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Canaloplasty and transient anterior chamber haemorrhage: a prognostic factor? | An attempt has been made to evaluate transient anterior chamber haemorrhage after canaloplasty. In the period from November 2008 to October 2009 a total of 21 eyes in 17 patients underwent canaloplasty for primary open angle glaucoma in our clinic. At the end of surgery all eyes left the surgical table with an intraocular pressure (IOP) of 5 - 10 mmHg and a deep anterior chamber without any bleeding. The IOP on day 1 after surgery was 9.6 mmHg in average. By that time 15 of 21 eyes showed anterior chamber haemorrhage with a hyphaema between 0.5 - 2 mm in height. Eyes without hyphaema showed an IOP of>15 mmHg at the same time. In no case was there further haemorrhage, the blood was absorbed in all cases within a maximum of 1 week without further complications. | In contrast to trabeculectomy, where the natural anterior chamber water outflow is by-passed via an artificial fistula, canaloplasty attempts to re-establish the physiological anterior chamber water draining system by means of a 360 degree viscocanalostomy and a thread mediated dilation of Schlemm's canal and its collector channels. If the anterior chamber pressure temporarily lowers the level of the venous capillary pressure, it is consistent with a patent piping system when a reverse flow with blood reflux into the anterior chamber can be observed as long as a minimal physiological pressure gradient from the anterior chamber in the direction of channel Schlemm's canal has been restored. Thus, in the authors opinion, anterior chamber haemorrhage shows the desired consistency of the water draining system and should therefore logically be expected after each successful operation in all cases where hypotony in the postoperative period occurs. | closed_qa |
Are family-centred principles, functional goal setting and transition planning evident in therapy services for children with cerebral palsy? | Family-centred service, functional goal setting and co-ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada. Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1-h semi-structured interviews. Thirty-nine parents participated in eleven focus groups or two individual interviews. Evidence of family-centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family-centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family-centredness, goal setting and co-ordination between programmes. All respondents expressed commitment to the three concepts, but objective indicators of family-centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports. | Lack of formal processes for delivery of family-centred service, goal-setting and co-ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme. | closed_qa |
Elective cesarean delivery: does it have a negative effect on breastfeeding? | Cesarean delivery has negative effects on breastfeeding. The objective of this study was to evaluate breastfeeding rates, defined in accordance with World Health Organization guidelines, from delivery to 6 months postpartum in infants born by elective and emergency cesarean section and in infants born vaginally. Delivery modalities were assessed in relation to breastfeeding patterns in 2,137 term infants delivered at a tertiary center, the Padua University School of Medicine in northeastern Italy, from January to December 2007. The study population included 677 (31.1%) newborns delivered by cesarean section, 398 (18.3%) by elective cesarean, 279 (12.8%) by emergency cesarean section, and 1,496 (68.8%) delivered vaginally. Breastfeeding prevalence in the delivery room was significantly higher after vaginal delivery compared with that after cesarean delivery (71.5% vs 3.5%, p<0.001), and a longer interval occurred between birth and first breastfeeding in the newborns delivered by cesarean section (mean ± SD, hours, 3.1 ± 5 vs 10.4 ± 9, p<0.05). No difference was found in breastfeeding rates between the elective and emergency cesarean groups. Compared with elective cesarean delivery, vaginal delivery was associated with a higher breastfeeding rate at discharge and at the subsequent follow-up steps (7 days, 3 mo, and 6 mo of life). | Emergency and elective cesarean deliveries are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery. The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association. | closed_qa |
Does prosthodontic rehabilitation change the eating patterns among completely edentulous patients? | Nutrition is compromised in completely edentulous individuals. As there is limited literature available on the nutritional health of the elderly in the Indian population, the present study was undertaken to assess these changes before and 1 month after placement of complete dentures in a dental hospital in Indore, Madhya Pradesh, India. The 10-item closed-ended questionnaire was completed by the investigator who interviewed the subjects (n = 35) before placement of complete dentures and 1 month later. A statistically significant difference was found for having an illness or condition that led to a change in the type and/or amount of food eaten (p = 0.013); eating few fruits, vegetables, or milk products (p = 0.005) and having oral problems that made it difficult to eat (p = 0.003). | Prosthodontic rehabilitation improved the eating pattern with increased intake of fruits, vegetables and milk products. | closed_qa |
