A Randomized, Controlled Trial Comparing the Impact of a Low-Calorie Ketogenic vs a Standard Low-Calorie Diet on Fat-Free Mass in Patients Receiving an Elipse™ Intragastric Balloon Treatment

xlomafota.13 shared this article with you from Inoreader A Randomized, Controlled Trial Comparing the Impact of a Low-Calorie Ketogenic vs a Standard Low-Calorie Diet on Fat-Free Mass in Patients Receiving an Elipse™ Intragastric Balloon Treatment Via Latest Results for Obesity Surgery Abstract Background The Elipse™ intragastric balloon (EIGB) is a new swallowable balloon for weight loss (WL). Preserving metabolically active fat-free mass (FFM) and resting metabolic rate (RMR) during WL are crucial to maximize fat mass (FM) loss. After EIGB placement, a standard low-calorie diet (LCD) is generally prescribed. A low-calorie ketogenic diet (LCKD) has proven to be safe and effective in reducing FM while preserving FFM and RMR. Objective To prospectively compare the effects on WL, FM, FFM, and RMR in two groups of patients who were randomized to two different diets: LCKD and a standard LCD after EIGB placement. Methods WL, FM, FFM, and RMR were measured before EIGB and at 4 months in 48 patients who received either a LCKD (n = 24) or a standard LCD (n = 24). Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of LCKD and LCD on renal function was also evaluated. Results The LCKD group showed a significantly lower decrease in FFM and RMR when compared with the LCD group (3.55 vs 14.3%, p < 0.001; 9.79 vs 11.4%, p < 0.001, respectively). FM decreased more significantly with LCKD compared to LCD (41.6 vs 33.1%, p = 0.0606). Compliance in following the prescribed diets, without negative impact on renal function, was found. Conclusion Based on our findings, despite the small sample size, we were able to support the hypothesis that LCKD is associated with an increased FM loss while reducing the FFM loss and the RMR, without interfering with renal function after EIGB. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics

xlomafota.13 shared this article with you from Inoreader Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics Via Latest Results for Advances in T... Abstract The high prevalence of infectious diseases in the intensive care unit (ICU) and consequently elevated pressure for immediate and effective treatment have led to increased antimicrobial therapy consumption and misuse. Moreover, the emerging global threat of antimicrobial resistance and lack of novel antimicrobials justify the implementation of judicious antimicrobial stewardship programs (ASP) in the ICU. However, even though the importance of ASP is generally accepted, its implementation in the ICU is far from optimal and current evidence regarding strategies such as de-escalation remains controversial. The limitations of clinical guidance for antimicrobial therapy initiation and discontinuation have led to multiple studies for the evaluation of more objective tools, such as biomarkers as adjuncts for ASP. C-reactive protein and procalcitonin can be adequate for clinical use in acute infectious diseases, the latter being the most studied for ASP purposes. Althoug h promising, current evidence highlights challenges in biomarker application and interpretation. Furthermore, the physiological alterations in the critically ill render pharmacokinetics and pharmacodynamics crucial parameters for adequate antimicrobial therapy use. Individual pharmacokinetic and pharmacodynamic targets can reduce antimicrobial therapy misuse and risk of antimicrobial resistance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Physical Activity, Medical Home, and Health Behavior Counseling Among Adolescents with Special Health Care Needs: NSCH 2016–2017

