186 research outputs found
Disseminated superficial porokeratosis involving the groin and genitalia in a 72-year-old immunocompetent man
The porokeratoses are a group of disorders of
abnormal epidermal keratinization resulting in the
characteristic histologic feature of the cornoid
lamella. Several clinical variants of porokeratosis
exist, which are unified by this common histologic
feature but differ in morphology, distribution, and
clinical course. The typical lesions of porokeratosis
are characterized by an atrophic center surrounded
by an elevated keratotic rim formed by the cornoid
lamella. The lesions can be found almost anywhere
on the body; however, the groin and genitalia are
rarely involved. We report an unusual presentation
of a rare clinical variant
Ariel - Volume 6 Number 4
Editors
Mark Dembert
J.D. Kanofsky
Frank Chervenak
John Lammie
Curt Cummings
Entertainment
Robert Breckenridge
Joe Conti
Gary Kaskey
Photographer
Larry Glazerman
Overseas Editor
Mike Sinason
Humorist
Jim McCann
Staff
Ken Jaffe
Bob Sklaroff
Halley Faust
Jim Burk
Ariel - Volume 6 Number 4 (Alternate Version)
Editors
Mark Dembert
J.D. Kanofsky
Frank Chervenak
John Lammie
Curt Cummings
Entertainment
Robert Breckenridge
Joe Conti
Gary Kaskey
Photographer
Larry Glazerman
Overseas Editor
Mike Sinason
Humorist
Jim McCann
Staff
Kenn Jaffe
Bob Sklaroff
Halley Faust
Jim Burke
Jay Amsterdam
Morton A. Klein
Nancy Redfer
VLSJ Members Fall 2017
Performers: Bing Crosby, Bob Hope, Dorothy LamourPiano, Voice and Chord
Lodgepole pine management guidelines for land managers in the wildland-urban interface
As a consequence of the current mountain pine beetle epidemic, many landowners and land managers are concerned about how to actively manage lodgepole pine stands. The following guidelines cover treating the dead standing trees killed by the insects, protecting homes and communities from wildfire, and ensuring that the future forest is better structured to prevent widespread mortality from insect epidemics and wildfire
Ariel - Volume 7 Number 1
Editors
Mark Dembert
Frank Chervanek
John Lammie
Jim Burke
Nancy Redfern
Business
Alf Levy
Photographer
Larry Glazerman
Staff
Hal Faust
Curt Cummings
Bob Levin
tOO mUCH (University Medical College Hospital - London
Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States
BACKGROUND AND PURPOSE: Ischemic stroke patients with large vessel occlusion (LVO) could benefit from direct transportation
to an intervention center for endovascular treatment, but non-LVO patients need rapid IV thrombolysis in the nearest center.
Our aim was to evaluate prehospital triage strategies for suspected stroke patients in the United States.
METHODS: We used a decision tree model and geographic information system to estimate outcome of suspected stroke
patients transported by ambulance within 4.5 hours after symptom onset. We compared the following strategies: (1) Always
to nearest center, (2) American Heart Association algorithm (ie, directly to intervention center if a prehospital stroke scale
suggests LVO and total driving time from scene to intervention center is <30 minutes, provided that the delay would not
exclude from thrombolysis), (3) modified algorithms with a maximum additional driving time to the intervention center of <30
minutes, <60 minutes, or without time limit, and (4) always to intervention center. Primary outcome was the annual number
of good outcomes, defined as modified Rankin Scale score of 0–2. The preferred strategy was the one that resulted in the
best outcomes with an incremental number needed to transport to intervention center (NNTI) <100 to prevent one death or
severe disability (modified Rankin Scale score of >2).
RESULTS: Nationwide implementation of the American Heart Association algorithm increased the number of good outcomes
by 594 (+1.0%) compared with transportation to the nearest center. The associated number of non-LVO patients transported
to the intervention center was 16714 (NNTI 28). The modified algorithms yielded an increase of 1013 (+1.8
Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke:Systematic Review and External Validation
BACKGROUND AND PURPOSE: Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice. METHODS: We systematically searched within Medline, Embase, Cochrane, Web of Science, to include prediction models. Models identified from the search were validated in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, which includes all patients treated with endovascular treatment within 6.5 hours after stroke onset in the Netherlands between March 2014 and November 2017. Predictive performance was evaluated according to discrimination (area under the curve) and calibration (slope and intercept of the calibration curve). Good functional outcome was defined as a score of 0–2 or 0–3 on the modified Rankin Scale depending on the model. RESULTS: After screening 3468 publications, 19 models were included in this validation. Variables included in the models mainly addressed clinical and imaging characteristics at baseline. In the validation cohort of 3156 patients, discriminative performance ranged from 0.61 (SPAN-100 [Stroke Prognostication Using Age and NIH Stroke Scale]) to 0.80 (MR PREDICTS). Best-calibrated models were THRIVE (The Totaled Health Risks in Vascular Events; intercept −0.06 [95% CI, −0.14 to 0.02]; slope 0.84 [95% CI, 0.75–0.95]), THRIVE-c (intercept 0.08 [95% CI, −0.02 to 0.17]; slope 0.71 [95% CI, 0.65–0.77]), Stroke Checkerboard score (intercept −0.05 [95% CI, −0.13 to 0.03]; slope 0.97 [95% CI, 0.88–1.08]), and MR PREDICTS (intercept 0.43 [95% CI, 0.33–0.52]; slope 0.93 [95% CI, 0.85–1.01]). CONCLUSIONS: The THRIVE-c score and MR PREDICTS both showed a good combination of discrimination and calibration and were, therefore, superior in predicting functional outcome for patients with ischemic stroke after endovascular treatment within 6.5 hours. Since models used different predictors and several models had relatively good predictive performance, the decision on which model to use in practice may also depend on simplicity of the model, data availability, and the comparability of the population and setting
- …