Notes

Venous thromboembolism: determining sufferers vulnerable and establishing prophylaxis.
Skin cancer-associated clinicodermoscopic features were more frequently observed in patients with NVP, who simultaneously lost dermoscopic patterns associated to poromas and acquired those associated with skin cancer, than those with VP.The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.Homologous recombination deficiency is a critical biologic feature of ovarian cancer. This weakness in DNA damage repair relies on functional poly(ADP-ribose) polymerase. Niraparib is a poly(ADP-ribose) polymerase inhibitor, orally available and initially approved for maintenance therapy in women with ovarian cancer by the US FDA in 2017 and by the EMA in 2017 for the same indication. Ovarian cancer represents the most lethal of gynecologic malignancies. The efficacy of niraparib has changed the landscape of ovarian cancer treatment, but overall survival data is still to come. This review summarizes the data regarding niraparib mechanism of action, toxicities, single agent efficacy and novel combinations in ovarian cancer.
Psychodermatologic disorders are difficult to identify and treat. Knowledge about the prevalence of these conditions in dermatological practice in Canada is scarce. This hampers our ability to address potential gaps and establish optimal care pathways.

To provide an estimate of the frequencies of psychodermatologic conditions in dermatological practice in Alberta, Canada.

Two administrative provincial databases were used to estimate the prevalence of potential psychodermatological conditions in Alberta from 2014 to 2018. Phospho(enol)pyruvic acid monopotassium in vitro Province-wide dermatology claims data were examined to extract relevant International Classification of Disease codes as available. Claims were linked with pharmacy dispensation data to identify patients who received at least 1 psychoactive medication within 90 days of the dermatology claim.

Of 243 963 patients identified, 28.6% had received at least 1 psychotropic medication (mean age 47.9 years; 67.5% female). Rates of concurrent psychotropic medications were highest for pruritus angic conditions and/or concurrent mental health issues in dermatology. Diagnostic and care pathways should include a multidisciplinary approach to better identify and treat these conditions.
Medial malleolar osteotomy is an established procedure for accessing the medial localized osteochondral lesions of the talus. The purpose of this study was to describe a single approach, which allows perpendicular access to the lesion without a malleolar osteotomy.

Six patients were treated surgically for medial localized talar osteochondral lesions. Four patients had stage III and 2 patients had stage IV lesions. A single posteromedial approach was used for accessing the medial talar dome.

The method of treatment was mosaicplasty in 4 patients and osteochondral fragment fixation in 2 patients. One patient who was treated with a fragment fixation procedure showed screw loosening. Incorporation of the osteochondral grafts was proved by magnetic resonance imaging in all mosaicplasty cases.

A single posteromedial approach was sufficient in the posteromedial localized osteochondral lesion of the talus. As the lesion was approached by soft tissue exposure only, a malleolar osteotomy was not required. Thus, osteotomy-related complications were avoided.

Level IV, retrospective case series.
Level IV, retrospective case series.
In preaxial polydactyly of the foot, the choice for excision of the lateral or medial hallux is not straightforward, in particular with proximal phalangeal (type IV) and metatarsal (type VI) duplication, because of anatomical characteristics. We evaluated whether medial or lateral hallux excision gives better outcomes in these duplication types, to help clinical decision making.

Children with type IV or type VI duplication (n=14, age 4.4-17.2 years), who were operatively treated by excision of the lateral or medial hallux, were assessed for foot function using plantar pressure measurements and clinical examination. Foot aesthetics were scored by the child, an expert, and 10 laypersons, and additional patient-reported outcome questionnaires were obtained. Outcomes were compared between lateral and medial excision, per duplication type.

In type IV duplication (n=11), lateral excision showed a better distribution of peak pressure between the hallux and first metatarsal with significantly lower median first metatarsal peak pressure (
= .008). Lateral excision showed more medial hallux deviation (
= .017). Foot aesthetics were not different between excision sides. In type VI duplication (n=12), lateral excision showed a 59% higher hallux peak pressure, larger medial hallux deviation (
= .004), and more reoperations. Foot aesthetics were scored significantly better after lateral excision by experts and laypersons.

Foot function by virtue of plantar pressure was better after lateral hallux excision in type IV and after medial hallux excision in type VI duplication. Surgeons and laypersons perceived the foot as more normal after lateral excision in type VI, whereas children reported no differences. These outcomes can be used in clinical decision making.

