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Nuclear medicine provides methods and techniques in that has benefited pediatric patients and their referring physicians for over 40 years. Nuclear medicine provides qualitative and quantitative information about overall and regional function of organs, systems, and lesions in the body. This involves applications in many organ systems including the skeleton, the brain, the kidneys and the heart as well as in the diagnosis and treatment of cancer. The practice of nuclear medicine requires the administration of radiopharmaceuticals which expose the patient to very low levels of ionizing radiation. Advanced approaches in the estimation of radiation dose from the internal distribution of radiopharmaceuticals in patients of various sizes and shapes have been developed in the past 20 years. Although there is considerable uncertainty in the estimation of the risk of adverse health effects from radiation at the very low exposure levels typically associated with nuclear medicine, some considers it prudent to be more cautious when applied to children as they are generally considered to be at higher risk than adults. Standard guidelines for administered activities for nuclear medicine procedures in children have been established including the North American consensus guidelines and the Paediatric Dosage Card developed by the European Association of Nuclear Medicine. MKI-1 price As we move into the future, these guidelines would likely be reviewed in response to changes in clinical practice, a better understanding of radiation dosimetry as applied to children as well as new clinical applications, new advancements in the field with respect to both instrumentation and image reconstruction and processing.
Ultrasound-guided injections of botulinum neurotoxin in cervical dystonia have a number of theoretical advantages. However, their action has never been compared to that of non-guided injections. The objectives of the study were to compare the outcome of botulinum neurotoxin type A treatment in patients with idiopathic, focal cervical dystonia, according to two methods inspection and palpation of anatomical landmarks (non-guided group) or ultrasound guidance (ultrasound-guided group).
We included consecutive patients in this single-center, prospective, real-life, non-randomized study. The outcomes were evaluated one month after the injections Cervical Dystonia Impact Profile 58 (main outcome), Toronto Western Spasmodic Torticollis Rating Scale-2 (pain and disability subscores), Toronto Western Spasmodic Torticollis Rating Scale-PSYCH, patient-rated Clinical Global Impression - Improvement and adverse events. We used propensity score methods for statistical analysis; ten predefined confounding factors were ess the impact of botulinum neurotoxin injections into deep cervical muscles.Epidermolysis bullosa (EB) is a group of inherited skin and mucosal fragility disorders resulting from mutations in genes encoding basement membrane zone (BMZ) components or proteins that maintain the integrity of BMZ and adjacent keratinocytes. More than 30 years have passed since the first causative gene for EB was identified, and over 40 genes are now known to be responsible for the protean collection of mechanobullous diseases included under the umbrella term of EB. Through the elucidation of disease mechanisms using human skin samples, animal models, and cultured cells, we have now reached the stage of developing more effective therapeutics for EB. This review will initially focus on what is known about blister wound healing in EB, since recent and emerging basic science data are very relevant to clinical translation and therapeutic strategies for patients. We then place these studies in the context of the latest information on gene therapy, read-through therapy, and cell therapy that provide optimism for improved clinical management of people living with EB.Autoimmune bullous diseases (AIBDs) are skin disorders which are mainly induced by autoantibodies against desmosomal or hemidesmosomal structural proteins. Previous studies using patients' samples and animal disease models identified target antigens and elucidated the mechanisms of blister formation. Pemphigus has been the subject of more active clinical and basic research than any other AIBD. These efforts have revealed the pathogenesis of pemphigus, which in turn has led to optimal diagnostic methods and novel therapies, such as rituximab. In bullous pemphigoid (BP), studies with passive-transfer mouse models using rabbit anti-mouse BP180 antibodies and studies with passive-transfer or active mouse models using autoantigen-humanized mice elucidated the immune reactions to BP180 in vivo. Recently, dipeptidyl peptidase-4 inhibitors have attracted attention as a trigger for BP. For epidermolysis bullosa acquisita (EBA), investigations using mouse models are actively under way and several molecules have been identified as targets for novel therapies. In this review, we give an overview and discussion of the recent progress in our understanding of the pathogenesis of pemphigus, BP, and EBA. Further studies on the breakdown of self-tolerance and on the identification of key molecules that are relevant to blister formation may expand our understanding of the etiology of AIBDs and lead to the development of novel therapeutic strategies.
There exists conflicting data in the literature with regard to adequate adenoma detection rate (ADR) as well as other quality metrics during colonoscopy based on the time of day that the procedure is performed. The aim of this study was to investigate the effect of time of day on quality metrics in patients undergoing screening colonoscopy.
Screening colonoscopies performed between January 2010 and September 2018 by twenty-eight colorectal surgeons were queried from a prospectively maintained database. Quality parameters examined included adenoma detection rate (ADR), gender-specific ADR, withdrawal time, total examination time, cecal intubation rate, bowel preparation quality, and intra-procedural complications. Colonoscopies were compared between morning (0730-1159 AM) and afternoon (1200-1700 PM) groups.
