Precision medicine in rheumatoid arthritis: are we there yet?

Clinical Rheumatology -     

Preconception planning: Are we making progress?

According to the American Diabetes Association, unplanned pregnancies in women with diabetes could lead to abnormal metabolic control, which causes fetal and maternal complications. Preconception planning can decrease these risks. This article reports on the progress in preconception planning over the past 2 years.     

Are we making efficient use of clopidogrel?

This editorial refers to "Limited early antiplatelet effectof 300 mg clopidogrel in patients with aspirin therapy undergoingpercutaneous coronary interventions"¹ by Lepäntalo et al.on page 476 Blood platelets play a major role in the occurrence of thromboticcomplications after percutaneous coronary interventions (PCI).Introduction of the thienopyridine drug ticlopidine as an adjunctiveantiplatelet therapy has considerably improved the outcome ofpatients who undergo PCI.¹ Thienopyridines act via blockadeof one (P2Y₁₂) of the three adenosine 5-diphosphate (ADP) receptors, reducing ADP-induced platelet activation andaggregation.² Concerns about the side effects of ticlopidine,especially severe neutropenia and thrombotic thrombocytopenicpurpura, were a major reason for the rapid replacement of thisdrug with clopidogrel. Another important limitation of ticlopidineis its delayed     

Update on anti-angiogenic therapy in non-small cell lung cancer: Are we making progress?

Non-small cell lung cancer (NSCLC) remains a leading cause of death worldwide among patients diagnosed with malignancy. Despite new chemotherapy regimens and new cytotoxic combinations investigated in multiple clinical trials in recent years, no significant improvement in the prognosis of patients with lung cancer was achieved. The five-year survival rate for all patients diagnosed with NSCLC is about 15%, only 5% better than that of more than 40 years ago. New therapeutic approaches that target various different aspects of tumor progression and metastasis are of particular interest in to NSCLC patients. Drugs that block tumor vascularization (angiogenesis) or interfere with the activity of growth factor receptors and molecular pathways that are triggered by activation of these receptors are already used in clinical practice. In this review we will briefly discuss briefly the basic mechanisms of lung cancer angiogenesis, rationale for using drugs that block this process and present the most current recent data on their clinical efficacy.     

Surveillance in infection control: are we making progress?

PURPOSE OF THE REVIEW: Surveillance of nosocomial infections is an indispensable tool in infection control, and is used for detecting problem areas, defining patients who are at risk and evaluating intervention strategies. Surveillance techniques are continuously being evaluated and improved. RECENT FINDINGS: Problems with definitions, risk stratification and case finding render development of (inter)national surveillance systems difficult with respect to the comparability of data between different hospitals. These problems also influence surveillance in specific areas of nosocomial infections, such as urinary tract infections, ventilator-associated pneumonia and surgical site infections. Examples of such problem areas are discussed in the present review. SUMMARY: Despite continuing efforts made to improve quality of (inter)national and local surveillance systems, issues of infection definition and risk stratification are still under debate and need further research.     

Are we doing too much?: local excision before radical surgery in early rectal cancer

Purpose

In early rectal cancer cases, the use of local excision is increasing. The general indication for local excision is based on the preoperative stage, but there is often a discrepancy between pre and postoperative stages. We sought to determine the indications for local excision in T1 rectal adenocarcinoma patients by comparing the preoperative clinical and postoperative pathological stages. A second aim was to compare the oncologic outcomes between local excision and radical resection.

Methods

Between 2004 and 2014, 152 T1 rectal adenocarcinoma patients were enrolled. We divided the subjects into two groups, local excision and radical resection, depending on the modality of treatment the patients initially received. The group of patients who underwent radical resection was subsequently subdivided into “excisable” and “non-excisable” groups based on the postoperative pathology.

Results

Of 152 patients, 28 patients (18.4%) underwent local excision, while 124 patients (81.6%) underwent radical resection. Of 124 patients, in clinically suspected T2 or less and N0 (93) cases, 50 patients (53.8%) needed treatment beyond local excision, and local excision was sufficient for 43 patients (46.2%). The 3-year overall survival (p?=?0.393) and 3-year disease-free survival (p?=?0.076) between the local excision and radical resection groups showed no significant difference.

Conclusions

The clinical T stage was overestimated in more than half of the cases. Therefore, if cT1/2 tumors with cN0 are suspected preoperatively, local excision is initially recommended and will allow for determination of underlying pathology. The clinician can then decide whether to monitor or intervene with radical resection.