Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage: net risk estimation

Journal of Neurology - Every anticoagulation decision has in inherent risk of hemorrhage; intracerebral hemorrhage (ICH) is the most devastating hemorrhagic complication. We examined whether...     

Ambulatory blood pressure phenotypes and isolated elevation of office central or brachial blood pressure

Disagreements in office brachial and central blood pressure (BP) have resulted in the identification of novel hypertension phenotypes, namely isolated central hypertension (ICH) and isolated brachial hypertension (IBH). This study investigated the relationship of ICH and IBH with ambulatory BP phenotypes among 753 individuals (mean age = 47.6 ± 15.2 years, 48% males) who underwent office and 24‐hours brachial and central BP measures using a Mobil‐O‐Graph PWA monitor. Thresholds for elevated office central and brachial BP were 130/90 and 140/90 mm Hg. Results of multivariable analysis adjusted for potential confounders showed that ICH (n = 25) had 3.71‐fold (95% CI 1.48‐9.32; P = .005) greater risk of masked hypertension than normal brachial/central BP (n = 362), while IBH (n = 20) had 4.65‐fold (95% CI 1.76‐12.25; P = .002) greater risk of white coat hypertension compared with combined brachial/central hypertension (n = 346). These findings suggest that the diagnosis of ICH and IBH might be useful in identifying individuals at higher risk of presenting discordant office and ambulatory BP phenotypes.     

Treatment and outcomes in classic Hodgkin lymphoma post‐transplant lymphoproliferative disorder in children

Classic Hodgkin lymphoma post‐transplant lymphoproliferative disorder (HL‐PTLD) has been rarely reported in children, with limited data available to guide treatment decisions. We report a retrospective review of five children diagnosed with classic HL‐PTLD following solid organ transplant between 2007 and 2013 at Stanford University. Patients were treated with Stanford V chemotherapy and involved field radiation therapy. With a median follow‐up of 7.2 years (range, 4.7–10.5 years) since diagnosis, all patients remain in remission from HL‐PTLD and free from graft failure. In this series, combined modality therapy with risk‐adapted chemotherapy and radiation therapy was a successful strategy for the treatment of classic HL‐PTLD.     

New neuromodulation techniques for treatment resistant depression

Abstract

In the treatment of depression, when pharmacotherapy, psychotherapy and the oldest brain stimulation techniques are deadlocked, the emergence of new therapies is a necessary development. The field of neuromodulation is very broad and controversial. This article provides an overview of current progress in the technological advances in neuromodulation and neurostimulation treatments for treatment-resistant depression: magnetic seizure therapy; focal electrically administered seizure therapy; low field magnetic stimulation; transcranial pulsed electromagnetic fields; transcranial direct current stimulation; epidural cortical stimulation; trigeminal nerve stimulation; transcutaneous vagus nerve stimulation; transcranial focussed ultrasound; near infra-red transcranial radiation; closed loop stimulation. The role of new interventions is expanding, probably with more efficacy. Nowadays, still under experimentation, neuromodulation will probably revolutionise the field of neuroscience. At present, major efforts are still necessary before that these therapies are likely to become widespread.

• Key points

• There is a critical need for new therapies for treatment resistant depression.

• Newer therapies are expanding. In the future, these therapies, as an evidence-based adjunctive treatments, could offer a good therapeutic choice for the patients with a TRD.

• The current trend in the new neuromodulation therapies is to apply a personalised treatment.

• These news therapies can be complementary.

• That treatment approaches can provide clinically significant benefits.

     

Methods of synthesis,properties and biomedical applications of polyhydroxyalkanoates: a review

This study aims to provide an overview of the main polyhydroxyalkanoates (PHAs) used in medical applications. In this review, it has been demonstrated that the properties of PHAs can be controlled both by varying the concentration of units in the copolymer and the substrate for PHA production.

Another way of controlling the mechanical properties of PHAs is varying the 3HV content, such as the case of P(3HB-co-3HV). A higher 3HV content in the structure of this polyester will lead to a lower cristallinity and, therefore, to greater flexibility, strength and elongation at break.

PHAs are biocompatible, completely biodegradable, and non-toxic. Considering the state of the art technologies and their ideal properties, PHAs (especially the short-chain-length PHA polymers) can be tailored for specific medical applications, such as surgical suture, scaffolds, grafts and heart valves or drug delivery systems. Nowaday, random copolyesters of 3HB and 4HB (P(3HB-co-4HB)) are used for the development of biodegradable implants loaded with antibiotics for therapeutic treatment of chronic osteomyelitis.

It is also believed that these biodegradable materials can be efficient alternatives for reducing the pollution produced by the medical waste consisting of replacing plastic handles, packs, syringes or tubes that are trashed into the homes, clinics and hospitals around the world.     

Inzidenz des Status epilepticus – eine rezente populationsbasierte Studie

Clinical Epileptology - Die Inzidenz des Status epilepticus erlaubt im Rahmen von Public Health eine Abschätzung der notwendigen Ressourcen in Gesundheitssystemen. Weiters ist die Inzidenz...