Notes

Minimal Recurring Ailment Dynamics soon after Venetoclax-Obinutuzumab Treatment: Lengthy Off-Treatment Follow-up Through the Randomized CLL14 Review.
The second bottle-neck in current management is that of mandatory adrenal venous sampling for all but 1-2% of patients, a costly procedure requiring rare expertise. Ideally, it should be reserved - on the basis of likelihood, enhanced imaging, or peripheral steroid profiles - for a small minority of patients with clear evidence for unilateral disease. Only when costs are minimized and roadblocks removed will primary aldosteronism be properly treated as the public health issue that it is. © Georg Thieme Verlag KG Stuttgart · New York.Although subacute thyroiditis (SAT) is thought to be a self-limited inflammatory thyroid disease, the recurrence rate of SAT is approximately 10-20%. It is difficult for these patients to stop glucocorticoid treatment, and they are usually bothered with recurrent pain and the side effects of glucocorticoids for more than several months. We describe three cases who were diagnosed with recurrent subacute thyroiditis after a reduction in prednisolone (PSL) dose, either immediately upon the cessation of PSL or shortly thereafter. Their symptoms, including the adverse effects of PSL, severely impacted their quality of life. After a complete assessment, we administered colchicine at 1 mg per day for 1-2 months to control the recurrence of SAT and monitored their routine blood parameters every two weeks. All 3 patients were successfully tapered off of PSL treatment and were free of frequently recurrent SAT. Colchicine may be therapeutic in patients with prednisolone-refractory, recurrent SAT. However, a large-scale, double-blind, controlled, prospective multicenter study is required to provide a solid body of evidence. © Georg Thieme Verlag KG Stuttgart · New York.Polycystic ovary syndrome (PCOS) is a chronic dysfunction associated with obesity and metabolic disorders that can be ameliorated by treatment with metformin. Brown adipose tissue (BAT) has been recently identified in adult humans, and irisin is a myokine that induces BAT formation. The aim of this randomized controlled trial was to evaluate whether a short term treatment with metformin alters BAT activity and plasma irisin levels in women with PCOS. The participants were randomly assigned to receive metformin (1500 mg/day, n=21) or placebo (n=24) during 60 days. BAT activity was assessed by 18F-FDG positron emission tomography-computed tomography (PET-CT) and plasma irisin levels were measured by enzyme immunoassay. The groups were similar in age, body measures, metabolic profile and PCOS phenotypes. BAT activity did not change significantly in the women treated with metformin (median Δ SUVmax=-0.06 g/ml, interquartile interval -2.81 to 0.24 g/ml, p=0.484, Wilcoxon's test) or placebo (median Δ SUVmax=0.98 g/ml, interquartile interval -2.94 to 4.60 g/ml, p=0.386). In addition, plasma irisin levels remained unchanged in the groups treated with metformin (median Δ=-98 ng/ml, interquartile interval -366 to 60 ng/ml, p=0.310) and placebo (median Δ=28 ng/ml, interquartile interval -1260 to 215 ng/ml, p=0.650). These results suggest that in PCOS women BAT activity and plasma irisin levels may not change after a brief treatment with metformin. © Georg Thieme Verlag KG Stuttgart · New York.in English, German Mit dem kürzlich ratifizierten Digitale-Versorgung-Gesetz – DVG wurde der Weg geebnet u. a. für die Verschreibung von Gesundheits-Apps auf Rezept. Das DVG schafft erstmalig einen Leistungsanspruch deutscher (gesetzlich) Versicherter auf digitale Gesundheitsanwendungen, beschränkt auf Medizinprodukte niedriger Risikoklassen. Die Aufnahme in das Verzeichnis für digitale Gesundheitsanwendungen erfolgt nach Antragstellung durch den Hersteller und Prüfung, ob die Gesundheits-App grundlegende Anforderungen an Medizinprodukte und Datensicherheit sowie positive Versorgungseffekte aufweist. Um der Fragestellung nachzugehen, ob das DVG künftig eine nachhaltige Verbesserung in der Patientenversorgung bewirken kann und um die Digitalisierungsstrategie der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie und des Berufsverbands für Orthopädie und Unfallchirurgie basisnah ausrichten zu können, wurde unter den entsprechenden Mitgliedern eine Onlineumfrage zur Thematik des DVGs und dessen konsekutiven Chancen und Risiken durchgeführt. An der Umfrage beteiligten sich insgesamt 461 deutschsprachige, überwiegend männliche, erfahrene und ältere Ärzte in Führungspositionen. In dieser Studie konnte gezeigt werden, dass dem Großteil der teilnehmenden deutschen Orthopäden und Unfallchirurgen, trotz eines grundlegenden, positiven Interesses an der Digitalisierung, die Inhalte des DVGs unbekannt sind und derzeit noch eine skeptische Haltung gegenüber der Verschreibung von „Apps auf Rezept“ und möglicher aktuell nicht abschätzbarer Risiken herrscht. Der Schulterschluss von Medizin, IT und Legislative in Form von sektorübergreifenden Expertengruppen und einer Involvierung von medizinischen Fachgesellschaften ist als obligat anzusehen.in English, German HINTERGRUND In der operativen Therapie der idiopathischen Skoliose hat sich die dorsale Korrekturspondylodese mit Pedikelschrauben-Doppelstabsystem in Freihandtechnik bewährt und wird häufig durchgeführt. Durch Fehllage der Pedikelschrauben können schwerwiegende neurovaskuläre Komplikationen resultieren. selleck chemicals Zur Überprüfung einer korrekten Schraubenlage werden intraoperative fluoroskopische Kontrollen sowie neurophysiologische Messungen durchgeführt. Neuere Verfahren mit fluoroskopischer oder computertomografisch gestützter Navigation werden als risikoärmer und mit genauerer Schraubenlage beworben. FRAGESTELLUNG Ist die Freihandtechnik in der operativen Behandlung der idiopathischen Skoliose in Bezug auf die Komplikationen durch Schraubenfehllage