Children with irritable bowel syndrome (IBS) may recover more successfully with reassurance than with medication, according to a study from Federico II University in Naples, Italy.

Of 83 children in this single-center observational study, 30 of the 48 children (62.8%) who reported symptom resolution were not put on medication, according to Eleonora Giannetti, MD, and her colleagues (J Pediatr. 2017 Jan 18. doi: 10.1016/j.jpeds.2016.12.036).

Zerbor/Thinkstock

[email protected]

On Twitter @EAZtweets

Children with irritable bowel syndrome (IBS) may recover more successfully with reassurance than with medication, according to a study from Federico II University in Naples, Italy.

Of 83 children in this single-center observational study, 30 of the 48 children (62.8%) who reported symptom resolution were not put on medication, according to Eleonora Giannetti, MD, and her colleagues (J Pediatr. 2017 Jan 18. doi: 10.1016/j.jpeds.2016.12.036).

Zerbor/Thinkstock

[email protected]

On Twitter @EAZtweets

Children with irritable bowel syndrome (IBS) may recover more successfully with reassurance than with medication, according to a study from Federico II University in Naples, Italy.

Of 83 children in this single-center observational study, 30 of the 48 children (62.8%) who reported symptom resolution were not put on medication, according to Eleonora Giannetti, MD, and her colleagues (J Pediatr. 2017 Jan 18. doi: 10.1016/j.jpeds.2016.12.036).

Zerbor/Thinkstock

[email protected]

On Twitter @EAZtweets

Also from PAGS 2016:

• Dr. Tommaso Falcone offers Top 3 things I learned at the PAGS 2016 symposium
• Visit PAGS

Also from PAGS 2016:

• Dr. Tommaso Falcone offers Top 3 things I learned at the PAGS 2016 symposium
• Visit PAGS

Also from PAGS 2016:

• Dr. Tommaso Falcone offers Top 3 things I learned at the PAGS 2016 symposium
• Visit PAGS

SNOWMASS, COLO. – If you thought biosimilars would bring sharply reduced pricing compared with their parent agents, with resultant greater patient access to highly effective therapies for rheumatic diseases ... think again.

“The promise to our patients of biosimilars – greater access to treatments – is something I think we’re just not going to see, at least not here in the U.S.,” Michael E. Weinblatt, MD, declared at the Winter Rheumatology Symposium sponsored by the American College of Rheumatology.

[email protected]
 

SNOWMASS, COLO. – If you thought biosimilars would bring sharply reduced pricing compared with their parent agents, with resultant greater patient access to highly effective therapies for rheumatic diseases ... think again.

“The promise to our patients of biosimilars – greater access to treatments – is something I think we’re just not going to see, at least not here in the U.S.,” Michael E. Weinblatt, MD, declared at the Winter Rheumatology Symposium sponsored by the American College of Rheumatology.

[email protected]
 

SNOWMASS, COLO. – If you thought biosimilars would bring sharply reduced pricing compared with their parent agents, with resultant greater patient access to highly effective therapies for rheumatic diseases ... think again.

“The promise to our patients of biosimilars – greater access to treatments – is something I think we’re just not going to see, at least not here in the U.S.,” Michael E. Weinblatt, MD, declared at the Winter Rheumatology Symposium sponsored by the American College of Rheumatology.

[email protected]
 

RIVIERA BEACH, FL—If a neurologist is at a sporting event during which a player sustains a head injury, audience members or officials may look to him or her for guidance, according to an overview delivered at the 44th Annual Meeting of the Southern Clinical Neurological Society. Understanding how to diagnose and manage concussion may be a vital skill for neurologists, regardless of specialty.

What Is Concussion?

Loss of consciousness previously was considered necessary for a diagnosis of concussion. Later, it was taken as a marker of serious injury. Neither of these principles is accepted any longer. Data indicate that at least 90% of concussions are not associated with loss of consciousness, and studies have not shown that loss of consciousness portends a worse prognosis or protracted recovery from the injury, said Dr. Kosa.

The pathophysiology of concussion is not certain. The current proposal is that concussion entails disruption of neuronal cell membranes resulting from disruption of normal ion channels (eg, calcium, potassium, and sodium), leading to a loss of normal neuronal homeostasis. This situation can cause a cascade of events, including mitochondrial dysfunction that causes neuronal energy failure, loss of normal glucose metabolism, activation of NMDA receptors from increased levels of glutamate, production of lactic acid, and generation of free radicals, all of which damage the neurons and supporting cells. Most cells survive the concussive injury, but can be functionally compromised. Severe injuries can lead to neuronal cell death.

What Are the Possible Sequelae of Concussion?

Concussion increases the risk of second impact syndrome, which can occur if the patient sustains another injury at between 24 hours and 10 days after a concussion. Research on second impact syndrome is limited, but the syndrome is understood to entail rapid and massive brain edema that leads to brain herniation and likely death or severe disability. The syndrome occurs within minutes of the second impact and is thought to be enabled by the period of vulnerability that follows an initial concussion. The syndrome occurs mostly in young patients, but has been described in boxers. For this reason, neurologists should be especially cautious when deciding whether to let a child with concussion return to play, said Dr. Kosa. The Centers for Disease Control and Prevention (CDC) estimate that second impact syndrome causes four to six deaths in patients under age 18 annually.

Concussion may be accompanied by traumatic brain injury (TBI). In 2010, the CDC reported 2.5 million hospital encounters related to TBI. Among these encounters, 87% of patients were treated in the emergency department and released, 11% were hospitalized and discharged, and 2% died. The highest incidence of TBI is in young children, and causes include sports accidents, bicycle accidents, skateboard accidents, vehicular accidents, and falls. The CDC estimates that between 3.2 million and 5.3 million people in the United States have permanent TBI-related disability, which results in great economic, physical, and emotional burdens.

Patients with repeated mild TBI may be at risk of chronic traumatic encephalopathy (CTE). This disorder has been described in football players, veterans, and boxers. Symptoms develop later in the patient’s life, and four stages have been described. The first stage includes headaches, inattention, and poor concentration. Stage two consists of significant mood disturbance with depression, along with explosive bouts of anger and short-term memory impairment. The third stage includes further cognitive or memory impairment that manifests as prominent executive dysfunction, where reasoning and organization or planning are most affected. In stage four, the patient has dementia; the cognitive and memory impairment has progressed to the point where the patient depends on others for activities of daily living.

McKee et al observed that CTE was associated with cerebral atrophy, mammillary body atrophy, dilation of the lateral ventricles, fenestrations of the septum pellucidum, and tau deposition. Researchers and clinicians, however, have not arrived at a consensus about the pathologic and clinical criteria for CTE. Furthermore, Cantu et al stated that it is not yet possible to determine the causality or risk factors of CTE with certainty. The hypothesis that repeated concussion or subconcussive impacts leads to the development of CTE has not been scientifically proven to date, they added.

What Should Be Done on the Field?

If a player at a sporting event sustains a head injury, he or she should be removed from play immediately and not allowed to return to the game. If he or she has not directly observed the injury, the neurologist should get information about it from witnesses. The neurologist should perform a focused physical examination, searching for evidence of decreased level of consciousness, confusion, focal weakness or incoordination, visual disturbance, cervical spine injury, or facial fractures. The Sport Concussion Assessment Tool (SCAT) can assist the clinician in concussion evaluation and treatment in a standardized and methodical way to determine whether and when a player can safely return to play.

