Effect of selumetinib vs chemotherapy on progression-free survival in uveal melanoma: a randomized clinical trial.

Importance: Uveal melanoma is characterized by mutations in GNAQ and GNA11, resulting in mitogen-activated protein kinase pathway activation.

Objective: To assess the efficacy of selumetinib, a selective, non-adenosine triphosphate competitive inhibitor of MEK1 and MEK2, in uveal melanoma.

Design, Setting, And Participants: Randomized, open-label, phase 2 clinical trial comparing selumetinib vs chemotherapy conducted from August 2010 through December 2013 among 120 patients with metastatic uveal melanoma at 15 academic oncology centers in the United States and Canada.

Another look at the association between diabetes and keratoconus.

Purpose: The aim of this study was to evaluate the association between diabetes mellitus (DM) and keratoconus.

Methods: We conducted 2 substudies: (1) Retrospective comparison of the prevalence of DM in patients with keratoconus with that of control patients without keratoconus and (2) Cross-sectional study of the severity of keratoconus in diabetic keratoconus-affected patients and nondiabetic keratoconus-affected patients. Patients seen at the Wills Eye Hospital Cornea Service from January 2008 to August 2012 were included.

MicroRNA expression altered by diet: can food be medicinal?

As the link between metabolism and major disease processes becomes more well-defined, the identification of key molecular targets is leading to new therapeutic strategies. As a result, small non-coding RNA molecules that regulate gene expression via epigenetic alterations, microRNAs have been identified as regulators of these metabolic processes. In the last decade, dietary interventions have been used to change metabolism and to potentially alter disease progression and clinical outcomes.

Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial.

Objective: To compare the incidence of wound complications between suture and staple skin closure after cesarean delivery.

Methods: This prospective, randomized clinical trial conducted at three hospitals in the United States between 2010 and 2012 included women undergoing cesarean delivery at 23 weeks of gestation or greater through a low-transverse skin incision. Women were randomized to closure of the skin incision with suture or staples after stratifying by body mass index and primary compared with repeat cesarean delivery.

Greater trochanteric pain syndrome diagnosis and treatment.

Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions.

Carpal tunnel syndrome diagnosis.

Carpal tunnel syndrome (CTS) is a common median nerve compression syndrome and the most common peripheral mononeuropathy. The clinical syndrome is diagnosed by history and physical examination. Electrodiagnostic testing is the objective method used to measure median nerve dysfunction at the wrist and confirm the clinical diagnosis of CTS.

First-trimester maternal serum C-reactive protein as a predictor of third-trimester impaired glucose tolerance.

Objective: We evaluated whether first-trimester high-sensitivity C-reactive protein (hsCRP), a suggested marker of pregnancy-associated hyperglycemia, predicts third-trimester impaired glucose tolerance (IGT) in a secondary analysis of a prospective cohort of nondiabetic singletons enrolled at <26 weeks gestation.

Study Design: We measured the association between hsCRP collected at <14 weeks among women classified as IGT (gestational diabetes screening results, 135 to <200 mg/dL) and those among normoglycemic women. Multivariable modeling estimated the association between log hsCRP and IGT, adjusted for maternal body mass index (BMI).

Practical guide to the use of enzalutamide.

Introduction: We summarize the development, definitive trials, and practical use of enzalutamide for practicing urologists and medical oncologists. The care paradigm for patients with metastatic castration resistant prostate cancer (mCRPC) is a changing landscape, with the ongoing discovery of drivers of cancer progression yielding actionable targets for drug development. Since 2010, sipuleucel-T, cabazitaxel, abiraterone with prednisone, radium 223 and enzalutamide have been Food and Drug Administration approved based upon improvement in overall survival in men with mCRPC.

The quality frontier.

Quality is gaining increased attention in medicine including oncology. This heightened focus on quality is long overdue, as noted by the Institute of Medicine over a decade ago. Unfortunately, medical practice including the numerous disciplines of oncology continues to fall short of its 'quality frontier', an analogous concept to the productivity frontier in business.

Cardiovascular adverse effects of newer antidepressants.

Newer antidepressants that are more selective in their neurotransmitter effects include the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and others (agomelatine, bupropion, mirtazapine, reboxetine, vilazodone, vortioxetine). This article systematically reviews data from a variety of sources regarding the potential adverse effects of these medications on various cardiovascular parameters. Potential biochemical mechanisms by which these antidepressants may adversely affect the cardiovascular system are also discussed.

Molecular markers to predict clinical outcome and radiation induced toxicity in lung cancer.

The elucidation of driver mutations involved in the molecular pathogenesis of cancer has led to a surge in the application of novel targeted therapeutics in lung cancer. Novel oncologic research continues to lead investigators towards targeting personalized tumor characteristics rather than applying targeted therapy to broad patient populations. Several driver genes, in particular epidermal growth factor receptor (EGFR) and ALK fusions, are the earliest to have made their way into clinical trials.

Comparative evaluation of dual Scheimpflug imaging parameters in keratoconus, early keratoconus, and normal eyes.

Purpose: To determine the efficacy of various parameters measured by dual Scheimpflug imaging technology in differentiating eyes with keratoconus or early keratoconus from normal eyes.