und die intraoperative Strahlenexposition im Vergleich zu anderen Verfahren sicher? MATERIAL UND METHODEN Prospektiv wurden Registerdaten von 34 konsekutiven Patienten erfasst und retrospektiv analysiert, die aufgrund einer doppelbogigen idiopathischenichbarer Genauigkeit sicher und effektiv gesetzt werden, führen jedoch zu einer signifikant geringeren Strahlenbelastung für den Patienten.Pediculosis is a prevalent ectoparasite infestation caused by lice. The head louse (Pediculus humanus capitis) and body louse (Pediculus humanus humanus) are obligatory parasites whose only known hosts are humans. Pediculosis is probably the most common ectoparasitic infestation, affecting up to 80% of the population in several countries, and particularly prevalent in the infant population worldwide. Several treatment options, including shampoos and creams containing insecticides, have been introduced for the treatment of pediculosis. Recently, the use of synthetic chemicals to control human lice has raised concerns pertaining to human health and the environment. Therefore, increasing efforts have been undertaken to develop effective pediculicides with low environmental toxicity and minimal environmental residual activity. In this study, we focus on the essential oils derived from 22 plant genera, their constituents, and the major factors that play important roles in the effectiveness of these oils in the treatment of pediculosis. Furthermore, we discuss the advantages and limitations of the mentioned essential oils, and ultimately suggest those demonstrating the most effective in vitro pediculicidal activities. The genera such as Aloysia, Cinnamomum, Eucalyptus, Eugenia, Lavandula, Melaleuca, Mentha, Myrcianthes, Origanum, Pimpinella, and Thymus appear to be more efficient against lice. These genera are rich in anethole, 1,8-cineole, cinnamaldehyde, p-cymene, eugenol, linalool, limonene, pulegone, terpinen-4-ol, and thymol compounds. Georg Thieme Verlag KG Stuttgart · New York.Menispermum dauricum is widely used to treat respiratory inflammation, including laryngopharyngitis, tonsillitis, tracheitis, and bronchitis. Total alkaloids isolated from M. dauricum have shown a variety of beneficial bioactivities. However, available data on the effects of M. dauricum total alkaloids against allergic asthma has not been reported. In present study, the protective effect of M. dauricum total alkaloids was evaluated by using an ovalbumin-induced in vivo model of asthma. The asthma model was prepared by sensitizing and challenging mice with ovalbumin, and M. dauricum total alkaloids (100, 200, and 400 mg/kg) were administrated to asthmatic mice by gavage. Histopathological analysis of pulmonary changes was detected by hematoxylin and eosin, and periodic acid-schiff staining. Inflammatory cell counts were determined in bronchoalveolar lavage fluid. Total immunoglobulin E and ovalbumin-specific immunoglobulin E levels in serum, and T-helper 2 cytokines and chemokine levels in bronchoalveolar lavage fluid were detected by an ELISA. Histological results demonstrated that M. dauricum total alkaloids significantly attenuated pulmonary inflammation in asthmatic mice. M. dauricum total alkaloid treatment exhibited marked effects on asthmatic mice in reducing inflammatory cell counts, decreasing interleukin-4, interleukin-5, and interleukin-13 concentrations, and downregulating TNF-α and eotaxin levels in bronchoalveolar lavage fluid. In addition, M. dauricum total alkaloids could also inhibit the elevated serum levels of total immunoglobulin E and ovalbumin-specific immunoglobulin E. These findings confirmed that M. dauricum total alkaloids could suppress airway inflammation in ovalbumin-induced asthma through regulating the T-helper 2 response and chemokine level. M. dauricum total alkaloids may be a potential ethnopharmacological agent for asthmatic patients. Georg Thieme Verlag KG Stuttgart · New York.Obacunone is one of the major bioactive constituents from Dictamni cortex, a traditional Chinese medicine widely used in China. Oral administration of obacunone or Dictamni cortex extract has been shown to cause liver injury in rats. Given that obacunone contains a furan ring, which is a structural alert, metabolic activation might be responsible for obacunone-induced liver injury. In this study, bioactivation pathways of obacunone in rat and human liver microsomes were investigated. Obacunone was first metabolized into cis-butene-1,4-dial, and then cis-butene-1,4-dial was captured by glutathione, N-acetyl-cysteine, and N-acetyl-lysine in the microsomal incubation system. A total of 13 adducts derived from the reaction of cis-butene-1,4-dial with glutathione and/or N-acetyl-lysine were detected and structurally identified by liquid chromatography coupled to high-resolution tandem mass spectrometry. The major metabolite (M7) was identified to be the cyclic mono-glutathione conjugate of cis-butene-1,4-dial, which was detected in bile and urine of obacunone-treated rats. M9 and M10, obacunone-derived glutathione-cis-butene-1,4-dial-NAL conjugates, were detected in the microsomal incubations of obacunone fortified with glutathione and N-acetyl-lysine as trapping agents. M3 and M4, pyrroline-2-one derivatives, were also detected in microsomal incubations. Further phenotyping studies indicated that ketoconazole showed a strong inhibitory effect on the production of cis-butene-1,4-dial in a concentration-dependent manner. CYP3A4 was demonstrated to be the primary enzyme responsible for the bioactivation of obacunone by using individual recombinant human CYP450 enzymes. The current study provides an overview of CYP450-dominated bioactivation of obacunone and contributes to the understanding of the role of bioactivation in obacunone-induced liver injury. Georg Thieme Verlag KG Stuttgart · New York.
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