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Black tea
Camellia sinensis, an evergreen tree belonging to the Theaceae family and used by human beings for approximately 4,000 years, is the source of the beverage tea, which is popular throughout the world, especially in Asia.1 Of the four main true teas (that is, derived from the tea plant C. sinensis), green and white are unfermented, black tea is fermented, and oolong tea is semifermented.2,3
Polyphenols, many of which act as strong antioxidants, are a diverse family of thousands of chemical substances found in plants. Theaflavins are black tea polyphenols with well-documented tumor-suppressing activity.4 In fact, they are thought to be the primary constituents of black tea responsible for conferring chemoprotection against cancer.5 Black tea, through oral administration and topical application, has been shown in the laboratory setting to protect skin from UV-induced erythema, premature aging, and cancer.6
Halder et al. have found that theaflavins and thearubigins, another key class of black tea polyphenols, can suppress A431 (human epidermoid carcinoma) and A375 (human malignant melanoma) cell proliferation without adversely impacting normal human epidermal keratinocytes. The researchers concluded that theaflavins and thearubigins appear to impart chemopreventive activity via cell cycle arrest and promotion of apoptosis in human skin cancer cells through a mitochondrial death cascade.7
In a 2005 English-language literature review, Thornfeldt cited green and black tea, as well as pomegranate, as the only ingredients supported by clinical trial evidence for effectiveness in treating extrinsic aging.2
Oral administration findings in animals and humans
More than 2 decades ago, Wang et al. found that the effects of orally administered black tea were comparable to those of green tea in suppressing UVB-induced skin carcinogenesis in 7,12-dimethylbenz[a]anthracene (DMBA)-initiated SKH-1 mice.8
In 1997, Lu et al. found that orally administered black tea inhibited the proliferation of skin tumors and enhanced apoptosis in nonmalignant and malignant skin tumors in female CD-1 mice with tumors initiated by the application of DMBA and promoted with 12-O-tetradecanoylphorbol-13-acetate (TPA).9 Record et al. reported in 1998 that black tea may confer greater protection than green tea against simulated solar irradiation.10
Hakim and Harris conducted a population-based case-control study in 2001 to assess the effects of the consumption of citrus peel and black tea on squamous cell skin cancer. They found that participants who reported intake of hot black tea and citrus peel had a significant reduction in the risk of squamous cell carcinoma. Further, they concluded that hot black tea and citrus peel displayed independent potential protection against SCC.11
Two years earlier, Zhao et al. used cultured keratinocytes and mouse and human skin to evaluate the effect of both orally and topically administered standardized black tea extract and its two major polyphenolic subfractions against UVB-induced photodamage. Topical pretreatment with the extract on SKH-1 hairless mice significantly lowered the incidence and severity of erythema and diminished skinfold thickness, compared with UVB-exposed nontreated mice. The black tea extract was similarly effective in human subjects. UVB-induced inflammation in murine as well as human skin also was reduced when the standardized extract was administered 5 minutes after UVB exposure. The investigators suggested that their findings indicated that black tea extracts have the capacity to mitigate UVB-generated erythema in human and murine skin.12
In 2011, George et al. assessed the chemopreventive effects of topical resveratrol and oral black tea polyphenols in blocking skin carcinogenesis in a two-stage mouse model initiated and promoted by DMBA and TPA, respectively. The combined treatment was found to reduce tumor incidence by approximately 89% (resveratrol alone, approximately 67%; black tea polyphenols alone, approximately 75%). Tumor volume and number also were significantly diminished by the synergistic combination, which, histologically, was noted for suppressing cellular proliferation and inducing apoptosis. The investigators concluded that oral black tea polyphenols combined with topical resveratrol exert greater chemopreventive activity than either compound alone and warrant study in trials for treating skin and other cancers.13
Animal studies on topical application
In 1997, Katiyar et al. investigated the anti-inflammatory effects of topically applied black tea polyphenols, primarily theaflavin gallates and (-)-epigallocatechin-3-gallate (EGCG), against TPA-induced inflammatory responses in murine skin. Significant inhibition against TPA-promoted induction of epidermal edema, hyperplasia, leukocyte infiltration, and proinflammatory cytokine expression was rendered by the preapplication of black tea polyphenols prior to TPA exposure. The investigators concluded that black tea polyphenols may be effective against human cutaneous inflammatory responses.14
Just over a decade later, Patel et al. investigated the in vivo antitumor-promoting effects of the most plentiful polymeric black tea polyphenols (thearubigins) in mice exposed to tumor-initiating DMBA and tumor-promoting TPA over a 40-week period. Pretreatment with topical thearubigins resulted in antipromoting effects in terms of latency, multiplicity, and incidence of skin papillomas. The black tea polyphenols also were found to reduce TPA-induced cell proliferation and epidermal cell apoptosis. The researchers attributed the protective effects of these compounds to their inhibitory impact on TPA-induced cellular proliferation.15
In 2011, Choi and Kim assessed the whitening effect of black tea water extract topically applied twice daily (6 days a week for 4 weeks) to UVB-induced hyperpigmented spots on the backs of brown guinea pigs. Treatment was divided into control (UVB and saline), vehicle control (UVB, propylene glycol, ethanol, and water), positive control (UVB and 2% hydroquinone), and two experimental groups (UVB and 1% black tea; UVB and 2% black tea). The investigators observed that the hyperpigmented spots treated with hydroquinone and black tea were clearly lighter than those treated by the control or vehicle-control groups. Histologic examination revealed that melanin pigmentation, melanocyte proliferation, and melanin production were significantly diminished in the groups treated with hydroquinone and both concentrations of black tea. The authors concluded that black tea suppresses melanocyte proliferation and melanosome synthesis in vivo, thus displaying the capacity to whiten skin in brown guinea pigs.16
In 2013, Yeh et al. found in nude mouse skin in vitro that niosomes appear to be feasible as a delivery vehicle for the dermal administration of black tea extracts as a sunscreen agent.1
Topical studies in humans
Building on findings 3 years earlier18, Türkoglu et al., in 2010, assessed the photoprotective effects of dermal gels produced from green and black tea aqueous extracts tested in vivo in the forearms of six volunteers exposed to artificial UV light (200-400 nm). In addition to the green tea and black tea gels, a 0.3% caffeine gel, a carbomer gel base, and a control were tested. The investigators reported no eruptions of UV-induced erythema in any of the black and green tea gel sites, but erythema was present to varying degrees at the areas treated with caffeine gel, carbomer gel, and control. The investigators concluded that the black and green tea extracts exhibited potent UV absorbance and that the formulated gels were effective in protecting the skin against UV-induced erythema. Further, the investigators suggested that these agents have the potential to protect against other harm caused by UV radiation, including photoaging.19
Conclusion
Though not as widely investigated as green tea, the therapeutic potential of black tea is of great interest. Although an abundance of laboratory evidence has emerged, clinical evidence is sparse. Nevertheless, laboratory data suggest the potential uses of black tea in the dermatologic realm and justify more human trials.
References
1. Cancer Lett. 1997 Mar 19;114(1-2):315-7.
2. Dermatol. Surg. 2005;31(7 Pt 2):873-80.
3. Oxid Med Cell Longev. 2012:2012:560682.
4. J Environ Pathol Toxicol Oncol. 2010;29(1):55-68.
5. Mol Carcinog. 2000 Jul;28(3):148-55.
6. Am J Clin Dermatol. 2010;11(4):247-67.
7. Carcinogenesis. 2008 Jan;29(1):129-38.
8. Cancer Res. 1994 Jul 1;54(13):3428-35.
9. Carcinogenesis. 1997 Nov;18(11):2163-9.
10. Mutat Res. 1998 Nov 9;422(1):191-9.
12. Photochem Photobiol. 1999 Oct;70(4):637-44.
13. PLoS One. 2011;6(8):e23395.
14. Carcinogenesis. 1997 Oct;18(10):1911-6.
15. Cell Prolif. 2008 Jun;41(3):532-53.
16. Toxicol Res. 2011 Sep;27(3):153-60.
17. Int J Dermatol. 2013 Feb;52(2):239-45.
18. Int J Cosmet Sci. 2007 Dec;29(6):437-42.
19. Drug Discov Ther. 2010 Oct;4(5):362-7.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002) and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). She has contributed to the Cosmeceutical Critique column in Dermatology News since January 2001. Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever.