Level III, therapeutic, comparative study.
Level III, therapeutic, comparative study.In this paper, we developed a novel strategy of preparing doxorubicin (DOX) nanocrystal (NC) exerting spherical particles with a diameter of 102 nm, which experienced following coating of chondroitin sulphate derivative (CSOA) shell via electrostatic and hydrophobic interactions. Such multifunctional outerwear resulted in drug nanocapsules with high drug loading content up to 70% and high colloidal stability under physiological conditions. It exhibited accelerated drug release behaviour when dispersing in hyaluronidase (HAase) containing medium or incubated with cancer cells. CSOA/NCs were effectively taken up by cancer cells via CD44 receptor-mediated endocytosis, but were rarely internalised into normal fibroblasts. With the comparison of typical drug-loaded micelles system (DOX/PEG-PCL), CSOA/NCs showed greater inhibition to cancer cells due to the targeted and sensitive drug delivery.
Foot and ankle surgery often requires bone healing, whether in elective arthrodesis or trauma. While primary bone healing is possible, the rate of nonunion in foot and ankle surgery remains variable. The addition of autogenous bone graft can allow for higher union rates by adding to the biology at the site of bone healing. Harvesting autogenous bone graft from the calcaneus for foot and ankle surgery can be done quickly and efficiently and allow for an adequate amount of graft.

A retrospective chart and radiographic review was performed for 1438 patients at a single center between August 1, 2015, and December 15, 2018, who underwent calcaneal autograft harvesting using a power-driven reaming graft harvester.

In total, 966 patients were included and evaluated for the safety and complication rate associated with the procedure. Only 1 patient (0.1%) had a major complication, and there were 14 minor complications (1.4%).

The safety profile and low complication rate of this case series demonstrate that this simple and efficient calcaneal autograft harvest technique can be considered when a small to moderate amount of autogenous bone graft is required to augment bone healing.

Therapeutic level IV, case series.
Therapeutic level IV, case series.Amphotericin B (AmB) is an important antifungal agent available in the clinical practice with the action mechanism related to the inhibition of ergosterol molecule present in the fungal cell wall. Given this, in order to expand AmB knowledge, this review article gathers important information of the AmB physical, chemical, and biological properties. In addition, the main analytical methods for quantifying and determining the AmB were also reported in this review, such as high-performance liquid chromatography (HPLC), liquid chromatography, tandem mass spectrophotometry (LC-MS/MS), immunoenzymatic assay (ELISA), capillary zone electrophoresis (CE) stands out and among others. Based in this review article, the scientific community will have important information to choose the best method for analysis in their scientific or clinical research, providing greater security and reliability in the obtained results.This study aimed to increase the solubility of glycyrrhetinic acid (GA) in water and enhance its liver-targeting ability using self-assembling nanomicelles (NMs) based on stearic acid-modified fenugreek gum (FG-C18). The GA/FG-C18 NMs were prepared by an ultrasonication dispersion method. The nanomicelles were spherical particles with a particle size of 198.61 ± 1.58 nm and a zeta potential of -30.12 ± 0.28 mV. The drug loading and encapsulation efficiency were 13.34 ± 0.24% and 80.07 ± 1.44%, respectively. The results of differential scanning calorimetry (DSC) and X-ray powder diffraction (XRD) indicated that GA was successfully encapsulated into the nanomicelles in a molecularly dispersed state. An in vitro release test showed that GA/FG-C18 NMs possessed a slow drug release profile in PBS (pH 7.4) over 200 h. The cytotoxicity assay indicated that GA/FG-C18 NMs showed much higher inhibitory efficacy in HepG2 cells than in MCF-7 cells. Tissue section studies indicated that the accumulation of DiR-loaded FG-C18 nanomicelles in the liver of mice was higher than that of the DiR solution, and the fluorescence intensity decreased over time. GA/FG-C18 NMs showed a larger area under the curve (AUC) and mean residence time (MRT) compared with free GA after intravenous administration in mice. The in vivo studies showed that GA mainly accumulated in the liver after encapsulation by FG-C18 NMs, and the drug concentration was higher than that of free GA. These results suggested that FG-C18 NMs could serve as a potential drug delivery system for targeting GA to liver tissue.
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