Clinical research and trials最新文献

{"title":"Phaeochromocytoma of the urinary bladder","authors":"Sarmah Pb, Kelly Bd, N. A, Ryan Pg","doi":"10.15761/crt.1000304","DOIUrl":"https://doi.org/10.15761/crt.1000304","url":null,"abstract":"Phaeochromocytoma is a benign tumour which mostly occurs in the adrenal glands but can arise in extra-adrenal locations. We report a case in a Caucasian male who presented only with visible haematuria. Flexible cystoscopy revealed a mass on the left lateral wall, confirmed on a contrast-enhanced computed tomography scan of the urinary tract. The patient underwent a transurethral resection of bladder tumour with histological analysis demonstrating paraganglioma. Further reresection demonstrated a small nodule of recurrent disease in the lamina propria. Phaeochromocytoma of the urinary bladder is a rare condition which requires close investigation and follow-up due to its malignant potential. *Correspondence to: Sarmah PB, Department of Urology, City Hospital, Birmingham, UK, E-mail: piyushbsarmah@doctors.org.uk Received: April 23, 2020; Accepted: May 06, 2020; Published: May 11, 2020 Introduction Phaeochromocytoma commonly affects the adrenal gland but can have extra-adrenal locations due to distribution along the paraganglion system, including the urinary bladder. We report a case in a male patient without typical symptoms, and discuss the presentation, diagnosis and management of this condition. Clinical Practice Points A 56 year old male was seen in the Urology two week wait clinic with visible haematuria. He had undergone a flexible cystoscopy in his native country one month earlier and been informed that he had a bladder mass, however no biopsy was taken as he was taking Warfarin at the time for atrial fibrillation and he was advised to return to the UK. He had a further background history of Type II diabetes and hypertension, and was taking medications in the form of insulin, metformin, amlodipine, bisoprolol, ramipril and torasemide. He was a non-smoker and unemployed. On examination he was markedly obese. Abdominal examination revealed no tenderness or abdominal masses. There was a buried penis. Flexible cystoscopy was performed which demonstrated a large 3x4cm solid mass on the left lateral wall. Blood tests revealed impaired renal function but normal electrolytes (Table 1) and full blood count, and urine cytology and culture were normal. A computed tomography (CT) scan of the urinary tract with contrast was performed confirming the presence of a solid mass against the left lateral wall of the bladder with minor perivesical stranding (Figure 1), but normal upper urinary tracts. The patient underwent a transurethral resection of bladder tumour (TURBT) with the findings from flexible cystoscopy confirmed, and post-operatively had instillation of intravesical Mitomycin-C. Histology from the operative chippings included muscularis propria and found solid nests of cells diffusely arranged with a slightly packeted arrangement, separate by prominent vasculature. The tumour cells were immunoreactive for S100 and CD56, and overall appearances were consistent with an extra adrenal paraganglioma or phaeochromocytoma. A repeat TURBT and random bladde","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67458919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical trials during COVID-19: Keeping clinical trial participants informed during this pandemic","authors":"Wong Lx, B. Chee, Park Jm","doi":"10.15761/crt.1000312","DOIUrl":"https://doi.org/10.15761/crt.1000312","url":null,"abstract":"Currently, per the World Health Organization (WHO), the novel coronavirus disease 2019 (COVID-19) surpassed five million confirmed cases and the numbers continue to alarmingly climb world-wide [1]. COVID-19 is caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inducing potentially lifethreatening circumstances in all age ranges, primarily in that of 3065 [2]. Especially in light of early studies showing COVID-19 patients with co-morbidities likely to have more severe symptoms and increase risk of death than that of those who did not have co-morbidities [3,4], global municipalities, states and countries have enacted a various forms of quarantine strategies to mitigate the adverse effects of COVID-19 on people and our global society [5].","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67459270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marfan syndrome with unileaflet mitral valve, moderate mitral regurgitation and atrial septal defect. An uncommon association","authors":"N. Espinola-Zavaleta, Rodrigo