scholarly journals Present and future management of anti-neutrophil cytoplasmic antibody associated vasculitis: how therapy changed the prognosis

2013 ◽  
pp. 14-25
Author(s):  
Massimo L’Andolina ◽  
Giovanni Forte ◽  
Norma M. Marigliano ◽  
Salvatore Galasso ◽  
Francesca Mazzei ◽  
...  
Keyword(s):  
Immune System ◽  
New Drugs ◽  
Diagnostic Tools ◽  
Second Phase ◽  
Treatment Protocols ◽  
Therapeutic Guidelines ◽  
Chest X Ray ◽  
Diagnostic Approaches ◽  
Therapeutic Protocols

Anti-neutrophil cytoplasmic antibody associated vasculitis is part of a multi-systemic idiopathic, small vessel pouci-immune vasculitis. Given the heterogeneous spectrum of the disease, and the need to update therapeutic protocols, the aim of this review was to evaluate clinical-diagnostic approaches. We examined statistical data available in the literature, in particular the 2010 review of St. Hamour et al. Management of Anca-associated Vasculitis, published in Therapeutics and Clinical Risk Management. Acute immunosuppressive therapy and long-term maintenance, with the use of prednisolone, have significantly changed the prognosis of this disease, particularly compared with the 1970s before the introductions of steroids and cyclophosphamide. New drugs such as rituximab, monoclonal antibodies and other modulating immune system molecules are entering clinical use, and experience will confirm whether or not therapeutic guidelines are appropriate. The current diagnostic tools, ranging from laboratory and autoimmune tests, chest X-ray, broncho-alveolar lavage to capillaroscopy, allow prompt diagnosis and early treatment through a first phase of induction-remission, and a second phase of maintenance. There are, however, recurrent and refractory forms of the disease that require long-term immunosuppression and further research into this is merited. These issues have continued to drive the search for safer and more effective modulation of the immune system using targeted immunotherapy. However, the treatment limitations of incomplete efficacy, infection, and cumulative toxicity persist. Modifications to traditional treatment protocols by the use of azathioprine or methotrexate rather than cyclophosphamide, and the introduction of newer agents, such as rituximab, have meant that outcomes have been maintained while toxicity has been reduced.

scholarly journals Diagnostic Role of Chromosomal Instability in Melanoma

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Nitika Dabas ◽  
Diana M. Byrnes ◽  
Ashley M. Rosa ◽  
Mark S. Eller ◽  
James M. Grichnik
Keyword(s):  
Chromosomal Instability ◽  
Diagnostic Tools ◽  
Molecular Tools ◽  
Term Survival ◽  
Diagnostic Role ◽  
Diagnostic Approaches ◽  
Malignant Lesions ◽  
Melanoma Patients

Early diagnosis gives melanoma patients the best chance for long term survival. However discrimination of an early melanoma from an unusual/atypical benign nevus can represent a significant challenge. There are no current pathological markers to definitively define malignant potential in these indeterminate lesions. Thus, there is a need for improved diagnostic tools. Chromosomal instability (CIN) is a hallmark of cancer and is markedly prevalent in melanoma. Advances in genomics have opened the door for the development of molecular tools to better segregate benign and malignant lesions. This paper focuses on CIN in melanoma and the role of current diagnostic approaches.

Microstructural characterization of a rapidly solidified Al-Fe-V-Si alloy for elevated temperature applications

1988 ◽  
Vol 46 ◽  
pp. 550-551
Author(s):  
R. E. Franck ◽  
J. A. Hawk ◽  
G. J. Shiflet
Keyword(s):  
High Temperature ◽  
Elevated Temperature ◽  
Grain Growth ◽  
Volume Fraction ◽  
Microstructural Characterization ◽  
Second Phase ◽  
Microstructural Stability ◽  
Elevated Temperature Strength ◽  
Temperature Applications

Rapid solidification processing (RSP) is one method of producing high strength aluminum alloys for elevated temperature applications. Allied-Signal, Inc. has produced an Al-12.4 Fe-1.2 V-2.3 Si (composition in wt pct) alloy which possesses good microstructural stability up to 425°C. This alloy contains a high volume fraction (37 v/o) of fine nearly spherical, α-Al12(Fe, V)3Si dispersoids. The improved elevated temperature strength and stability of this alloy is due to the slower dispersoid coarsening rate of the silicide particles. Additionally, the high v/o of second phase particles should inhibit recrystallization and grain growth, and thus reduce any loss in strength due to long term, high temperature annealing.The focus of this research is to investigate microstructural changes induced by long term, high temperature static annealing heat-treatments. Annealing treatments for up to 1000 hours were carried out on this alloy at 500°C, 550°C and 600°C. Particle coarsening and/or recrystallization and grain growth would be accelerated in these temperature regimes.

