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[Hughes-Stovin syndrome: a life-threatening manifestation of Behçet's syndrome].
No full textHughes-Stovin syndrome (HSS) is a systemic inflammatory condition of unknown origin that is considered to be part of the Behçet's syndrome (BS) spectrum. Recurrent venous thrombosis and superficial thrombophlebitis in combination with bilateral pulmonary artery aneurysms (PAA) represent the hallmark of HSS. The diagnostic evaluation includes computed tomography pulmonary angiography to detect signs of pulmonary vasculitis. The management of HSS is based on the European Alliance of Associations for Rheumatology (EULAR) recommendations for BS and mainly comprises immunosuppressive therapy with glucocorticoids and cyclophosphamide. In addition to drug therapy, PAA should be evaluated for interventional treatment. Spontaneous PAA rupture due to fragile vessel architecture can occur even in cases of remission and/or PAA regression
The 2022 European Postgraduate (Residency) Program in Neurology in an historical and international perspective.
Get PDFNeurology residency programs, which were first established at the beginning of the 20th century, have become mandatory all over Europe in the last 40-50 years. The first European Training Requirements in Neurology (ETRN) were published in 2005 and first updated in 2016. The new (2022) ETRN suggests a 5-year training subdivided in three phases: a first phase (2 years) of general neurology training, a second phase (2 years) of training in neurophysiology/neurological subspecialties, and a third phase (1 year) to expand clinical training (e.g. in other neurodisciplines) or for research (path for clinical neuroscientist). The necessary theoretical and clinical competencies as well as learning objectives in diagnostic test have been updated, are newly organized in 4 levels and include 19 neurological subspecialties. Finally, the new ETRN require, in addition to a program director, a team of clinician-educators who regularly review the resident's progress. The 2022 update of the ETRN reflects emerging requirements for the practice of neurology and contribute to the international standardization of training necessary for the increasing needs of residents and specialists across Europe
Electrophysiological Correlates of Reward Anticipation in Subjects with Schizophrenia: An ERP Microstate Study.
No full textThe current study aimed to investigate alterations of event-related potentials (ERPs) microstate during reward anticipation in subjects with schizophrenia (SCZ), and their association with hedonic experience and negative symptoms. EEG data were recorded in thirty SCZ and twenty-three healthy controls (HC) during the monetary incentive delay task in which reward, loss and neutral cues were presented. Microstate analysis and standardized low-resolution electromagnetic tomography (sLORETA) were applied to EEG data. Furthermore, analyses correlating a topographic index (the ERPs score), calculated to quantify brain activation in relationship to the microstate maps, and scales assessing hedonic experience and negative symptoms were performed. Alterations in the first (125.0-187.5 ms) and second (261.7-414.1 ms) anticipatory cue-related microstate classes were observed. In SCZ, reward cues were associated to shorter duration and earlier offset of the first microstate class as compared to the neutral condition. In the second microstate class, the area under the curve was smaller for both reward and loss anticipation cues in SCZ as compared to HC. Furthermore, significant correlations between ERPs scores and the anticipation of pleasure scores were detected, while no significant association was found with negative symptoms. sLORETA analysis showed that hypo-activation of the cingulate cortex, insula, orbitofrontal and parietal cortex was detected in SCZ as compared to HC. Abnormalities in ERPs could be traced already during the early stages of reward processing and were associated with the anticipation of pleasure, suggesting that these dysfunctions might impair effective evaluation of incoming pleasant experiences. Negative symptoms and anhedonia are partially independent results
Influence of polishing technique and coffee thermal cycling on the surface roughness and color stability of additively and subtractively manufactured resins used for definitive restorations.
Get PDFPURPOSE
To evaluate how different polishing techniques and coffee thermal cycling effect the surface roughness and stainability of additively and subtractively manufactured resins used for definitive prostheses.
