The American journal of the medical sciences
-
Percutaneous core needle biopsy (CNB) has been widely performed as a standard technique for initial histological diagnosis of suspicious breast lesions. There have been an increased number of atypical lesions diagnosed on CNB as a consequence of the advances in breast imaging techniques. The authors aim to identify if any of the radiological and histopathological criteria evaluated in this study can predict the presence of malignancy associated with atypical hyperplasia (AH) diagnosed on CNB. ⋯ Upgrade rate to cancer after surgical excision was 11.3% of AH patients diagnosed on CNB. However, none of the variables are significant in determining the presence of malignancy associated with AH diagnosed by CNB.
-
Secretory phospholipases A2 (sPLA2) hydrolyze phospholipids in cell membranes and extracellular structures such as pulmonary surfactant. This study tests the hypothesis that sPLA2 are elevated in human lungs during acute respiratory distress syndrome (ARDS) and that sPLA2 levels are associated with surfactant injury by hydrolysis of surfactant phospholipids. ⋯ These results support the hypothesis that sPLA2-mediated hydrolysis of surfactant phospholipid, especially PG by PLA2G2A, contributes to surfactant injury during early ARDS.
-
Ankylosing spondylitis (AS) is associated with both significant direct and indirect costs, which vary by country, and have generally increased dramatically since the introduction of anti-tumor necrosis factor therapy. The cost-effectiveness of biologic agents is controversial, although cost-effectiveness studies need to consider the potential impact of anti-tumor necrosis factor treatments on work ability. ⋯ No studies have examined differences in patient outcomes based on subspecialty care. Establishing an evidence base for these questions would help inform policy decisions to design the most cost-effective measures to treat AS.
-
Since the first biologic agent was tested in the treatment of ankylosing spondylitis (AS), the ability of these therapies to dramatically improve the clinical symptoms and signs of the disease was very evident. Over the past decade, 4 tumor necrosis factor-alpha inhibitors have been approved by the Food and Drug Administration for the treatment of AS. Published data include randomized controlled trials, registries and observational studies. ⋯ Whether these agents can alter the natural history of AS if started very early in the course or whether they can prevent extra-articular manifestations are among the important unanswered questions. Most of the data summarized in this review relate to tumor necrosis factor-alpha inhibitors, and other biologic agents that have been studied are included, as well. This review also summarizes what questions remain about the use of biologics in AS and what type of studies will be required to answer them.
-
The major comorbidities of ankylosing spondylitis include uveitis, bowel inflammation, psoriasis and heart disease. The pathogenic mechanism to account for the coexistence of comorbidities remains largely unknown. In some instances, the comorbidity has a major impact on the choice of therapy.