A patient with an abnormal examination may need to be transferred to the local emergency department for further testing. CT imaging should not be performed automatically, because it may expose the patient to radiation unnecessarily. Two sets of criteria offer guidance about CT imaging. The New Orleans criteria state that a patient should undergo CT if he or she has a headache, has vomited, is older than 60, had been using alcohol or other drugs, had a seizure, has visible trauma above the clavicle, or has a short-term memory deficit. The Canadian CT Head Rule lists similar criteria, including a Glasgow Coma Scale score at two hours of less than 15, any sign of a basal skull fracture, and amnesia for events that took place 30 minutes before the injury.

Anticoagulants increase the risk of immediate or delayed hemorrhage after head injury. If a patient has intracranial hemorrhage on CT and has been using anticoagulants, the clinician should rapidly reverse the anticoagulant effect with the appropriate agent. A repeat head CT 24 hours later should be considered in those thought to be at high risk for intracranial hemorrhage and whose initial CT imaging is negative for bleed. “Err on the side of admitting these patients, at least for observation,” said Dr. Kosa. Before the patient is discharged from the emergency room, he or she should receive education about postconcussion symptoms that should prompt another visit to the emergency department. Educational materials are available on the CDC’s website.

When Can a Patient Return to Play?

The consensus statement on concussion in sport adopted at the Third International Conference on Concussion in Sport includes guidelines for graduated return to play. At first, the patient should undergo symptom-limited physical and cognitive rest until he or she recovers. Next, the patient may start light aerobic exercise such as walking, swimming, or cycling. The goal is to increase heart rate, but the patient should reduce activity if symptoms occur. Then, the patient may engage in sport-specific exercise. If recovery proceeds well, the patient may begin noncontact training drills and, later, full contact practice. Only when the patient has full confidence and coaching or training staff has assessed his or her functional skills can the athlete return to play.

What Concussion Research Is Under Way?

Investigations currently under way aim to improve understanding of concussion, as well as to aid diagnosis and treatment. Researchers are looking for a reliable biomarker of concussion that can be detected with an easy, cost-effective, and preferably noninvasive test. Saliva, tears, urine, blood, and CSF are among the candidate samples being studied. CSF is the most reliable fluid to test because of its proximity to the brain and its low susceptibility to extracerebral confounders, but it is the most invasive option. Groups are examining potential serum biomarkers such as S100b, neuron-specific enolase, myelin basic protein, glial fibrillary acidic protein, and cleaved tau.

In addition, McKee and colleagues are working to define clear pathologic criteria defining the various stages of CTE. They also are seeking a way of distinguishing CTE from Alzheimer’s disease, amyotrophic lateral sclerosis, and other neurodegenerative diseases in postmortem brain tissue. The group’s ultimate goal is to identify features that may assist in the diagnosis of CTE in living people using advanced neuroimaging.

—Erik Greb

Suggested Reading

Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257.

McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport--the 3rd International Conference on concussion in sport, held in Zurich, November 2008. J Clin Neurosci. 2009;16(6):755-763.

Omalu BI, Hamilton RL, Kamboh MI, et al. Chronic traumatic encephalopathy (CTE) in a National Football League Player: Case report and emerging medicolegal practice questions. J Forensic Nurs. 2010;6(1):40-46.

RIVIERA BEACH, FL—If a neurologist is at a sporting event during which a player sustains a head injury, audience members or officials may look to him or her for guidance, according to an overview delivered at the 44th Annual Meeting of the Southern Clinical Neurological Society. Understanding how to diagnose and manage concussion may be a vital skill for neurologists, regardless of specialty.

What Is Concussion?

Loss of consciousness previously was considered necessary for a diagnosis of concussion. Later, it was taken as a marker of serious injury. Neither of these principles is accepted any longer. Data indicate that at least 90% of concussions are not associated with loss of consciousness, and studies have not shown that loss of consciousness portends a worse prognosis or protracted recovery from the injury, said Dr. Kosa.

The pathophysiology of concussion is not certain. The current proposal is that concussion entails disruption of neuronal cell membranes resulting from disruption of normal ion channels (eg, calcium, potassium, and sodium), leading to a loss of normal neuronal homeostasis. This situation can cause a cascade of events, including mitochondrial dysfunction that causes neuronal energy failure, loss of normal glucose metabolism, activation of NMDA receptors from increased levels of glutamate, production of lactic acid, and generation of free radicals, all of which damage the neurons and supporting cells. Most cells survive the concussive injury, but can be functionally compromised. Severe injuries can lead to neuronal cell death.

What Are the Possible Sequelae of Concussion?

Concussion increases the risk of second impact syndrome, which can occur if the patient sustains another injury at between 24 hours and 10 days after a concussion. Research on second impact syndrome is limited, but the syndrome is understood to entail rapid and massive brain edema that leads to brain herniation and likely death or severe disability. The syndrome occurs within minutes of the second impact and is thought to be enabled by the period of vulnerability that follows an initial concussion. The syndrome occurs mostly in young patients, but has been described in boxers. For this reason, neurologists should be especially cautious when deciding whether to let a child with concussion return to play, said Dr. Kosa. The Centers for Disease Control and Prevention (CDC) estimate that second impact syndrome causes four to six deaths in patients under age 18 annually.

Concussion may be accompanied by traumatic brain injury (TBI). In 2010, the CDC reported 2.5 million hospital encounters related to TBI. Among these encounters, 87% of patients were treated in the emergency department and released, 11% were hospitalized and discharged, and 2% died. The highest incidence of TBI is in young children, and causes include sports accidents, bicycle accidents, skateboard accidents, vehicular accidents, and falls. The CDC estimates that between 3.2 million and 5.3 million people in the United States have permanent TBI-related disability, which results in great economic, physical, and emotional burdens.

Patients with repeated mild TBI may be at risk of chronic traumatic encephalopathy (CTE). This disorder has been described in football players, veterans, and boxers. Symptoms develop later in the patient’s life, and four stages have been described. The first stage includes headaches, inattention, and poor concentration. Stage two consists of significant mood disturbance with depression, along with explosive bouts of anger and short-term memory impairment. The third stage includes further cognitive or memory impairment that manifests as prominent executive dysfunction, where reasoning and organization or planning are most affected. In stage four, the patient has dementia; the cognitive and memory impairment has progressed to the point where the patient depends on others for activities of daily living.

McKee et al observed that CTE was associated with cerebral atrophy, mammillary body atrophy, dilation of the lateral ventricles, fenestrations of the septum pellucidum, and tau deposition. Researchers and clinicians, however, have not arrived at a consensus about the pathologic and clinical criteria for CTE. Furthermore, Cantu et al stated that it is not yet possible to determine the causality or risk factors of CTE with certainty. The hypothesis that repeated concussion or subconcussive impacts leads to the development of CTE has not been scientifically proven to date, they added.

What Should Be Done on the Field?

If a player at a sporting event sustains a head injury, he or she should be removed from play immediately and not allowed to return to the game. If he or she has not directly observed the injury, the neurologist should get information about it from witnesses. The neurologist should perform a focused physical examination, searching for evidence of decreased level of consciousness, confusion, focal weakness or incoordination, visual disturbance, cervical spine injury, or facial fractures. The Sport Concussion Assessment Tool (SCAT) can assist the clinician in concussion evaluation and treatment in a standardized and methodical way to determine whether and when a player can safely return to play.