There were 13,809 endoscopic screening examinations performed in asymptomatic patients older than 45 years. Patients had a mean age of 59.8 years, and 48.5% were female. A total of 8868 (64%) of the scopes were performed in the morning and 4941 (36%) were performed in the afternoon. Median endoscopist volume was 189 [54, 701] and included only surgeons who performed both afternoon and morning colonoscopies. There was no difference in both ADR and bowel preparation quality between the two groups. Both groups exceeded all national quality benchmarks, with the morning group having significantly shorter examination times.
In our practice, colonoscopies meet and exceed all national quality benchmarks, independent of the time of day they are performed.
In our practice, colonoscopies meet and exceed all national quality benchmarks, independent of the time of day they are performed.
Although the risk of colorectal cancer increases with advancing age, there remains a lack of guidelines for surveillance colonoscopy in the octogenarian and older population. Our objective is to document the diagnostic yield of surveillance colonoscopies, and to analyze adenoma characteristics, complications, and short-term survival in asymptomatic octogenarian and older patients undergoing adenoma surveillance colonoscopy.
Surveillance colonoscopies performed at a tertiary level hospital colorectal surgery department between January 2010 and September 2018 were queried from a prospectively maintained institutional colonoscopy database. Patients 80 years old or older undergoing routine surveillance colonoscopy after having had an adenoma or advanced adenoma diagnosed on a prior exam were included in the study.
604 patients were included in the study with a median age of 82 and 43% were female. Median follow-up was 52 months (range 2-110), with 511(85%) patients alive at their last available follow-up. Overall, 292 patients had at least one had adenomatous lesion and 105 (17.4%) patients had advanced adenomas. Increasing age was not associated with increased rate of sessile serrated lesions (p=0.2) however, there was an association between increasing age and advanced adenoma rates (p=0.01). Advanced adenomas were more commonly found to be right-sided (p=0.02). Four asymptomatic patients were diagnosed with cancer at surveillance (0.6%).
Patients 80 years of age or older with a previous history of colorectal adenoma(s) may have a high risk of future advanced lesions and can be considered to undergo surveillance colonoscopy.
Patients 80 years of age or older with a previous history of colorectal adenoma(s) may have a high risk of future advanced lesions and can be considered to undergo surveillance colonoscopy.
LEAN was developed by Toyota to provide a systematic way to eliminate waste and standardize processes. We sought to introduce LEAN methodology to surgical residents with the goal of increasing rounding efficiency.
A Kaizen event was used as a rounding efficiency improvement strategy. A multidisciplinary healthcare team participated in the event; first to identify the current state of rounds, second to create the ideal state. Value-stream maps were created and improved efficiency was seen by increased ratio of productive time to lead time.
Two interventions were prioritized. The first introduced table rounds before walk rounds and the second changed the sign-out tool from Baton to Microsoft Word with file encryption. The ratio of productive time to lead time during morning rounds was higher after implementing these interventions (3.73 vs. 2.03).
This Kaizen event introduced surgical trainees to LEAN and resulted in improved efficiency of morning rounds.
This Kaizen event introduced surgical trainees to LEAN and resulted in improved efficiency of morning rounds.
Patients with hip fractures (HF) have an increased risk of venous thromboembolism (VTE). In elective orthopedic surgery direct oral anticoagulants (DOACs) have proven to be similarly or more effective compared to low molecular weight heparin (LMWH), but DOACs are not yet approved for thromboprophylaxis in trauma patients with HF. The aim of this study was to systematically review the literature comparing the effectiveness of DOACs and LMWH for thromboprophylaxis in trauma patients with surgically treated HF.
We searched PubMed, the Cochrane Library, Web of Science, and Embase. The primary outcome was the incidence of VTE (symptomatic and asymptomatic combined). Secondary outcomes were symptomatic VTE; a symptomatic VTE, symptomatic deep venous thrombosis (DVT); symptomatic pulmonary embolism (PE); major, clinically relevant non-major (CRNM), and minor bleeding. Meta-analysis was performed to compare the odds of VTE and secondary outcomes between DOACs and LMWH.
The search resulted in 738 titles. Five studies matched inclusion criteria. In total, 4748 hip fracture patients were analyzed (DOACs 2276 patients, LMWH 2472 patients). The pooled odds ratio for the risk of VTE for DOAC use was 0.52 (95% confidence interval 0.25-1.11, p=0.09) compared to LMWH. No statistically significant differences between DOAC and LMWH were found for asymptomatic VTE, symptomatic DVT, PE, major or CRNM bleeding, and minor bleeding.
Meta-analysis of the literature suggests that DOACs are associated with equivalent effectiveness and safety compared to LMWH.
Meta-analysis of the literature suggests that DOACs are associated with equivalent effectiveness and safety compared to LMWH.