Is the association between Helicobacter pylori infection and anemia age dependent? | The relationship between H. pylori infection and anemia in childhood is still unclear. The aim of the study was to examine the association between H. pylori infection and anemia or iron deficiency in school-age children and in infants. Six- to 9-year-old Israeli Arab children (N = 202) and infants (N = 197) were examined for hemoglobin and ferritin levels. ELISA was used to detect H. pylori antigens in stool specimens collected from the participants. Household characteristics were obtained through personal interviews with the mothers. The prevalence of anemia was 15.5 versus 5.5% in H. pylori-positive and -negative school-age children, respectively and 34.5 versus 29.8% in H. pylori-positive and -negative infants, respectively. The Mantel-Haenszel age-adjusted prevalence ratio (PR) and 95% confidence intervals (CIs) were 1.6 (95%CI 1.0, 2.6). In multivariate analysis controlling for socioeconomic variables, H. pylori infection was associated with 2.8 higher prevalence of anemia only in school-age children: adjusted PR 2.8 (95% CI 0.9, 9.3). The adjusted mean difference in hemoglobin levels between H. pylori infected school-age children and uninfected ones was -0.372 gr/dL (95% CI -0.704, -0.039) (p = .04). The respective mean ferritin difference was -6.74 μg/L (95% CI -13.38, -.011) (p = .04). Such differences were not found in infants. | H. pylori infection is associated with higher prevalence of anemia in school-age children independently of socioeconomic variables. Such association was not observed in infants. These findings are of clinical and public health importance. | closed_qa |
Is there any difference between right hepatectomy and left lateral sectionectomy for living donors? | The worldwide rising demand for cadaveric donors in liver transplantation is an important incentive for the development of alternative transplantation options, such as living donors. A precise evaluation of surgical complications is, therefore, considered to be an important issue in this setting.AIM: Present a retrospective analysis of 126 living donors hepatectomies undertaken at our centre. From December 2002 to August 2009, 126 living donors were submitted to hepatectomy. Donors' complications were stratified according to Clavien's scoring system to compare the morbidity of right hepatectomy (RH) (Group 1) and left lateral sectionectomy (LLS) (Group 2). Thirty-nine complications were observed in 35 patients. Sixty LLS, 3 left (LH) and 63 RH were performed. The complications were classified as: Clavien grade 1-11 (28.2%), grade 2-12 (30.7%), grade 3A-13 (33.3%), grade 3B-2 (5.1%) and grade 4A-1 (2.5%). When Group 1 (63 patients) and Group 2 (60 patients) were compared, there was no significant difference between the number of complications: 20 (31%) and 14 (23%), respectively (P>0.3). | Hepatectomy for living donor liver transplantation (LDLT) was a safe procedure, regardless of the type of liver resection undertaken. We found no difference in morbidity between RH and LLS, which suggests that complications may occur despite the amount of liver retrieved. | closed_qa |
Ambulatory health services utilization in patients with dementia - Is there an urban-rural difference? | Due to demographic changes and an un-equal distribution of physicians, regional analyses of service utilization of elderly patients are crucial, especially for diseases with an impact like dementia. This paper focuses on dementia patients. The aim of the study is to identify differences in service utilization of incident dementia patients in urban and rural areas. Basis for the analysis were all insured persons of a German Health Insurance fund (the GEK) aged 65 years and older living in rural and urban areas. We focussed on physician contacts in the outpatient sector during the first year after an incidence diagnosis of dementia. Special attention was given to contacts with primary care physicians and neurologists/psychiatrists. The dementia cohort was analyzed together with a non-dementia control group drawn according to age, gender and amount of physician contacts. Uni- and bivariate as well as multivariate analysis were performed to estimate the influences on service utilization. Results show that the provision of primary care seems to be equally given in urban and rural areas. For specialists contacts however, rural patients are less likely to consult neurologists or psychiatrists. This trend can already be seen before the incident diagnosis of dementia. All consultations rise in the quarter of the incident dementia diagnosis compared to the control group. The results were also tested in a linear and a logistic regression, showing a higher chance for persons living in urban areas to visit a specialist and an overall higher rate in service utilization for dementia patients. | Because of a probable increase in the number of dementia patients, service provision has to be accessible even in rural areas. Due to this and the fact that demographic change is happening at different paces in different regions, regional variations have to be considered to ensure the future service provision. | closed_qa |
