The current status of surgical pilonidal sinus disease therapy in Germany

European Surgery - Treatment of pilonidal sinus disease (PSD) requires a tailored approach. A national guideline was published in 2014. The current status of surgical PSD therapy...     

Magnetic resonance elastography with guided pressure waves

Magnetic resonance elastography aims to non-invasively and remotely characterize the mechanical properties of living tissues. To quantitatively and regionally map the shear viscoelastic moduli in vivo, the technique must achieve proper mechanical excitation throughout the targeted tissues. Although it is straightforward, ante manibus, in close organs such as the liver or the breast, which practitioners clinically palpate already, it is somewhat fortunately highly challenging to trick the natural protective barriers of remote organs such as the brain. So far, mechanical waves have been induced in the latter by shaking the surrounding cranial bones. Here, the skull was circumvented by guiding pressure waves inside the subject's buccal cavity so mechanical waves could propagate from within through the brainstem up to the brain. Repeatable, reproducible and robust displacement fields were recorded in phantoms and in vivo by magnetic resonance elastography with guided pressure waves such that quantitative mechanical outcomes were extracted in the human brain.     

Impact of Addition of Metformin to Abiraterone in Metastatic Castration-Resistant Prostate Cancer Patients With Disease Progressing While Receiving Abiraterone Treatment (MetAb-Pro): Phase 2 Pilot Study

Background

There is evidence linking metformin to improved prostate cancer–related outcomes.

Oxygen uptake plateau occurrence depends on oxygen kinetics and oxygen deficit accumulation

We tested the hypothesis that participants with an oxygen uptake () plateau during incremental exercise exhibit a lower VO₂‐deficit (VO_2DEF)‐accumulation in the submaximal intensity domain due to faster ramp and square wave O₂‐kinetics. Twenty‐six male participants performed a standard ramp test (increment: 30 W·min^?1), a ramp test with an individualized ramp slope and a two‐step (moderate and severe) square wave exercise followed by a ‐verification bout. VO_2DEF was calculated by the difference between individualized ramp test O₂ and O₂‐demand estimated from steady‐state O₂‐kinetics. Twenty‐four participants verified their O_2max in the verification test. Ten of them showed a plateau in the individualized ramp test. VO_2DEF at the end of this ramp test (4.34 ± 0.60 vs 4.54 ± 0.43 L) was not different between the plateau and the non‐plateau group (P > 0.05). The plateau group had a significantly (P < 0.05) lower VO_2DEF 2 minutes before termination of the individualized ramp test (2.24 ± 0.40 vs 2.78 ± 0.33 L). This coincided with a shorter mean response time (43 ± 9 vs 53 ± 7 seconds), a higher increase in O₂ per W (10.1 ± 0.2 vs 9.2 ± 0.5 mL·min^?1·W^?1) at the individualized ramp test as well as shorter time constants of moderate (36 ± 6 vs 48 ± 7 seconds) and severe (62 ± 9 vs 86 ± 10 seconds) square wave kinetics (all P < 0.05). We conclude that the O₂‐plateau occurrence requires a fast O₂‐kinetics and a low VO_2DEF‐accumulation at intensities below O_2max.     

Current therapeutical strategies for allergic rhinitis

Introduction: Allergic rhinitis is a common condition with increasing prevalence and is associated with several comorbid disorders such as bronchial asthma and atopic dermatitis. If allergen avoidance is not possible, allergen-specific immunotherapy is the only causal treatment option.

Areas covered: This review focuses on current treatments and the future outlook for allergic rhinitis. Pharmacotherapy includes mast cell stabilizers, antihistamines, glucocorticosteroids (GCSs), leukotriene receptor antagonists, and nasal decongestants. Nasal GCSs are currently regarded as the most effective treatment and are considered first-line therapy together with non-sedating antihistamines. The new formulation MP29-02 combines the nasal GCS fluticasone propionate with azelastine in one single spray and has achieved greater improvements than those under monotherapy with modern GCSs or antihistamines. Furthermore, this review discusses allergen immunotherapy alone and in combination with modern monoclonal antibodies.

Expert opinion: Despite the variety of medications for allergic rhinitis, ranging from general symptomatic agents like GCSs or decongestants, to more specific ones like histamine receptor or leukotriene blockers, to causal therapy like immunotherapy, many patients still experience treatment failures or unsatisfactory results. The ultimate goal may be to endotype every downstream pathway separately in order to offer patients individualized, targeted therapy with specific antibodies against the respective pathway.