Camellia sinensis, an evergreen tree belonging to the Theaceae family and used by human beings for approximately 4,000 years, is the source of the beverage tea, which is popular throughout the world, especially in Asia.1 Of the four main true teas (that is, derived from the tea plant C. sinensis), green and white are unfermented, black tea is fermented, and oolong tea is semifermented.2,3
Polyphenols, many of which act as strong antioxidants, are a diverse family of thousands of chemical substances found in plants. Theaflavins are black tea polyphenols with well-documented tumor-suppressing activity.4 In fact, they are thought to be the primary constituents of black tea responsible for conferring chemoprotection against cancer.5 Black tea, through oral administration and topical application, has been shown in the laboratory setting to protect skin from UV-induced erythema, premature aging, and cancer.6
Halder et al. have found that theaflavins and thearubigins, another key class of black tea polyphenols, can suppress A431 (human epidermoid carcinoma) and A375 (human malignant melanoma) cell proliferation without adversely impacting normal human epidermal keratinocytes. The researchers concluded that theaflavins and thearubigins appear to impart chemopreventive activity via cell cycle arrest and promotion of apoptosis in human skin cancer cells through a mitochondrial death cascade.7
In a 2005 English-language literature review, Thornfeldt cited green and black tea, as well as pomegranate, as the only ingredients supported by clinical trial evidence for effectiveness in treating extrinsic aging.2
Oral administration findings in animals and humans
More than 2 decades ago, Wang et al. found that the effects of orally administered black tea were comparable to those of green tea in suppressing UVB-induced skin carcinogenesis in 7,12-dimethylbenz[a]anthracene (DMBA)-initiated SKH-1 mice.8
In 1997, Lu et al. found that orally administered black tea inhibited the proliferation of skin tumors and enhanced apoptosis in nonmalignant and malignant skin tumors in female CD-1 mice with tumors initiated by the application of DMBA and promoted with 12-O-tetradecanoylphorbol-13-acetate (TPA).9 Record et al. reported in 1998 that black tea may confer greater protection than green tea against simulated solar irradiation.10
Hakim and Harris conducted a population-based case-control study in 2001 to assess the effects of the consumption of citrus peel and black tea on squamous cell skin cancer. They found that participants who reported intake of hot black tea and citrus peel had a significant reduction in the risk of squamous cell carcinoma. Further, they concluded that hot black tea and citrus peel displayed independent potential protection against SCC.11
Two years earlier, Zhao et al. used cultured keratinocytes and mouse and human skin to evaluate the effect of both orally and topically administered standardized black tea extract and its two major polyphenolic subfractions against UVB-induced photodamage. Topical pretreatment with the extract on SKH-1 hairless mice significantly lowered the incidence and severity of erythema and diminished skinfold thickness, compared with UVB-exposed nontreated mice. The black tea extract was similarly effective in human subjects. UVB-induced inflammation in murine as well as human skin also was reduced when the standardized extract was administered 5 minutes after UVB exposure. The investigators suggested that their findings indicated that black tea extracts have the capacity to mitigate UVB-generated erythema in human and murine skin.12
In 2011, George et al. assessed the chemopreventive effects of topical resveratrol and oral black tea polyphenols in blocking skin carcinogenesis in a two-stage mouse model initiated and promoted by DMBA and TPA, respectively. The combined treatment was found to reduce tumor incidence by approximately 89% (resveratrol alone, approximately 67%; black tea polyphenols alone, approximately 75%). Tumor volume and number also were significantly diminished by the synergistic combination, which, histologically, was noted for suppressing cellular proliferation and inducing apoptosis. The investigators concluded that oral black tea polyphenols combined with topical resveratrol exert greater chemopreventive activity than either compound alone and warrant study in trials for treating skin and other cancers.13
Animal studies on topical application
In 1997, Katiyar et al. investigated the anti-inflammatory effects of topically applied black tea polyphenols, primarily theaflavin gallates and (-)-epigallocatechin-3-gallate (EGCG), against TPA-induced inflammatory responses in murine skin. Significant inhibition against TPA-promoted induction of epidermal edema, hyperplasia, leukocyte infiltration, and proinflammatory cytokine expression was rendered by the preapplication of black tea polyphenols prior to TPA exposure. The investigators concluded that black tea polyphenols may be effective against human cutaneous inflammatory responses.14
Just over a decade later, Patel et al. investigated the in vivo antitumor-promoting effects of the most plentiful polymeric black tea polyphenols (thearubigins) in mice exposed to tumor-initiating DMBA and tumor-promoting TPA over a 40-week period. Pretreatment with topical thearubigins resulted in antipromoting effects in terms of latency, multiplicity, and incidence of skin papillomas. The black tea polyphenols also were found to reduce TPA-induced cell proliferation and epidermal cell apoptosis. The researchers attributed the protective effects of these compounds to their inhibitory impact on TPA-induced cellular proliferation.15
In 2011, Choi and Kim assessed the whitening effect of black tea water extract topically applied twice daily (6 days a week for 4 weeks) to UVB-induced hyperpigmented spots on the backs of brown guinea pigs. Treatment was divided into control (UVB and saline), vehicle control (UVB, propylene glycol, ethanol, and water), positive control (UVB and 2% hydroquinone), and two experimental groups (UVB and 1% black tea; UVB and 2% black tea). The investigators observed that the hyperpigmented spots treated with hydroquinone and black tea were clearly lighter than those treated by the control or vehicle-control groups. Histologic examination revealed that melanin pigmentation, melanocyte proliferation, and melanin production were significantly diminished in the groups treated with hydroquinone and both concentrations of black tea. The authors concluded that black tea suppresses melanocyte proliferation and melanosome synthesis in vivo, thus displaying the capacity to whiten skin in brown guinea pigs.16
In 2013, Yeh et al. found in nude mouse skin in vitro that niosomes appear to be feasible as a delivery vehicle for the dermal administration of black tea extracts as a sunscreen agent.1
Topical studies in humans
Building on findings 3 years earlier18, Türkoglu et al., in 2010, assessed the photoprotective effects of dermal gels produced from green and black tea aqueous extracts tested in vivo in the forearms of six volunteers exposed to artificial UV light (200-400 nm). In addition to the green tea and black tea gels, a 0.3% caffeine gel, a carbomer gel base, and a control were tested. The investigators reported no eruptions of UV-induced erythema in any of the black and green tea gel sites, but erythema was present to varying degrees at the areas treated with caffeine gel, carbomer gel, and control. The investigators concluded that the black and green tea extracts exhibited potent UV absorbance and that the formulated gels were effective in protecting the skin against UV-induced erythema. Further, the investigators suggested that these agents have the potential to protect against other harm caused by UV radiation, including photoaging.19
Conclusion
Though not as widely investigated as green tea, the therapeutic potential of black tea is of great interest. Although an abundance of laboratory evidence has emerged, clinical evidence is sparse. Nevertheless, laboratory data suggest the potential uses of black tea in the dermatologic realm and justify more human trials.
References
1. Cancer Lett. 1997 Mar 19;114(1-2):315-7.
2. Dermatol. Surg. 2005;31(7 Pt 2):873-80.
3. Oxid Med Cell Longev. 2012:2012:560682.
4. J Environ Pathol Toxicol Oncol. 2010;29(1):55-68.
5. Mol Carcinog. 2000 Jul;28(3):148-55.
6. Am J Clin Dermatol. 2010;11(4):247-67.
7. Carcinogenesis. 2008 Jan;29(1):129-38.
8. Cancer Res. 1994 Jul 1;54(13):3428-35.
9. Carcinogenesis. 1997 Nov;18(11):2163-9.
10. Mutat Res. 1998 Nov 9;422(1):191-9.
12. Photochem Photobiol. 1999 Oct;70(4):637-44.
13. PLoS One. 2011;6(8):e23395.
14. Carcinogenesis. 1997 Oct;18(10):1911-6.
15. Cell Prolif. 2008 Jun;41(3):532-53.
16. Toxicol Res. 2011 Sep;27(3):153-60.
17. Int J Dermatol. 2013 Feb;52(2):239-45.
18. Int J Cosmet Sci. 2007 Dec;29(6):437-42.
19. Drug Discov Ther. 2010 Oct;4(5):362-7.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002) and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). She has contributed to the Cosmeceutical Critique column in Dermatology News since January 2001. Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever.
Camellia sinensis, an evergreen tree belonging to the Theaceae family and used by human beings for approximately 4,000 years, is the source of the beverage tea, which is popular throughout the world, especially in Asia.1 Of the four main true teas (that is, derived from the tea plant C. sinensis), green and white are unfermented, black tea is fermented, and oolong tea is semifermented.2,3
Polyphenols, many of which act as strong antioxidants, are a diverse family of thousands of chemical substances found in plants. Theaflavins are black tea polyphenols with well-documented tumor-suppressing activity.4 In fact, they are thought to be the primary constituents of black tea responsible for conferring chemoprotection against cancer.5 Black tea, through oral administration and topical application, has been shown in the laboratory setting to protect skin from UV-induced erythema, premature aging, and cancer.6
Halder et al. have found that theaflavins and thearubigins, another key class of black tea polyphenols, can suppress A431 (human epidermoid carcinoma) and A375 (human malignant melanoma) cell proliferation without adversely impacting normal human epidermal keratinocytes. The researchers concluded that theaflavins and thearubigins appear to impart chemopreventive activity via cell cycle arrest and promotion of apoptosis in human skin cancer cells through a mitochondrial death cascade.7
In a 2005 English-language literature review, Thornfeldt cited green and black tea, as well as pomegranate, as the only ingredients supported by clinical trial evidence for effectiveness in treating extrinsic aging.2
Oral administration findings in animals and humans
More than 2 decades ago, Wang et al. found that the effects of orally administered black tea were comparable to those of green tea in suppressing UVB-induced skin carcinogenesis in 7,12-dimethylbenz[a]anthracene (DMBA)-initiated SKH-1 mice.8
In 1997, Lu et al. found that orally administered black tea inhibited the proliferation of skin tumors and enhanced apoptosis in nonmalignant and malignant skin tumors in female CD-1 mice with tumors initiated by the application of DMBA and promoted with 12-O-tetradecanoylphorbol-13-acetate (TPA).9 Record et al. reported in 1998 that black tea may confer greater protection than green tea against simulated solar irradiation.10
Hakim and Harris conducted a population-based case-control study in 2001 to assess the effects of the consumption of citrus peel and black tea on squamous cell skin cancer. They found that participants who reported intake of hot black tea and citrus peel had a significant reduction in the risk of squamous cell carcinoma. Further, they concluded that hot black tea and citrus peel displayed independent potential protection against SCC.11