Suicide and unintentional poisoning mortality trends in the United States, 1987-2006: two unrelated phenomena? | Two counter trends in injury mortality have been separately reported in the US in recent times - a declining suicide rate and a rapidly rising unintentional poisoning mortality rate. Poisoning suicides are especially difficult to detect, and injury of undetermined intent is the underlying cause-of-death category most likely to reflect this difficulty. We compare suicide and poisoning mortality trends over two decades in a preliminary assessment of their independence and implications for suicide misclassification. Description of overall and gender- and age-specific trends using national mortality data from WISQARS, the Web-based Injury Statistics Query and Reporting System, maintained by the Centers for Disease Control and Prevention (CDC). Subjects were the 936,633 residents dying in the 50 states and the District of Columbia between 1987 and 2006 whose underlying cause of death was classified as suicide, unintentional poisoning, or injury mortality of undetermined intent. The official US suicide rate declined 18% between 1987 and 2000, from 12.71 to 10.43 deaths per 100,000 population. It then increased to 11.15 deaths per 100,000 by 2006, a 7% rise. By contrast to these much smaller rate changes for suicide, the unintentional poisoning mortality rate rose more than fourfold between 1987 and 2006, from 2.19 to 9.22 deaths per 100,000. Only the population aged 65 years and older showed a sustained decline in the suicide rate over the entire observation period. Consistently highest in gender-age comparisons, the elderly male rate declined by 35%. The elderly female rate declined by 43%. Unlike rate trends for the non-elderly, both declines appeared independent of corresponding mortality trends for unintentional poisoning and poisoning of undetermined intent. The elderly also deviated from younger counterparts by having a smaller proportion of their injury deaths of undetermined intent classified as poisoning. Poisoning manifested as a less common method of suicide for this group than other decedents, except for those aged 15-24 years. Although remaining low, the undetermined poisoning mortality rate increased over the observation period. | The official decline in the suicide rate between 1987 and 2000 may have been a partial artifact of misclassification of non-elderly suicides within unintentional poisoning mortality. We recommend in-depth national, regional, and local population-based research investigations of the poisoning-suicide nexus, and endorse calls for widening the scope of the definition of suicide and evaluation of its risk factors. | closed_qa |
Does left atrial volume affect exercise capacity of heart transplant recipients? | Heart transplant (HT) recipients demonstrate limited exercise capacity compared to normal patients, very likely for multiple reasons. In this study we hypothesized that left atrial volume (LAV), which is known to predict exercise capacity in patients with various cardiac pathologies including heart failure and hypertrophic cardiomyopathy is associated with limited exercise capacity of HT recipients. We analyzed 50 patients [age 57 ±2 (SEM), 12 females] who had a post-HT echocardiography and cardiopulmonary exercise test (CPX) within 9 weeks time at clinic follow up. The change in LAV (ΔLAV) was also computed as the difference in LAV from the preceding one-year to the study echocardiogram. Correlations among the measured parameters were assessed with a Pearson's correlation analysis. LAV (n = 50) and ΔLAV (n = 40) indexed to body surface area were 40.6 ± 11.5 ml·m-2 and 1.9 ± 8.5 ml·m-2·year-1, data are mean ± SD, respectively. Indexed LAV and ΔLAV were both significantly correlated with the ventilatory efficiency, assessed by the VE/VCO2 slope (r = 0.300, p = 0.038; r = 0.484, p = 0.002, respectively). LAV showed a significant correlation with peak oxygen consumption (r = -0.328, p = 0.020). | Although our study is limited by a retrospective study design and relatively small number of patients, our findings suggest that enlarged LAV and increasing change in LAV is associated with the diminished exercise capacity in HT recipients and warrants further investigation to better elucidate this relationship. | closed_qa |
