Drewogle2706

The diagnosis of check-point inhibitor-related pneumonitis (CIP) relies on radiological and clinical patterns which are not specific and can mimic other conditions (cancer progression, infectious diseases or interstitial pneumonitis). Cell pattern analysis of bronchoalveolar lavage (BAL) is well-known to support the diagnosis of interstitial lung disease; nevertheless, this analysis is somewhat performed and not required by immune-toxicity management guidelines for CIP.

We performed BAL analysis in 5 metastatic melanoma (MM) patients who developed CIP among 112 patients treated with checkpoint inhibitors. We also correlated the BAL features with the computed tomography (CT) scan patterns and with various peripheral blood parameters to better define the profile of this patient population.

BAL flow cytometer and cytopathology analyses showed typical and homogeneous features with increased lymphoid population, prevalent CD8 + T cells and inversion of the CD4/CD8 ratio. Moreover, the extent of activated CD3 + HLA-DR + T cells was related to the grading of adverse events. Blood leucocytosis, hypoxemia, normal values for procalcitonin and lactate dehydrogenase were also found together with a cryptogenic organizing pneumonia-like radiologic pattern. In all our patients, CIP was associated with partial or complete response.

Identification of a specific BAL cellular pattern allows clinicians to place this investigation in the appropriate position of CIP diagnosis and management to avoid misdiagnosis or considering this condition as progressive disease and delaying proper treatment.

Identification of a specific BAL cellular pattern allows clinicians to place this investigation in the appropriate position of CIP diagnosis and management to avoid misdiagnosis or considering this condition as progressive disease and delaying proper treatment.

The osteoclast bone resorption is critical in aseptic loosening after joint replacement. The balance between activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) is considered to play a central role in osteoclast maturation. Fibroblasts from the periprosthetic membrane express RANKL and promote osteoclast formation. Studies have demonstrated that naringin inhibited osteoclastogenesis and wear particle-induced osteolysis. In this study, the naringin-induced OPG/RANKL effects and its underlying mechanism were studied in fibroblasts from periprosthetic membrane.

Fibroblasts were isolated from the periprosthetic membrane during hip arthroplasty for revision due to aseptic loosening. Fibroblasts were cultured and treated with or without naringin and DKK-1 (the classical inhibitor of Wnt/β-catenin signaling pathway). OPG and RANKL mRNA and protein levels, gene expression of β-catenin, and cyclin D1, which participate in the Wnt signaling pathway, were examined by real-time polymerase chain reaction and enzyme-linked immunosorbent assay.

The mRNA and protein levels of OPG were enhanced by naringin in a dose-dependent manner compared to that of the non-treated control. In contrast, naringin did not affect the expression of RANKL. Importantly, DKK-1 attenuated OPG expression in fibroblasts under naringin treatment. Moreover, naringin stimulated the gene expression of β-catenin and cyclin D1 in fibroblasts, and the effect could be inhibited by DKK-1.

The results indicated that naringin enhanced OPG expression through Wnt/β-catenin signaling pathway in fibroblasts from periprosthetic membrane, which may be useful to inhibit periprosthetic osteolysis during aseptic loosening after total joint arthroplasty.

The results indicated that naringin enhanced OPG expression through Wnt/β-catenin signaling pathway in fibroblasts from periprosthetic membrane, which may be useful to inhibit periprosthetic osteolysis during aseptic loosening after total joint arthroplasty.

The recently described 'critical trochanter angle' (CTA) is a novel parameter in the preoperative risk assessment of stem malalignment in total hip arthroplasty. As its reproducibility needs to be evaluated, the given study aims to investigate intra- and interobserver reliability. It is hypothesized that both analyses justify the clinical use of the CTA.

A total of 100 pelvic radiographs obtained prior to total hip arthroplasty were retrospectively reviewed by four observers with different levels of clinical experience. The CTA was measured twice by each observer at different occasions in the previously described technique. Intra- and interobserver reliability was evaluated using intraclass correlation coefficients (ICC) with confidence intervals (CI) and the Bland-Altman approach.

The mean CTA in both measuring sequences was 20.58° and 20.78°. The observers' means ranged from 17.76° to 25.23°. Intraobserver reliability showed a mean difference of less than 0.5° for all four observers (95% limit of agreement -7.70-6.70). Intraobserver ICCs ranged from 0.92 to 0.99 (CI 0.88-0.99). For interobserver variation analysis, ICCs of 0.83 (CI 0.67-0.90) and 0.85 (CI 0.68-0.92) were calculated.

Analyses concerning intra- and interobserver reliability in the assessment of the CTA showed 'very good' and 'good' results, respectively. In view of these findings, the use of the CTA as an additional preoperative parameter to assess the risk of intraoperative stem malalignment seems to be justified.

Analyses concerning intra- and interobserver reliability in the assessment of the CTA showed 'very good' and 'good' results, respectively. In view of these findings, the use of the CTA as an additional preoperative parameter to assess the risk of intraoperative stem malalignment seems to be justified.

As a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals.

We obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007-2017. selleck chemicals We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP.

On average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47 and 10.42%, the revenue from medicine sales reduced by 24.04 and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22 and 89.3% in county general and TCM hospitals, respectively.