Escalante-Armenta, Dana Leyla Rei-Cassab, Luis Javier Castellanos-Vizcaíno, E. Alexanderson-Rosas","doi":"10.15761/crt.1000289","DOIUrl":"https://doi.org/10.15761/crt.1000289","url":null,"abstract":"This is a case of a patient with Marfan Syndrome, who has as outstanding characteristics of a unicuspid mitral valve with moderate mitral regurgitation and atrial septal defect, both reported in an echocardiographic study. The association between both congenital cardiovascular alterations is very rare, and even more as unique findings in a patient with Marfan Syndrome.","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67458375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amount of PPE against COVID-19 to Sub-Saharan Africa may determine the region’s uptake to patient care and clinical research","authors":"T. Nyirenda, Min Jae Shin, S. Shin, David S. Chung","doi":"10.15761/crt.1000308","DOIUrl":"https://doi.org/10.15761/crt.1000308","url":null,"abstract":"Sub-Saharan Africa is faced with weak health systems and disproportionately inadequate number of health workers. Some studies have shown high vulnerability of these workers to occupational health infections from their patients. The COVID-19 pandemic which is spreading to the region and has affected the health work force in the west is likely to do the same in Sub-Saharan Africa. Non-availability or inadequate supply of good personal protective equipment (PPE) may become a disincentive to caring for the diagnosed cases and slow uptake for clinical research in the region. Slow manufacturing plans, poor supply chain and poor adherence by health workers could all contribute to the scarcity and effectiveness of PPE to the region if not well managed. Ensuring PPE are adequately available may be a big challenge for many of the poor countries in sub-Saharan Africa, but it is huddle that needs to be avoided for better uptake of clinical care and research. *Correspondence to: Thomas Nyirenda, MD MPH, European and Developing Countries Clinical Trials Partnership, Medical Research Council, Francie van Zyl Drive, Cape Town 7505, South Africa, Tel: 0027824174743; E-mail: nyirenda@edctp.org","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67459035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we worry about elevated B12 levels in children?","authors":"S. Butala, Mary Teresczuk, S. Malay, Irina B. Pateva","doi":"10.15761/CRT.1000335","DOIUrl":"https://doi.org/10.15761/CRT.1000335","url":null,"abstract":"Background: Vitamin B 12 (B 12 ) is an essential nutrient for DNA synthesis and cell metabolism. While B 12 deficiency has been extensively studied, the importance of elevated B 12 is under investigation. High levels are described in adults with malignancies and many other conditions. Limited and conflicting data exists pertaining to children with elevated levels. Methods: A single institution retrospective study was conducted. Patients younger than 18 years with high B 12 levels during the period of 2010-2018 were included. Patients with a history of or concurrent B 12 therapy were excluded. B 12 levels, complete blood cell counts, concurrent, prior and future diagnoses were collected. Results: A total of 384 patients with high B 12 levels were identified. An indication for obtaining a B 12 level was documented for 296 patients (77.1%) with most common reasons being fatigue (n = 36 , 12.2%), failure to thrive (n = 32, 10.8%) and anemia (n = 25, 8.4%). Seven indications, (2.4%) were obtained as follow-up of a previous malignancy. Within the 5 year follow up 47.8% of patients (n=142) had documentation of future diagnoses. The top 3 subspecialties with future diagnoses were psychiatry (n=53, 23.0%), gastroenterology (n=32, 13.9%) and neurology (n=26, 11.3%). Only one patient developed an oncologic diagnosis, Langerhans Cell Histiocytosis. Conclusion: Our study found no association of elevated B 12 with pediatric malignancies. However, we highlight a possible link between elevated B 12 and neuropsychiatric and gastroenterological processes. More studies are needed to further delineate the importance of elevated B 12 in the pediatric population.","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67460144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blockade of mini-TrpRS for treatment of diabetic foot syndrome","authors":"E. Biros, V. Vangaveti, C. Moran, U. Malabu","doi":"10.15761/crt.1000328","DOIUrl":"https://doi.org/10.15761/crt.1000328","url":null,"abstract":"Diabetic foot syndrome demonstrates wound chronicity due to impaired tissue perfusion in