause of the burn out of the health system in many countries. The aim of this paper is to suggest a pathophysiologic hypothesis to explain the main characteristics of severe cases of COVID-19 and its underlying conditions. In fact, the clinical and biological picture of severe cases of COVID-19 can easily be explained by free heme toxicity exceeding the endogenous antioxidant systems. Severe cases of COVID-19 are comparable to acute porphyria. On the other hand, the geographical distribution of severe cases of COVID-19 is directly associated to how fresh or polluted the air is. Finally, the relatively low rate of severe cases of COVID-19 could be explained by the presence of an unstable hemoglobin variant highly sensitive to the intrinsic conditions resulting from the a cute pneumonia secondary to SARS-CoV2 infection. The combination of air pollution and free heme toxicity, resulting from the interaction between an unstable hemoglobin variant and SARS-CoV2 infection, seems to be the best scheme to explain clinical and biological manifestations in severe COVID-19. The arguments to support this hypothesis are detailed. We also propose some strategies to verify the concordance of our hypothesis with the reality and the implications it could have, if verified, either for scientists and decision makers. PMID:33489438 | PMC:PMC7811897 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lymph Node to Vein Anastomosis (LNVA) for lower extremity lymphedema

xlomafota13 shared this article with you from Inoreader Lymph Node to Vein Anastomosis (LNVA) for lower extremity lymphedema Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jan 30:S1748-6815(21)00048-6. doi: 10.1016/j.bjps.2021.01.005. Online ahead of print. ABSTRACT The microsurgical options for lower limb lymphedema is a challenge. In search to improve the overall result, we hypothesized it would be beneficial to add the functioning lymph nodes to vein anastomosis (LNVA) in addition to lymphovenous anastomosis (LVA). This is a retrospective study of 160 unilateral stage II & III lower extremity lymphedema comparing the outcome between the LNVA + LVA group and the LVA only group from May 2013 to June 2018. MRI was used to identify the functioning lymph nodes. Patient outcome, including lower extremity circumference, body weight, bio impedance test, and other data were analyzed to evaluate whether lymph nodes to vein anastomosis (LNVA) improved outcome. The LNVA + LVA group showed significantly better results for circumference reduction rate, body weight reduction r ate, and extracellular fluid reduction rate of the affected limb as compared to the LVA only group for both stage II and III lymphedema. The MRI imaging revealed that 9 cases had no identifiable lymph nodes of the affected limb and 54 cases with a nonfunctioning lymph node upon exploration despite positive imaging. Correlation showed the lymph node size needed to be at least 8 mm in the MRI to be functional. The LNVA + LVA approach for lymphedema has the benefit of better reduction as compared to LVA alone in the lower limb as well as the suprapubic region. Preoperative MRI will help to identify the functioning lymph node by increasing the overall probability of positive outcome. PMID:33640308 | DOI:10.1016/j.bjps.2021.01.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Concurrent chemoradiotherapy with additional chemotherapy for nasopharyngeal carcinoma: A pooled analysis of propensity score‐matching studies

xlomafota13 shared this article with you from Inoreader Concurrent chemoradiotherapy with additional chemotherapy for nasopharyngeal carcinoma: A pooled analysis of propensity score‐matching studies Via Head & Neck Abstract Objective To determine the benefits of adding induction chemotherapy (IC) and adjuvant chemotherapy (AC) to concurrent chemoradiotherapy (CCRT) for nasopharyngeal carcinoma (NPC) based on propensity score‐matching (PSM) studies. Methods Eligible PSM studies were searched in the PubMed, Web of Science, and Embase databases from inception to September 1, 2020. The primary endpoints included overall survival (OS), distant metastasis‐free survival (DMFS), and locoregional recurrence‐free survival (LRFS). Results A total of 14 trials consisting of 4086 participants were included. Significant benefits were observed between IC + CCRT and CCRT for OS (hazard ratio [HR], 0.76; 95% confidence interval [CI]: 0.64–0.91) and DMFS (HR, 0.77; 95% CI: 0.64–0.94) with the exception of LRFS (HR, 1.14; 95% CI: 0.90–1.43). However, CCRT + AC did not achieve significant improvements. Conclusions IC with CCRT yields significant survival benefits in terms of OS and DMFS, whereas CCRT with AC fails to achieve any additional benefit in all endpoints. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Survival outcomes in locally advanced cutaneous squamous cell carcinoma presenting with clinical perineural invasion alone