A patient with an abnormal examination may need to be transferred to the local emergency department for further testing. CT imaging should not be performed automatically, because it may expose the patient to radiation unnecessarily. Two sets of criteria offer guidance about CT imaging. The New Orleans criteria state that a patient should undergo CT if he or she has a headache, has vomited, is older than 60, had been using alcohol or other drugs, had a seizure, has visible trauma above the clavicle, or has a short-term memory deficit. The Canadian CT Head Rule lists similar criteria, including a Glasgow Coma Scale score at two hours of less than 15, any sign of a basal skull fracture, and amnesia for events that took place 30 minutes before the injury.

Anticoagulants increase the risk of immediate or delayed hemorrhage after head injury. If a patient has intracranial hemorrhage on CT and has been using anticoagulants, the clinician should rapidly reverse the anticoagulant effect with the appropriate agent. A repeat head CT 24 hours later should be considered in those thought to be at high risk for intracranial hemorrhage and whose initial CT imaging is negative for bleed. “Err on the side of admitting these patients, at least for observation,” said Dr. Kosa. Before the patient is discharged from the emergency room, he or she should receive education about postconcussion symptoms that should prompt another visit to the emergency department. Educational materials are available on the CDC’s website.

When Can a Patient Return to Play?

The consensus statement on concussion in sport adopted at the Third International Conference on Concussion in Sport includes guidelines for graduated return to play. At first, the patient should undergo symptom-limited physical and cognitive rest until he or she recovers. Next, the patient may start light aerobic exercise such as walking, swimming, or cycling. The goal is to increase heart rate, but the patient should reduce activity if symptoms occur. Then, the patient may engage in sport-specific exercise. If recovery proceeds well, the patient may begin noncontact training drills and, later, full contact practice. Only when the patient has full confidence and coaching or training staff has assessed his or her functional skills can the athlete return to play.

What Concussion Research Is Under Way?

Investigations currently under way aim to improve understanding of concussion, as well as to aid diagnosis and treatment. Researchers are looking for a reliable biomarker of concussion that can be detected with an easy, cost-effective, and preferably noninvasive test. Saliva, tears, urine, blood, and CSF are among the candidate samples being studied. CSF is the most reliable fluid to test because of its proximity to the brain and its low susceptibility to extracerebral confounders, but it is the most invasive option. Groups are examining potential serum biomarkers such as S100b, neuron-specific enolase, myelin basic protein, glial fibrillary acidic protein, and cleaved tau.

In addition, McKee and colleagues are working to define clear pathologic criteria defining the various stages of CTE. They also are seeking a way of distinguishing CTE from Alzheimer’s disease, amyotrophic lateral sclerosis, and other neurodegenerative diseases in postmortem brain tissue. The group’s ultimate goal is to identify features that may assist in the diagnosis of CTE in living people using advanced neuroimaging.

—Erik Greb

Suggested Reading

Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257.

McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport--the 3rd International Conference on concussion in sport, held in Zurich, November 2008. J Clin Neurosci. 2009;16(6):755-763.

Omalu BI, Hamilton RL, Kamboh MI, et al. Chronic traumatic encephalopathy (CTE) in a National Football League Player: Case report and emerging medicolegal practice questions. J Forensic Nurs. 2010;6(1):40-46.

RIVIERA BEACH, FL—If a neurologist is at a sporting event during which a player sustains a head injury, audience members or officials may look to him or her for guidance, according to an overview delivered at the 44th Annual Meeting of the Southern Clinical Neurological Society. Understanding how to diagnose and manage concussion may be a vital skill for neurologists, regardless of specialty.

What Is Concussion?

Loss of consciousness previously was considered necessary for a diagnosis of concussion. Later, it was taken as a marker of serious injury. Neither of these principles is accepted any longer. Data indicate that at least 90% of concussions are not associated with loss of consciousness, and studies have not shown that loss of consciousness portends a worse prognosis or protracted recovery from the injury, said Dr. Kosa.

The pathophysiology of concussion is not certain. The current proposal is that concussion entails disruption of neuronal cell membranes resulting from disruption of normal ion channels (eg, calcium, potassium, and sodium), leading to a loss of normal neuronal homeostasis. This situation can cause a cascade of events, including mitochondrial dysfunction that causes neuronal energy failure, loss of normal glucose metabolism, activation of NMDA receptors from increased levels of glutamate, production of lactic acid, and generation of free radicals, all of which damage the neurons and supporting cells. Most cells survive the concussive injury, but can be functionally compromised. Severe injuries can lead to neuronal cell death.

What Are the Possible Sequelae of Concussion?

Concussion increases the risk of second impact syndrome, which can occur if the patient sustains another injury at between 24 hours and 10 days after a concussion. Research on second impact syndrome is limited, but the syndrome is understood to entail rapid and massive brain edema that leads to brain herniation and likely death or severe disability. The syndrome occurs within minutes of the second impact and is thought to be enabled by the period of vulnerability that follows an initial concussion. The syndrome occurs mostly in young patients, but has been described in boxers. For this reason, neurologists should be especially cautious when deciding whether to let a child with concussion return to play, said Dr. Kosa. The Centers for Disease Control and Prevention (CDC) estimate that second impact syndrome causes four to six deaths in patients under age 18 annually.

Concussion may be accompanied by traumatic brain injury (TBI). In 2010, the CDC reported 2.5 million hospital encounters related to TBI. Among these encounters, 87% of patients were treated in the emergency department and released, 11% were hospitalized and discharged, and 2% died. The highest incidence of TBI is in young children, and causes include sports accidents, bicycle accidents, skateboard accidents, vehicular accidents, and falls. The CDC estimates that between 3.2 million and 5.3 million people in the United States have permanent TBI-related disability, which results in great economic, physical, and emotional burdens.

Patients with repeated mild TBI may be at risk of chronic traumatic encephalopathy (CTE). This disorder has been described in football players, veterans, and boxers. Symptoms develop later in the patient’s life, and four stages have been described. The first stage includes headaches, inattention, and poor concentration. Stage two consists of significant mood disturbance with depression, along with explosive bouts of anger and short-term memory impairment. The third stage includes further cognitive or memory impairment that manifests as prominent executive dysfunction, where reasoning and organization or planning are most affected. In stage four, the patient has dementia; the cognitive and memory impairment has progressed to the point where the patient depends on others for activities of daily living.

McKee et al observed that CTE was associated with cerebral atrophy, mammillary body atrophy, dilation of the lateral ventricles, fenestrations of the septum pellucidum, and tau deposition. Researchers and clinicians, however, have not arrived at a consensus about the pathologic and clinical criteria for CTE. Furthermore, Cantu et al stated that it is not yet possible to determine the causality or risk factors of CTE with certainty. The hypothesis that repeated concussion or subconcussive impacts leads to the development of CTE has not been scientifically proven to date, they added.

What Should Be Done on the Field?