MATERIALS AND METHODS
Two additively manufactured composite resins (Crowntec, CT and VarseoSmile Crown Plus, VS) and a subtractively manufactured resin nanoceramic (Cerasmart, CS) were used to fabricate 90 rectangular-shaped specimens (14 × 12 × 1 mm) (n = 30). After baseline surface roughness (Ra ) measurements, specimens were divided into 3 groups based on the polishing technique; conventional polishing with a 2-stage polishing kit (CP) and surface sealant application (Optiglaze, OG or Vita Akzent LC, VA) (n = 10). After polishing, specimens were subjected to 10000 cycles of coffee thermal cycling. Ra and color coordinate measurements were performed after polishing and after coffee thermal cycling. Color difference (ΔE00 ) was calculated. Scanning electron microscope images were taken at each time interval. Kruskal-Wallis or 1-way analysis of variance (ANOVA) were used to evaluate Ra of materials within each polishing-time interval pair and different polishing techniques within each material-time interval pair, while Friedman or repeated measures ANOVA were used to evaluate Ra at different time intervals within each material-polishing pair. ΔE00 was assessed with 2-way ANOVA (α = .05).
RESULTS
Other than VA-after polishing (P = .055), tested materials had significantly different Ra within each polishing-time interval pair (P ≤ .038). When Ra differences among different polishing techniques within each material-time interval pair were considered, CS had differences after coffee thermal cycling, CT had differences before polishing and after coffee thermal cycling, and VS had differences within each time interval (P ≤ .038). When Ra differences among different time intervals within each material-polishing pair were considered, significant differences were observed among all pairs (P ≤ .016), except for CS-VA (P = .695) and VS-VA (P = .300). ΔE00 values were affected by material and polishing technique interaction (P = .007).
CONCLUSIONS
Ra of CS was similar to or lower than the Ra of other materials, regardless of the time interval or polishing technique. CP mostly led to lower Ra than other polishing techniques, whereas VA resulted in a high Ra regardless of the material-time interval pair. Polishing reduced the Ra , while coffee thermal cycling was found to have a small effect. Among tested material-polishing pairs, only CS-VA had moderately unacceptable color change when previously reported threshold values were considered. This article is protected by copyright. All rights reserved
Influence of the Level of Compliance with Preventive Maintenance Therapy upon the Prevalence of Peri-Implant Diseases: A cross-sectional study.
No full textBACKGROUND
A study was made to evaluate peri-implant conditions in compliers and erratic compliers with peri-implant maintenance therapy (PIMT), and to assess the role of site-specific confounders.
METHODS
Erratic PIMT compliers (EC) were defined as presenting attendance < 2x/year, while regular compliers (RC) attended ≥ 2x/year. Generalized estimating equations (GEE) were employed to perform a multivariable multilevel analysis in which the peri-implant condition was established as dependent variable.
RESULTS
Overall, 86 non-smoker patients (42 RC and 44 EC) attending the department of periodontology of the Universitat Internacional de Catalunya were recruited consecutively on a cross-sectional basis. The mean period of loading was 9.5y. An implant placed in an erratic patient has 88% higher probability of presenting peri-implant diseases versus RC. Furthermore, the probability of diagnosis of peri-implantitis was significantly higher in EC vs RC (OR 5.26; 95% CI: 1.51 - 18.29) (p = 0.009). Among other factors, history of periodontitis, non-hygienic prosthesis, period of implant loading and Modified Plaque Index (MPI) at implant level were shown to significantly increase the risk of peri-implantitis diagnosis. Although not associated with peri-implantitis diagnosis risk, keratinized mucosa (KM) width and vestibular depth (VD) were significantly associated to plaque accumulation (mPI).
CONCLUSIONS
Compliance with PIMT was found to be significantly associated with peri-implant status. In this sense, attending PIMT < 2x/year may not be sufficient to prevent peri-implantitis. These outcomes should be limited to a non-smokers population. This article is protected by copyright. All rights reserved
KESTREL and KITE Phase 3 studies: 100-week results with brolucizumab in patients with diabetic macular edema.
Get PDFPURPOSE
To report the 100-week outcomes from KESTREL and KITE.
DESIGN
Two phase 3, double-masked, active-controlled, randomized trials.