Two years earlier, Zhao et al. used cultured keratinocytes and mouse and human skin to evaluate the effect of both orally and topically administered standardized black tea extract and its two major polyphenolic subfractions against UVB-induced photodamage. Topical pretreatment with the extract on SKH-1 hairless mice significantly lowered the incidence and severity of erythema and diminished skinfold thickness, compared with UVB-exposed nontreated mice. The black tea extract was similarly effective in human subjects. UVB-induced inflammation in murine as well as human skin also was reduced when the standardized extract was administered 5 minutes after UVB exposure. The investigators suggested that their findings indicated that black tea extracts have the capacity to mitigate UVB-generated erythema in human and murine skin.12
In 2011, George et al. assessed the chemopreventive effects of topical resveratrol and oral black tea polyphenols in blocking skin carcinogenesis in a two-stage mouse model initiated and promoted by DMBA and TPA, respectively. The combined treatment was found to reduce tumor incidence by approximately 89% (resveratrol alone, approximately 67%; black tea polyphenols alone, approximately 75%). Tumor volume and number also were significantly diminished by the synergistic combination, which, histologically, was noted for suppressing cellular proliferation and inducing apoptosis. The investigators concluded that oral black tea polyphenols combined with topical resveratrol exert greater chemopreventive activity than either compound alone and warrant study in trials for treating skin and other cancers.13
Animal studies on topical application
In 1997, Katiyar et al. investigated the anti-inflammatory effects of topically applied black tea polyphenols, primarily theaflavin gallates and (-)-epigallocatechin-3-gallate (EGCG), against TPA-induced inflammatory responses in murine skin. Significant inhibition against TPA-promoted induction of epidermal edema, hyperplasia, leukocyte infiltration, and proinflammatory cytokine expression was rendered by the preapplication of black tea polyphenols prior to TPA exposure. The investigators concluded that black tea polyphenols may be effective against human cutaneous inflammatory responses.14
Just over a decade later, Patel et al. investigated the in vivo antitumor-promoting effects of the most plentiful polymeric black tea polyphenols (thearubigins) in mice exposed to tumor-initiating DMBA and tumor-promoting TPA over a 40-week period. Pretreatment with topical thearubigins resulted in antipromoting effects in terms of latency, multiplicity, and incidence of skin papillomas. The black tea polyphenols also were found to reduce TPA-induced cell proliferation and epidermal cell apoptosis. The researchers attributed the protective effects of these compounds to their inhibitory impact on TPA-induced cellular proliferation.15
In 2011, Choi and Kim assessed the whitening effect of black tea water extract topically applied twice daily (6 days a week for 4 weeks) to UVB-induced hyperpigmented spots on the backs of brown guinea pigs. Treatment was divided into control (UVB and saline), vehicle control (UVB, propylene glycol, ethanol, and water), positive control (UVB and 2% hydroquinone), and two experimental groups (UVB and 1% black tea; UVB and 2% black tea). The investigators observed that the hyperpigmented spots treated with hydroquinone and black tea were clearly lighter than those treated by the control or vehicle-control groups. Histologic examination revealed that melanin pigmentation, melanocyte proliferation, and melanin production were significantly diminished in the groups treated with hydroquinone and both concentrations of black tea. The authors concluded that black tea suppresses melanocyte proliferation and melanosome synthesis in vivo, thus displaying the capacity to whiten skin in brown guinea pigs.16
In 2013, Yeh et al. found in nude mouse skin in vitro that niosomes appear to be feasible as a delivery vehicle for the dermal administration of black tea extracts as a sunscreen agent.1
Topical studies in humans
Building on findings 3 years earlier18, Türkoglu et al., in 2010, assessed the photoprotective effects of dermal gels produced from green and black tea aqueous extracts tested in vivo in the forearms of six volunteers exposed to artificial UV light (200-400 nm). In addition to the green tea and black tea gels, a 0.3% caffeine gel, a carbomer gel base, and a control were tested. The investigators reported no eruptions of UV-induced erythema in any of the black and green tea gel sites, but erythema was present to varying degrees at the areas treated with caffeine gel, carbomer gel, and control. The investigators concluded that the black and green tea extracts exhibited potent UV absorbance and that the formulated gels were effective in protecting the skin against UV-induced erythema. Further, the investigators suggested that these agents have the potential to protect against other harm caused by UV radiation, including photoaging.19
Conclusion
Though not as widely investigated as green tea, the therapeutic potential of black tea is of great interest. Although an abundance of laboratory evidence has emerged, clinical evidence is sparse. Nevertheless, laboratory data suggest the potential uses of black tea in the dermatologic realm and justify more human trials.
References
1. Cancer Lett. 1997 Mar 19;114(1-2):315-7.
2. Dermatol. Surg. 2005;31(7 Pt 2):873-80.
3. Oxid Med Cell Longev. 2012:2012:560682.
4. J Environ Pathol Toxicol Oncol. 2010;29(1):55-68.
5. Mol Carcinog. 2000 Jul;28(3):148-55.
6. Am J Clin Dermatol. 2010;11(4):247-67.
7. Carcinogenesis. 2008 Jan;29(1):129-38.
8. Cancer Res. 1994 Jul 1;54(13):3428-35.
9. Carcinogenesis. 1997 Nov;18(11):2163-9.
10. Mutat Res. 1998 Nov 9;422(1):191-9.
12. Photochem Photobiol. 1999 Oct;70(4):637-44.
13. PLoS One. 2011;6(8):e23395.
14. Carcinogenesis. 1997 Oct;18(10):1911-6.
15. Cell Prolif. 2008 Jun;41(3):532-53.
16. Toxicol Res. 2011 Sep;27(3):153-60.
17. Int J Dermatol. 2013 Feb;52(2):239-45.
18. Int J Cosmet Sci. 2007 Dec;29(6):437-42.
19. Drug Discov Ther. 2010 Oct;4(5):362-7.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002) and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). She has contributed to the Cosmeceutical Critique column in Dermatology News since January 2001. Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever.
Compound could aid fight against malaria
infecting an RBC
Image courtesy of St. Jude
Children’s Research Hospital
Luminol, the compound detectives spray at crime scenes to find trace amounts of blood, can help kill malaria parasites, according to preclinical research published in eLife.
Luminol glows blue when it encounters the hemoglobin in red blood cells (RBCs), and researchers have found they can trick malaria-infected RBCs into
building up a volatile chemical stockpile that can be set off by luminol’s glow.
To achieve this, the researchers exposed infected RBCs to an amino acid known as 5-aminolevulinic acid (ALA), luminol, and 4-iodophenol (a small-molecule that enhances the intensity and duration of luminol chemiluminescence).
This triggered buildup of the chemical, protoporphyrin IX (PPIX), which effectively killed the parasites. When the team substituted artemisinin for 4-iodophenol, they observed similar results.
“The light that luminol emits is enhanced by the antimalarial drug artemisinin,” said study author Daniel Goldberg, MD, PhD, of the Washington University School of Medicine in St Louis, Missouri.
“We think these agents could be combined to form an innovative treatment for malaria.”
The researchers believe this type of therapy would have an advantage over current malaria treatments, which have become less effective as the parasite mutates. That is because the new approach targets proteins made by human RBCs, which the parasite can’t mutate.
To uncover this approach, Dr Goldberg and his colleagues worked with human RBCs infected with Plasmodium falciparum. The team wanted to better understand how the parasite gets hold of heme, which is essential to the parasite’s survival.
They found that P falciparum opens an unnatural channel on the surface of RBCs. When the researchers put ALA (an ingredient of heme) into a solution containing infected RBCs, ALA entered the cells through the channel and started the heme-making process.
This led to a buildup of PPIX. When exposed to luminol and 4-iodophenol, PPIX emitted free radicals. This potently inhibited parasite growth, according to the researchers. And microscopic examination revealed widespread parasite death.
The ALA/luminol/4-iodophenol combination also worked in a parasite line that was resistant to antifolate and quinolone antibiotics, as well as one with a kelch-13 protein mutation, which confers artemisinin tolerance.
The researchers then wanted to determine if artemisinin would enhance their strategy. So they incubated malaria-infected RBCs with ALA, luminol, and/or sub-therapeutic doses of dihydroartemisinin.
Each of the components alone or 2 of them together had little effect, but all 3 in combination successfully ablated parasite growth.
The researchers are now planning to test this treatment approach in vivo.
“All of these agents—the amino acid, the luminol, and artemisinin—have been cleared for use in humans individually, so we are optimistic that they won’t present any safety problems together,” Dr Goldberg said. “This could be a promising new treatment for a devastating disease.” 
infecting an RBC
Image courtesy of St. Jude
Children’s Research Hospital
Luminol, the compound detectives spray at crime scenes to find trace amounts of blood, can help kill malaria parasites, according to preclinical research published in eLife.
Luminol glows blue when it encounters the hemoglobin in red blood cells (RBCs), and researchers have found they can trick malaria-infected RBCs into
building up a volatile chemical stockpile that can be set off by luminol’s glow.
To achieve this, the researchers exposed infected RBCs to an amino acid known as 5-aminolevulinic acid (ALA), luminol, and 4-iodophenol (a small-molecule that enhances the intensity and duration of luminol chemiluminescence).
This triggered buildup of the chemical, protoporphyrin IX (PPIX), which effectively killed the parasites. When the team substituted artemisinin for 4-iodophenol, they observed similar results.
“The light that luminol emits is enhanced by the antimalarial drug artemisinin,” said study author Daniel Goldberg, MD, PhD, of the Washington University School of Medicine in St Louis, Missouri.
“We think these agents could be combined to form an innovative treatment for malaria.”
The researchers believe this type of therapy would have an advantage over current malaria treatments, which have become less effective as the parasite mutates. That is because the new approach targets proteins made by human RBCs, which the parasite can’t mutate.
To uncover this approach, Dr Goldberg and his colleagues worked with human RBCs infected with Plasmodium falciparum. The team wanted to better understand how the parasite gets hold of heme, which is essential to the parasite’s survival.
They found that P falciparum opens an unnatural channel on the surface of RBCs. When the researchers put ALA (an ingredient of heme) into a solution containing infected RBCs, ALA entered the cells through the channel and started the heme-making process.
This led to a buildup of PPIX. When exposed to luminol and 4-iodophenol, PPIX emitted free radicals. This potently inhibited parasite growth, according to the researchers. And microscopic examination revealed widespread parasite death.
The ALA/luminol/4-iodophenol combination also worked in a parasite line that was resistant to antifolate and quinolone antibiotics, as well as one with a kelch-13 protein mutation, which confers artemisinin tolerance.
The researchers then wanted to determine if artemisinin would enhance their strategy. So they incubated malaria-infected RBCs with ALA, luminol, and/or sub-therapeutic doses of dihydroartemisinin.
Each of the components alone or 2 of them together had little effect, but all 3 in combination successfully ablated parasite growth.