Avoiding concomitant prescription of drugs with a potential for interaction: mission impossible? | The increased prevalence of multi-drug therapy increases the risk of drug interactions. We conducted a study with the aim of evaluating the prevalence of prescribing potentially interacting drug combinations, their severity, mechanism, and in particular, their clinical relevance, in medical inpatients at two Croatian university hospitals. A cross-sectional study was conducted that included all medical inpatients receiving>= 2 drugs. Data were analyzed for 200 predefined drug-drug combinations compiled from the Micromedex data-base and literature. Two rating scales were used, one indicating the severity of a potential drug-drug interaction (pDDI) (minor, moderate, major), and the other assessing its clinical relevance (1: contraindicated; 2: avoidable; 3: consider risk-benefit ratio; 4: hardly avoidable). The prescribing patterns were similar between evaluated hospitals. The prevalence of pDDIs was 46%. The mean number of drugs prescribed per patient was 6.2 (± 95% CI 5.9 - 6.5). Out of 200 predefined pDDIs, 96 were found in our study population with mean 2.8 pDDIs per patient (± 95% CI 2.4 - 3.1). Out of 478 single identified pDDIs, most were of moderate and major severity (56% and 33%, respectively). However, only 9% out of them were considered completely avoidable, 57% were considered hardly avoidable, and for 35% the consideration of risk-benefit ratio was recommended. Most pDDIs were classified as pharmacodynamic by mechanism of interaction (45%). Age and number of prescribed drugs were significant risk factors for prescription of potentially interacting drug combinations (OR 1.01 (± 95% CI 1.001 - 1.03) and OR 1.46 (± 95% CI 1.33 - 1.59), respectively). | Despite the high prevalence of pDDIs, only 1 in 10 was considered avoidable. | closed_qa |
Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? | Preoperative chemotherapy (CT) and preoperative chemoradiation therapy (CRT) for resectable oesophageal cancer have been shown to improve overall survival in meta-analyses. There are limited data comparing these preoperative therapies. We report the outcomes of a randomised phase II trial comparing preoperative CT and CRT for resectable adenocarcinoma of the oesophagus and gastro-oesophageal junction. Patients were randomised to receive preoperative CT with cisplatin (80 mg/m(2)) and infusional 5 fluorouracil (1000 mg/m(2)/d) on days 1 and 21, or preoperative CRT with the same drugs accompanied by concurrent radiation therapy commencing on day 21 of chemotherapy and the 5 fluorouracil reduced to 800 mg/m(2)/d. The radiation dose was 35 Gy in 15 fractions over 3 weeks. The endpoints were toxicity, response rates, resection (R) status, progression-free survival (PFS), overall survival (OS) and quality of life. Seventy-five patients were enrolled on the study: 36 received preoperative CT and 39 preoperative CRT. Toxicity was similar for CT and CRT. Eight patients (11%) did not proceed to resection. The histopathological response rate (CRT 31% versus CT 8%, p = 0.01) and R1 resection rate (CRT 0% versus CT 11%, p = 0.04) favoured those receiving CRT. The median PFS was 14 and 26 months for CT and CRT respectively (p = 0.37). The median OS was 29 months for CT compared with 32 months for CRT (p = 0.83). | Despite no difference in survival, the improvement from preoperative CRT with respect to margin involvement makes this treatment a reasonable option for bulky, locally advanced resectable adenocarcinoma of the oesophagus. | closed_qa |
Early stage breast cancer: is exclusive radiotherapy an option for early breast cancers with complete clinical response after neoadjuvant chemotherapy? | To determine whether exclusive radiotherapy could be a therapeutic option after complete clinical response (cCR) to neoadjuvant chemotherapy (NCT) for early breast cancers (EBC). Between 1985 and 1999, 1477 patients received néoadjuvante chemotherapy for early breast cancer considered to be too large for primary conservative surgery. Of 165 patients with complete clinical response, 65 were treated by breast surgery (with radiotherapy) and 100 by exclusive radiotherapy. The two groups were comparable in terms of baseline characteristics, except for larger initial tumor sizes in the exclusive radiotherapy group. There were no significant differences in overall, disease-free and metastasis-free survivals. Five-year and 10-year overall survivals were 91 and 77% in the no surgery group and 82 and 79% in the surgery group, respectively (P = 0.9). However, a non-significant trend towards higher locoregional recurrence rates (LRR) was observed in the no surgery group (31 vs. 17% at 10 years; P = 0.06). In patients with complete responses on mammography and/or ultrasound, LRR were not significantly different (P=0.45, 10-year LRR: 21 in surgery vs. 26% in exclusive radiotherapy). No significant differences were observed in terms of the rate of cutaneous, cardiac or pulmonary toxicities. | Surgery is a key component of locoregional treatment for breast cancers that achieved complete clinical response to neoadjuvant chemotherapy. | closed_qa |
