Physiological,pharmacological and toxicological considerations of drug-induced structural cardiac injury

The incidence of drug-induced structural cardiotoxicity, which may lead to heart failure, has been recognized in association with the use of anthracycline anti-cancer drugs for many years, but has also been shown to occur following treatment with the new generation of targeted anti-cancer agents that inhibit one or more receptor or non-receptor tyrosine kinases, serine/threonine kinases as well as several classes of non-oncology agents. A workshop organized by the Medical Research Council Centre for Drug Safety Science (University of Liverpool) on 5 September 2013 and attended by industry, academia and regulatory representatives, was designed to gain a better understanding of the gaps in the field of structural cardiotoxicity that can be addressed through collaborative efforts. Specific recommendations from the workshop for future collaborative activities included: greater efforts to identify predictive (i) preclinical; and (ii) clinical biomarkers of early cardiovascular injury; (iii) improved understanding of comparative physiology/pathophysiology and the clinical predictivity of current preclinical in vivo models; (iv) the identification and use of a set of cardiotoxic reference compounds for comparative profiling in improved animal and human cellular models; (v) more sharing of data (through publication/consortia arrangements) on target-related toxicities; (vi) strategies to develop cardio-protective agents; and (vii) closer interactions between preclinical scientists and clinicians to help ensure best translational efforts.     

EADV Taskforce's recommendations on measurement of health‐related quality of life in paediatric dermatology

The impact of skin conditions in children can profoundly affect a variety of lifestyle parameters that may have important personal consequences. Several national guidelines for children with different skin conditions recommend health‐related quality of life (HRQoL) measurement as part of the assessment process. HRQoL also plays an important role in educational programmes for children with chronic skin conditions and their parents. In this paper, the EADV Taskforce on Quality of life provides researchers and clinicians data on the achievements in this field, as well as the peculiarities of HRQoL assessment in children, and an overview of the most commonly used and validated generic, dermatology‐specific and disease‐specific instruments related to paediatric dermatology. Finally, an analysis of the current problems of HRQoL assessment in children with skin diseases and directions for future studies are also discussed. The main goal of this paper is to help dermatologists decide which HRQoL instrument to use with children, depending on the context.     

义龈修复与牙周菌群变化相关性研究

目的 :通过对牙周菌群在两种义龈修复前后的种属变化探讨义龈修复对严重牙龈退缩患者修复治疗的远期效果及与牙周健康的关系。方法 :严重的牙龈退缩患者经过系统性牙周治疗后随机分为常规义龈修复组及弹性义龈修复组 ,分别提取修复治疗前后各观察时段内龈沟液 ,作细菌培养和分类计数观察。结果 :对细菌形态学的记数比较显示 ,弹性材料组的螺旋体及梭杆菌的改变较常用热凝塑料组慢 ,修复 6个月后才能检测出显著性差异 ,常规材料修复 1个月后即可发现显著性变化 ;对几种特异性的牙周厌氧菌的分类培养显示在常规材料组组内差异明显 ,随时间的延长 ,组间差异更加明显。结论 :弹性塑料由于材料组织相容性好等优点 ,制作的义龈对于患者牙周健康的保持更为有利 ,是一种较为满意的治疗严重牙龈退缩的修复方法     

Polyorchidism and adenomatous hyperplasia of the rete testis: a case report with sonographic and magnetic resonance imaging findings and review of literature

Supernumerary testis or polyorchidism is a rare congenital anomaly with about 200 reported cases in the literature. It may be associated with cryptorchidism, testicular torsion and neoplasms. Ultrasonography and magnetic resonance imaging are effective noninvasive methods of accurately detecting polyorchidism. In most cases, ultrasonography is diagnostic and magnetic resonance imaging plays confirmatory role by providing additional information if complicated with neoplasia. We report a case of 16‐year‐old man with right supernumerary testis associated with adenomatous hyperplasia of the rete testis, its sonographic and magnetic resonance imaging findings and management.     

In Vitro Evaluation of ECG‐Synchronized Pulsatile Flow Using the i‐cor Diagonal Pump in Neonatal and Pediatric ECLS Systems

The objective was to assess the i‐cor electrocardiogram‐synchronized diagonal pump in terms of hemodynamic energy properties for off‐label use in neonatal and pediatric extracorporeal life support (ECLS) circuits. The neonatal circuit consisted of an i‐cor pump and console, a Medos Hilite 800 LT oxygenator, an 8Fr arterial cannula, a 10Fr venous cannula, 91 cm of 0.6‐cm ID arterial tubing, and 91 cm of 0.6‐cm ID venous tubing. The pediatric circuit was identical except it included a 12Fr arterial cannula, a 14Fr venous cannula, and a Medos Hilite 2400 LT oxygenator. Neonatal trials were conducted at 36°C with hematocrit 40% using varying flow rates (200–600 mL/min, 200 mL increments) and postarterial cannula pressures (40–100 mm Hg, 20 mm Hg increments) under nonpulsatile mode and pulsatile mode with various pulsatile amplitudes (1000–4000 rpm, 1000 rpm increments). Pediatric trials were conducted at different flow rates (800–1600 mL/min, 400 mL/min increments). Mean pressure and energy equivalent pressure increased with increasing postarterial cannula pressure, flow rate, and pulsatile amplitude. Physiologic‐like pulsatility was achieved between pulsatile amplitudes of 2000–3000 rpm. Pressure drops were greatest across the arterial cannula. Pulsatile flow generated significantly higher total hemodynamic energy (THE) levels than nonpulsatile flow. THE levels at postarterial cannula site increased with increasing postarterial cannula pressure, pulsatile amplitude, and flow rate. No surplus hemodynamic energy (SHE) was generated under nonpulsatile mode. Under pulsatile mode, preoxygenator SHE increased with increasing postarterial cannula pressure and pulsatile amplitude, but decreased with increasing flow rate. The i‐cor system can provide nonpulsatile and pulsatile flow for neonatal and pediatric ECLS. Pulsatile amplitudes of 2000–3000 rpm are recommended for use in neonatal and pediatric patients.