The researchers are now planning to test this treatment approach in vivo.
“All of these agents—the amino acid, the luminol, and artemisinin—have been cleared for use in humans individually, so we are optimistic that they won’t present any safety problems together,” Dr Goldberg said. “This could be a promising new treatment for a devastating disease.”
infecting an RBC
Image courtesy of St. Jude
Children’s Research Hospital
Luminol, the compound detectives spray at crime scenes to find trace amounts of blood, can help kill malaria parasites, according to preclinical research published in eLife.
Luminol glows blue when it encounters the hemoglobin in red blood cells (RBCs), and researchers have found they can trick malaria-infected RBCs into
building up a volatile chemical stockpile that can be set off by luminol’s glow.
To achieve this, the researchers exposed infected RBCs to an amino acid known as 5-aminolevulinic acid (ALA), luminol, and 4-iodophenol (a small-molecule that enhances the intensity and duration of luminol chemiluminescence).
This triggered buildup of the chemical, protoporphyrin IX (PPIX), which effectively killed the parasites. When the team substituted artemisinin for 4-iodophenol, they observed similar results.
“The light that luminol emits is enhanced by the antimalarial drug artemisinin,” said study author Daniel Goldberg, MD, PhD, of the Washington University School of Medicine in St Louis, Missouri.
“We think these agents could be combined to form an innovative treatment for malaria.”
The researchers believe this type of therapy would have an advantage over current malaria treatments, which have become less effective as the parasite mutates. That is because the new approach targets proteins made by human RBCs, which the parasite can’t mutate.
To uncover this approach, Dr Goldberg and his colleagues worked with human RBCs infected with Plasmodium falciparum. The team wanted to better understand how the parasite gets hold of heme, which is essential to the parasite’s survival.
They found that P falciparum opens an unnatural channel on the surface of RBCs. When the researchers put ALA (an ingredient of heme) into a solution containing infected RBCs, ALA entered the cells through the channel and started the heme-making process.
This led to a buildup of PPIX. When exposed to luminol and 4-iodophenol, PPIX emitted free radicals. This potently inhibited parasite growth, according to the researchers. And microscopic examination revealed widespread parasite death.
The ALA/luminol/4-iodophenol combination also worked in a parasite line that was resistant to antifolate and quinolone antibiotics, as well as one with a kelch-13 protein mutation, which confers artemisinin tolerance.
The researchers then wanted to determine if artemisinin would enhance their strategy. So they incubated malaria-infected RBCs with ALA, luminol, and/or sub-therapeutic doses of dihydroartemisinin.
Each of the components alone or 2 of them together had little effect, but all 3 in combination successfully ablated parasite growth.
The researchers are now planning to test this treatment approach in vivo.
“All of these agents—the amino acid, the luminol, and artemisinin—have been cleared for use in humans individually, so we are optimistic that they won’t present any safety problems together,” Dr Goldberg said. “This could be a promising new treatment for a devastating disease.”
The six Ps of vascular surgery
Vascular Surgery has evolved to balance clinical medicine, open and minimally invasive surgical interventions, and innovation into a unique career where technological advancement is constantly pushing the boundaries of what is possible in surgical capabilities.
Being awed and inspired by the Vascular Surgery specialty, we have put together the 6Ps for pursuing a career in Vascular Surgery in the spirit of the notorious 6Ps for acute limb ischemia.
1. Patients: Vascular patients are a unique and complex population of patients burdened with numerous comorbidities. Approaching and managing vascular patients requires a good understanding of preoperative medical assessment, risk factor modification, and clinical medicine. Moreover, the nature of vascular disease allows vascular surgeons to develop longstanding relationships with their patients and their families, and follow them through numerous stages of their illness and recovery.
2. Procedures: Performing vascular surgery is a delicate and exhilarating experience operating on arteries, veins, and lymphatics virtually in every part of the body, from the neck, chest, abdomen, and upper and lower limbs. We perform complex procedures from minimally invasive routes to intricate open procedures. Vascular surgeons offer lifesaving, limb-salvaging and quality of life-improving procedures on a daily basis.
3. Problem solving: As medical students and residents can appreciate in vascular teaching rounds, there is never one answer to a clinical situation. Each particular case may be considered through multiple approaches – open surgery, endovascular surgery, hybrid surgery, or medical management. Strikingly, within each category there are further numerous options to consider. Trying to develop the solutions and clinical judgment around a case is what makes this specialty tantalizing. 4. People: Vascular surgeons are the nicest group of surgeons we have ever worked with (there might be a large bias in this statement). They are passionate about their specialty, dedicated to patient care, enthusiastic to teach students, and always easily approachable. We have both been fortunate to be mentored by vascular surgeons and as such decided to pursue careers in this extremely patient-centered field. Given that it is a small community, it truly feels like you are part of the vascular family.
5. Potential: Technology is advancing at an extraordinarily fast pace and the vascular community fosters innovation from preventative strategies, new imaging modalities, and new graft designs just to name a few. The big question is, where will the vascular specialty be in 10 years? And our belief is that it depends on the limits of our imagination. We need to challenge conventional thinking with courage and imagination, bringing innovation to the health care platform.
And finally, one should pursue a career in vascular surgery because it is simply ...
6. Pretty awesome.
As the frontiers of science and technology push forward, so too do the ideas, creativity, and innovation of talented people. Our hope is to be at that cutting edge leading the development of improved medical care and surgical delivery as vascular surgeons.
Vascular Surgery has evolved to balance clinical medicine, open and minimally invasive surgical interventions, and innovation into a unique career where technological advancement is constantly pushing the boundaries of what is possible in surgical capabilities.
Being awed and inspired by the Vascular Surgery specialty, we have put together the 6Ps for pursuing a career in Vascular Surgery in the spirit of the notorious 6Ps for acute limb ischemia.
1. Patients: Vascular patients are a unique and complex population of patients burdened with numerous comorbidities. Approaching and managing vascular patients requires a good understanding of preoperative medical assessment, risk factor modification, and clinical medicine. Moreover, the nature of vascular disease allows vascular surgeons to develop longstanding relationships with their patients and their families, and follow them through numerous stages of their illness and recovery.
2. Procedures: Performing vascular surgery is a delicate and exhilarating experience operating on arteries, veins, and lymphatics virtually in every part of the body, from the neck, chest, abdomen, and upper and lower limbs. We perform complex procedures from minimally invasive routes to intricate open procedures. Vascular surgeons offer lifesaving, limb-salvaging and quality of life-improving procedures on a daily basis.
3. Problem solving: As medical students and residents can appreciate in vascular teaching rounds, there is never one answer to a clinical situation. Each particular case may be considered through multiple approaches – open surgery, endovascular surgery, hybrid surgery, or medical management. Strikingly, within each category there are further numerous options to consider. Trying to develop the solutions and clinical judgment around a case is what makes this specialty tantalizing. 4. People: Vascular surgeons are the nicest group of surgeons we have ever worked with (there might be a large bias in this statement). They are passionate about their specialty, dedicated to patient care, enthusiastic to teach students, and always easily approachable. We have both been fortunate to be mentored by vascular surgeons and as such decided to pursue careers in this extremely patient-centered field. Given that it is a small community, it truly feels like you are part of the vascular family.
5. Potential: Technology is advancing at an extraordinarily fast pace and the vascular community fosters innovation from preventative strategies, new imaging modalities, and new graft designs just to name a few. The big question is, where will the vascular specialty be in 10 years? And our belief is that it depends on the limits of our imagination. We need to challenge conventional thinking with courage and imagination, bringing innovation to the health care platform.
And finally, one should pursue a career in vascular surgery because it is simply ...
6. Pretty awesome.
As the frontiers of science and technology push forward, so too do the ideas, creativity, and innovation of talented people. Our hope is to be at that cutting edge leading the development of improved medical care and surgical delivery as vascular surgeons.
Vascular Surgery has evolved to balance clinical medicine, open and minimally invasive surgical interventions, and innovation into a unique career where technological advancement is constantly pushing the boundaries of what is possible in surgical capabilities.
Being awed and inspired by the Vascular Surgery specialty, we have put together the 6Ps for pursuing a career in Vascular Surgery in the spirit of the notorious 6Ps for acute limb ischemia.
1. Patients: Vascular patients are a unique and complex population of patients burdened with numerous comorbidities. Approaching and managing vascular patients requires a good understanding of preoperative medical assessment, risk factor modification, and clinical medicine. Moreover, the nature of vascular disease allows vascular surgeons to develop longstanding relationships with their patients and their families, and follow them through numerous stages of their illness and recovery.
2. Procedures: Performing vascular surgery is a delicate and exhilarating experience operating on arteries, veins, and lymphatics virtually in every part of the body, from the neck, chest, abdomen, and upper and lower limbs. We perform complex procedures from minimally invasive routes to intricate open procedures. Vascular surgeons offer lifesaving, limb-salvaging and quality of life-improving procedures on a daily basis.
3. Problem solving: As medical students and residents can appreciate in vascular teaching rounds, there is never one answer to a clinical situation. Each particular case may be considered through multiple approaches – open surgery, endovascular surgery, hybrid surgery, or medical management. Strikingly, within each category there are further numerous options to consider. Trying to develop the solutions and clinical judgment around a case is what makes this specialty tantalizing. 4. People: Vascular surgeons are the nicest group of surgeons we have ever worked with (there might be a large bias in this statement). They are passionate about their specialty, dedicated to patient care, enthusiastic to teach students, and always easily approachable. We have both been fortunate to be mentored by vascular surgeons and as such decided to pursue careers in this extremely patient-centered field. Given that it is a small community, it truly feels like you are part of the vascular family.
5. Potential: Technology is advancing at an extraordinarily fast pace and the vascular community fosters innovation from preventative strategies, new imaging modalities, and new graft designs just to name a few. The big question is, where will the vascular specialty be in 10 years? And our belief is that it depends on the limits of our imagination. We need to challenge conventional thinking with courage and imagination, bringing innovation to the health care platform.
