Callahanallen3497

In the last years, molecular genetic features have been integrated into the diagnosis of several types of the parasellar tumours enhancing diagnostic accuracy and providing information of the value for targeting therapies. In this review, we will present histopathological and molecular genetic features, updated classification criteria, recent advances in the diagnostics and rationale for novel pharmacological therapies of selected types of parasellar neoplasms. © 2020 S. Karger AG, Basel.BACKGROUND Malignant pleural effusion (MPE) poses a considerable healthcare burden, but little is known about trends in directly attributable hospital utilization. OBJECTIVE We aimed to study national trends in healthcare utilization and outcomes among hospitalized MPE patients. DFOM METHODS We analyzed adult hospitalizations attributable to MPE using the Healthcare Cost and Utilization Project - National Inpatient Sample (HCUP-NIS) databases from 2004, 2009, and 2014. Cases were included if MPE was coded as the principal admission diagnosis or if unspecified pleural effusion was coded as the principal admission diagnosis in the setting of metastatic cancer. Annual hospitalizations were estimated for the entire US hospital population using discharge weights. Length of stay (LOS), hospital charges, and hospital mortality were also estimated. RESULTS We analyzed 92,034 hospital discharges spanning a decade (2004-2014). Yearly hospitalizations steadily decreased from 38,865 to 23,965 during this time frame, the mean LOS decreased from 7.7 to 6.3 days, and the adjusted hospital mortality decreased from 7.9 to 4.5% (p = 0.00 for all trend analyses). The number of pleurodesis procedures also decreased over time (p = 0.00). The mean inflation-adjusted charge per hospitalization rose from USD 41,252 to USD 56,951, but fewer hospitalizations drove the total annual charges down from USD 1.51 billion to USD 1.37 billion (p = 0.00 for both analyses). CONCLUSIONS The burden of hospital-based resource utilization associated with MPE has decreased over time, with a reduction in attributable hospitalizations by one third in the span of 1 decade. Correspondingly, the number of inpatient pleurodesis procedures has decreased during this time frame. © 2020 S. Karger AG, Basel.Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5-2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment. © 2020 S. link2 Karger AG, Basel.INTRODUCTION A number of factors that can impact the outcomes of percutaneous nephrolithotomy (PCNL) procedures have previously been investigated. Complex stones that extend to the anterior calyx could affect the success and complication rates of PCNL. OBJECTIVE We analyzed the effect of anterior calyx involvement on the outcomes of patients with complex stones treated with PCNL. METHODS A total of 132 consecutive patients who underwent PCNL due to complex stones (multiple, partial staghorn, or staghorn stones) between 2015 and 2017 were enrolled in this study. They were stratified into two groups based on whether the stone extended to the anterior calyx (group 1, n = 45) or not (group 2, n = 87). The stratification was achieved through contrast-enhanced computerized tomography (CT). Demographics, laboratory tests, and peri- and postoperative findings (operation and fluoroscopy duration, hospital stay, utilization of flexible instruments, access numbers, total blood count change, stone-free rate [SFR], and complications) were compared between the groups. The SFR was evaluated by plain kidney-ureter-bladder radiography or CT. RESULTS The demographics, operation and fluoroscopy duration, access number, and hospital stay were similar between the groups (p 0.05). CONCLUSIONS Our study demonstrated that complicated stones with extension to the anterior calyx are more challenging than cases without extension to the anterior calyx. This was noted by a lower SFR, a more prominent drop in total blood count, and more frequent utilization of flexible scopes. © 2020 S. Karger AG, Basel.BACKGROUND The histopathological correct diagnosis of gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) is crucial for treatment selection and prognostication. It is also very challenging due to a limited experience in non-expert centers. Revision of pathology is standard of care for most patients who are referred to NEN expert centers. OBJECTIVES To describe the clinical impact of histopathological revision for GEP-NEN patients referred to an expert center. METHODS Retrospective multicenter analysis of all GEP-NENs receiving a histopathological revision in 6 European NEN expert centers (Jan 2016‒Dec 2016) to evaluate the impact on patient management Results 175 patients were included and 14.7% referred for a second opinion. Histological samples were 69.1% biopsies, 23.4% surgical specimens and 7.5% endoscopic resections. Histopathological changes due to revision included first assessment of Ki67 in 8.6% of cases, change in grading in 11.4% (3.4% G1 to G2; 5.7% G2 to G1; 0.6% G2 to G3; 1.7% G3 to G2), definition of tumor invasion in 10.8%, additional immunohistochemical staining in 2.3%, diagnosis of mixed adeno-neuroendocrine carcinoma (MANEC) in 3.4%, exclusion of a NEN in 3.4%, first diagnosis of NEN in 2.3%, tumor differentiation for G3 in 1.7%. The revision had a clinical impact in 