lower limbs. Previous studies showed interferon-gamma (IFN-γ), a central inflammatory mediator in diabetic foot syndrome, to induce the truncated form of tryptophanyl-tRNA synthetase (mini-TrpRS) that has strong angiostatic properties. Recently we reported that mini-TrpRS signalling could be blocked in the presence of IFN-γ with D-tryptophan in vitro. Here we discuss the IFN-γ/mini-TrpRS axis in the pathology of diabetic foot syndrome and emerging therapeutic options.","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67460297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of sequential respiratory training on patients with stable chronic obstructive pulmonary disease: a randomized controlled clinical trial","authors":"Xiaobing Wang, An Guo, Honggang Wang, Wei Huang, Ming-qiao Ding","doi":"10.15761/crt.1000314","DOIUrl":"https://doi.org/10.15761/crt.1000314","url":null,"abstract":"Objective: To explore the effect of sequential respiratory training rehabilitation methods on the pulmonary function of patients with stable chronic obstructive pulmonary disease. Methods: This is a randomized controlled clinical trial. A total of 200 cases of stable chronic obstructive pulmonary disease patients were recruited from June 2014 to May 2015 in the respiratory medicine clinic, which were randomly divided into sequential breathing training group and control group. Forced expiratory volume in the first second (FEVI%), British Medical Research Council (mMRC) questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score, the number of acute exacerbation frequency were and 6-minute walk test (6MWT) were assessed after treatment for 3, 6 and 12 months. Results: During the 12-month follow-up period, a total of 170 patients had complete follow-up information. There were 85 patients both in sequential breathing training group and control group. In the experimental group, there were 59 males and 26 females, with an average age of (65.02 ± 7.84) years. In the control group, there were 64 males and 21 females, with an average age of (64.96 ± 7.02) years. After treatment for 3, 6 and 12 months, FEVI%, mMRC score, CAT score, the number of acute exacerbation frequency and 6MWT were all significantly improved in the experimental group than control group (p<0.05). Conclusion: Sequential breathing training therapy can better improve the pulmonary function of stable chronic obstructive pulmonary disease patients and distinctly reduce the incidence of acute exacerbation of chronic obstructive pulmonary disease, which provides a basis for clinical rehabilitation. Trial registration: This study was registered in the Chinese Clinical Trials Registry Platform (ChiCTR-OPC-14005290). *Correspondence to: Mingxing Ding, Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No.1188 Wuzhou Street, Jinhua 321007, Zhejiang, China, E-mail: mtd5tc@163.com","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67459403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchial Mucus: Basic research and clinical application","authors":"A. Alvarado","doi":"10.15761/crt.1000316","DOIUrl":"https://doi.org/10.15761/crt.1000316","url":null,"abstract":"Mucoobstructive lung diseases, including chronic obstructive pulmonary disease, asthma, cystic fibrosis, non-cystic bronchiectasis and, primary ciliary dyskinesia, are characterized by intrapulmonary accumulations of hyperconcentrated mucus. Clearance of intrapulmonary mucus by the high-velocity airflow generated by cough is the major rescue clearance mechanism in subjects with mucoobstructive diseases. Ultimately, the mucus accumulation in diseases reflects the failure of said clearance mechanism. Given the multifunctionality of mucus, the various mechanisms of mucus production and exposure to the environment, but also to the systemic circulation, it is not surprising that both its genesis and its operation can be compromised in said pathologies. We proceed to review the biochemical and biophysical properties of mucus relative to airway function, the mucin concentration in health and diseases and the integrated cilia and cough-dependent mucus clearance. Then we proceed to review various diseases that have mucus dysfunction in common, the mechanism that generates this dysfunction and how it impacts the symptoms and the natural evolution of these pathologies. At the end it is discussed how restoration of cough efficacy may be most effectively provided by restoring mucus concentrations to normal ranges with hydrating agents coupled with viscosity-lowering agents.","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67459876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced liver disease: It is not all about Covid-19","authors":"Del Pino Bellido Pilar, Guerra Veloz Maria Fernanda, Muñoz Garcia-Borruel Maria, Salamanca Rivera Elena, Carmona Soria Isabel","doi":"10.15761/crt.1000318","DOIUrl":"https://doi.org/10.15761/crt.1000318","url":null,"abstract":"Patients with advanced chronic liver disease may be at increased risk of infection and/or severe course due to the cirrhosis-associated immune dysfunction. However, there is limited data linking chronic liver disease and Covid-19. Patients with cirrhosis are known to have abnormalities of immune function (immunodeficiency), as well as systemic inflammation, which is the pathophysiological hallmark of increased susceptibility to infection. Patients with cirrhosis are at a high risk of having a severe course of the influenza, including the development of organ failures. However, there is limited data on the course of Covid-19 in patients with chronic liver disease (CLD) and whether SARS-Cov2 can increase the risk of decompensation or development of acute-on-chronic liver failure (ACLF). Actual data indicates a prevalence (0-11%) of pre-existing liver conditions in patients with COVID-19. We present two cases of patients with decompensated liver disease that were evaluated for the SARS-Cov2 due to the new hospital policy of testing all patients who require hospital admission. One of them was asymptomatic, while the other presented mild respiratory symptoms. We believe that COVID-19 did not worsen liver function in our patients, and as such did not increase their risk of mortality or develop ACLF during admission.","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"157 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67460051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare system barriers of breast and thyroid screening for childhood and young adulthood cancer survivors in France: A qualitative study of the DeNaCaPST programme at one year","authors":"C. demoor-goldschmidt, C. Berger, I. Guichard, S. Supiot, A. Dezellus, B. Filhon, piere-yves bondiau, M. Poirée, C. Oudot, L. Claude, G. Truc, C. Briandet, L. Padovani, C. Coze, V. Bernier, C. Kerr, Y. Réguerre, H. Sudour-Bonnange, J. Gaudichon, C. Vigneron, A. Dumas, F. Vathaire","doi":"10.21203/rs.2.11121/v1","DOIUrl":"https://doi.org/10.21203/rs.2.11121/v1","url":null,"abstract":"\u0000 Purpose\u0000Childhood, adolescent and young adult cancer survivors (CAYACS) who were treated by radiotherapy have a significant risk of developing subsequent malignancies, particularly breast and thyroid cancers when the field of irradiation concerned these organs. Advice regarding their increased risk of developing secondary breast (SBC) and thyroid (STC) cancer are recommended to ensure risk-stratified life-long follow-up care including appropriate screening. In France, a national program called DeNaCaPST was started to promote this care. We aimed to explore the perspectives of medical practitioners (MP) on the healthcare system factors that limited inclusion in this programme.\u0000Methods\u0000Data of the DeNaCAPST programme regarding organisation were studied, including data from a qualitative survey done among MP.\u0000Results\u0000Seventeen months after the DeNaCaPST programme started, 84.6% of the French regions had participating centres/hospitals, along with one overseas territory. The main barriers to screening highlighted by MP were: 1) inconvenient and under-resourced healthcare professionals to perform these consultations, (2) difficulty determining which CAYACS need SBC and/or STC screening, (3) difficulty organising the network of professionals from paediatric to adult health services.\u0000Conclusions\u0000Despite a slow inclusion speed and a suboptimal geographical coverage, changes are underway and should allow for several improvements and interesting perspectives for this study. CAYACS lost to follow-up are difficult to invite for a consultation. The absence of real long-term follow-up care is a real barrier to promoting such screening, which must involve a transition care between the paediatric oncologists who know who are at risk and why and the adult medical professionals who have the knowledge to do the screening. The involvement and empowerment of CAYACS is necessary to promote patient-centred healthcare solutions and seems feasible.","PeriodicalId":90808,"journal":{"name":"Clinical research and trials","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41699833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}