The desperate plea of women with the nutcracker syndrome

Phlebologie ◽  
2010 ◽  
Vol 39 (02) ◽  
pp. 104-111
Author(s):  
J. L. Villavicencio
Keyword(s):  
Renal Vein ◽  
Imaging Techniques ◽  
Left Renal Vein ◽  
Diagnostic Tools ◽  
Nutcracker Syndrome ◽  
Treatment Techniques ◽  
Children And Young Adults ◽  
Good Number ◽  
Pelvic Congestion

Summary Objective: To increase awareness on the severe impact of the nutcracker syndrome in women with undiagnosed disease. Patients and methods: We reviewed the medical literature and analyzed six representative series with 73 patients with nutcracker syndrome. Women with left flank pain, dyspareunia, dysuria, dysmenorrhea, micro- or macrohaematuria and pelvic congestion symptoms, should be carefully investigated for evidence of meso aortic left renal vein compression. A good number of our colleagues do not believe in the existence of the nutcracker syndrome and send these patients in a long pilgrimage in search of someone who can help them to get relief to their pain. New and improved imaging techniques can assist in the diagnosis but retrograde reno-gonadal phlebography and renocaval gradient are the most reliable diagnostic tools. Results: Among an assortment of treatment techniques, renal vein transposition and endovenous stenting were the two most commonly used procedures. There are no long term studies on renal vein stenting in children and young adults. Its use in these cases should be carefully considered. The nutcracker syndrome may present with pelvic congestion symptoms and its diagnosis missed. The patient's age, severity of symptoms and haemo dynamic renal studies should guide the treatment. Conclusion: An increased awareness of the existence of the nutcracker syndrome may prevent many unfortunate undiagnosed women from spending many months and often years of suffering.

Antiplatelet Therapy in Acute Coronary Syndromes

2010 ◽  
Vol 6 (1) ◽  
pp. 58
Author(s):  
Sasha Koul ◽  
David Erlinge ◽  
◽  
Keyword(s):  
Platelet Function ◽  
Acute Coronary Syndromes ◽  
New Drugs ◽  
Antiplatelet Drugs ◽  
Bleeding Complications ◽  
Great Promise ◽  
Mortality Data ◽  
Poor Responders ◽  
Coronary Syndromes

Drugs inhibiting platelet function play a major role in the treatment of acute coronary syndromes (ACS). The first drug used, which is still considered the cornerstone of therapy today, is aspirin. Although very impressive in acutely decreasing rates of myocardial infarction as well as death, long-term data are scarce, despite our current recommendation for lifelong aspirin. The thienopyridines, most notably clopidogrel, are the next line of antiplatelet drugs. Well-documented data support the usage of clopidogrel for non-STEMI-ACS (NSTE-ACS). Although positive mortality data exist regarding clopidogrel and STEMI patients in a medically treated population, including thrombolysis, no larger amounts of randomised data exist in a primary PCI setting. Poor responders to aspirin and/or clopidogrel are a clinical problem, with these individuals constituting a higherrisk group for recurrent ischaemic events. Whereas very little can be done regarding aspirin resistance, clopidogrel resistance might be diminished by increasing the dosage or changing to more potent and newer-generation antiplatelet drugs. The role of glycoprotein IIb/IIIa inhibitors has diminished drastically and instead paved the way for thrombin antagonists (bivalirudin), which have fewer bleeding complications with resulting better long-term mortality. Novel adenosine diphosphate (ADP)-receptor blockers such as prasugrel and ticagrelor have shown increased efficacy over clopidogrel and hold great promise for the future. However, not all patients may benefit from these new drugs and economic constraints may also limit their use. Platelet function tests could possibly help in identifying risk groups in need of stronger platelet inhibition.