METHODS
Patients with diabetic macular edema (DME) were randomized 1:1:1 to brolucizumab 3 mg/6 mg (BRO3/BRO6) or aflibercept 2 mg (AFL) in KESTREL (N=566) or 1:1 to BRO6 or AFL in KITE (N=360). BRO3/BRO6 arms received 5 loading doses every 6 weeks (q6w) followed by q12w dosing, with an option to adjust to q8w at predefined disease activity assessment visits. In KITE, at Week 72, based on the disease stability assessment, treatment intervals could be extended by 4 weeks in the BRO6 arm. AFL arms received 5 monthly loading doses followed by fixed q8w dosing.
RESULTS
At Week 100, change from baseline in BCVA (letters) was +8.8 for BRO6 and +10.6 for AFL in KESTREL; +10.9 for BRO6 and +8.4 for AFL in KITE. In both studies, fewer BRO6 subjects had intraretinal fluid and/or subretinal fluid versus (vs) AFL. Results were achieved with 32.9% (KESTREL) and 47.5% (KITE) of BRO6 subjects maintained on q12w and q12w/q16w dosing, respectively. Intraocular inflammation rates for BRO6 vs AFL were 4.2% vs 1.1% (KESTREL) and 2.2% vs 1.7% (KITE) of which retinal vasculitis rates were 0.5% vs 0% in KESTREL, with no cases in KITE. Retinal vascular occlusion rates were 1.6% vs 0.5% (KESTREL) and 0.6% in both treatment arms in KITE.
CONCLUSION
Results show the long-term efficacy and durability of brolucizumab in improving visual and anatomical outcomes in DME; the overall safety profile of brolucizumab remained unchanged through Year 2
Recent advances in the treatment of tuberculosis.
Get PDFBACKGROUND
Tuberculosis is a global health challenge and one of the leading causes of death worldwide. In the last decade, the tuberculosis treatment landscape has dramatically changed. After long years of stagnation, new compounds entered the market (bedaquiline, delamanid and pretomanid) and phase III clinical trials have shown promising results towards shortening duration of treatment for both drug-susceptible (Study 31/A5349, TRUNCATE-TB, SHINE) and drug-resistant tuberculosis (STREAM, NiX-TB, ZeNix, TB-PRACTECAL). Dose optimization of rifamycins and repurposed drugs have also brought hopes of further development of safe and effective regimens. Consequently, international and World Health Organization clinical guidelines have been updated multiple times in the last years to keep pace with these advances.
OBJECTIVES
This narrative review aims to summarize the state-of-the-art on treatment of drug-susceptible and drug-resistant tuberculosis, as well as recent trials results and an overview of ongoing clinical trials.
SOURCES
A non-systematic literature review was conducted in PubMed and MEDLINE, focusing on the treatment of tuberculosis. Ongoing clinical trials were listed according to the authors' knowledge, and completed consulting clinicaltrials.gov and other publicly available websites (www.resisttb.org/clinical-trials-progress-report, www.newtbdrugs.org/pipeline/trials).
CONTENT
This review summarizes the recent, major changes in the landscape for drug-susceptible and drug-resistant treatment, with a specific focus on their potential impact on patient outcomes and programmatic TB management. Moreover, insights in host-directed therapies, and advances in pharmacokinetic and pharmacogenomics are discussed. A thorough outline of ongoing therapeutic clinical trials is presented, highlighting different approaches and goals in current TB clinical research.
IMPLICATIONS
Future research should be directed to individualize regimens and protect these recent breakthroughs by preventing and identifying the selection of drug resistance and providing widespread, affordable, patient-centered access to new treatment options for all people affected by tuberculosis
Accuracy of implant placement in the posterior maxillary region depending on the alveolar residual bone height and sinus morphology: An in vitro study.
Get PDFOBJECTIVES
The primary aim of this in vitro study was to assess the effect of alveolar residual bone height in the posterior maxilla on the accuracy of the final implant position via free-handed and static Computer-Assisted Implant Placement (sCAIP). The secondary aim was to evaluate the influence of the maxillary sinus morphology on the accuracy of final implant position.