xlomafota.13 shared this article with you from Inoreader Physical Activity, Medical Home, and Health Behavior Counseling Among Adolescents with Special Health Care Needs: NSCH 2016–2017 Via Latest Results for Maternal and Child Health Journal Abstract Objectives Aim 1 was to establish updated prevalence estimates for meeting national physical activity (PA) guidelines among adolescents with and without special healthcare needs (SHCN), 12–17 years old. To identify at-risk subgroups, our sub-aim was to compare the distribution of prevalence estimates across PA levels by SHCN subtypes, and in reference to peers without SHCN. Aim 2 was to examine the association between meeting PA guidelines, having a medical home, and receiving positive health behavior counseling in this population. Methods Weighted prevalence estimates for meeting the 2018 National PA Guidelines (inactive, insufficiently active, sufficiently active: guidelines met) were calculated from a secondary analysis of the National Survey of Children's Health 2016–2017 ( n = 16,171, 27% SHCN). Adjusted odds ratios and 95% CIs were estimated from logistic regression models to measure the association between PA, medical home, and postive health behavior counseling. Results Of adolescents with SHCN, 15% were reported to be meeting PA guidelines compared to 19% of peers without SHCN peers. Among adolescents with a medical home, regardless of SHCN status, those receiving positive health behavior counseling had 1.70 times the adjusted odds of meeting PA guidelines compared to peers without counseling. Conclusions for Practice Adolescents with and without SHCN were more likely to meet PA guidelines if they had a medical home and received positive health behavior counseling, highlighting the value of comprehensive healthcare practices for PA promotion. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Seeking international consensus on approaches to primary tumour treatment in Ewing sarcoma

xlomafota.13 shared this article with you from Inoreader Seeking international consensus on approaches to primary tumour treatment in Ewing sarcoma Via Latest Results for Clinical Sarcoma Research Abstract Background The local treatment of Ewing sarcoma of bone involves surgery, radiotherapy or both. The selection of treatment depends on the anatomical extent of the tumour, the effectiveness of the proposed treatment, its morbidity, and the expectation of cure. However, not only are there variations in the approach to local treatment between individual patients, but also between treatment centres and countries. Our aim was to explore variation in practice and develop consensus statements about local treatment. Methods A three stage modified Delphi technique was used with international collaborators. This involved an expert panel to identify areas of controversy, an online survey of international collaborators and a consensus meeting in London, UK in June 2017. In the consensus meeting, teams of clinicians discussed the local management of selected cases and their responses were collected with electronic voting. Results Areas of greater or less consensus were identified. The lack of evidence underpinning different approaches was noted and areas for collaborative research became apparent. Conclusion This has demonstrated that there is an international consensus around many aspects of the local treatment of Ewing sarcoma of bone, including the use of specialist MultiDisciplinary Team (MDT) meetings with access to all appropriate treatments. However, considerable variation remains including the use of different staging investigations, decision making, definitions of response, and radiotherapy doses and timing. Further collaborative work should be undertaken to determine the impact of these variations in order to define best practice. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Preoperative accelerated radiotherapy combined with chemotherapy in a defined cohort of patients with high risk soft tissue sarcoma: a Scandinavian Sarcoma Group study