xlomafota13 shared this article with you from Inoreader Survival outcomes in locally advanced cutaneous squamous cell carcinoma presenting with clinical perineural invasion alone Via Head & Neck Abstract Background Cutaneous squamous cell carcinomas (CSCC) involving the head and neck are common, but initial presentation or recurrence limited to the cranial nerves is rare. Methods We conducted a retrospective study of 21 patients with clinical perineural invasion (PNI) from CSCC and no measurable disease by RECIST 1.1. Patients treated with radiotherapy or chemoradiotherapy were included. Results The median time from symptom onset until diagnosis was 13.0 months (2.6–83.1). All patients received radiotherapy. Fourteen received concurrent systemic therapy. The median follow‐up time was 30.5 months (1.1–106.0). Ten patients recurred, with the majority being locoregional. The 2‐year overall survival rate was 85%. The median progression‐free survival (PFS) was 21.5 months with an estimated 2‐year PFS of 44.5% (95%CI: 22.3–66.8). Conclusions CSCCs with clinical PNI alone are difficult to diagnose and can have a long interval between appearance of symptoms and diagnosis. They can successfully be treated with chemoradiotherapy. However, many patients still suffer from locoregional recurrences. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence and Outcome of Anterior and Middle Cranial Fossae Encephaloceles without Cerebrospinal Fluid Leak or Meningitis

xlomafota13 shared this article with you from Inoreader Prevalence and Outcome of Anterior and Middle Cranial Fossae Encephaloceles without Cerebrospinal Fluid Leak or Meningitis Via leak of cerebrospinal fluid World Neurosurg. 2021 Jan 30:S1878-8750(21)00119-4. doi: 10.1016/j.wneu.2021.01.088. Online ahead of print. ABSTRACT BACKGROUND: With advances in imaging techniques, encephaloceles, meningoceles, and meningoencephaloceles are occasionally discovered incidentally. These can be located in anterior cranial fossa (ACF), mostly protruding into sphenoid and ethmoid sinuses, or middle cranial fossa (MCF), protruding into the temporal bone. We reviewed a large series of cranial computed tomography and magnetic resonance imaging scans to identify the prevalence of asymptomatic encephaloceles, meningoceles, and meningoencephaloceles and describe their outcome. METHODS: We retrospectively reviewed a database of all magnetic resonance imaging and computed tomography scans done at Weill Cornell Medicine for any reason between 2003 and 2018. Encephaloceles, meningoceles, or meningoencephaloceles were confirmed on 72 scans. Of these, chart reviews wer e performed to identify incidentally discovered cases with symptoms other than cerebrospinal fluid leak, and chart reviews and phone calls were conducted to determine patient demographics, treatment, and outcome. RESULTS: There were 18 incidental cases for a prevalence of 0.0074%, of which 6 were located in ACF, and 12 were located in MCF. The mean age for ACF cases was 39 ± 15.9 years and for MCF cases was 49.5 ± 19.8 years. There were no leaks in any cases after the encephaloceles were discovered. Eleven of 12 (91.6%) MCF cases were treated conservatively, while 3 of 6 (50%; P = 0.083) ACF cases were treated surgically. CONCLUSIONS: This study showed that encephaloceles, meningoceles, and meningoencephaloceles without cerebrospinal fluid leak or meningitis in MCF were more often conservatively managed with observation only, whereas these entities in ACF were often repaired prophylactically. Incidentally discovered encephaloceles have a relatively benign natural histo ry and do not precipitously leak. PMID:33529766 | DOI:10.1016/j.wneu.2021.01.088 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Peristapedial bulb: an indicator of spontaneous CSF leak in cochlear candidates with Mondini dysplasia