And finally, one should pursue a career in vascular surgery because it is simply ...
6. Pretty awesome.
As the frontiers of science and technology push forward, so too do the ideas, creativity, and innovation of talented people. Our hope is to be at that cutting edge leading the development of improved medical care and surgical delivery as vascular surgeons.
Percutaneous thrombectomy reduces risk of postthrombotic syndrome
Adding a mechanical suction technique to local thrombolysis to break up and remove blood clots reduced postthrombotic syndrome (PTS) after deep vein thrombosis (DVT) without causing increased complications, according to a small retrospective study.
Dr. Chun-Yang Huang of the National Yang Ming University (Taipei, Taiwan) and colleagues examined patients diagnosed with acute proximal lower limb DVT. Patients received either thrombolysis alone via a catheter-directed thrombolysis (CDT), or percutaneous mechanical thrombectomy (PMT) by a combination of pharmacologic thrombolysis and suction; both techniques were accompanied by systemic anticoagulation. Though both treatment groups fared well during treatment and for the 12-month follow-up period, the PMT group had a significantly lower incidence of PTS 1 year after treatment (Ann. Vascular Surg. 2015. doi: 10.1016/j.avsg.2015.01.014).
For those with DVT, parenteral anticoagulation prevents propagation of the clot and minimizes risk of pulmonary embolism (PE); however, anticoagulation does not accelerate dissolution of the existing clot. According to study authors, 30%-40% of those with proximal leg DVTs will go on to develop PTS, with the prolonged distal venous stasis from an undisturbed clot causing loss of valvular competence and resultant chronic venous insufficiency. PTS can involve leg swelling, discomfort, skin changes, and ulceration, with significant impact on quality of life and health care costs.
Techniques such as CDT and PMT can increase the rate of clot dissolution, thus restoring patency sooner and minimizing risk for PTS. However, these methods also can carry increased risk of bleeding and infection, considerations that must be balanced against potential benefit.
Investigators reviewed records for 39 patients who were diagnosed with ultrasound- or CT-confirmed acute proximal lower limb DVT and received either CDT or PMT during the period from November 2010 to November 2013. Patients were not randomized to treatment arms but were assigned using clinical judgment and patient preference. During the 12-month follow-up, three participants died of malignancy and two were lost to follow-up. Analysis was completed for the remaining 34 patients.
Overall, patient characteristics did not differ significantly between groups, with mean ages of 62.75 for the PMT group (n = 16) and 64.17 for the CDT group (n = 18). In all, 13/34 participants were female. Patients in both treatment groups fared well, with no 30-day mortality, and no episodes of major bleeding, PE, or renal failure. Ten patients in the PMT group and six in the CDT group required stenting of the common iliac vein to maintain patency, a nonsignificant difference. Just one participant in the CDE group experienced a minor bleeding event.
Turning to outcomes, study authors assessed postprocedure patency, finding improved patency for both procedures (P less than .001 for both, compared with preoperation patency scores), with no significant difference between the two groups post procedure. Thrombus scores were also significantly better for both treatment arms post procedure (P less than .001). Clot burden tended to improve more rapidly over the 12-month follow-up period for the PMT group, though the difference between groups was just short of statistically significant.
At 12 months, though the amount of venous reflux did not differ significantly between groups, those who had received PMT had significantly fewer signs and symptoms of PTS. This assessment used the Villalta scale, a standardized assessment and scoring system for PTS, where higher numbers indicate worse PTS. The PMT group’s Villalta score was 2.06 +/–2.95, compared with 5.06 +/–4.07 for the CDT group (P = .030).
Study limitations included the small study size, retrospective study design, and lack of randomization. Acknowledging these limitations, Dr. Huang and coauthors called for larger, multicenter, randomized controlled studies of PMT. The personal and economic costs of PTS, they argue, warrant exploring whether PMT may help minimize total thrombolysis dose, reduce hospital stays, and decrease costs while minimizing the risks of chronic venous insufficiency post DVT.
Dr. Huang and coauthors reported no conflicts of interest.
Adding a mechanical suction technique to local thrombolysis to break up and remove blood clots reduced postthrombotic syndrome (PTS) after deep vein thrombosis (DVT) without causing increased complications, according to a small retrospective study.
Dr. Chun-Yang Huang of the National Yang Ming University (Taipei, Taiwan) and colleagues examined patients diagnosed with acute proximal lower limb DVT. Patients received either thrombolysis alone via a catheter-directed thrombolysis (CDT), or percutaneous mechanical thrombectomy (PMT) by a combination of pharmacologic thrombolysis and suction; both techniques were accompanied by systemic anticoagulation. Though both treatment groups fared well during treatment and for the 12-month follow-up period, the PMT group had a significantly lower incidence of PTS 1 year after treatment (Ann. Vascular Surg. 2015. doi: 10.1016/j.avsg.2015.01.014).
For those with DVT, parenteral anticoagulation prevents propagation of the clot and minimizes risk of pulmonary embolism (PE); however, anticoagulation does not accelerate dissolution of the existing clot. According to study authors, 30%-40% of those with proximal leg DVTs will go on to develop PTS, with the prolonged distal venous stasis from an undisturbed clot causing loss of valvular competence and resultant chronic venous insufficiency. PTS can involve leg swelling, discomfort, skin changes, and ulceration, with significant impact on quality of life and health care costs.
Techniques such as CDT and PMT can increase the rate of clot dissolution, thus restoring patency sooner and minimizing risk for PTS. However, these methods also can carry increased risk of bleeding and infection, considerations that must be balanced against potential benefit.
Investigators reviewed records for 39 patients who were diagnosed with ultrasound- or CT-confirmed acute proximal lower limb DVT and received either CDT or PMT during the period from November 2010 to November 2013. Patients were not randomized to treatment arms but were assigned using clinical judgment and patient preference. During the 12-month follow-up, three participants died of malignancy and two were lost to follow-up. Analysis was completed for the remaining 34 patients.
Overall, patient characteristics did not differ significantly between groups, with mean ages of 62.75 for the PMT group (n = 16) and 64.17 for the CDT group (n = 18). In all, 13/34 participants were female. Patients in both treatment groups fared well, with no 30-day mortality, and no episodes of major bleeding, PE, or renal failure. Ten patients in the PMT group and six in the CDT group required stenting of the common iliac vein to maintain patency, a nonsignificant difference. Just one participant in the CDE group experienced a minor bleeding event.
Turning to outcomes, study authors assessed postprocedure patency, finding improved patency for both procedures (P less than .001 for both, compared with preoperation patency scores), with no significant difference between the two groups post procedure. Thrombus scores were also significantly better for both treatment arms post procedure (P less than .001). Clot burden tended to improve more rapidly over the 12-month follow-up period for the PMT group, though the difference between groups was just short of statistically significant.
At 12 months, though the amount of venous reflux did not differ significantly between groups, those who had received PMT had significantly fewer signs and symptoms of PTS. This assessment used the Villalta scale, a standardized assessment and scoring system for PTS, where higher numbers indicate worse PTS. The PMT group’s Villalta score was 2.06 +/–2.95, compared with 5.06 +/–4.07 for the CDT group (P = .030).
Study limitations included the small study size, retrospective study design, and lack of randomization. Acknowledging these limitations, Dr. Huang and coauthors called for larger, multicenter, randomized controlled studies of PMT. The personal and economic costs of PTS, they argue, warrant exploring whether PMT may help minimize total thrombolysis dose, reduce hospital stays, and decrease costs while minimizing the risks of chronic venous insufficiency post DVT.
Dr. Huang and coauthors reported no conflicts of interest.
Adding a mechanical suction technique to local thrombolysis to break up and remove blood clots reduced postthrombotic syndrome (PTS) after deep vein thrombosis (DVT) without causing increased complications, according to a small retrospective study.
Dr. Chun-Yang Huang of the National Yang Ming University (Taipei, Taiwan) and colleagues examined patients diagnosed with acute proximal lower limb DVT. Patients received either thrombolysis alone via a catheter-directed thrombolysis (CDT), or percutaneous mechanical thrombectomy (PMT) by a combination of pharmacologic thrombolysis and suction; both techniques were accompanied by systemic anticoagulation. Though both treatment groups fared well during treatment and for the 12-month follow-up period, the PMT group had a significantly lower incidence of PTS 1 year after treatment (Ann. Vascular Surg. 2015. doi: 10.1016/j.avsg.2015.01.014).
For those with DVT, parenteral anticoagulation prevents propagation of the clot and minimizes risk of pulmonary embolism (PE); however, anticoagulation does not accelerate dissolution of the existing clot. According to study authors, 30%-40% of those with proximal leg DVTs will go on to develop PTS, with the prolonged distal venous stasis from an undisturbed clot causing loss of valvular competence and resultant chronic venous insufficiency. PTS can involve leg swelling, discomfort, skin changes, and ulceration, with significant impact on quality of life and health care costs.
Techniques such as CDT and PMT can increase the rate of clot dissolution, thus restoring patency sooner and minimizing risk for PTS. However, these methods also can carry increased risk of bleeding and infection, considerations that must be balanced against potential benefit.
Investigators reviewed records for 39 patients who were diagnosed with ultrasound- or CT-confirmed acute proximal lower limb DVT and received either CDT or PMT during the period from November 2010 to November 2013. Patients were not randomized to treatment arms but were assigned using clinical judgment and patient preference. During the 12-month follow-up, three participants died of malignancy and two were lost to follow-up. Analysis was completed for the remaining 34 patients.
Overall, patient characteristics did not differ significantly between groups, with mean ages of 62.75 for the PMT group (n = 16) and 64.17 for the CDT group (n = 18). In all, 13/34 participants were female. Patients in both treatment groups fared well, with no 30-day mortality, and no episodes of major bleeding, PE, or renal failure. Ten patients in the PMT group and six in the CDT group required stenting of the common iliac vein to maintain patency, a nonsignificant difference. Just one participant in the CDE group experienced a minor bleeding event.