Setting: Cornea Service, Wills Eye Institute, Philadelphia, Pennsylvania, USA.

Design: Comparative case series.

Calcium/vitamin D supplementation, serum 25-hydroxyvitamin D concentrations, and cholesterol profiles in the Women's Health Initiative calcium/vitamin D randomized trial.

Objective: The objective of this study was to evaluate whether increased serum 25-hydroxyvitamin D3 (25OHD3) concentrations, in response to calcium/vitamin D (CaD) supplementation, are associated with improved lipids in postmenopausal women.

Methods: The parent trial was a double-blind, randomized, placebo-controlled, parallel-group trial designed to test the effects of CaD supplementation (1,000 mg of elemental calcium + 400 IU of vitamin D3 daily) versus placebo in postmenopausal women. Women from the general community, including multiple sites in the United States, were enrolled between 1993 and 1998.

Tocolytics for preterm premature rupture of membranes.

Background: In women with preterm labor, tocolysis has not been shown to improve perinatal mortality; however, it is often given for 48 hours to allow for the corticosteroid effect for fetal maturation. In women with preterm premature rupture of membranes (PPROM), the use of tocolysis is still controversial. In theory, tocolysis may prolong pregnancy in women with PPROM, thereby allowing for the corticosteroid benefit and reducing the morbidity and mortality associated with prematurity.

Clinical and histologic characteristics of clinically unsuspected melanomas.

Thin melanomas are recognized and captured by clinicians at an alarming rate, whereas thick melanomas remain underrecognized. Improved recognition of thick melanomas will require further understanding of their clinical and histologic characteristics at various stages of development because emerging data suggest that the thin melanomas being captured today may not represent the forerunners of the thick melanomas. In this retrospective analysis, pathology requisition forms from melanomas diagnosed by histopathology were examined for submitted clinical diagnosis, patient characteristics, melanoma thickness, and biopsy method.

SALL4 expression in germ cell and non-germ cell tumors: a systematic immunohistochemical study of 3215 cases.

The SALL4 transcription factor is associated with embryonic cell pluripotency and has been shown as a useful immunohistochemical marker for germ cell tumors. However, information of SALL4 distribution in normal human tissues and non-germ cell tumors is limited. In this study we examined normal human tissues and 3215 tumors for SALL4 expression using a monoclonal antibody 6E3 and automated immunohistochemistry.

Dual atrioventricular nodal pathways physiology: a review of relevant anatomy, electrophysiology, and electrocardiographic manifestations.

More than half a century has passed since the concept of dual atrioventricular (AV) nodal pathways physiology was conceived. Dual AV nodal pathways have been shown to be responsible for many clinical arrhythmia syndromes, most notably AV nodal reentrant tachycardia. Although there has been a considerable amount of research on this topic, the subject of dual AV nodal pathways physiology remains heavily debated and discussed.

Prostate-specific antigen bounce predicts for a favorable prognosis following brachytherapy: a meta-analysis.

Purpose: Controversy exists whether the prostate-specific antigen (PSA) bounce phenomenon following definitive radiation for prostate cancer has prognostic significance. Here, we perform a meta-analysis to determine the association between PSA bounce and biochemical control after brachytherapy alone.

Material And Methods: We reviewed Medline, EMBASE, and CENTRAL citations through February 2012.

Association of vitamin D deficiency, secondary hyperparathyroidism, and heterotopic ossification in spinal cord injury.

Our objective was to explore the relationship between low vitamin D, secondary hyperparathyroidism, and heterotopic ossification (HO) in patients with spinal cord injury (SCI). Ninety-six subjects with acute or chronic motor complete SCI participated. Levels of serum vitamin D25(OH), calcium, and intact parathyroid hormone (PTH) were collected, and information regarding nutritional patterns and fracture history was obtained from subjects.

Asynchronous presentation of follicle center lymphoma and reactive lymphoid hyperplasia of the ocular adnexa.

Although ocular lymphoproliferative diseases may be rarely encountered by dermatopathologists, the frequency may increase particularly as more and more subspecialties rely on dermatopathology services. Emerging data suggest that there are some similarities between ocular and cutaneous lymphoproliferative diseases with respect to their clinical behavior, prognosis, and cytogenetics. In this case report, a patient with ocular follicle center lymphoma who subsequently developed ocular reactive lymphoid hyperplasia is presented with an accompanying review of the literature on the subjects.

An update on Parkinson's disease: improving patient outcomes.

Neurologists are faced with many challenges in caring for patients with Parkinson's disease (PD). This chronic, long-term illness that affects at least one million people in the United States requires a coordinated healthcare partnership between the physician and the patient. The importance of early diagnosis is essential to delaying disease progression and early diagnosis and intervention may be aided by recent advances in biomarkers, genomics, and imaging.

Spontaneously resolving macular cyst in an infant.

The purpose of this study is to describe transient macular cysts in an infant and correlate their occurrence with normal development events. A newborn Caucasian girl presented with a protruding corneal mass in her left eye at birth. She underwent a complete ophthalmic examination.