If a player at a sporting event sustains a head injury, he or she should be removed from play immediately and not allowed to return to the game. If he or she has not directly observed the injury, the neurologist should get information about it from witnesses. The neurologist should perform a focused physical examination, searching for evidence of decreased level of consciousness, confusion, focal weakness or incoordination, visual disturbance, cervical spine injury, or facial fractures. The Sport Concussion Assessment Tool (SCAT) can assist the clinician in concussion evaluation and treatment in a standardized and methodical way to determine whether and when a player can safely return to play.

A patient with an abnormal examination may need to be transferred to the local emergency department for further testing. CT imaging should not be performed automatically, because it may expose the patient to radiation unnecessarily. Two sets of criteria offer guidance about CT imaging. The New Orleans criteria state that a patient should undergo CT if he or she has a headache, has vomited, is older than 60, had been using alcohol or other drugs, had a seizure, has visible trauma above the clavicle, or has a short-term memory deficit. The Canadian CT Head Rule lists similar criteria, including a Glasgow Coma Scale score at two hours of less than 15, any sign of a basal skull fracture, and amnesia for events that took place 30 minutes before the injury.

Anticoagulants increase the risk of immediate or delayed hemorrhage after head injury. If a patient has intracranial hemorrhage on CT and has been using anticoagulants, the clinician should rapidly reverse the anticoagulant effect with the appropriate agent. A repeat head CT 24 hours later should be considered in those thought to be at high risk for intracranial hemorrhage and whose initial CT imaging is negative for bleed. “Err on the side of admitting these patients, at least for observation,” said Dr. Kosa. Before the patient is discharged from the emergency room, he or she should receive education about postconcussion symptoms that should prompt another visit to the emergency department. Educational materials are available on the CDC’s website.

When Can a Patient Return to Play?

The consensus statement on concussion in sport adopted at the Third International Conference on Concussion in Sport includes guidelines for graduated return to play. At first, the patient should undergo symptom-limited physical and cognitive rest until he or she recovers. Next, the patient may start light aerobic exercise such as walking, swimming, or cycling. The goal is to increase heart rate, but the patient should reduce activity if symptoms occur. Then, the patient may engage in sport-specific exercise. If recovery proceeds well, the patient may begin noncontact training drills and, later, full contact practice. Only when the patient has full confidence and coaching or training staff has assessed his or her functional skills can the athlete return to play.

What Concussion Research Is Under Way?

Investigations currently under way aim to improve understanding of concussion, as well as to aid diagnosis and treatment. Researchers are looking for a reliable biomarker of concussion that can be detected with an easy, cost-effective, and preferably noninvasive test. Saliva, tears, urine, blood, and CSF are among the candidate samples being studied. CSF is the most reliable fluid to test because of its proximity to the brain and its low susceptibility to extracerebral confounders, but it is the most invasive option. Groups are examining potential serum biomarkers such as S100b, neuron-specific enolase, myelin basic protein, glial fibrillary acidic protein, and cleaved tau.

In addition, McKee and colleagues are working to define clear pathologic criteria defining the various stages of CTE. They also are seeking a way of distinguishing CTE from Alzheimer’s disease, amyotrophic lateral sclerosis, and other neurodegenerative diseases in postmortem brain tissue. The group’s ultimate goal is to identify features that may assist in the diagnosis of CTE in living people using advanced neuroimaging.

—Erik Greb

Suggested Reading

Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257.

McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport--the 3rd International Conference on concussion in sport, held in Zurich, November 2008. J Clin Neurosci. 2009;16(6):755-763.

Omalu BI, Hamilton RL, Kamboh MI, et al. Chronic traumatic encephalopathy (CTE) in a National Football League Player: Case report and emerging medicolegal practice questions. J Forensic Nurs. 2010;6(1):40-46.

SNOWMASS, COLO. – Dactylitis is a common and painful extra-articular manifestation of psoriatic arthritis that takes on added clinical significance because it’s also a marker of greater disease severity, Christopher T. Ritchlin, MD, said at the Winter Rheumatology Symposium sponsored by the American College of Rheumatology.

Indeed, psoriatic arthritis (PsA) patients with dactylitis are more likely to have polyarticular disease and radiologic evidence of bony damage, noted Dr. Ritchlin, professor of medicine and chief of the allergy, immunology, and rheumatology division at the University of Rochester (N.Y.).

Bruce Jancin/Frontline Medical News

Enthesitis

Enthesitis, another cardinal extra-articular manifestation of PsA, is defined by inflammation at the sites where tendons, ligaments, and joint capsules attach into bone. The most commonly involved sites are the Achilles tendon and plantar fascia.

“It can also involve a lot of other areas and can lead to misdiagnosis as a result. Many of these patients end up in rheumatologists’ offices with previous diagnoses ranging from fibromyalgia or other chronic pain syndromes to malingering,” Dr. Ritchlin said.

Sites to examine for enthesitis, in addition to the foot and Achilles tendon, include the patellar and quadriceps tendons, iliac crest, greater trochanter, lateral epicondyle, the small joints of the hands, and the supraspinatus tendon.

“We have a registry of several hundred psoriatic arthritis patients, and I’ve been struck by the amount of enthesopathy when we examine these points,” the rheumatologist observed.

Enthesitis is a prominent feature of both early and established PsA. Power Doppler ultrasound is more sensitive than radiographs at identifying it. Italian investigators have shown ultrasound to be useful in the differential diagnosis between early rheumatoid arthritis and early PsA in patients with hand involvement. They assessed 52 clinically involved joints in 26 patients with early PsA and 68 involved joints in 34 early-RA patients. Synovitis was detected in 91% of the joints of the RA patients, compared with only 60% of the PsA patients’ joints.

In contrast, soft tissue edema was present in 42% of the most clinically involved fingers of the early PsA patients, compared with just 3% in those with early RA. Central slip enthesitis was seen in 21% of the clinically involved proximal interphalangeal joints of the PsA patients but in none of those belonging to patients with early RA. Peritendon inflammation of the extensor digitorum tendon was noted in 54% of the joints of the PsA group, compared with less than 3% of the early RA group (Clin Exp Rheumatol. 2016 May-Jun;34[3]:459-65).

“Basically, if you do ultrasound, you see there is significantly more enthesitis in early psoriatic arthritis than early rheumatoid arthritis, which has certainly been our experience as well,” Dr. Ritchlin commented.

Enthesitis is not as simple a disease process as most physicians were taught in training. Dr. Ritchlin credits Dennis McGonagle, MD, of the University of Leeds (England) with introducing the now-accepted concept of a synovio-entheseal complex as being a key player in the expression of PsA (Arthritis Rheum. 2007 Aug;56[8]:2482-91).

“The old idea is that the enthesis inserts onto bone and that’s where the pathology is. But it’s more complicated than that,” Dr. Ritchlin explained.

Dr. McGonagle and his coworkers showed that fibrocartilagenous entheses attach to bone much more deeply than previously recognized, like a tree with deep roots. That makes for lots of intimate contact between bony cells and vascular channels. And key structures are located near the intersection of enthesis and bone, including bursae and synovial membrane. For example, the Achilles tendon synovio-entheseal complex includes sesamoid fibrocartilage, periosteal fibrocartilage, the retrocalcaneal bursa, subchondral bone, and enthesis fibrocartilage, as well as the tendon itself.

Dr. McGonagle and coworkers argued that the pathogenesis of tissue inflammation and damage in PsA involves biomechanical stress, with resultant synovial inflammation accompanied by the release of inflammatory cytokines, which in turn leads to diffuse inflammation in and around the area where the enthesis inserts.

