Our findings suggest, for the first time, that low-dose colchicine therapy favorably modifies coronary plaque, independent of high-dose statin intensification therapy and substantial low-density lipoprotein reduction. The improvements in plaque morphology are likely driven by the anti-inflammatory properties of colchicine, as demonstrated by reductions in hsCRP, rather than changes in lipoproteins. Colchicine may be beneficial as an additional secondary prevention agent in patients post-ACS if validated in future studies.
Melanocytes are an intraepidermal population of dendritic cells responsible for the production of melanin, a pigment that varies from yellow to brown to black pigment that after transfer to neighboring keratinocytes acts both as an endogenous screen and a buffering system against harmful ultraviolet (UV) wavelengths in sunlight [1]. Skin pigmentation has both individual and societal implications. The cosmetic desire for increased pigmentation (tanning) has resulted in many deleterious alterations including hastened skin ageing with wrinkles and poikiloderma and an increase in lentigines, melanocytic nevi, and melanoma. Focal or widespread loss of normal pigmentation not only renders individuals extraordinarily vulnerable to the harmful effects of sunlight (eg, increased risk of skin cancer in albinism), but it can also result in severe emotional stress and, in some societies, ostracism and discrimination (eg, vitiligo).Melanocytes are derived from the neural crest and are located along the basal layer of the epidermis and within the hair follicle, predominately the basal layer of the hair bulb matrix [1,2]. By the 50th day of intrauterine life, melanocytes can be detected in the epidermis; their migration to the epidermis and survival is dependent on receptor tyrosine kinase (RTK) c-Kit and its ligand stem cell factor (SCF) within the epidermis [3,4]. Mutations of the c-Kit gene lead to patches of hypopigmentation caused by lack of melanocyte migration, termed piebaldism [5]. Another important signaling molecule in melanocyte migration and development is Wnt5a, which signals via the Frizzled-5 receptor [6]. Overexpression of Wnt5a/ Frizzled is found in melanomas and associated with increased cell motility and invasiveness [7,8].Skin keratinocytes obtain melanin pigment from melanocytes, and keratinocytes provide the necessary microenvironment for melanocyte survival, proliferation, differentiation, and migration via production of ligands that interact with melanocyte receptors [1,[9][10][11] NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript epidermal melanin unit denotes the symbiotic relationship between one melanocyte transporting melanin via its dendritic processes to approximately 36 keratinocytes [10]. Melanocytes are located on the basement membrane among basal keratinocytes at ratio of 1 melanocyte per 5 basal keratinocytes in hematoxylin and eosin-stained histologic sections. This balance is maintained through regulated induction of melanocyte division. During childhood as the skin surface expands, throughout adulthood to maintain melanocyte numbers, and in response to exposure to sunlight or skin wounding, melanocytes are stimulated to proliferate at a low rate. Melanocyte proliferation entails uncoupling from keratinocytes, loss of their dendrites, cell division, migration along the basement membrane, then recoupling with keratinocytes to form the epidermal melanin unit. Keratinocytes regulate melanocyte growth and expression of melanocyte cell surface receptors via cell adhes...
Background and objective Current guidelines for the diagnosis of idiopathic pulmonary fibrosis (IPF) provide specific criteria for diagnosis in the setting of multidisciplinary discussion (MDD). We evaluate the utility and reproducibility of these diagnostic guidelines, using clinical data from the Australian IPF Registry. Methods All patients enrolled in the registry undergo a diagnostic review whereby international IPF guidelines are applied via a registry MDD. We investigated the clinical applicability of these guidelines with regard to: (i) adherence to guidelines, (ii) Natural history of IPF diagnostic categories and (iii) Concordance for diagnostic features. Results A total of 417 participants (69% male, 70.6 ± 8.0 years) with a clinical diagnosis of IPF underwent MDD. The 23% of participants who did not meet IPF diagnostic criteria displayed identical disease behaviour to those with confirmed IPF. Honeycombing on radiology was associated with a worse prognosis and this translated into poorer prognosis in the ‘definite’ IPF group. While there was moderate agreement for IPF diagnostic categories, agreement for specific radiological features, other than honeycombing, was poor. Conclusion In clinical practice, physicians do not always follow IPF diagnostic guidelines. We demonstrate a cohort of IPF patients who do not meet IPF diagnostic guideline criteria, based largely on their radiology and lack of lung biopsy, but who have outcomes identical to those with IPF.
Purpose: To estimate the incidence and examine the pattern of post-thoracotomy pulmonary complications (PPC) that are amenable to physiotherapy treatment and to estimate the effect size of a pre-thoracotomy physiotherapy education session compared to no preoperative physiotherapy for reducing PPC. Methods: Forty-two patients undergoing thoracotomy participated in this two-group retrospective-prospective cohort study. The preop group (n ¼ 22) received physiotherapy education prior to surgery and the no preop group (n ¼ 20) did not receive preoperative physiotherapy education. Chest radiographs were examined for PPC for 5 days postoperatively. Incidences of PPC were determined. The effect size was based on a grand count of PPC. Results: The 5-day incidence of atelectasis, collapse, consolidation, and other complications was 85.0%, 39.0%, 31.7%, and 38.1%, respectively. Patterns of PPC showed large increases at days 2 and 3. The effect size for pre-thoracotomy physiotherapy education was zero. Conclusions: In our sample, incidence of PPC was high and did not substantially differ based on whether or not preoperative education was provided.Key Words: education, postoperative pulmonary complications, preoperative physiotherapy, thoracotomy Reid JC, Jamieson A, Bond J, Versi BM, Nagar A, Ng BHK, Moreland JD. A pilot study of the incidence of post-thoracotomy pulmonary complications and the effectiveness of pre-thoracotomy physiotherapy patient education. Physiother Can. 2010;62:66-74. RÉ SUMÉObjectif : É valuer l'incidence et analyser le modè le des complications postopé ratoires pulmonaires (CPP) à la suite d'une thoracotomie dans les cas soumis à des traitements de physiothé rapie; é valuer la valeur de l'effet d'une sé ance de physiothé rapie é ducative pré opé ratoire comparativement à aucun traitement de physiothé rapie visant à ré duire les CPP avant l'intervention. Mé thodes : Quarante-deux patients subissant une thoracotomie ont formé la cohorte de cette é tude ré trospective-prospective à deux groupes. Le groupe pré opé ratoire (n ¼ 22) a reç u des traitements de physiothé rapie é ducative avant l'intervention, alors que le groupe non pré opé ratoire (n ¼ 20) n'en a rec¸u aucun. Des radiographies thoraciques ont é té examiné es afin de dé tecter toute CPP dans les cinq jours suivant l'intervention. Les incidences de CPP ont é té é tablies. La valeur de l'effet é tait basé e sur un dé nombrement total des CPP. Ré sultats : Aprè s cinq jours, les incidences d'até lectasie, de collapsus cardiovasculaire, de consolidation et d'autres complications é taient de 85,0 %, de 39,0 %, de 31,7 % et de 38,1 %, respectivement. Les modè les de CPP ont é té marqué s par des augmentations appré ciables aux jours deux et trois. La valeur de l'effet de la physiothé rapie en pré thoracotomie é tait donc de zé ro. Conclusions : Dans notre é chantillon, les incidences de CPP ont é té é levé es et ne diffé raient pas substantiellement en fonction du fait qu'une é ducation pré opé ratoire é tait offerte ou non.Mots clé s : c...
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