Turning to outcomes, study authors assessed postprocedure patency, finding improved patency for both procedures (P less than .001 for both, compared with preoperation patency scores), with no significant difference between the two groups post procedure. Thrombus scores were also significantly better for both treatment arms post procedure (P less than .001). Clot burden tended to improve more rapidly over the 12-month follow-up period for the PMT group, though the difference between groups was just short of statistically significant.
At 12 months, though the amount of venous reflux did not differ significantly between groups, those who had received PMT had significantly fewer signs and symptoms of PTS. This assessment used the Villalta scale, a standardized assessment and scoring system for PTS, where higher numbers indicate worse PTS. The PMT group’s Villalta score was 2.06 +/–2.95, compared with 5.06 +/–4.07 for the CDT group (P = .030).
Study limitations included the small study size, retrospective study design, and lack of randomization. Acknowledging these limitations, Dr. Huang and coauthors called for larger, multicenter, randomized controlled studies of PMT. The personal and economic costs of PTS, they argue, warrant exploring whether PMT may help minimize total thrombolysis dose, reduce hospital stays, and decrease costs while minimizing the risks of chronic venous insufficiency post DVT.
Dr. Huang and coauthors reported no conflicts of interest.
Key clinical point: Both percutaneous PMT and catheter-directed thrombolysis (CDT) were safe and effective, but PMT reduced risk of postthrombotic syndrome.
Major finding: In a small retrospective analysis of patients with deep vein thrombosis (DVT), both PMT and CDT were safe and effective when used in combination with systemic anticoagulation; however, postthrombotic syndrome (PTS) scoring was significantly better for those receiving PMT (Villalta score 2.1 +/- 3.0 vs. 5.1 +/- 4.1, P = .030).
Data source: Retrospective study of 39 patients who were diagnosed with acute proximal DVT of the lower limb between November 2010 and November 2013 at a Taiwanese hospital.
Disclosures: The authors reported that they had no conflicts of interest; funding source was not provided.
NICE recommends empagliflozin in combo therapy for type 2 diabetes
The National Institute for Health and Care Excellence (NICE) has issued guidance on the clinical and cost-effectiveness of empagliflozin in combination therapy for treatment of type 2 diabetes.
The guideline, released in March, is for advanced-practice nurses, nurses, physician assistants, and physicians, according to a summary by the National Guideline Clearinghouse (NGC).
The summary lists recommendations by NICE for treatment of type 2 diabetes as follows:
• Empagliflozin in a dual-therapy regimen in combination with metformin, only if a sulfonylurea is contraindicated or not tolerated, or if the person is at significant risk of hypoglycemia or its consequences.
• Empagliflozin in a triple-therapy regimen, in combination with metformin and a sulfonylurea or metformin and a thiazolidinedione.
• Empagliflozin in combination with insulin with or without other antidiabetic drugs.
According to the summary, the most commonly reported adverse reactions for empagliflozin are hypoglycemia in combination with insulin or a sulfonylurea, vulvovaginal candidiasis, urinary tract infection, and polyuria or pollakiuria.
As for the cost-effectiveness, an appraisal committee independent of NICE “concluded that the very small differences in costs and quality-adjusted life years between empagliflozin (10 mg and 25 mg) and its key comparators showed that empagliflozin was a cost-effective use of National Health Service resources as dual therapy in combination with metformin, triple therapy in combination with metformin and either a sulfonylurea or a thiazolidinedione, and as an add-on treatment to insulin.”
The National Institute for Health and Care Excellence (NICE) has issued guidance on the clinical and cost-effectiveness of empagliflozin in combination therapy for treatment of type 2 diabetes.
The guideline, released in March, is for advanced-practice nurses, nurses, physician assistants, and physicians, according to a summary by the National Guideline Clearinghouse (NGC).
The summary lists recommendations by NICE for treatment of type 2 diabetes as follows:
• Empagliflozin in a dual-therapy regimen in combination with metformin, only if a sulfonylurea is contraindicated or not tolerated, or if the person is at significant risk of hypoglycemia or its consequences.
• Empagliflozin in a triple-therapy regimen, in combination with metformin and a sulfonylurea or metformin and a thiazolidinedione.
• Empagliflozin in combination with insulin with or without other antidiabetic drugs.
According to the summary, the most commonly reported adverse reactions for empagliflozin are hypoglycemia in combination with insulin or a sulfonylurea, vulvovaginal candidiasis, urinary tract infection, and polyuria or pollakiuria.
As for the cost-effectiveness, an appraisal committee independent of NICE “concluded that the very small differences in costs and quality-adjusted life years between empagliflozin (10 mg and 25 mg) and its key comparators showed that empagliflozin was a cost-effective use of National Health Service resources as dual therapy in combination with metformin, triple therapy in combination with metformin and either a sulfonylurea or a thiazolidinedione, and as an add-on treatment to insulin.”
The National Institute for Health and Care Excellence (NICE) has issued guidance on the clinical and cost-effectiveness of empagliflozin in combination therapy for treatment of type 2 diabetes.
The guideline, released in March, is for advanced-practice nurses, nurses, physician assistants, and physicians, according to a summary by the National Guideline Clearinghouse (NGC).
The summary lists recommendations by NICE for treatment of type 2 diabetes as follows:
• Empagliflozin in a dual-therapy regimen in combination with metformin, only if a sulfonylurea is contraindicated or not tolerated, or if the person is at significant risk of hypoglycemia or its consequences.
• Empagliflozin in a triple-therapy regimen, in combination with metformin and a sulfonylurea or metformin and a thiazolidinedione.
• Empagliflozin in combination with insulin with or without other antidiabetic drugs.
According to the summary, the most commonly reported adverse reactions for empagliflozin are hypoglycemia in combination with insulin or a sulfonylurea, vulvovaginal candidiasis, urinary tract infection, and polyuria or pollakiuria.
As for the cost-effectiveness, an appraisal committee independent of NICE “concluded that the very small differences in costs and quality-adjusted life years between empagliflozin (10 mg and 25 mg) and its key comparators showed that empagliflozin was a cost-effective use of National Health Service resources as dual therapy in combination with metformin, triple therapy in combination with metformin and either a sulfonylurea or a thiazolidinedione, and as an add-on treatment to insulin.”
NICE releases guidelines on medicine optimization
Effective systems and processes are a key part of minimizing the risk of preventable medicine-related problems and ensuring best possible outcomes for care, according to newly released clinical guidelines from the Medicines Prescribing Centre of the U.K.-based National Institute for Health and Care Excellence (NICE).
The guidelines, developed by a multidisciplinary Guideline Development Group (GDG) of NICE staff, health professionals, and lay members, were designed to ensure that National Health Service patients get the best possible outcomes from their medicines.
“Relevant information about medicines should be shared with patients, and their family members or carers, where appropriate, and between health and social care practitioners when a person moves from one care setting to another, to support high-quality care,” wrote the authors of the guidelines, led by Dr. Weeliat Chong, chair of the GDG.
The report identified four key recommendations as priorities for implementation:
• Consider using multiple methods (such as health record review, patient surveys and direct observation of medicines administration) to identify medicine-related patient safety incidents
• Organizations should ensure that medicines reconciliation (i.e., making sure medicines prescribed on admission correspond to those that the patient was taking before admission) is carried out by a trained and competent health professional with effective communication skills, technical knowledge of processes for managing medicines, and therapeutic knowledge of medicines use.
• Health and social care practitioners should share relevant information about the [patients] and their medicines via medicines-related communication systems when a person transfers from one care setting to another.
• Consider sending the patient’s medicines discharge information to [his or her] nominated community pharmacy, when possible and in agreement with the patient.
Click here for the full report.
Effective systems and processes are a key part of minimizing the risk of preventable medicine-related problems and ensuring best possible outcomes for care, according to newly released clinical guidelines from the Medicines Prescribing Centre of the U.K.-based National Institute for Health and Care Excellence (NICE).
The guidelines, developed by a multidisciplinary Guideline Development Group (GDG) of NICE staff, health professionals, and lay members, were designed to ensure that National Health Service patients get the best possible outcomes from their medicines.
“Relevant information about medicines should be shared with patients, and their family members or carers, where appropriate, and between health and social care practitioners when a person moves from one care setting to another, to support high-quality care,” wrote the authors of the guidelines, led by Dr. Weeliat Chong, chair of the GDG.
The report identified four key recommendations as priorities for implementation:
• Consider using multiple methods (such as health record review, patient surveys and direct observation of medicines administration) to identify medicine-related patient safety incidents
• Organizations should ensure that medicines reconciliation (i.e., making sure medicines prescribed on admission correspond to those that the patient was taking before admission) is carried out by a trained and competent health professional with effective communication skills, technical knowledge of processes for managing medicines, and therapeutic knowledge of medicines use.
• Health and social care practitioners should share relevant information about the [patients] and their medicines via medicines-related communication systems when a person transfers from one care setting to another.
• Consider sending the patient’s medicines discharge information to [his or her] nominated community pharmacy, when possible and in agreement with the patient.
Click here for the full report.
Effective systems and processes are a key part of minimizing the risk of preventable medicine-related problems and ensuring best possible outcomes for care, according to newly released clinical guidelines from the Medicines Prescribing Centre of the U.K.-based National Institute for Health and Care Excellence (NICE).
The guidelines, developed by a multidisciplinary Guideline Development Group (GDG) of NICE staff, health professionals, and lay members, were designed to ensure that National Health Service patients get the best possible outcomes from their medicines.
“Relevant information about medicines should be shared with patients, and their family members or carers, where appropriate, and between health and social care practitioners when a person moves from one care setting to another, to support high-quality care,” wrote the authors of the guidelines, led by Dr. Weeliat Chong, chair of the GDG.
The report identified four key recommendations as priorities for implementation:
• Consider using multiple methods (such as health record review, patient surveys and direct observation of medicines administration) to identify medicine-related patient safety incidents
• Organizations should ensure that medicines reconciliation (i.e., making sure medicines prescribed on admission correspond to those that the patient was taking before admission) is carried out by a trained and competent health professional with effective communication skills, technical knowledge of processes for managing medicines, and therapeutic knowledge of medicines use.