“The purpose of the enthesis is to distribute force away from the area where the tendon inserts into bone. So when biomechanical stress pulls on that tendon, other adjacent areas are also affected. What’s come out from imaging studies is that there’s synovial inflammation, bursitis, and also inflammation in and around the fibrocartilage in areas of enthesitis,” Dr. Ritchlin said.

He reported serving as a consultant to half a dozen pharmaceutical companies.

[email protected]

SNOWMASS, COLO. – Dactylitis is a common and painful extra-articular manifestation of psoriatic arthritis that takes on added clinical significance because it’s also a marker of greater disease severity, Christopher T. Ritchlin, MD, said at the Winter Rheumatology Symposium sponsored by the American College of Rheumatology.

Indeed, psoriatic arthritis (PsA) patients with dactylitis are more likely to have polyarticular disease and radiologic evidence of bony damage, noted Dr. Ritchlin, professor of medicine and chief of the allergy, immunology, and rheumatology division at the University of Rochester (N.Y.).

Bruce Jancin/Frontline Medical News

Enthesitis

Enthesitis, another cardinal extra-articular manifestation of PsA, is defined by inflammation at the sites where tendons, ligaments, and joint capsules attach into bone. The most commonly involved sites are the Achilles tendon and plantar fascia.

“It can also involve a lot of other areas and can lead to misdiagnosis as a result. Many of these patients end up in rheumatologists’ offices with previous diagnoses ranging from fibromyalgia or other chronic pain syndromes to malingering,” Dr. Ritchlin said.

Sites to examine for enthesitis, in addition to the foot and Achilles tendon, include the patellar and quadriceps tendons, iliac crest, greater trochanter, lateral epicondyle, the small joints of the hands, and the supraspinatus tendon.

“We have a registry of several hundred psoriatic arthritis patients, and I’ve been struck by the amount of enthesopathy when we examine these points,” the rheumatologist observed.

Enthesitis is a prominent feature of both early and established PsA. Power Doppler ultrasound is more sensitive than radiographs at identifying it. Italian investigators have shown ultrasound to be useful in the differential diagnosis between early rheumatoid arthritis and early PsA in patients with hand involvement. They assessed 52 clinically involved joints in 26 patients with early PsA and 68 involved joints in 34 early-RA patients. Synovitis was detected in 91% of the joints of the RA patients, compared with only 60% of the PsA patients’ joints.

In contrast, soft tissue edema was present in 42% of the most clinically involved fingers of the early PsA patients, compared with just 3% in those with early RA. Central slip enthesitis was seen in 21% of the clinically involved proximal interphalangeal joints of the PsA patients but in none of those belonging to patients with early RA. Peritendon inflammation of the extensor digitorum tendon was noted in 54% of the joints of the PsA group, compared with less than 3% of the early RA group (Clin Exp Rheumatol. 2016 May-Jun;34[3]:459-65).

“Basically, if you do ultrasound, you see there is significantly more enthesitis in early psoriatic arthritis than early rheumatoid arthritis, which has certainly been our experience as well,” Dr. Ritchlin commented.

Enthesitis is not as simple a disease process as most physicians were taught in training. Dr. Ritchlin credits Dennis McGonagle, MD, of the University of Leeds (England) with introducing the now-accepted concept of a synovio-entheseal complex as being a key player in the expression of PsA (Arthritis Rheum. 2007 Aug;56[8]:2482-91).

“The old idea is that the enthesis inserts onto bone and that’s where the pathology is. But it’s more complicated than that,” Dr. Ritchlin explained.

Dr. McGonagle and his coworkers showed that fibrocartilagenous entheses attach to bone much more deeply than previously recognized, like a tree with deep roots. That makes for lots of intimate contact between bony cells and vascular channels. And key structures are located near the intersection of enthesis and bone, including bursae and synovial membrane. For example, the Achilles tendon synovio-entheseal complex includes sesamoid fibrocartilage, periosteal fibrocartilage, the retrocalcaneal bursa, subchondral bone, and enthesis fibrocartilage, as well as the tendon itself.

Dr. McGonagle and coworkers argued that the pathogenesis of tissue inflammation and damage in PsA involves biomechanical stress, with resultant synovial inflammation accompanied by the release of inflammatory cytokines, which in turn leads to diffuse inflammation in and around the area where the enthesis inserts.

“The purpose of the enthesis is to distribute force away from the area where the tendon inserts into bone. So when biomechanical stress pulls on that tendon, other adjacent areas are also affected. What’s come out from imaging studies is that there’s synovial inflammation, bursitis, and also inflammation in and around the fibrocartilage in areas of enthesitis,” Dr. Ritchlin said.

He reported serving as a consultant to half a dozen pharmaceutical companies.

[email protected]

SNOWMASS, COLO. – Dactylitis is a common and painful extra-articular manifestation of psoriatic arthritis that takes on added clinical significance because it’s also a marker of greater disease severity, Christopher T. Ritchlin, MD, said at the Winter Rheumatology Symposium sponsored by the American College of Rheumatology.

Indeed, psoriatic arthritis (PsA) patients with dactylitis are more likely to have polyarticular disease and radiologic evidence of bony damage, noted Dr. Ritchlin, professor of medicine and chief of the allergy, immunology, and rheumatology division at the University of Rochester (N.Y.).

Bruce Jancin/Frontline Medical News

Enthesitis

Enthesitis, another cardinal extra-articular manifestation of PsA, is defined by inflammation at the sites where tendons, ligaments, and joint capsules attach into bone. The most commonly involved sites are the Achilles tendon and plantar fascia.

“It can also involve a lot of other areas and can lead to misdiagnosis as a result. Many of these patients end up in rheumatologists’ offices with previous diagnoses ranging from fibromyalgia or other chronic pain syndromes to malingering,” Dr. Ritchlin said.

Sites to examine for enthesitis, in addition to the foot and Achilles tendon, include the patellar and quadriceps tendons, iliac crest, greater trochanter, lateral epicondyle, the small joints of the hands, and the supraspinatus tendon.

“We have a registry of several hundred psoriatic arthritis patients, and I’ve been struck by the amount of enthesopathy when we examine these points,” the rheumatologist observed.

Enthesitis is a prominent feature of both early and established PsA. Power Doppler ultrasound is more sensitive than radiographs at identifying it. Italian investigators have shown ultrasound to be useful in the differential diagnosis between early rheumatoid arthritis and early PsA in patients with hand involvement. They assessed 52 clinically involved joints in 26 patients with early PsA and 68 involved joints in 34 early-RA patients. Synovitis was detected in 91% of the joints of the RA patients, compared with only 60% of the PsA patients’ joints.

In contrast, soft tissue edema was present in 42% of the most clinically involved fingers of the early PsA patients, compared with just 3% in those with early RA. Central slip enthesitis was seen in 21% of the clinically involved proximal interphalangeal joints of the PsA patients but in none of those belonging to patients with early RA. Peritendon inflammation of the extensor digitorum tendon was noted in 54% of the joints of the PsA group, compared with less than 3% of the early RA group (Clin Exp Rheumatol. 2016 May-Jun;34[3]:459-65).