xlomafota.13 shared this article with you from Inoreader Preoperative accelerated radiotherapy combined with chemotherapy in a defined cohort of patients with high risk soft tissue sarcoma: a Scandinavian Sarcoma Group study Via Latest Results for Clinical Sarcoma Research Abstract Background We recently reported outcomes from a Scandinavian Sarcoma Group adjuvant study (SSG XX group A) conducted on localized and operable high risk soft tissue sarcoma (STS) of the extremities and trunk wall. SSG XX, group B, comprised of patients in a defined cohort with locally advanced STS considered at high risk for intralesional surgery. These patients received preoperative accelerated radiotherapy, together with neoadjuvant and adjuvant chemotherapy. Herein we report the results of this group B. Methods Twenty patients with high-grade, locally advanced and deep STS located in lower extremities (n = 12), upper extremities (5) or trunk wall (3) were included. The median age was 59 years and 14 patients were males. The treatment regimen consisted of 6 cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2), with three cycles given neoadjuvantly, and preoperative radiotherapy (1, 8 Gyx2/daily to 36 Gy) between cycles 2 and 3. After a repeated MRI surgery was then conducted, and the remaining 3 chemotherapy cycles were given postoperatively at 3 weeks intervals. Survival data, local control, toxicity of chemotherapy and postoperative complications are presented. Results Median follow-up time for metastasis-free survival (MFS) was 2.8 years (range 0.3–10.4). The 5-year MFS was 49.5% (95% confidence interval [CI] 31.7–77.4). The median follow-up time was 5.4 years (range 0.3–10.4) for overall survival (OS). The 5-year OS was 64.0% (95% CI 45.8–89.4). The median tumour size was 13 cm, with undifferentiated pleomorphic sarcoma (n = 10) and synovial sarcoma (n = 6) diagnosed most frequently. All patients completed surgery. Resection margins were R0 in 19 patients and R1 in 1 patient. No patients had evidence of disease progression preoperatively. Three patients experienced a local recurrence, in 2 after lung metastases had already been diagnosed. Eleven patients (55%) had postoperative wound problems (temporary in 8 and persistent in 3). Conclusions Preoperative chemotherapy and radiotherapy were associated with temporary wound-healing problems. Survival outcomes, local control and toxicities were deemed satisfactory when considering the locally advanced sarcoma disease status at primary diagnosis. Trial registration This study was registered at ClinicalTrials.gov Identifier NCT00790244 and with European Union Drug Regulating Authorities Clinical Trials No. EUDRACT 2007-001152-39 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Solitary extrapleural fibrous tumor with hepatic bilobar metastases: multimodal approach treatment

xlomafota.13 shared this article with you from Inoreader Solitary extrapleural fibrous tumor with hepatic bilobar metastases: multimodal approach treatment Via Latest Results for Clinical Sarcoma Research Abstract Background Solitary fibrous tumor is an unusual fibroblastic mesenchymal neoplasm typically described in the pleura. It may appear anywhere with a varied anatomic distribution and essentially it can develop from any soft tissue or visceral location. Its course is usually indolent and it rarely causes distant metastases, so it has a prolonged survival rate. It sometimes presents itself as a disseminate disease being the liver the most frequently involved location. In these occasions, the management should be discussed in a multidisciplinary tumor committee formed by surgeons, oncologists and radiologists. Surgery remains the gold standard for treatment. Case representation We present the case of a woman with a tumor in the left abdominal wall and bilobar massive liver metastases, both locations histologically diagnosed as solitary fibrous tumor. She receives biological treatment for a severe case of Crohn´s disease. Evaluated in a multidisciplinary committee, surgery was recommended for both the primary lesion and the liver metastases. The hepatobiliary surgeons considered a two-stage hepatectomy with portal vein embolization (PVE) as the best strategy. After the first procedure consisting in cleaning the left hepatic lobe followed by PVE the future liver remnant volume (FLRV) was considered inadequate, so the patient was also treated with right transarterial radioembolizacion with yttrium 90 (TARE-Y90) intending a double goal: to treat the tumor and to increased the FLRV. Furthermore, a severe flare of Crohn´s disease forced us to intensify the patient's treatment with the addition of biological agents (infliximab and adal imumab) until complete remission of the symptoms. The second stage of the liver surgery had to be postponed for more than 6 months and could finally be carried out without complications, achieving an R0 resection. The postoperative course was uneventful and the follow up has showed no recurrence to date. Conclusion Solitary fibrous tumours with extensive liver metastases are infrequent but when they appear modern surgical strategies like two stage hepatectomy are the treatment of choice and must be carried out by specialised units. The therapeutic decisions should be guided by a multidisciplinary committee. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoperative Applications of Topical Corticosteroid Therapy for Chronic Rhinosinusitis.