xlomafota13 shared this article with you from Inoreader Peristapedial bulb: an indicator of spontaneous CSF leak in cochlear candidates with Mondini dysplasia Via leak of cerebrospinal fluid Acta Otolaryngol. 2021 Feb 27:1-6. doi: 10.1080/00016489.2021.1887930. Online ahead of print. ABSTRACT BACKGROUND: Mondini dysplasia with spontaneous cerebrospinal fluid (CSF) leak is rare in cochlear implantation (CI) candidates but lethal. Detailed evaluation and surgical intervention are needed for these patients. AIM/OBJECTIVE: To report our findings of the peristapedial bulb in computer tomography (CT) as diagnostic evidence of spontaneous CSF leak and discuss its clinical value to direct the surgical plan for patients with profound sensorineural hearing loss (SNHL) and meningitis. MATERIAL AND METHODS: A retrospective review was conducted, including patients' demographic features, radiographic examination, operation records, auditory/speech evaluation. The patients presented with a peristapedial bulb were included. RESULTS: In 2775 CI recipients, 7 out of 219 (3.2%) patients with Mondini anomaly had detectable peristap edial bulbs in HRCT, among whom 6 patients have a history of meningitis. Surgical exploration verified the radiographic findings in 6 out of 7 patients. All patients received CI and vestibular obliteration. Control of meningitis was acceptable. The threshold of hearing significantly decreased from 74.1 dB ± 6.9 dB to 37.1 ± 4.8 dB after CI and the word recognition score elevated from 21.4 ± 14.9% to 78.6 ± 9.3%. CONCLUSIONS AND SIGNIFICANCE: Peristapedial bulb is an indicator of spontaneous CSF leak in patients with profound SHNL and Mondini anomaly. Patients will benefit from CI and surgical intervention. PMID:33641594 | DOI:10.1080/00016489.2021.1887930 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

New drug approval: Olaparib and niraparib - first line in ovarian cancer

xlomafota13 shared this article with you from Inoreader New drug approval: Olaparib and niraparib - first line in ovarian cancer Via Association française pour l'étude du cancer Bull Cancer. 2021 Feb 25:S0007-4551(21)00038-2. doi: 10.1016/j.bulcan.2021.01.003. Online ahead of print. NO ABSTRACT PMID:33641880 | DOI:10.1016/j.bulcan.2021.01.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Optimal Activity of Radioactive Iodine for Remnant Ablation in Low/Intermediate Risk Differentiated Thyroid Carcinoma: A Continuous Controversy and Meta-Analysis

xlomafota13 shared this article with you from Inoreader The Optimal Activity of Radioactive Iodine for Remnant Ablation in Low/Intermediate Risk Differentiated Thyroid Carcinoma: A Continuous Controversy and Meta-Analysis Via radioactive iodine Cureus. 2021 Jan 27;13(1):e12937. doi: 10.7759/cureus.12937. ABSTRACT Radioactive iodine (RAI) is widely used for remnant ablation in low/intermediate differentiated thyroid carcinoma (DTC). However, the optimal effective dose that overweighs the benefits over unwanted side effects is a matter of controversy. This meta-analysis aimed to assess low versus high doses of RAI activity for DTC remnant ablation. Two authors independently searched PubMed and Cochrane Library using the key words low dose radioactive iodine, high dose radioactive iodine, low-risk/intermediate risk, differentiated thyroid carcinoma, and remnant ablation. Two hundred and twenty references were identified when limiting the engine to controlled trials in English and during the period from January 2010 to December 2020. Nine trials (five from Europe and four from Asia) including 3137 patients fulfilled the inclusion and exclusion criteria. The data were then entered in an extraction sheet detailing the trial information including the author's name, year of publication, country, and type of surgery, preparation for RAI, the patients and control number in the low and high-dose groups, follow-up period, and the results. Out of 220 articles retrieved, nine controlled trials were included (follow-up period range, six months to 12 years, 3137 patients, and low risk of bias). The analysis favored the high dose for remnants ablation, odd ratio, 0.73, 95% CI, 0.50-1.07; P-value for the overall effect was 0.10. However, the results were limited due to the significant heterogeneity observed (56%, P-value 0.03). High-dose RAI was better for DTC remnants ablation. Further studies focusing on intermediate-risk DTC and adjusting for preoperative and postoperative factors are recommended. PMID:33643743 | PMC:PMC7885745 | DOI:10.7759/cureus.12937 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Radiolabeled Self-assembled Nanoparticle Probe for Diagnosis of Lung-Metastatic Melanoma