MATERIALS AND METHODS
Partially edentulous standardized maxillary models simulating three different residual bone heights and different sinus floor morphologies were investigated. One-hundred eighty equally distributed implants, which were placed either free-handed or sCAIP, constituted the study sample. 3D digital deviations were obtained by superimposing the post-surgical scans on the initial treatment plan.
RESULTS
Angular and linear deviation assessment demonstrated higher implant position accuracy in the sCAIP group. sCAIP revealed similar outcomes independently of the alveolar bone height and sinus floor morphology. Contrarily, in the free-handed group, alveolar bone height and sinus morphology statistically affected the final implant position. Non-parametric three-way ANOVA showed significance for implant placement protocol (p < .0001) and alveolar bone height (p ≤ .02) when angular, and linear deviations were evaluated. Sinus morphology was statistically significantly associated with angular deviation (p = .0009).
CONCLUSIONS
sCAIP demonstrated higher 3D implant position accuracy. Alveolar bone height (strongly) and sinus morphology are associated with the accuracy of final implant position when the free-handed implant protocol is followed. However, these anatomical factors did not affect final implant position during sCAIP
EEG-Meta-Microstates: Towards a More Objective Use of Resting-State EEG Microstate Findings Across Studies.
Get PDFOver the last decade, EEG resting-state microstate analysis has evolved from a niche existence to a widely used and well-accepted methodology. The rapidly increasing body of empirical findings started to yield overarching patterns of associations of biological and psychological states and traits with specific microstate classes. However, currently, this cross-referencing among apparently similar microstate classes of different studies is typically done by "eyeballing" of printed template maps by the individual authors, lacking a systematic procedure. To improve the reliability and validity of future findings, we present a tool to systematically collect the actual data of template maps from as many published studies as possible and present them in their entirety as a matrix of spatial similarity. The tool also allows importing novel template maps and systematically extracting the findings associated with specific microstate maps from ongoing or published studies. The tool also allows importing novel template maps and systematically extracting the findings associated with specific microstate maps in the literature. The analysis of 40 included sets of template maps indicated that: (i) there is a high degree of similarity of template maps across studies, (ii) similar template maps were associated with converging empirical findings, and (iii) representative meta-microstates can be extracted from the individual studies. We hope that this tool will be useful in coming to a more comprehensive, objective, and overarching representation of microstate findings
Prevalence and factors associated with cancer-related fatigue in Swiss adult survivors of childhood cancer.
Get PDFPURPOSE
Reported prevalence of cancer-related fatigue (CRF) among childhood cancer survivors (CCS) varies widely, and evidence on factors associated with CRF among CCS is limited. We aimed to investigate the prevalence of CRF and its associated factors among adult CCS in Switzerland.
METHODS
In a prospective cohort study, we invited adult CCS who survived at least 5 years since last cancer diagnosis, and were diagnosed when age 0-20 years and treated at Inselspital Bern between 1976 and 2015 to complete two fatigue-measuring instruments: the Checklist Individual Strength subjective fatigue subscale (CIS8R; increased fatigue 27-34, severe fatigue ≥ 35) and the numerical rating scale (NRS; moderate fatigue 4-6, severe fatigue 7-10). We collected information about previous cancer treatment and medical history, and calculated β coefficients for the association between CIS8R/NRS fatigue scores and potential determinants using multivariable linear regression.
RESULTS
We included 158 CCS (participation rate: 30%) with a median age at study of 33 years (interquartile range 26-38). Based on CIS8R, 19% (N = 30) of CCS reported increased fatigue, yet none reported severe fatigue. CRF was associated with female sex, central nervous system (CNS) tumors, sleep disturbance, and endocrine disorders. Lower CRF levels were observed among CCS age 30-39 years compared to those younger.
CONCLUSIONS
A considerable proportion of adult CCS reported increased levels of CRF.
IMPLICATIONS FOR CANCER SURVIVORS
CCS who are female and < 30 years old, have a history of CNS tumor, report sleep disturbance, or have an endocrine disorder should be screened for CRF
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