Do the effects of testosterone on muscle strength, physical function, body composition, and quality of life persist six months after treatment in intermediate-frail and frail elderly men? | Short-term testosterone (T) treatment in frail elderly men improves muscle mass and strength. It is unclear whether these effects can be maintained post treatment. To assess the durability of androgen effects in frail men. Single center, randomized, double-blind, placebo-controlled trial to investigate the effects of 6 months T (25-75 mg daily) on muscle strength, body composition, physical function, and quality of life (QoL). Participants were assessed at the end of treatment (6 months) and 6 months after treatment cessation (12 months). 274 intermediate-frail and frail elderly men aged 65-90 years with low T levels. Mean T increased from 11.1 (3.1) nmol/liter at baseline to 18.4 (3.5) nmol/liter at 6 months, then declined to 10.5 (3.7) nmol/L at 12 months, in the T-treated group. Isometric knee extension peak torque increased in the T-treated group compared with placebo to give an adjusted mean difference (95% CI) between groups of 8.1 (-0.2 to 16.5) Nm at 6 months. Lean mass increased in the T-treated group giving a difference between groups of 1.2 (0.8 to 1.7) kg at 6 months. Somatic and sexual symptoms improved during treatment. None of these differences between groups remained at 12 months. Prostate specific antigen (PSA) levels and haematocrit increased slightly during treatment but returned to baseline by 12 months. | The effects of 6-month T treatment on muscle strength, lean mass, and QoL in frail men are not maintained at 6 months post treatment. | closed_qa |
Do older and younger people differ in their reported well-being? | National face-to-face interview survey of adults aged ≥16 years, conducted by the Office for National Statistics for their Omnibus Survey in Britain (response 58%; 1049 of 1823 eligible). People aged 65+ years were more likely than younger people to define well-being as being able to continue to do the things they had always done. Most men and women, in all age groups, rated their well-being and mental well-being positively. Self-rated health, mental health symptoms, long-standing illness and social support were the main drivers of overall well-being in all age groups. Mental health symptoms, long-standing illness and social support were the main drivers of mental well-being. For example, in reduced multivariable models, those who reported no long-standing illness had almost twice the odds of others, of good, rather than not good, overall well-being, and over three times the odds of good, rather than not good, mental well-being. The odds of good versus not good overall well-being were also multiplied by 1.002 for each additional available person for comfort and support and similarly by 1.073 in relation to mental well-being. | Understanding the drivers of well-being among adults, including older adults, is of high policy importance. Attention should be focused on improvements in population health and functioning and on encouraging younger and older people to develop and maintain social support networks and engagement in social activities. | closed_qa |
Adipose tissue palmitoleic acid and obesity in humans: does it behave as a lipokine? | Animal models have shown that adipose-derived palmitoleic acid may serve as a lipokine that contributes to resistance to diet-induced obesity. Studies in humans have evaluated only plasma palmitoleic acid concentrations, which reflect stearoyl-coenzyme A desaturase 1 (SCD1) activity in the liver and are associated with increased risk of obesity. These apparent opposite effects of palmitoleic acid deserve further research in humans. Because carbohydrate intake can increase hepatic SCD1 activity, it could be used as a stratifying variable to disentangle the effects of adipose tissue SCD1 compared with the effects of liver SCD1 activity on obesity. We examined whether the effects of adipose tissue palmitoleic acid and SCD1 activity were associated with decreased obesity prevalence and whether this association was modified by carbohydrate intake. Prevalence ratios (PRs) of obesity [body mass index (in kg/m²)>30] were examined in a cross-sectional study in 1926 adults in Costa Rica. Two desaturation indexes (16:1/16:0 and 18:1/18:0) were used as surrogate measures of adipose tissue SCD1 activity. We observed a positive association between adipose tissue palmitoleic acid concentrations and obesity (PR for lowest compared with highest quintiles of palmitoleic acid: 2.27; 95% CI: 1.52, 3.38; P for trend<0.0001). A significant association was also observed between obesity and adipose desaturation indexes. The association between adipose tissue palmitoleic acid concentrations and obesity was attenuated in persons with low carbohydrate intake. | There is no direct evidence that adipose tissue palmitoleic acid behaves as a lipokine to reduce obesity occurrence in humans. However, the attenuation of the association by low carbohydrate intake warrants further research on adipose-derived palmitoleic acid and obesity risk. | closed_qa |
Sixty-four-multidetector-row computed tomography angiography with bolus tracking to time arterial-phase imaging in healthy liver: is there a correlation between quantitative and qualitative scores? | To determine the optimal 64-multidetector-row computed tomography scan delay from bolus-tracking trigger for the arterial phase and the evaluation of vascularization in healthy liver. One hundred twenty patients are randomized into 3 groups according to scan delay (5-, 10-, 15-second arterial phase) and underwent CT of the liver. Images were evaluated on the basis of quantitative and qualitative scores. A correlation analysis between them was managed to find the most effective scan delay for best radiologists' diagnostically performances. Scanning too early results in images that are acquired before the vascular peak enhancement while scanning to late results in the increasing of liver parenchyma portal feeding. Good performances were obtained with a scan delay ranging between 10 and 19 seconds from the trigger. | When a 64-multidetector-row computed tomography with a bolus-tracking program is used, only 1 arterial phase should be acquired, setting a scan delay of 10 to 19 seconds. | closed_qa |