Inflammatory disease of the womans reproductive system: modern trends in diagnosis and therapy (literature review)

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 35-41
Author(s):  
T Yu Pestrikova ◽  
I V Yurasov ◽  
E A Yurasova
Keyword(s):  
Genital Tract ◽  
Inflammatory Diseases ◽  
Diagnosis And Treatment ◽  
Long Term Results ◽  
Modern Approach ◽  
Pelvic Organs ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Diagnostic Approaches

Medical, social and economic relevance of inflammatory diseases of the woman's reproductive organs requires a very careful attitude to the diagnosis and treatment of this pathology. The number of patients with genital infections and inflammatory diseases of the pelvic organs can takes the first place in structure of gynecological morbidity, and is 60.4-65.0%, and this fact is not unique to Russia, but all over the world. Incidence rate of inflammatory diseases of the pelvic organs in the first decade of the twenty-first century is increased at 1.4 times in patients who are from 18 to 24 years old and at 1.8 times in patients aged 25-29 years. At the same time, the cost of diagnosis and treatment has increased, reaching 50-60% of the total cost of providing gynecological care for population. The inflammatory diseases of pelvic organs are a collective concept. It includes of various nosological forms. There are numerous contradictions in the views on diagnostic approaches and treatment tactics, the nature of screening and control over the long-term results of treatment, the etiological and pathogenetic significance of various microorganisms found in the genital tract in patients with inflammatory diseases of the pelvic organs. Currently, there are many opinions among specialists about diagnostic approaches and treatment tactics, the type of screening and monitoring the long-term results of treatment, the etiological and pathogenetic role of various microorganisms which can be found in the genital tract in patients with inflammatory diseases. This review presents the results of a modern approach to the diagnosis, management and rehabilitation of patients with inflammatory diseases of the pelvic organs.

Long-Term Sustained Disease Control With Immunotherapy in Chemotherapy-Refractory Merkel Cell Carcinoma

2019 ◽  
pp. 8-11
Author(s):  
Deborah Yihler ◽  
Kathrin Vollmer ◽  
Antonio Cozzio
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Inadequate Response ◽  
Merkel Cell ◽  
First Line ◽  
Treatment Protocols ◽  
First Line Therapy ◽  
Significant Toxicity ◽  
Clinical Responses

ABSTRACT Merkel cell carcinoma (MCC) is a rare and difficult-to-treat cutaneous malignancy with a poor prognosis. Treatment protocols for localized MCC are well established. Until recently, metastatic MCC has generally been treated with chemotherapy, which was often associated with poor clinical responses and significant toxicity. In this report, the case of a patient with metastatic MCC who received avelumab, an immune checkpoint inhibitor, after an inadequate response to first-line radiotherapy and chemotherapy, is presented. Nine months after the initiation of the treatment with avelumab, the patient achieved a partial remission with no treatment-related adverse events. After a follow-up of 17 months, a systematically ongoing partial response was reported. In conclusion, this case study offers a clinical insight into the patient’s case and highlights the importance of immunotherapy as a first-line therapy for metastatic MCC.

Recognition of Fungal Components by the Host Immune System

2020 ◽  
Vol 21 (3) ◽  
pp. 245-264 ◽  
Author(s):  
Laura C. García-Carnero ◽  
José A. Martínez-Álvarez ◽  
Luis M. Salazar-García ◽  
Nancy E. Lozoya-Pérez ◽  
Sandra E. González-Hernández ◽  
...  
Keyword(s):  
Immune System ◽  
Histoplasma Capsulatum ◽  
Paracoccidioides Brasiliensis ◽  
Sporothrix Schenckii ◽  
Clinical Importance ◽  
Pathogenic Fungi ◽  
Diagnostic Tools ◽  
Future Research ◽  
Host Immune System ◽  
Fungal Antigens

: By being the first point of contact of the fungus with the host, the cell wall plays an important role in the pathogenesis, having many molecules that participate as antigens that are recognized by immune cells, and also that help the fungus to establish infection. The main molecules reported to trigger an immune response are chitin, glucans, oligosaccharides, proteins, melanin, phospholipids, and others, being present in the principal pathogenic fungi with clinical importance worldwide, such as Histoplasma capsulatum, Paracoccidioides brasiliensis, Aspergillus fumigatus, Candida albicans, Cryptococcus neoformans, Blastomyces dermatitidis, and Sporothrix schenckii. Knowledge and understanding of how the immune system recognizes and responds to fungal antigens are relevant for the future research and development of new diagnostic tools and treatments for the control of mycosis caused by these fungi.

Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus

2021 ◽  
Vol 30 (7) ◽  
pp. 416-421
Author(s):  
Phillip Correia Copley ◽  
John Emelifeonwu ◽  
Pasquale Gallo ◽  
Drahoslav Sokol ◽  
Jothy Kandasamy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Care ◽  
Pilocytic Astrocytoma ◽  
Parental Education ◽  
Chronic Hydrocephalus ◽  
Treatment Protocols ◽  
New Approach ◽  
Viable Treatment

This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.

scholarly journals XCOVNet: Chest X-ray Image Classification for COVID-19 Early Detection Using Convolutional Neural Networks

2021 ◽  
Author(s):  
Vishu Madaan ◽  
Aditya Roy ◽  
Charu Gupta ◽  
Prateek Agrawal ◽  
Anand Sharma ◽  
...  
Keyword(s):  
Image Classification ◽  
Second Phase ◽  
Two Phase ◽  
X Ray ◽  
The Neural Network ◽  
Rapid Spread ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
Two Phases ◽  
Active Patients

AbstractCOVID-19 (also known as SARS-COV-2) pandemic has spread in the entire world. It is a contagious disease that easily spreads from one person in direct contact to another, classified by experts in five categories: asymptomatic, mild, moderate, severe, and critical. Already more than 66 million people got infected worldwide with more than 22 million active patients as of 5 December 2020 and the rate is accelerating. More than 1.5 million patients (approximately 2.5% of total reported cases) across the world lost their life. In many places, the COVID-19 detection takes place through reverse transcription polymerase chain reaction (RT-PCR) tests which may take longer than 48 h. This is one major reason of its severity and rapid spread. We propose in this paper a two-phase X-ray image classification called XCOVNet for early COVID-19 detection using convolutional neural Networks model. XCOVNet detects COVID-19 infections in chest X-ray patient images in two phases. The first phase pre-processes a dataset of 392 chest X-ray images of which half are COVID-19 positive and half are negative. The second phase trains and tunes the neural network model to achieve a 98.44% accuracy in patient classification.

scholarly journals Incidental whole-body MRI evidence of COVID-19 in an asymptomatic patient in a high prevalence region

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Valentina Angelini ◽  
Alberta Villanacci ◽  
Angelo Belotti ◽  
Francesca Castagnoli ◽  
Barbara Frittoli ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Whole Body ◽  
Diagnostic Tools ◽  
Historical Period ◽  
Case Presentation ◽  
Whole Body Mri ◽  
High Prevalence ◽  
Chest X Ray ◽  
Full Knowledge ◽  
Polymerase Chain

Abstract Background The purpose of this case report is to emphasize the importance of curing any clinical radiological elements in this historical period, especially in the area of endemic to coronavirus disease 19 (COVID-19) such as Lombardy and to stress the importance of the management of the asymptomatic patient, their crucial role in the spread of contagion. Case presentation We reported the case of incidental diagnosis of interstitial pneumonia by first finding on whole-body MR (WB-MR) in the patient affected by multiple myeloma (MM), with a negative respiratory symptoms at the time and with previous (1 month before) negative chest X-ray. The patient was promptly subjected to chest CT, which confirmed the suspicion of interstitial COVID-19 pneumonia and, in hospitalization, performed nasopharyngeal swabs for real-time polymerase chain reaction (RNA-PCR), with a doubtful outcome. Once the bacterial nature of the alterations was serologically and radiologically excluded, the patient was definitively diagnosed with COVID-19 and appropriately treated in hospitalization. Conclusion The clinical choices must, therefore, to make use of all the diagnostic tools available and full knowledge of the limitation of each of them.

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