- Morning plasma cortisol as a cardiovascular risk factor: findings from prospective cohort and Mendelian randomization studies. [Journal Article]
- EJEur J Endocrinol 2019 Jul 01
- CONCLUSIONS: All three approaches demonstrated a positive association between morning plasma cortisol and incident CVD. Together these findings suggest that elevated morning cortisol is a causal risk factor for CVD. The current data suggest strategies targeted at lowering cortisol action should be evaluated for their effects on CVD.
- Significance of plasma fibrinogen level and antithrombin activity in sepsis: A multicenter cohort study using a cubic spline model. [Journal Article]
- TRThromb Res 2019 Jul 02; 181:17-23
- CONCLUSIONS: The fibrinogen level and antithrombin activity should be reconsidered as unique biomarkers for sepsis and sepsis-induced DIC.
- Identification of a functional polymorphism within the 3'-untranslated region of denticleless E3 ubiquitin protein ligase homolog associated with survival in acral melanoma. [Journal Article]
- EJEur J Cancer 2019 Jul 17; 118:70-81
- CONCLUSIONS: The rs11275300:G allele in the 3'UTR of DTL may lead to a poor prognosis and allele-specific increase in the expression of DTL by post-transcriptional regulation in AM.
- Conversion From Venovenous to Venoarterial Extracorporeal Membrane Oxygenation Is Associated With Increased Mortality in Children. [Journal Article]
- JSJ Surg Res 2019 Jul 17; 244:389-394
- CONCLUSIONS: VV-to-VA conversion does occur and is associated with increased mortality. The need for conversion from VV to VA ECMO may represent an early failure to recognize physiologic parameters or disease severity that would be better managed with initial VA support. Further research is needed to pinpoint the cause of increased mortality and to identify predictors of VV failure to optimize initial mode selection.
- Integrative Chinese herbal medicine therapy reduced the risk of type 2 diabetes mellitus in patients with polycystic ovary syndrome: A nationwide matched cohort study. [Journal Article]
- JEJ Ethnopharmacol 2019 Jul 17; :112091
- CONCLUSIONS: Thus, CHM may help prevent T2DM-related complications in patients with PCOS. Further clinical and pharmacological analysis based on these findings is expected in the future.
- Calprotectin alone is not sufficient to predict response to methotrexate in early ACR/EULAR 2010 rheumatoid arthritis: analysis of the ESPOIR cohort. [Letter]
- JBJoint Bone Spine 2019 Jul 17
- Pediatric and Young Adult Vulvovaginal Graft-versus-Host Disease. [Journal Article]
- BBBiol Blood Marrow Transplant 2019 Jul 17
- Vulvovaginal graft-versus-host disease (GVHD) is an under-diagnosed and poorly recognized complication of hematopoietic stem cell transplant (HSCT). Previous studies have reported findings restricted…
Vulvovaginal graft-versus-host disease (GVHD) is an under-diagnosed and poorly recognized complication of hematopoietic stem cell transplant (HSCT). Previous studies have reported findings restricted to predominantly adult populations. This is a case series of pediatric and young adult vulvovaginal GVHD, which was identified in 19 patients (median age 11.8 years; range: 2.4-21.9 years) out of a total 302 female patients transplanted over eight years at a pediatric hematopoietic stem cell transplant center. The majority of patients had concomitant non-genital GVHD; only one patient had isolated vulvovaginal GVHD. The median time from BMT to diagnosis of vulvovaginal GVHD was 30 months (range: 2.3 - 97.5 months). A high frequency of patients in our series were without vulvar or vaginal symptoms (n=8, 42%), despite 17 patients (89%) presenting with Grade 3 disease based on current adult grading scales. Vulvar exam findings most frequently included interlabial and clitoral hood adhesions (89%), loss of architecture of the labia minora or clitoral hood (42%), and skin erosions or fissures (37%). Only five patients underwent a speculum exam, and none of these had vaginal GVHD. Exam findings of primary ovarian insufficiency (POI) can overlap with those of GVHD, and six patients (32%) in this cohort were diagnosed with POI; only one patient was on systemic hormone replacement therapy (HRT) at the time of vulvovaginal GVHD diagnosis. The majority of patients (n=16) were treated with topical steroid therapies, with a median time to response of 43 days. Five patients (26%) had a complete response and 10 patients (53%) had a partial response to therapy. This cohort provides valuable insight into pediatric and young adult vulvovaginal GVHD, and highlights the potential need for increased screening for vulvar disease in this population.