Masked hypertension in untreated normotensives: difference between a work day and a leisure day? | To compare ambulatory blood pressure recorded during a work day with a leisure day regarding masked hypertension. A randomized crossover study in middle-aged normotensives. Thirty-seven untreated middle-aged normotensives (17 women), who had repeated office blood pressure less than 140/90 mmHg. Individual difference of masked hypertension between a work day and a leisure day. Office systolic/diastolic blood pressure mean (SD) was 0.3/0.6 (6.4/5.2) mmHg higher during the work day. The mean (SD) systolic/diastolic 24-h, day and night blood pressure was 2.8/3.1 (4.5/3.6), 2.2/2.5 (4.9/4.2) and 1.3/1.9 (4.6/4.0) mmHg higher during the work day than during the leisure day. Individual comparisons of occurrence of ambulatory blood pressure values above normal during day (systolic ≥135 or diastolic ≥85) showed a statistically significant difference between the work day and the leisure day, P=0.0412. The P values for the individual comparisons of occurrence of ambulatory blood pressure values above normal during 24 h (systolic ≥130 or diastolic ≥80), and during night (systolic ≥120 or diastolic ≥70 mmHg) were P=0.0771 and 0.6171, respectively. | Ambulatory blood pressure was somewhat higher during the work day than during the leisure day, and there was statistically significant individual difference concerning masked hypertension during daytime. Thus, in normotensives such as in hypertensives, ambulatory blood pressure during a work day seems to give the best information. Diastolic blood pressure values above normal were more common than systolic. However, systolic blood pressure is considered of greater importance in this age group and no participant had extremely high values. | closed_qa |
Is it possible to predict the length of knee flexor tendons by anthropometry? | To compare the anthropometric data and the sportive way of life with the hamstring tendons dimensions, prospectively, in order to create a rule to predetermine its dimensions. General and anthropometric data were collected from 30 patients that were submitted to anterior cruciate ligament reconstruction. These data were correlated to the diameter and length of the hamstring tendons. The data collected were: height, weight, age, knee lesion side, body mass, sportive training level, femoral length, tibia length, thigh circumference, and knee circumference. The correlation was made by Pearson coefficient. Statistic significant correlation occurred only with height and tibia length versus the gracilis and semitendinous tendon length. Using linear regression the relations found could be expressed with the following formulas: semitendinous length = -2.276 + 0.177 x height; semitendinous length = 13.048 + 0.46 x tibia height; gracilis length = -9.413 + 0.207 x height; gracilis length = 7.036 + 0.583 x tibia height. | It is possible to predetermine hamstring tendons length through linear regression formulas before surgical intervention. | closed_qa |
Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: a major cause for concern? | We assessed sunlight and dietary contributions to vitamin D status in British postmenopausal women. Our true longitudinal 25-hydroxyvitamin D (25(OH)D) measurements varied seasonally, being lower in the north compared to the south and lower in Asian women. Sunlight exposure in summer and spring provided 80% total annual intake of vitamin D. Vitamin D deficiency is highlighted as a potential problem for countries at high latitude, but there are few true longitudinal, seasonal data to allow regional comparisons. We aimed to directly compare seasonal variation in vitamin D status (25(OH)D) in postmenopausal women at two northerly latitudes and to assess the relative contributions of sunlight exposure and diet. Vitamin D status was assessed in 518 postmenopausal women (age 55-70 years) in a two-centre cohort study with serum collected at fixed three-monthly intervals from summer 2006 for immunoassay measurement of 25(OH)D and parathyroid hormone. At 57° N (Aberdeen, Scotland, UK), there were 338 Caucasian women; at 51° N (Surrey, South of England, UK), there were 144 Caucasian women and 35 Asian women. UVB exposure (polysulphone film badges) and dietary vitamin D intakes (food diaries) were also estimated. Caucasian women had lower 25(OH)D (p < 0.001) at 57° N compared to 51° N. Median (interquartile range) in nanomoles per litre for summer (June-August) at 57° N was 43.0 (20.9) and at 51° N was 62.5 (26.6) and for winter (December-February) at 57° N was 28.3 (18.9) and at 51° N was 39.9 (24.0). For Asian women at 51° N, median 25(OH)D was 24.0 (15.8) nmol/L in summer and 16.9 (15.9) nmol/L in winter. Median dietary vitamin D intakes were 80-100 IU for Caucasians and 50-65 IU for the Asian women. Sunlight was the main contributor to 25(OH)D with spring and summer providing>80% total annual intake. | These longitudinal data show significant regional and ethnic differences in UVB exposure and vitamin D status for postmenopausal women at northerly latitudes. The numbers of women who are vitamin D deficient is a major concern and public health problem. | closed_qa |
