Adverse effects of extra-articular corticosteroid injections: a systematic review

<p>Abstract</p> <p>Background</p> <p>To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection.</p> <p>Methods</p> <p>A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention).</p> <p>Results</p> <p>The search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting.</p> <p>Conclusion</p> <p>In this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.</p

Universal DNA methylation age across mammalian tissues.

Aging, often considered a result of random cellular damage, can be accurately estimated using DNA methylation profiles, the foundation of pan-tissue epigenetic clocks. Here, we demonstrate the development of universal pan-mammalian clocks, using 11,754 methylation arrays from our Mammalian Methylation Consortium, which encompass 59 tissue types across 185 mammalian species. These predictive models estimate mammalian tissue age with high accuracy (r > 0.96). Age deviations correlate with human mortality risk, mouse somatotropic axis mutations and caloric restriction. We identified specific cytosines with methylation levels that change with age across numerous species. These sites, highly enriched in polycomb repressive complex 2-binding locations, are near genes implicated in mammalian development, cancer, obesity and longevity. Our findings offer new evidence suggesting that aging is evolutionarily conserved and intertwined with developmental processes across all mammals

Emerging concepts in biomarker discovery; The US-Japan workshop on immunological molecular markers in oncology

Supported by the Office of International Affairs, National Cancer Institute (NCI), the "US-Japan Workshop on Immunological Biomarkers in Oncology" was held in March 2009. The workshop was related to a task force launched by the International Society for the Biological Therapy of Cancer (iSBTc) and the United States Food and Drug Administration (FDA) to identify strategies for biomarker discovery and validation in the field of biotherapy. The effort will culminate on October 28th 2009 in the "iSBTc-FDA-NCI Workshop on Prognostic and Predictive Immunologic Biomarkers in Cancer", which will be held in Washington DC in association with the Annual Meeting. The purposes of the US-Japan workshop were a) to discuss novel approaches to enhance the discovery of predictive and/or prognostic markers in cancer immunotherapy; b) to define the state of the science in biomarker discovery and validation. The participation of Japanese and US scientists provided the opportunity to identify shared or discordant themes across the distinct immune genetic background and the diverse prevalence of disease between the two Nations

Gambling and nonexpected utility: the perils of the power function

The use of the power utility function is problematic in expected utility theory. We show that, this is also the case in cumulative prospect theory, where the power function violates the assumption of loss-aversion at small stake levels, so that an optimal model of gambling is precluded. In the case of rank-dependent expected utility it has the counterfactual implication that agents will gamble all of their wealth at actuarially unfair odds.

Fluid dynamic analysis of pollutants' dispersion behind an aircraft engine during idling

The potential impact of emissions from airports on human health and air quality has become a significant issue. The aim of this paper is to investigate the dispersion behind an aircraft engine during idle-engine operations at airports. When these operations are conducted on the apron, jet engine emissions worsen the air quality where ground handling personnel works and passengers embark or disembark. Ground operations at airports are designed according to the International Civil Aviation Organization jet blast definition that indicates the exhaust gas velocity of 56 km/h as the threshold limit for the comfort of operations behind an aircraft, without considering the pollutants' dispersion and concentration levels. In this paper, carbon monoxide (CO), formaldehyde (CH2O), and acrolein (C3H4O) dispersion behind a twin engine jet aircraft during idling is investigated using a computational fluid dynamic tool. The complete geometry of a Boeing 737-500 is used as reference. The steady-state simulation of turbulent jet flow is carried out using a realizable k − ε model. Three different scenarios are investigated at standard day conditions—101,325 Pa and 288 K, with no wind, and the plume concentrations are presented and discussed. CO, CH2O, and C3H4O concentration curves are drawn and compared with the exposure threshold limit defined by scientific international communities to guarantee human health. The information provided from this study represents a first step in understanding apron air quality issues during idle-engine operation

A new preference handling technique for interactive multiobjective optimization without trading-off

Because the purpose of multiobjective optimization methods is to optimize conflicting objectives simultaneously, they mainly focus on Pareto optimal solutions, where improvement with respect to some objective is only possible by allowing some other objective(s) to impair. Bringing this idea into practice requires the decision maker to think in terms of trading-off, which may limit the ability of effective problem solving. We outline some drawbacks of this and exploit another idea emphasizing the possibility of simultaneous improvement of all objectives. Based on this idea, we propose a technique for handling decision maker’s preferences, which eliminates the necessity to think in terms of trade-offs. We incorporate this technique into an interactive trade-off-free method for multiobjective optimization. We call the resulting method NAUTILUS 2, which is also suitable for negotiation support. We demonstrate the applicability of the new method with an example problem.peerReviewe

Preventing childhood obesity during infancy in UK primary care: a mixed-methods study of HCPs' knowledge, beliefs and practice

Background: There is a strong rationale for intervening in early childhood to prevent obesity. Over a quarter of infants gain weight more rapidly than desirable during the first six months of life putting them at greater risk of obesity in childhood. However, little is known about UK healthcare professionals’ (HCPs) approach to primary prevention. This study explored obesity-related knowledge of UK HCPs and the beliefs and current practice of general practitioners (GPs)and practice nurses in relation to identifying infants at risk of developing childhood obesity. Method: Survey of UK HCPs (GPs, practice nurses, health visitors, nursery, community and children’s nurses). HCPs (n = 116) rated their confidence in providing infant feeding advice and completed the Obesity Risk Knowledge Scale (ORK-10). Semi-structured interviews with a sub-set of 12 GPs and 6 practice nurses were audio recorded, taped and transcribed verbatim. Thematic analysis was applied using an interpretative, inductive approach. Results: GPs were less confident about giving advice about infant feeding than health visitors (p = 0.001) and nursery nurses (p = 0.009) but more knowledgeable about the health risks of obesity (p < 0.001) than nurses (p = 0.009). HCPs who were consulted more often about feeding were less knowledgeable about the risks associated with obesity (r = -0.34, n = 114, p < 0.001). There was no relationship between HCPs’ ratings of confidence in their advice and their knowledge of the obesity risk. Six main themes emerged from the interviews: 1) Attribution of childhood obesity to family environment, 2) Infant feeding advice as the health visitor’s role, 3) Professional reliance on anecdotal or experiential knowledge about infant feeding, 4) Difficulties with recognition of, or lack of concern for, infants “at risk” of becoming obese, 5)Prioritising relationship with parent over best practice in infant feeding and 6) Lack of shared understanding for dealing with early years’ obesity. Conclusions: Intervention is needed to improve health visitors and nursery nurses’ knowledge of obesity risk and GPs and practice nurses’ capacity to identify and manage infants’ at risk of developing childhood obesity. GPs value strategies that maintain relationships with vulnerable families and interventions to improve their advice giving around infant feeding need to take account of this. Further research is needed to determine optimal ways of intervening with infants at risk of obesity in primary care