• Health and social care practitioners should share relevant information about the [patients] and their medicines via medicines-related communication systems when a person transfers from one care setting to another.
• Consider sending the patient’s medicines discharge information to [his or her] nominated community pharmacy, when possible and in agreement with the patient.
Click here for the full report.
“Cogwheel” and other signs of hydrosalpinx and pelvic inclusion cysts
Ultrasonography is the preferred imaging method to evaluate most adnexal cysts. Most types of pelvic cyst pathology have characteristic findings that, when identified, can guide counseling and management decisions. For instance, simple cysts have thin walls, are uniformly hypoechoic, and show no blood flow on color Doppler. Endometriomas, on the other hand, demonstrate diffuse, low-level internal echoes on ultrasonography.
In parts 1 and 2 of this 4-part series on adnexal pathology, we presented images detailing common benign adnexal cysts, including:
- simple and hemorrhagic cysts (Part 1:Telltale sonographic features of simple and hemorrhagic cysts)
- and mature cystic teratomas (dermoid cysts) and endometriomas (Part 2: Imaging the endometrioma and mature cystic teratoma).
In this part 3, we detail imaging for hydrosalpinx and pelvic inclusion cysts. In part 4 we will consider cystadenomas and ovarian neoplasias.
hydrosalpinx
These cysts are caused by fimbrial obstruction and result in tubal distention with serous fluid. A hydrosalpinx may occur following an episode of salpingitis or pelvic surgery.
Sonographic features diagnostic for hydrosalpinx include a tubular or S-shaped cystic mass separate from the ovary, with:
- “beads on a string” or “cogwheel” appearance (small round nodules less than 3 mm in size that represent endosalpingeal folds when viewed in cross section)
- “waist sign” (indentations on opposite sides)
- incomplete septations, which result from segments of distended tube folding over/adhering to other tubal segments
Levine and colleagues noted that 3-dimensional imaging may be helpful when the diagnosis is uncertain.1
When a mass is noted that has features classic for hydrosalpinx, the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement recommends1:
- no further imaging is necessary to establish the diagnosis
- frequency of follow-up imaging should be based on the patient’s age and clinical symptoms
In FIGURES 1 through 6 below (slides of image collections), we present 5 cases, including one of a 45-year-old patient presenting with chronic pelvic pain who was found to have bilateral hydrosalginges and right-sided tubo-ovarian complex.
pelvic inclusion cysts
Pelvic/peritoneal inclusion cysts, or peritoneal pseudocysts, are typically associated with factors that increase the risk for pelvic adhesive disease (including endometriosis, pelvic inflammatory disease, or prior pelvic surgery).
Classic sonographic features of pelvic inclusion cysts are:
- cystic mass, usually with septations/loculations
- the mass follows the contour of adjacent organs
- ovary at edge of the mass or sometimes suspended within it
- with or without flow in septation on color Doppler
When a mass is noted that has features classic for a peritoneal inclusion cyst, the US Society of Radiologists in Ultrasound recommends that1:
- no further imaging is necessary to establish the diagnosis (although further imaging may be needed if the diagnosis is uncertain)
- the frequency of follow-up imaging should be based on the patient’s age and clinical symptoms
In FIGURES 7 through 22 below (slides of image collections), we present several cases that demonstrate pelvic inclusion cysts on imaging. One case involves a 25-year-old patient presenting for 2- and 3-dimensional pelvic imaging due to infertility. She had a history of laparoscopic left ovarian cystectomy, right paratubal cystectomy, and lysis of adhesions. She was found to have a pelvic inclusion cyst and an endometrioma in the left ovary.
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Figure 10
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Figure 18
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Figure 20
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Figure 22
Reference
1. Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US Society of Radiologists in Ultrasound consensus conference statement. Ultrasound Q. 2010;26(3):121−131.
Michelle Stalnaker Ozcan, MD, and Andrew M. Kaunitz, MD
Dr. Ozcan is Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this article.
Michelle Stalnaker Ozcan, MD, and Andrew M. Kaunitz, MD
Dr. Ozcan is Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this article.
Michelle Stalnaker Ozcan, MD, and Andrew M. Kaunitz, MD
Dr. Ozcan is Assistant Professor and Associate Program Director, Obstetrics and Gynecology Residency, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, at the University of Florida College of Medicine–Jacksonville. Dr. Kaunitz serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this article.
Ultrasonography is the preferred imaging method to evaluate most adnexal cysts. Most types of pelvic cyst pathology have characteristic findings that, when identified, can guide counseling and management decisions. For instance, simple cysts have thin walls, are uniformly hypoechoic, and show no blood flow on color Doppler. Endometriomas, on the other hand, demonstrate diffuse, low-level internal echoes on ultrasonography.
In parts 1 and 2 of this 4-part series on adnexal pathology, we presented images detailing common benign adnexal cysts, including:
- simple and hemorrhagic cysts (Part 1:Telltale sonographic features of simple and hemorrhagic cysts)
- and mature cystic teratomas (dermoid cysts) and endometriomas (Part 2: Imaging the endometrioma and mature cystic teratoma).
In this part 3, we detail imaging for hydrosalpinx and pelvic inclusion cysts. In part 4 we will consider cystadenomas and ovarian neoplasias.
hydrosalpinx
These cysts are caused by fimbrial obstruction and result in tubal distention with serous fluid. A hydrosalpinx may occur following an episode of salpingitis or pelvic surgery.
Sonographic features diagnostic for hydrosalpinx include a tubular or S-shaped cystic mass separate from the ovary, with:
- “beads on a string” or “cogwheel” appearance (small round nodules less than 3 mm in size that represent endosalpingeal folds when viewed in cross section)
- “waist sign” (indentations on opposite sides)
- incomplete septations, which result from segments of distended tube folding over/adhering to other tubal segments
Levine and colleagues noted that 3-dimensional imaging may be helpful when the diagnosis is uncertain.1
When a mass is noted that has features classic for hydrosalpinx, the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement recommends1:
- no further imaging is necessary to establish the diagnosis
- frequency of follow-up imaging should be based on the patient’s age and clinical symptoms
In FIGURES 1 through 6 below (slides of image collections), we present 5 cases, including one of a 45-year-old patient presenting with chronic pelvic pain who was found to have bilateral hydrosalginges and right-sided tubo-ovarian complex.
pelvic inclusion cysts
Pelvic/peritoneal inclusion cysts, or peritoneal pseudocysts, are typically associated with factors that increase the risk for pelvic adhesive disease (including endometriosis, pelvic inflammatory disease, or prior pelvic surgery).
Classic sonographic features of pelvic inclusion cysts are:
- cystic mass, usually with septations/loculations
- the mass follows the contour of adjacent organs
- ovary at edge of the mass or sometimes suspended within it
- with or without flow in septation on color Doppler
When a mass is noted that has features classic for a peritoneal inclusion cyst, the US Society of Radiologists in Ultrasound recommends that1:
- no further imaging is necessary to establish the diagnosis (although further imaging may be needed if the diagnosis is uncertain)
- the frequency of follow-up imaging should be based on the patient’s age and clinical symptoms
In FIGURES 7 through 22 below (slides of image collections), we present several cases that demonstrate pelvic inclusion cysts on imaging. One case involves a 25-year-old patient presenting for 2- and 3-dimensional pelvic imaging due to infertility. She had a history of laparoscopic left ovarian cystectomy, right paratubal cystectomy, and lysis of adhesions. She was found to have a pelvic inclusion cyst and an endometrioma in the left ovary.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Ultrasonography is the preferred imaging method to evaluate most adnexal cysts. Most types of pelvic cyst pathology have characteristic findings that, when identified, can guide counseling and management decisions. For instance, simple cysts have thin walls, are uniformly hypoechoic, and show no blood flow on color Doppler. Endometriomas, on the other hand, demonstrate diffuse, low-level internal echoes on ultrasonography.
In parts 1 and 2 of this 4-part series on adnexal pathology, we presented images detailing common benign adnexal cysts, including:
- simple and hemorrhagic cysts (Part 1:Telltale sonographic features of simple and hemorrhagic cysts)
- and mature cystic teratomas (dermoid cysts) and endometriomas (Part 2: Imaging the endometrioma and mature cystic teratoma).
In this part 3, we detail imaging for hydrosalpinx and pelvic inclusion cysts. In part 4 we will consider cystadenomas and ovarian neoplasias.
hydrosalpinx
These cysts are caused by fimbrial obstruction and result in tubal distention with serous fluid. A hydrosalpinx may occur following an episode of salpingitis or pelvic surgery.
Sonographic features diagnostic for hydrosalpinx include a tubular or S-shaped cystic mass separate from the ovary, with:
- “beads on a string” or “cogwheel” appearance (small round nodules less than 3 mm in size that represent endosalpingeal folds when viewed in cross section)
- “waist sign” (indentations on opposite sides)
- incomplete septations, which result from segments of distended tube folding over/adhering to other tubal segments
Levine and colleagues noted that 3-dimensional imaging may be helpful when the diagnosis is uncertain.1
When a mass is noted that has features classic for hydrosalpinx, the Society of Radiologists in Ultrasound 2010 Consensus Conference Statement recommends1:
- no further imaging is necessary to establish the diagnosis
- frequency of follow-up imaging should be based on the patient’s age and clinical symptoms
In FIGURES 1 through 6 below (slides of image collections), we present 5 cases, including one of a 45-year-old patient presenting with chronic pelvic pain who was found to have bilateral hydrosalginges and right-sided tubo-ovarian complex.
pelvic inclusion cysts
Pelvic/peritoneal inclusion cysts, or peritoneal pseudocysts, are typically associated with factors that increase the risk for pelvic adhesive disease (including endometriosis, pelvic inflammatory disease, or prior pelvic surgery).