36.0% of patients, leading to a new therapeutic indication in 26.3%. Indication to then perform a new imaging test occurred in 21.1%, and recommendation to follow-up with no further treatments in 6.3%. CONCLUSIONS Histopathological revision in expert centers for NENs can change the diagnosis, with a significant clinical impact in about one third of patients. © 2020 S. link3 Karger AG, Basel.The esophageal diverticulum is a protruding pouch in a weak portion of the esophageal lining. Previously, our team has reported an endoscopic tunneling technique (STESD) for diverticulum treatment. However, it does not perform well for the diverticulum located in the upper esophagus, where most diverticulum locates. Herein we reported a new endoscopic technique, called endoscopic Transversal Incision and Longitudinal Septostomy (TILS). TILS provides both larger operational spaces and complete septostomy and can be done on most types of the diverticulum, including the Zenker's Diverticulum. © 2020 S. Karger AG, Basel.BACKGROUND Nonlife-threatening headaches account for 3% of emergency department (ED) admissions, with social and economic negative consequences. We aim to investigate clinical features and risk factors of nonlife-threatening headache patients referring to ED versus those referring to headache outpatient clinics. METHODS During 6 months, we promptly reevaluated in our headache unit (HU) patients discharged from ED. We compared the clinical characteristics of patients who referred to ED with those of HU outpatients visited in the same time interval. Discriminant Function Analysis and Correspondence Analysis were used to determine risk factors for ED referral. RESULTS We recruited 49 post-ED patients and 126 outpatients. The main reasons for ED admission were poor response to acute treatment and aura-related symptoms. Headache diagnoses made in ED were generally not confirmed later (overall concordance of 47%), except for cluster headache (CH) and migraine with aura (MA). ED patients complained higher headache intensity, longer duration, and prolonged aura compared to outpatients. Aura was the main risk factor associated with ED admission on statistical models, while less prominent risk factors were sex, age, and years from migraine onset. CONCLUSIONS ED patients presented a more severe headache clinical phenotype compared with outpatients. Headache diagnosis remains difficult in the emergency setting and is more easily achieved for the headache forms with standout features, such as MA or CH. According to statistical models, the aura is the most important risk factor for ED admissions. © 2020 S. Karger AG, Basel.Cathemeral primates perform significant amounts of activity during the daylight and dark portions of the 24-h cycle. Most brown lemurs have been reported to be cathemeral. A previous study reported that brown lemurs in Ankarafantsika National Park (ANP) shift their activity pattern from being cathemeral in the dry season to being diurnal in the wet season. From July 2015 to March 2016, we collected data on active behaviour of brown lemurs over 46 full-day and 33 full-night observations, distributed evenly between the dry and wet seasons. This study examined the abiotic factors that potentially allow this seasonal shift from cathemeral to diurnal activity. We analysed the effects of day length (time from sunrise to sunset), nocturnal luminosity, and climatic factors on the diurnal and nocturnal activities of the brown lemurs in ANP using generalized linear mixed models. We found that the brown lemurs were cathemeral regardless of season. Their diurnal activity increased with increasing day length and at high hof brown lemurs according to the great seasonal variation in tropical dry forests. © 2020 S. Karger AG, Basel.BACKGROUND Postoperative insulin resistance (PIR) is a common response after colorectal surgery and an independent risk factor for recovery. Preoperative oral carbohydrate (POC) has been known to reduce PIR. Herein, we investigated whether its mechanism of action involves AMP-activated protein kinase (AMPK) and mTOR/S6K1/insulin receptor substrate-1 (IRS-1) pathways. METHODS Patients undergoing colorectal cancer resection were randomly assigned to a POC, fasting, or placebo group. The exclusion criteria were association with diseases or intake of medication affecting insulin sensitivity. Pre- and postoperative insulin resistance, and protein phosphorylation of AMPK, mTOR, and IRS-1 in the rectus abdominis muscle were evaluated. RESULTS From January 2017 to December 2017, 70 patients were randomized and 63 were evaluated. No difference was found in the clinical and operative characteristics among the 3 groups. In the POC group, the levels of blood glucose, blood insulin, and homeostasis model assessment of insulin resistance were significantly lower in the POC group than the fasting and placebo groups, and the insulin sensitivity index was significantly higher. The phosphorylation of AMPK in the POC group was significantly higher than that in the other 2 groups, whereas the phosphorylation of mTOR and IRS-1 was significantly lower. CONCLUSION PIR involves AMPK and mTOR/S6K1/IRS-1 pathways. POC reduces PIR by the stimulation of AMPK, which suppresses the phosphorylation of mTOR/IRS-1 and attenuates PIR after colorectal resection. © 2020 S. Karger AG, Basel.