Development of a high throughput single nucleotide polymorphism screening method for the cytochrome P450 1A2 polymorphisms CYP1A2*1C and CYP1A2*1F: are they useful as predictive markers in mental disorders? | The cytochrome P450 1A2 (CYP1A2) gene encodes one of the most important enzymes of the Phase I drug metabolism, which is involved in the metabolism of many lipophilic xenobiotics, such as haloperidol, theophylline, phenacetine, and others. The recently discovered single nucleotide polymorphisms CYP1A2*1C (-3860G-->A) in the 5' flanking region of the gene and CYP1A2*1F (-163C-->A) in intron 1 seem to interfere with the expression rate or catalytic function of the enzyme. Polymorphism carriers may either have a risk of reduced drug degradation and side effects, or may present with an increased induction of enzymatic activity resulting in clinical non-response to the prescribed therapy. We investigated two populations, a mental disease group and a healthy control group, to identify whether these two genetic variants are correlated with the general development of a mental disorder and if they could potentially be used as predictive markers for manifestation of the same. Using specifically designed primers, we established a high-throughput multiplex screening realtime PCR method for the two polymorphisms on the CYP1A2 gene with the Roche LightCycler instrument. We analysed the two cohorts to identify whether one of the two described genetic variants may be associated with the manifestation of a mental disorder in general. For the CYP1A2*1C variant, we identified an allele frequency of 1.7% for both cohorts. For the CYP1A*1F polymorphism, we found an allele frequency of 74.5% for the mental disease group and 68.6% for the healthy control group. | This new diagnostic method of multiplex detection may be helpful to routinely identify carriers of CYP1A2 variants and to improve the therapeutic effectiveness by selection of the most appropriate therapeutic regimen. As a result of this pilot study, there appeared to be no significant correlation between the existence of one of the investigated genetic variants and the development of a mental disorder. | closed_qa |
Is tobacco smoking protective for sarcoidosis? | While tobacco smoking is commonly believed to be negatively associated with the occurrence of sarcoidosis, the relationship of environmental tobacco smoke (ETS) exposure with sarcoidosis is largely un-explored. We studied the impact of active smoking and ETS exposure on disease severity in newly diagnosed cases of sarcoidosis from India. Data on demographic variables, smoking habits and exposure to environmental tobacco smoke (ETS) among non-smoker sarcoidosis patients was collected prospectively. Presence of smoking and ETS exposure were compared among cases and controls. Among the sarcoidosis patients, clinical manifestations, radiology, spirometry and histopathological grading of lung biopsy were compared between the smokers vs. non-smokers and ETS exposed vs. not-exposed. We studied 98 newly diagnosed cases of sarcoidosis and 196 age, sex and religion- matched healthy volunteers. The study group comprised of 62 (63%) men and 36 (37%) women. The prevalence of smoking was similar in cases and controls (12.2% vs. 15.3%, p = 0.48). Among the never smoker patients with sarcoidosis, 20 (23%) reported ETS exposure vis-a-vis 57 (34%) in the matched controls. A conditional logistic regression analyses showed insignificant negative association with active smoking (OR 0.75; 95% CI, 0.35-1.56) or ETS exposure (OR 0.58; 95% CI, 0.32-1.06) after adjusting for age, gender, religion, and education. There were no differences in the clinical manifestations, radiological staging, spirometry and histopathological grading of lung biopsy in any of the group comparisons studied. | Smoking or ETS exposure may not have significant negative association with sarcoidosis. Also, tobacco smoke might not have any effect on the clinical behavior or disease severity in sarcoidosis. The belief that smoking is protective for sarcoidosis is not substantiated in this study and appears to be misfounded. | closed_qa |