- Outcomes and predictors of response in steroid-refractory acute graft-versus-host disease: single-center results from a cohort of 203 patients. [Journal Article]
- BBBiol Blood Marrow Transplant 2019 Jul 17
- The prognosis of steroid-refractory acute graft-versus-host disease (aGVHD) is poor and predictors of response and survival are unclear. In an exploratory analysis of 203 steroid-refractory aGVHD pat…
The prognosis of steroid-refractory acute graft-versus-host disease (aGVHD) is poor and predictors of response and survival are unclear. In an exploratory analysis of 203 steroid-refractory aGVHD patients with prospectively collected GVHD data who received antithymocyte globulin, etanercept, or mycophenolate mofetil (MMF) as second-line treatment, we determined the predictors of day 28 response, 2-year overall survival (OS), and 2-year non-relapse mortality (NRM). To minimize the risk of finding false positive results, we used lasso regression, aggressively eliminating variables that are unlikely to be associated with outcome. Day 28 response to second-line therapy was 38% (complete response [CR] 23%), with a 2-year OS of 25% and a 2-year NRM of 62%. Factors associated with response were GVHD prophylaxis, organ involvement, and initial aGVHD to steroid-refractory aGVHD interval. Specifically, compared with cyclosporine (CsA)/MMF as GVHD prophylaxis, the odds ratio (OR) for calcineurin inhibitor/methotrexate was 0.8 and for CsA/prednisone was 0.6. The OR for aGVHD to steroid-refractory aGVHD interval ≥14 vs. <14 days was 1.3. The ORs for skin only involvement and gut or liver only involvement when compared with multi-organ involvement were 1.4 and 1.2, respectively. The only variable associated with worse survival was age, with a hazard ratio (HR) per decade of 1.04 for overall mortality. Similarly, age was the only variable associated with NRM (HR 1.02 per decade). When compared with CR, no response at day 28 increased the risk of death (HR: 2.4, 95% confidence interval: 1.5-3.7). In conclusion, using an underutilized statistical technique in the field of transplantation, we identified predictors of response and survival in steroid-refractory aGVHD. Our results highlight the importance of developing novel treatment strategies as current treatments yield poor outcomes.
- Combined Endosonographic Mediastinal Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non-Small Cell Lung Cancer in high-risk patients. [Journal Article]
- STSemin Thorac Cardiovasc Surg 2019 Jul 17
- Positron emission tomography (PET) with computed tomography (CT) is routinely utilized to investigate lymph node (LN) metastases in non-small cell lung cancer. However, it is less sensitive in normal…
Positron emission tomography (PET) with computed tomography (CT) is routinely utilized to investigate lymph node (LN) metastases in non-small cell lung cancer. However, it is less sensitive in normal-sized LNs. This study was performed in order to define the prevalence of mediastinal LN metastases discovered on combined endosonography by endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) fine needle aspiration in patients with a radiologically normal mediastinum. This study consists of a retrospective, single-institution, tertiary care referral center review of a prospectively maintained database. Patients were identified from a cohort between January 2009 and December 2014. One hundred and sixty-one patients with biopsy proven, non-small cell lung cancer were identified in whom both the pre-endosonography CT and PET- CT were negative for mediastinal LN metastases. Combined endosonography (EBUS + EUS - FNA) was performed in all patients. Z test was used for statistical analysis. A p-value of <0.05 was considered statistically significant. A total of 161 consecutive patients were included. Patients were staged if they had central tumor, tumor size > 3cm, N1 lymph node involvement on PET- CT/CT, or if there was low SUV (< 2.5) in the primary tumor. A total of 416 lymph nodes were biopsied in the 161 patients using combined endosonography; 147 with EBUS and 269 with EUS. Mean and median number of lymph nodes biopsied per patient using combined EBUS/EUS was 2.5 and 3, respectively (mean and median EBUS: 0.91 and 2.5; mean and median EUS 1.6 and 3). Endosonographic staging upstaged 13% of patients with radiologically normal lymph nodes in the mediastinum, hilum, lobar and sub lobar regions (Confidence Interval 8.22-19.20). Twenty one out of 161 patients (13%) with radiologically normal mediastinum were positive on combined EBUS/EUS staging. Out of 21 patients upstaged on endosonography, 15 (71%) had tumor size > 3 cm. Six (28%) had occult N1 disease. Thirteen (61%) had occult N2 disease and 2 (9%) had adrenal involvement. None of the upstaged patients had N1 LN involvement on PET-CT or CT scan. Combined endosonographic lymph node staging should be considered in the pre-treatment staging of high risk patients with non-small cell lung cancer in the presence of radiologically normal mediastinal lymph nodes due to the significant rate of radiologically occult lymph node metastases.
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- Collagen type-V is a danger signal associated with primary graft dysfunction in lung transplantation. [Journal Article]
- TITranspl Immunol 2019 Jul 17; :101224
- CONCLUSIONS: This study demonstrated that col.(V) is an rapidly recognized by B cells and has specific transcriptional signature. In lung transplants recipients the rapid seroconversion to anti-col(V) Ab is linked to increased risk of grade 3 PGD.