xlomafota13 shared this article with you from Inoreader A Radiolabeled Self-assembled Nanoparticle Probe for Diagnosis of Lung-Metastatic Melanoma Via radioactive iodine Biol Pharm Bull. 2021;44(3):410-415. doi: 10.1248/bpb.b20-00810. ABSTRACT Melanoma is a highly malignant skin cancer that frequently metastasizes to the lung, bone, and brain at an early phase. Therefore, noninvasive detection of metastasized melanoma could be beneficial to determine suitable therapeutic strategies. We previously reported a biocompatible ternary anionic complex composed of plasmid DNA (pDNA), polyethyleneimine (PEI), and γ-polyglutamic acid (γ-PGA) based on an el ectrostatic interaction, which was highly taken up by melanoma cells (B16-F10), even if it was negatively charged. Here, we developed a radiolabeled γ-PGA complex by using indium-111 (111In)-labeled polyamidoamine dendrimer (4th generation; G4) instead of pDNA and iodine-125 (125I)-labeled PEI instead of native PEI, and evaluated its effectiveness as a melanoma-targeted imaging probe. This ternary complex was synthesized at a theoretical charge ratio; carboxyl groups of 111In-diethylenetriaminepentaacetic acid (DTPA)-G4 : amino groups of 125I-PEI : carboxyl groups of γ-PGA was 1 : 8 : 16, and the size and zeta potential were approximately 29 nm and -33 mV, respectively. This complex was taken up by B16-F10 cells with time. Furthermore, a biodistribution study, using normal mice, demonstrated its accumulation in the liver, spleen, and lung, where macrophage cells are abundant. Almost the same level of radioactivity derived from both 111In and 125I was observed in these organs at an early phase after probe injection. Compared with the normal mice, significantly higher lung-to-blood ratios of radioactivity were observed in the B16-F10-lung metastatic cancer model. In conclusion, the radiolabeled γ-PGA complex would hold potentialities for nuclear medical imaging of lung metastatic melanoma. PMID:33642549 | DOI:10.1248/bpb.b20-00810 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Influence of H2-Receptor Antagonist Administration to the 24-h Uptake of I-131 in the Thyroid Gland

xlomafota13 shared this article with you from Inoreader The Influence of H2-Receptor Antagonist Administration to the 24-h Uptake of I-131 in the Thyroid Gland Via radioactive iodine Nucl Med Mol Imaging. 2021 Feb;55(1):27-30. doi: 10.1007/s13139-020-00676-1. Epub 2021 Jan 7. ABSTRACT PURPOSE: The aim of this study was to determine the influence of H2RAs to the 24-h I-131 uptake in the thyroid gland. MATERIAL AND METHODS: A prospective study with quasi-experimental pre- and post-study design was done. Subjects with normal fT4 level who fulfilled the inclusion criteria were selected. All subjects received 0.2 mCi of I-131 orally, and the thyroid uptake cal culations were performed at 24 h later. The same procedure was performed 4 weeks later. All of the subjects were asked to consume H2RAs 1 h before the administration of I-131 of the second procedure. Both 24-h thyroid uptakes were statistically analysed. RESULTS: A total of 14 subjects were enrolled in this study. Most of them were women (78%) with an average age of 37.6 years old (range: 20-55). This study showed a median of 24-h thyroid uptake of I-131 before and after H2-receptor antagonist of 20.6% (range: 11.1-57.8%) and 16.7% (range: 8.1-39.4%) respectively. CONCLUSION: H2-receptor antagonist caused a significance reduction of 24-h I-131 uptake value in the thyroid gland. PMID:33643486 | PMC:PMC7881069 | DOI:10.1007/s13139-020-00676-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren

xlomafota13 shared this article with you from Inoreader Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren Via Brazilian Oral Research Abstract This study aimed to identify the prevalence of molar-incisor hypomineralization (MIH) in schoolchildren and its association with dental caries experience. This was a cross-sectional study with a sample of 471 children aged 8 to 10 years. Data were collected via a sociodemographic questionnaire. Intra-oral clinical examination was done to identify and diagnose MIH (EAPD Criteria) as well as dental caries (ICDAS Index). Statistical analyses were performed with Person's Chi-square, Fisher's exact, and Mann-Whitney tests, and Poisson regression models were built. Statistical significance was set at an alpha-level of 0.05. The prevalence of MIH in our participants was 9.8%, with lesions being mostly of the mild form (65.2%) and affecting the first permanent molars but not the incisors in 54.2% of the children. Dental caries was observed in 88.1% of subjects. We observed a significant association between dental caries and the following variables: presence of MIH (p < 0.01; PR = 1.13), dental visit (p < 0.02; PR=0.92), and parents or legal guardians' education level (p < 0.05; PR = 1.07). A MIH diagnosis was also significantly associated with family income (p < 0.05; PR = 4.09). Children with MIH had more caries lesions on molar surfaces (p < 0.01; PR = 4.05). The prevalence of MIH was found to be moderate, based on previous studies, and the presence of enamel defect was associated with dental caries. The teeth most affected by MIH lesions were the first permanent molars. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.