xlomafota13 shared this article with you from Inoreader Intraoperative Applications of Topical Corticosteroid Therapy for Chronic Rhinosinusitis. Via ear nose throat Related Articles Intraoperative Applications of Topical Corticosteroid Therapy for Chronic Rhinosinusitis. Ear Nose Throat J. 2020 Nov 10;:145561320970100 Authors: Lelegren MJ, Bloch RA, Lam KK Abstract OBJECTIVES: To provide an overview of recent techniques and technologies for the application of topical corticosteroid therapy immediately following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). METHODS: A comprehensive search in the PubMed and Google Scholar databases was conducted to identify publications between January 2000 and December 2019 detailing clinical trials that have evaluated the efficacy and safety of intraoperative applications of topical corticosteroids for CRS. RESULTS: A total of 21 articles, all of which highlight a variety of corticosteroid-infused products, including Propel corticosteroid-eluting stents, NasoPore, Merocel, SinuBand, calcium alginate, and bioresorbable gel-type products, are included for review. Propel stents are the only devices that have achieved level 1A evidence in terms of efficacy and have data to support their safety. The remaining products have shown mixed results in terms of efficacy and safety. CONCLUSION: A wide range of techniques and technologies have been introduced to enhance the topical delivery of corticosteroids into the neosinuses after ESS for CRS. Regarding efficacy, there is level 1A evidence to support the use of Propel stents. Most of the remaining strategies show some degree of efficacy. Direct comparisons across the different strategies are limited owing to the varied uses of delivery vectors, corticosteroid choices, and doses of corticosteroids. Propel stents and SinuBand have sufficient data to support systemic and ocular safety, whereas the remaining products have limited data to support their safety. PMID: 33170026 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Pilot Study of the Waterless Empirical Taste Test.

xlomafota13 shared this article with you from Inoreader A Pilot Study of the Waterless Empirical Taste Test. Via ear nose throat Related Articles A Pilot Study of the Waterless Empirical Taste Test. Ear Nose Throat J. 2020 Nov 10;:145561320967337 Authors: Jiang RS, Liu SA, Wang CP, Wu SH, Wang JJ Abstract OBJECTIVES: This study was performed to test the clinical applicability of a new taste test-the waterless empirical taste test (WETT). METHODS: Sixty healthy volunteers and 20 patients with oral cancer were enrolled. They all received the conventional solution-based whole-mouth suprathreshold taste test (WMTT), which contained sucrose, citric acid, sodium chloride, and caffeine solutions for tastants, along with the WETT. The WETT used plastic strips to deliver tastants. The strip was embedded with sucrose, citric acid, sodium chloride, caffeine, or monosodium glutamate taste enhancer in 4 different concentrations. Each strip was tested twice. Thirty of the healthy volunteers received the WETT again to measure a retest reliability. Case-control matching by age and gender was used to compare the scores of WMTT and WETT between 13 healthy volunteers and 13 patients with oral cancer. RESULTS: The correlation was not high between the WMTT and WETT (r < 0.7) whether in the healthy volunteers or in patients with oral cancer. In terms of retest reliability of the WETT, the mean total score was 24.9 ± 7.3 for the first test and 25.8 ± 8.4 for the second test. The intraclass correlation coefficient was 0.85 (P < .001). When case-control matching was performed, the WMTT scores were not significantly different between 13 healthy volunteers and 13 patients with oral cancer (P = .266), but the WETT scores were significantly lower in patients with oral cancer (P = .017). CONCLUSION: This study showed that the results of the WETT were not highly correlated with those of the WMTT. However, its retest reliability was high, and its results were significantly different between the healthy volunteers and the patients with oral cancer. PMID: 33170031 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adenoid Cystic Carcinoma of the Larynx: A SEER Database Review.