“Basically, if you do ultrasound, you see there is significantly more enthesitis in early psoriatic arthritis than early rheumatoid arthritis, which has certainly been our experience as well,” Dr. Ritchlin commented.

Enthesitis is not as simple a disease process as most physicians were taught in training. Dr. Ritchlin credits Dennis McGonagle, MD, of the University of Leeds (England) with introducing the now-accepted concept of a synovio-entheseal complex as being a key player in the expression of PsA (Arthritis Rheum. 2007 Aug;56[8]:2482-91).

“The old idea is that the enthesis inserts onto bone and that’s where the pathology is. But it’s more complicated than that,” Dr. Ritchlin explained.

Dr. McGonagle and his coworkers showed that fibrocartilagenous entheses attach to bone much more deeply than previously recognized, like a tree with deep roots. That makes for lots of intimate contact between bony cells and vascular channels. And key structures are located near the intersection of enthesis and bone, including bursae and synovial membrane. For example, the Achilles tendon synovio-entheseal complex includes sesamoid fibrocartilage, periosteal fibrocartilage, the retrocalcaneal bursa, subchondral bone, and enthesis fibrocartilage, as well as the tendon itself.

Dr. McGonagle and coworkers argued that the pathogenesis of tissue inflammation and damage in PsA involves biomechanical stress, with resultant synovial inflammation accompanied by the release of inflammatory cytokines, which in turn leads to diffuse inflammation in and around the area where the enthesis inserts.

“The purpose of the enthesis is to distribute force away from the area where the tendon inserts into bone. So when biomechanical stress pulls on that tendon, other adjacent areas are also affected. What’s come out from imaging studies is that there’s synovial inflammation, bursitis, and also inflammation in and around the fibrocartilage in areas of enthesitis,” Dr. Ritchlin said.

He reported serving as a consultant to half a dozen pharmaceutical companies.

[email protected]

Prophylactic corticosteroids before elective extubation could significantly reduce postextubation stridor and the incidence of reintubation, particularly in patients at high risk of airway obstruction, suggests a systematic review and meta-analysis.

While current guidelines for the management of tracheal extubation call for prophylactic use of corticosteroids in patients with airway compromise, Akira Kuriyama, MD, of Kurashiki Central Hospital in Japan, and coauthors noted that there is an outstanding question as to which patients are most likely to benefit.

Writing in the February 20 online edition of Chest, they reported on an analysis of 11 randomized, controlled trials of prophylactic corticosteroids given before elective extubation, involving 2,472 participants (Chest 2017 Feb 20. doi: 10.1016/j.chest.2017.02.017).

They found that the use of prophylactic corticosteroids was associated with a significant 57% reduction in the incidence of postextubation airway obstruction, laryngeal edema, or stridor, and a 58% reduction in reintubation rates, compared with placebo or no treatment.

A subgroup analysis showed that the benefit in reduction of postextubation airway events was evident only in the six trials that selected patients at high risk of airway obstruction, identified by a cuff-leak test (RR = 0.34), and was not seen in trials with an unselected patient population. Similarly, the reduced incidence of reintubation was evident in trials of high-risk individuals (RR = 0.35) but not in the general patient population.

The authors noted that while the latest systematic reviews had shown that corticosteroids reduce the incidence of postextubation stridor and reintubation, only one review examined the efficacy in high-risk populations and even then, it was a pooled subgroup analysis of only three trials.

“The numbers needed to prevent one episode of postextubation airway events and reintubation in individuals at high risk for postextubation airway obstruction were 5 (95%; CI: 4-7) and 16 (95%; CI: 8-166) respectively,” they wrote, noting that routine administration of corticosteroids before elective extubation is not recommended.

“While the use of prophylactic corticosteroids was associated with few adverse events, it is reasonable to use the cuff-leak test as a screening method, and administer prophylactic steroids only to those who are at risk of developing postextubation obstruction, given our study findings.”

Two of the six trials that identified high-risk individuals used a cuff-leak volume less than 24% of tidal volume during inflation, three used a cuff-leak volume of less than 110 mL, and one used a cuff-leak volume less than 25% of tidal volume.

“This potentially indicates that cuff-leak testing, while applied with varying cut-off values, might be able to select those at similar risk for airway obstruction and underlines the importance of screening for high-risk patients,” the authors said.

Researchers also noted that the longer patients were intubated, the lower the effect size of prophylactic corticosteroids on both postexutubation airway events and reintubation.

“Patients thus tended to benefit from prophylactic corticosteroids to prevent postextubation airway events and subsequent reintubation when the duration of mechanical ventilation was short,” they wrote.

The authors noted that the included trials did differ in terms of populations, corticosteroid protocols, and observation periods. However, they pointed out that the statistical heterogeneity in their primary outcome analysis was due to the risk of postextubation airway obstruction.

No conflicts of interest were declared.

Prophylactic corticosteroids before elective extubation could significantly reduce postextubation stridor and the incidence of reintubation, particularly in patients at high risk of airway obstruction, suggests a systematic review and meta-analysis.

While current guidelines for the management of tracheal extubation call for prophylactic use of corticosteroids in patients with airway compromise, Akira Kuriyama, MD, of Kurashiki Central Hospital in Japan, and coauthors noted that there is an outstanding question as to which patients are most likely to benefit.

Writing in the February 20 online edition of Chest, they reported on an analysis of 11 randomized, controlled trials of prophylactic corticosteroids given before elective extubation, involving 2,472 participants (Chest 2017 Feb 20. doi: 10.1016/j.chest.2017.02.017).

They found that the use of prophylactic corticosteroids was associated with a significant 57% reduction in the incidence of postextubation airway obstruction, laryngeal edema, or stridor, and a 58% reduction in reintubation rates, compared with placebo or no treatment.

A subgroup analysis showed that the benefit in reduction of postextubation airway events was evident only in the six trials that selected patients at high risk of airway obstruction, identified by a cuff-leak test (RR = 0.34), and was not seen in trials with an unselected patient population. Similarly, the reduced incidence of reintubation was evident in trials of high-risk individuals (RR = 0.35) but not in the general patient population.

The authors noted that while the latest systematic reviews had shown that corticosteroids reduce the incidence of postextubation stridor and reintubation, only one review examined the efficacy in high-risk populations and even then, it was a pooled subgroup analysis of only three trials.

“The numbers needed to prevent one episode of postextubation airway events and reintubation in individuals at high risk for postextubation airway obstruction were 5 (95%; CI: 4-7) and 16 (95%; CI: 8-166) respectively,” they wrote, noting that routine administration of corticosteroids before elective extubation is not recommended.

“While the use of prophylactic corticosteroids was associated with few adverse events, it is reasonable to use the cuff-leak test as a screening method, and administer prophylactic steroids only to those who are at risk of developing postextubation obstruction, given our study findings.”

Two of the six trials that identified high-risk individuals used a cuff-leak volume less than 24% of tidal volume during inflation, three used a cuff-leak volume of less than 110 mL, and one used a cuff-leak volume less than 25% of tidal volume.

“This potentially indicates that cuff-leak testing, while applied with varying cut-off values, might be able to select those at similar risk for airway obstruction and underlines the importance of screening for high-risk patients,” the authors said.

Researchers also noted that the longer patients were intubated, the lower the effect size of prophylactic corticosteroids on both postexutubation airway events and reintubation.