Classic sonographic features of pelvic inclusion cysts are:
- cystic mass, usually with septations/loculations
- the mass follows the contour of adjacent organs
- ovary at edge of the mass or sometimes suspended within it
- with or without flow in septation on color Doppler
When a mass is noted that has features classic for a peritoneal inclusion cyst, the US Society of Radiologists in Ultrasound recommends that1:
- no further imaging is necessary to establish the diagnosis (although further imaging may be needed if the diagnosis is uncertain)
- the frequency of follow-up imaging should be based on the patient’s age and clinical symptoms
In FIGURES 7 through 22 below (slides of image collections), we present several cases that demonstrate pelvic inclusion cysts on imaging. One case involves a 25-year-old patient presenting for 2- and 3-dimensional pelvic imaging due to infertility. She had a history of laparoscopic left ovarian cystectomy, right paratubal cystectomy, and lysis of adhesions. She was found to have a pelvic inclusion cyst and an endometrioma in the left ovary.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Reference
1. Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US Society of Radiologists in Ultrasound consensus conference statement. Ultrasound Q. 2010;26(3):121−131.
Reference
1. Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US Society of Radiologists in Ultrasound consensus conference statement. Ultrasound Q. 2010;26(3):121−131.
Endovascular stents effective for iliofemoral obstructions in patients with PTS
Endovascular stenting is a safe and effective way to treat iliofemoral obstructions in patients with postthrombotic syndrome, according to Dr. M. Yin of Shanghai (China) JiaoTong University, and associates.
The stenting process was achieved without major complications in 95% of cases. Cumulative primary, assisted primary, and secondary patency rates after 3 years were 69%, 79%, and 92%, respectively. Patients with severe postthrombotic syndrome (PTS) saw a significant drop in their Villalta score, compared with patients treated with elastic compression stockings (ECS) therapy, though scores were similar in patients with moderate PTS in both groups. The 24-month recurrence-free ulcer healing rate was significantly higher in the stenting group (87% vs. 71%).
“ECS therapy shows equal clinical effects with stent placement in patients with moderate PTS,” but the stented patients did not have to wear stockings after the procedure, the researchers wrote.
Find the full study in the European Journal of Vascular & Endovascular Surgery (doi: 10.1016/j.ejvs.2015.03.029).
Endovascular stenting is a safe and effective way to treat iliofemoral obstructions in patients with postthrombotic syndrome, according to Dr. M. Yin of Shanghai (China) JiaoTong University, and associates.
The stenting process was achieved without major complications in 95% of cases. Cumulative primary, assisted primary, and secondary patency rates after 3 years were 69%, 79%, and 92%, respectively. Patients with severe postthrombotic syndrome (PTS) saw a significant drop in their Villalta score, compared with patients treated with elastic compression stockings (ECS) therapy, though scores were similar in patients with moderate PTS in both groups. The 24-month recurrence-free ulcer healing rate was significantly higher in the stenting group (87% vs. 71%).
“ECS therapy shows equal clinical effects with stent placement in patients with moderate PTS,” but the stented patients did not have to wear stockings after the procedure, the researchers wrote.
Find the full study in the European Journal of Vascular & Endovascular Surgery (doi: 10.1016/j.ejvs.2015.03.029).
Endovascular stenting is a safe and effective way to treat iliofemoral obstructions in patients with postthrombotic syndrome, according to Dr. M. Yin of Shanghai (China) JiaoTong University, and associates.
The stenting process was achieved without major complications in 95% of cases. Cumulative primary, assisted primary, and secondary patency rates after 3 years were 69%, 79%, and 92%, respectively. Patients with severe postthrombotic syndrome (PTS) saw a significant drop in their Villalta score, compared with patients treated with elastic compression stockings (ECS) therapy, though scores were similar in patients with moderate PTS in both groups. The 24-month recurrence-free ulcer healing rate was significantly higher in the stenting group (87% vs. 71%).
“ECS therapy shows equal clinical effects with stent placement in patients with moderate PTS,” but the stented patients did not have to wear stockings after the procedure, the researchers wrote.
Find the full study in the European Journal of Vascular & Endovascular Surgery (doi: 10.1016/j.ejvs.2015.03.029).
NICE advises on how to maintain, achieve healthy weight
The National Institute for Health and Care Excellence (NICE) has issued a new guideline on maintaining a healthy weight and preventing excess weight gain.
This guideline replaces section 1.1.1 of NICE’s guideline on obesity, CG43 (2006).
The guideline, for those who educate people on how to maintain a healthy weight or prevent excess weight gain, comprises the following recommendations:
• Encourage people to make changes in line with existing advice.
• Encourage physical activity habits to avoid low energy expenditure.
• Encourage dietary habits that reduce the risk of excess energy intake.
• Provide further advice for parents and carers of children and young people.
• Encourage adults to limit the amount of alcohol they drink.
• Encourage self-monitoring.
• Clearly communicate the benefits of maintaining a healthy weight.
• Clearly communicate the benefits of gradual improvements to physical activity and dietary habits.
• Tailor messages for specific groups.
• Ensure activities are integrated with the local strategic approach to obesity.
The National Institute for Health and Care Excellence (NICE) has issued a new guideline on maintaining a healthy weight and preventing excess weight gain.
This guideline replaces section 1.1.1 of NICE’s guideline on obesity, CG43 (2006).
The guideline, for those who educate people on how to maintain a healthy weight or prevent excess weight gain, comprises the following recommendations:
• Encourage people to make changes in line with existing advice.
• Encourage physical activity habits to avoid low energy expenditure.
• Encourage dietary habits that reduce the risk of excess energy intake.
• Provide further advice for parents and carers of children and young people.
• Encourage adults to limit the amount of alcohol they drink.
• Encourage self-monitoring.
• Clearly communicate the benefits of maintaining a healthy weight.
• Clearly communicate the benefits of gradual improvements to physical activity and dietary habits.
• Tailor messages for specific groups.
• Ensure activities are integrated with the local strategic approach to obesity.
The National Institute for Health and Care Excellence (NICE) has issued a new guideline on maintaining a healthy weight and preventing excess weight gain.
This guideline replaces section 1.1.1 of NICE’s guideline on obesity, CG43 (2006).
The guideline, for those who educate people on how to maintain a healthy weight or prevent excess weight gain, comprises the following recommendations:
• Encourage people to make changes in line with existing advice.
• Encourage physical activity habits to avoid low energy expenditure.
• Encourage dietary habits that reduce the risk of excess energy intake.
• Provide further advice for parents and carers of children and young people.
• Encourage adults to limit the amount of alcohol they drink.
• Encourage self-monitoring.
• Clearly communicate the benefits of maintaining a healthy weight.
• Clearly communicate the benefits of gradual improvements to physical activity and dietary habits.
• Tailor messages for specific groups.
• Ensure activities are integrated with the local strategic approach to obesity.
Esophagogastric cancer chemotherapy commonly causes VTE
Venous thromboembolism is common in patients undergoing oxaliplatin, capecitabine, and epirubicin chemotherapy for esophagogastric cancer, according to Dr. Anders Christian Larsen of Aalborg (Denmark) University Hospital and associates.
There were 21 cases of VTE among the 129 patients with esophagogastric cancer, a rate of 16%. Of the VTE cases, 14 were asymptomatic and 7 were symptomatic. Gastric cancer and late-stage cancer were significant VTE risk factors, with odds ratios of 6.4 and 5.2, respectively. The median survival time was 18 months in non-VTE patients and 14 months in VTE patients.
“The extent of treatment-related VTE in upper GI cancer patients (with active cancer) receiving both chemotherapy and curative intended surgery may be greater than previously estimated. … Our data demonstrate the need to address this clinical problem with randomized clinical trials on VTE prophylaxis, particularly in patients undergoing neoadjuvant chemotherapy for resectable cancer disease,” the investigators concluded.
The authors said that there were no conflicts; the study was funded by private foundations.
Find the full study in Thrombosis Research.
Venous thromboembolism is common in patients undergoing oxaliplatin, capecitabine, and epirubicin chemotherapy for esophagogastric cancer, according to Dr. Anders Christian Larsen of Aalborg (Denmark) University Hospital and associates.
There were 21 cases of VTE among the 129 patients with esophagogastric cancer, a rate of 16%. Of the VTE cases, 14 were asymptomatic and 7 were symptomatic. Gastric cancer and late-stage cancer were significant VTE risk factors, with odds ratios of 6.4 and 5.2, respectively. The median survival time was 18 months in non-VTE patients and 14 months in VTE patients.
“The extent of treatment-related VTE in upper GI cancer patients (with active cancer) receiving both chemotherapy and curative intended surgery may be greater than previously estimated. … Our data demonstrate the need to address this clinical problem with randomized clinical trials on VTE prophylaxis, particularly in patients undergoing neoadjuvant chemotherapy for resectable cancer disease,” the investigators concluded.
The authors said that there were no conflicts; the study was funded by private foundations.
Find the full study in Thrombosis Research.
Venous thromboembolism is common in patients undergoing oxaliplatin, capecitabine, and epirubicin chemotherapy for esophagogastric cancer, according to Dr. Anders Christian Larsen of Aalborg (Denmark) University Hospital and associates.
There were 21 cases of VTE among the 129 patients with esophagogastric cancer, a rate of 16%. Of the VTE cases, 14 were asymptomatic and 7 were symptomatic. Gastric cancer and late-stage cancer were significant VTE risk factors, with odds ratios of 6.4 and 5.2, respectively. The median survival time was 18 months in non-VTE patients and 14 months in VTE patients.
“The extent of treatment-related VTE in upper GI cancer patients (with active cancer) receiving both chemotherapy and curative intended surgery may be greater than previously estimated. … Our data demonstrate the need to address this clinical problem with randomized clinical trials on VTE prophylaxis, particularly in patients undergoing neoadjuvant chemotherapy for resectable cancer disease,” the investigators concluded.
The authors said that there were no conflicts; the study was funded by private foundations.
Find the full study in Thrombosis Research.