xlomafota13 shared this article with you from Inoreader Adenoid Cystic Carcinoma of the Larynx: A SEER Database Review. Via ear nose throat Related Articles Adenoid Cystic Carcinoma of the Larynx: A SEER Database Review. Ear Nose Throat J. 2020 Nov 10;:145561320970691 Authors: Mur T, Jaleel Z, Agarwal P, Edwards HA Abstract BACKGROUND: Adenoid cystic carcinoma (AdCC) of the larynx is an uncommon malignancy of the head and neck with very little literature discussing treatment paradigms and prognostic factors influencing survival. METHODS: This retrospective cohort study uses data obtained from the Surveillance, Epidemiology and End Result database comprising of patients diagnosed with laryngeal AdCC from 1978 to 2016. RESULTS: A total of 89 records were analyzed. High histologic grade was a significant negative prognostic factor compared to low histologic grade disease for overall survival (OS; 5-year OS: 35.7% vs 90.5%, P < .005) and disease-specific survival (DSS; 5-year DSS: 38.7% vs 95.2%, P < .005). No differences in OS (5-year OS: 88.9% vs 76.4%, P = .287) or DSS (5-year DSS: 100% vs 79.1%, P = .159) were noted between patients with early versus late American Joint Committee on Cancer (AJCC) stage disease. No differences in DSS was noted in cohorts treated with just definitive surgery versus surgery and adjuvant radiation (5-year DSS: 92.9% vs 74.3%, P = .140) even when stratified for late stage disease (5-year DSS: 100% vs 78.6%, P = .290) or high-grade histology (5-year DSS: 100% vs 83.3%, P = .773). CONCLUSIONS: Histologic grade may be a more significant prognostic factor than AJCC stage for survival in laryngeal AdCC. Treatment with surgery and radiation may provide no additional survival advantage compared to just definitive surgery in these patients, although further study is warranted. PMID: 33170034 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

AHNS endocrine surgery section consensus statement on nasopharyngolaryngoscopy and clinic reopening during COVID‐19: How to get back to optimal safe care

xlomafota13 shared this article with you from Inoreader AHNS endocrine surgery section consensus statement on nasopharyngolaryngoscopy and clinic reopening during COVID‐19: How to get back to optimal safe care Via Head & Neck Abstract This article provides best practice guidelines regarding nasopharyngolaryngoscopy and OHNS clinic reopening during the COVID‐19 pandemic. The aim is to provide evidence‐based recommendations defining the risks of COVID‐19 in clinic, the importance of pre‐visit screening in addition to testing, along with ways to adhere to CDC guidelines for environmental, source, and engineering controls. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Electrophysiological and behavioral measures of some speech contrasts in varied attention and noise.

xlomafota13 shared this article with you from Inoreader Electrophysiological and behavioral measures of some speech contrasts in varied attention and noise. Via cortical auditory Related Articles Electrophysiological and behavioral measures of some speech contrasts in varied attention and noise. Hear Res. 2019 03 01;373:1-9 Authors: Morris DJ, Tøndering J, Lindgren M Abstract This paper investigates the salience of speech contrasts in noise, in relation to how listening attention affects scalp-recorded cortical responses. The contrasts that were examined with consonant-vowel syllables, were place of articulation, vowel length and voice-onset time (VOT) and our analysis focuses on the correspondence between the effect of attention on the electrophysiology and the decrement in behavioral results when noise was added to the stimuli. Normal-hearing subjects (n = 20) performed closed-set syllable identification in no noise, 0, 4 and 8 dB signal-noise ratio (SNR). Identification in noise decreased markedly for place of articulation, moderately for vowel length and marginally for VOT. The same syllables were used in two electrophysiology conditions, where subjects attended to the stimuli, and also while their attention was diverted to a visual discrimination task. Differences in global field power between the attention conditions from each contrast showed that that the effect of attention was negligible for place of articulation. They implied offset encoding of vowel length and were early (starting at 117 ms), and of high amplitude (>3 μV) for VOT. There were significant correlations between the difference in syllable identification in no noise and 0 dB SNR and the electrophysiology results between attention conditions for the VOT contrast. Comparison of the two attention conditions with microstate analysis showed a significant difference in the duration of microstate class D. These results show differential integration of attention and syllable processing according to speech contrast and they suggest that there is correspondence between the salience of a contrast in noise and the effect of attention on the evoked electrical response. PMID: 30553033 [PubMed - indexed for MEDLINE] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.