“Patients thus tended to benefit from prophylactic corticosteroids to prevent postextubation airway events and subsequent reintubation when the duration of mechanical ventilation was short,” they wrote.

The authors noted that the included trials did differ in terms of populations, corticosteroid protocols, and observation periods. However, they pointed out that the statistical heterogeneity in their primary outcome analysis was due to the risk of postextubation airway obstruction.

No conflicts of interest were declared.

Prophylactic corticosteroids before elective extubation could significantly reduce postextubation stridor and the incidence of reintubation, particularly in patients at high risk of airway obstruction, suggests a systematic review and meta-analysis.

While current guidelines for the management of tracheal extubation call for prophylactic use of corticosteroids in patients with airway compromise, Akira Kuriyama, MD, of Kurashiki Central Hospital in Japan, and coauthors noted that there is an outstanding question as to which patients are most likely to benefit.

Writing in the February 20 online edition of Chest, they reported on an analysis of 11 randomized, controlled trials of prophylactic corticosteroids given before elective extubation, involving 2,472 participants (Chest 2017 Feb 20. doi: 10.1016/j.chest.2017.02.017).

They found that the use of prophylactic corticosteroids was associated with a significant 57% reduction in the incidence of postextubation airway obstruction, laryngeal edema, or stridor, and a 58% reduction in reintubation rates, compared with placebo or no treatment.

A subgroup analysis showed that the benefit in reduction of postextubation airway events was evident only in the six trials that selected patients at high risk of airway obstruction, identified by a cuff-leak test (RR = 0.34), and was not seen in trials with an unselected patient population. Similarly, the reduced incidence of reintubation was evident in trials of high-risk individuals (RR = 0.35) but not in the general patient population.

The authors noted that while the latest systematic reviews had shown that corticosteroids reduce the incidence of postextubation stridor and reintubation, only one review examined the efficacy in high-risk populations and even then, it was a pooled subgroup analysis of only three trials.

“The numbers needed to prevent one episode of postextubation airway events and reintubation in individuals at high risk for postextubation airway obstruction were 5 (95%; CI: 4-7) and 16 (95%; CI: 8-166) respectively,” they wrote, noting that routine administration of corticosteroids before elective extubation is not recommended.

“While the use of prophylactic corticosteroids was associated with few adverse events, it is reasonable to use the cuff-leak test as a screening method, and administer prophylactic steroids only to those who are at risk of developing postextubation obstruction, given our study findings.”

Two of the six trials that identified high-risk individuals used a cuff-leak volume less than 24% of tidal volume during inflation, three used a cuff-leak volume of less than 110 mL, and one used a cuff-leak volume less than 25% of tidal volume.

“This potentially indicates that cuff-leak testing, while applied with varying cut-off values, might be able to select those at similar risk for airway obstruction and underlines the importance of screening for high-risk patients,” the authors said.

Researchers also noted that the longer patients were intubated, the lower the effect size of prophylactic corticosteroids on both postexutubation airway events and reintubation.

“Patients thus tended to benefit from prophylactic corticosteroids to prevent postextubation airway events and subsequent reintubation when the duration of mechanical ventilation was short,” they wrote.

The authors noted that the included trials did differ in terms of populations, corticosteroid protocols, and observation periods. However, they pointed out that the statistical heterogeneity in their primary outcome analysis was due to the risk of postextubation airway obstruction.

No conflicts of interest were declared.

LAS VEGAS – A brief sexual history should be part of the first patient visit, according to Anita H. Clayton, MD. However, addressing sexual health can prove challenging, especially if the patient is experiencing difficulty in that aspect of life.

“In America, we don’t talk about sex in a serious kind of way,” Dr. Clayton said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “If people are talking about sex they’re either bragging or lying.”

[email protected]

LAS VEGAS – A brief sexual history should be part of the first patient visit, according to Anita H. Clayton, MD. However, addressing sexual health can prove challenging, especially if the patient is experiencing difficulty in that aspect of life.

“In America, we don’t talk about sex in a serious kind of way,” Dr. Clayton said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “If people are talking about sex they’re either bragging or lying.”

[email protected]

LAS VEGAS – A brief sexual history should be part of the first patient visit, according to Anita H. Clayton, MD. However, addressing sexual health can prove challenging, especially if the patient is experiencing difficulty in that aspect of life.

“In America, we don’t talk about sex in a serious kind of way,” Dr. Clayton said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “If people are talking about sex they’re either bragging or lying.”

[email protected]

Nearly half of advanced Parkinson’s disease patients who receive treatment with subthalamic deep brain stimulation or levodopa-carbidopa intestinal gel infusion are affected by dysautonomia that has significant impacts on their daily lives, according to findings from a cross-sectional study.

“We suggest that identifying and managing autonomic targets, in addition to addressing motor disability, may enhance outcomes” of deep brain stimulation or levodopa-carbidopa intestinal gel therapies for advanced Parkinson’s disease, wrote the research team, led by Aristide Merola, MD, PhD, of the Gardner Family Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati.

designer491/Thinkstock

Nearly half of advanced Parkinson’s disease patients who receive treatment with subthalamic deep brain stimulation or levodopa-carbidopa intestinal gel infusion are affected by dysautonomia that has significant impacts on their daily lives, according to findings from a cross-sectional study.

“We suggest that identifying and managing autonomic targets, in addition to addressing motor disability, may enhance outcomes” of deep brain stimulation or levodopa-carbidopa intestinal gel therapies for advanced Parkinson’s disease, wrote the research team, led by Aristide Merola, MD, PhD, of the Gardner Family Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati.

designer491/Thinkstock

Nearly half of advanced Parkinson’s disease patients who receive treatment with subthalamic deep brain stimulation or levodopa-carbidopa intestinal gel infusion are affected by dysautonomia that has significant impacts on their daily lives, according to findings from a cross-sectional study.

“We suggest that identifying and managing autonomic targets, in addition to addressing motor disability, may enhance outcomes” of deep brain stimulation or levodopa-carbidopa intestinal gel therapies for advanced Parkinson’s disease, wrote the research team, led by Aristide Merola, MD, PhD, of the Gardner Family Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati.

designer491/Thinkstock

Oncology Practice will be on site this coming week at the annual meeting of the Society of Gynecologic Oncology in National Harbor, Md., reporting on the latest evidence for treating ovarian, cervical, and endometrial cancers. Key sessions include presentations on PARP inhibitors, novel radiation technologies, biomarker utilization in gynecologic oncology, rare tumors, and palliative care and survivorship.

The annual meeting begins Sunday, March 12, and our team will provide daily updates on the following presentations and more:

Rucaparib in patients with relapsed, primary platinum-sensitive high-grade ovarian carcinoma with germline or somatic BRCA mutations: Integrated summary of efficacy and safety from the phase II study ARIEL2.

Sentinel lymph node biopsy for early cervical cancer: Results of a randomized prospective, multicenter study (Senticol 2) comparing adding pelvic lymph node dissection vs. sentinel node biopsy only.

BRCA1 and RAD51C promoter hypermethylation confer sensitivity to the PARP inhibitor rucaparib in patients with relapsed, platinum-sensitive ovarian carcinoma in ARIEL2.

Cluster analysis of chemotherapy nonresponders for patients with serous epithelial ovarian cancer.

Oncologic outcomes of adjuvant chemotherapy in patients with risk factors after radical surgery in FIGO stage IB-IIA cervical cancer.

Combining whole pelvic radiation with chemotherapy in stage IVB cervical cancer: A novel treatment strategy.

Molecular response to neoadjuvant chemotherapy in high-grade serous ovarian carcinoma.

Clinical behavior of low-grade serous ovarian carcinoma: An analysis of 714 patients from the Ovarian Cancer Association Consortium (OCAC).

A randomized controlled trial comparing the efficacy of perioperative celecoxib versus ketorolac for perioperative pain control.

Combination therapy with IL-15 superagonist (ALT-803) and PD-1 blockade enhances human NK cell immunotherapy against ovarian cancer.

Reversal of obesity-driven aggressiveness of endometrial cancer by metformin.

A phase III trial of maintenance therapy in women with advanced ovarian/fallopian tube/peritoneal cancer after a complete clinical response to first-line therapy: An NRG oncology study.

Treatment with olaparib monotherapy in the maintenance setting significantly improves progression-free survival in patients with platinum-sensitive relapsed ovarian cancer: Results from the phase III SOLO2 study.

A prospective phase II trial of the listeria-based human papillomavirus immunotherpay axalimogene filolisbac in second- and third-line metastatic cervical cancer: A NRG oncology group trial.

Overall survival in BRCA1 or RAD51C methylated vs. mutated ovarian carcinoma following primary treatment with platinum chemotherapy.

Early palliative care is associated with improved quality of end-of-life care for women with high-risk gynecologic malignancies.

Contemporary recurrence and survival outcomes for stage IB squamous cell carcinoma of the vulva: Time to raise the bar.

Oncology Practice will be on site this coming week at the annual meeting of the Society of Gynecologic Oncology in National Harbor, Md., reporting on the latest evidence for treating ovarian, cervical, and endometrial cancers. Key sessions include presentations on PARP inhibitors, novel radiation technologies, biomarker utilization in gynecologic oncology, rare tumors, and palliative care and survivorship.

The annual meeting begins Sunday, March 12, and our team will provide daily updates on the following presentations and more:

Rucaparib in patients with relapsed, primary platinum-sensitive high-grade ovarian carcinoma with germline or somatic BRCA mutations: Integrated summary of efficacy and safety from the phase II study ARIEL2.

Sentinel lymph node biopsy for early cervical cancer: Results of a randomized prospective, multicenter study (Senticol 2) comparing adding pelvic lymph node dissection vs. sentinel node biopsy only.

BRCA1 and RAD51C promoter hypermethylation confer sensitivity to the PARP inhibitor rucaparib in patients with relapsed, platinum-sensitive ovarian carcinoma in ARIEL2.

Cluster analysis of chemotherapy nonresponders for patients with serous epithelial ovarian cancer.

Oncologic outcomes of adjuvant chemotherapy in patients with risk factors after radical surgery in FIGO stage IB-IIA cervical cancer.

Combining whole pelvic radiation with chemotherapy in stage IVB cervical cancer: A novel treatment strategy.

Molecular response to neoadjuvant chemotherapy in high-grade serous ovarian carcinoma.

Clinical behavior of low-grade serous ovarian carcinoma: An analysis of 714 patients from the Ovarian Cancer Association Consortium (OCAC).

A randomized controlled trial comparing the efficacy of perioperative celecoxib versus ketorolac for perioperative pain control.

Combination therapy with IL-15 superagonist (ALT-803) and PD-1 blockade enhances human NK cell immunotherapy against ovarian cancer.

Reversal of obesity-driven aggressiveness of endometrial cancer by metformin.

A phase III trial of maintenance therapy in women with advanced ovarian/fallopian tube/peritoneal cancer after a complete clinical response to first-line therapy: An NRG oncology study.

Treatment with olaparib monotherapy in the maintenance setting significantly improves progression-free survival in patients with platinum-sensitive relapsed ovarian cancer: Results from the phase III SOLO2 study.

A prospective phase II trial of the listeria-based human papillomavirus immunotherpay axalimogene filolisbac in second- and third-line metastatic cervical cancer: A NRG oncology group trial.

Overall survival in BRCA1 or RAD51C methylated vs. mutated ovarian carcinoma following primary treatment with platinum chemotherapy.

Early palliative care is associated with improved quality of end-of-life care for women with high-risk gynecologic malignancies.

Contemporary recurrence and survival outcomes for stage IB squamous cell carcinoma of the vulva: Time to raise the bar.

Oncology Practice will be on site this coming week at the annual meeting of the Society of Gynecologic Oncology in National Harbor, Md., reporting on the latest evidence for treating ovarian, cervical, and endometrial cancers. Key sessions include presentations on PARP inhibitors, novel radiation technologies, biomarker utilization in gynecologic oncology, rare tumors, and palliative care and survivorship.

The annual meeting begins Sunday, March 12, and our team will provide daily updates on the following presentations and more:

Rucaparib in patients with relapsed, primary platinum-sensitive high-grade ovarian carcinoma with germline or somatic BRCA mutations: Integrated summary of efficacy and safety from the phase II study ARIEL2.

Sentinel lymph node biopsy for early cervical cancer: Results of a randomized prospective, multicenter study (Senticol 2) comparing adding pelvic lymph node dissection vs. sentinel node biopsy only.

BRCA1 and RAD51C promoter hypermethylation confer sensitivity to the PARP inhibitor rucaparib in patients with relapsed, platinum-sensitive ovarian carcinoma in ARIEL2.

Cluster analysis of chemotherapy nonresponders for patients with serous epithelial ovarian cancer.

Oncologic outcomes of adjuvant chemotherapy in patients with risk factors after radical surgery in FIGO stage IB-IIA cervical cancer.

Combining whole pelvic radiation with chemotherapy in stage IVB cervical cancer: A novel treatment strategy.

Molecular response to neoadjuvant chemotherapy in high-grade serous ovarian carcinoma.

Clinical behavior of low-grade serous ovarian carcinoma: An analysis of 714 patients from the Ovarian Cancer Association Consortium (OCAC).

A randomized controlled trial comparing the efficacy of perioperative celecoxib versus ketorolac for perioperative pain control.

Combination therapy with IL-15 superagonist (ALT-803) and PD-1 blockade enhances human NK cell immunotherapy against ovarian cancer.

Reversal of obesity-driven aggressiveness of endometrial cancer by metformin.

A phase III trial of maintenance therapy in women with advanced ovarian/fallopian tube/peritoneal cancer after a complete clinical response to first-line therapy: An NRG oncology study.

Treatment with olaparib monotherapy in the maintenance setting significantly improves progression-free survival in patients with platinum-sensitive relapsed ovarian cancer: Results from the phase III SOLO2 study.

A prospective phase II trial of the listeria-based human papillomavirus immunotherpay axalimogene filolisbac in second- and third-line metastatic cervical cancer: A NRG oncology group trial.

Overall survival in BRCA1 or RAD51C methylated vs. mutated ovarian carcinoma following primary treatment with platinum chemotherapy.

Early palliative care is associated with improved quality of end-of-life care for women with high-risk gynecologic malignancies.

Contemporary recurrence and survival outcomes for stage IB squamous cell carcinoma of the vulva: Time to raise the bar.