Dental capitation insurance provider compensation: a fair deal? | To investigate the fairness of dental capitation insurance provider compensation amounts being paid by one of the nation's largest capitation insurance companies. Analysis of insurance company documents. The article first reports and then analyzes the capitation amounts paid by one of the nation's largest capitation plans over the past 13 years as retrieved directly from the insurance company documents. The annual rates of change in the capitation amounts are then compared with the annual rates of change in the mean dental office overhead expenses across the United States, as well as with the rates of change in income and expenses of the average US worker. The compensation (capitation amount) paid to participating providers decreased dramatically every year over the past 13 years, while the mean office overhead costs of participating providers increased every year. | Solo general dentists with office overhead costs greater than or equal to the national mean likely find that the capitation amounts paid by insurance companies are an unfair compensation or are incompatible with their income objectives. Participation by solo general practitioners in capitation plans with such compensation levels would be problematic or unlikely. | closed_qa |
Does nonresponse bias the results of retrospective surveys of end-of-life care? | To evaluate the effect of nonresponse bias on reports of the quality of end-of-life care that older adults receive. Nationwide retrospective survey of end-of-life care. Sixty-two Veterans Affairs Medical Centers. Patients were eligible if they died in a participating facility. One family member per patient was selected from medical records and invited to participate. The telephone survey included 14 items describing important aspects of the patient's care in the last month of life. Scores (0-100) reflect the percentage of items for which the family member reported that the patient received the best possible care, and a global item defined the proportion of families who said the patient received "excellent" care. To examine the effect of nonresponse bias, a model was created to predict the likelihood of response based on patient and family characteristics; then this model was used to apply weights that were equivalent to the inverse of the probability of response for that individual. Interviews were completed with family members of 3,897 of 7,110 patients (55%). Once results were weighted to account for nonresponse bias, the change in mean individual scores was 2% of families reporting "excellent" care. Of the 62 facilities in the sample, the scores of only 19 facilities (31%) changed more than 1% in either direction, and only 10 (16%) changed more than 2%. | Although nonresponse bias is a theoretical concern, it does not appear to have a significant effect on the facility-level results of this retrospective family survey. | closed_qa |
Primary stability, insertion torque and bone density of cylindric implant ad modum Branemark: is there a relationship? | Protocols of immediate loading have been reported in several studies. It has also been demonstrated that the cause of failure of immediate loaded implants is due to the micromotion on the bone-implant interface induced by immediate loading. There should be a minimum gap between the implant and the peri-implant bone, without micromotions occurring above a definite threshold risk as they induce bone resorption and fibrosis around the implant. Measurement of the torque necessary to insert an implant in the bone is a parameter for measuring initial stability. The higher the implant insertion torque, the higher the initial stability attained. The aim of this study was to evaluate in vitro the correlation between the micromotion of cylindric screw implants ad modum Branemark and the insertion torque in bone of different densities. The test was carried out on 2 × 2 cm samples of fresh bovine bone of three different densities: hard (H), medium (M) and soft (S). One hundred and fifty hexa implants ad modum Branemark were used, 3.75 mm in diameter and 9 mm long. To screw in the implants, a customized manual key was used, controlled digitally to evaluate the peak insertion torques. Ten implants were prepared for each torque (20, 35, 45, 70 and 100 N/cm). The bone sample was then fixed on a loading device, which allowed evaluating the micromotion. On each sample, we applied a 25 N horizontal force. The results indicate that the peak insertion torque and the implant micromotion are statistically correlated, and statistically significant differences in H and M bone were found compared with S bone. In S bone, we noted a micromotion significantly higher than the risk threshold, and it was not possible to reach peak insertion torque above 35 N/cm. In H and M bone, the micromotion is below the threshold of all insertion torques. | Increasing the peak insertion torque, we can reduce the extent of the micromotion between the implant and the bone when submitted to lateral forces in vitro. In soft bone, the micromotion was always high; hence, immediate loading of implants in low-density bone should be evaluated with care. | closed_qa |
Perspectives in microvascular fluid handling: does the distribution of coagulation factors in human myocardium comply with plasma extravasation in venular coronary segments? | Heterogeneity of vascular permeability has been suggested for the coronary system. Whereas arteriolar and capillary segments are tight, plasma proteins pass readily into the interstitial space at venular sites. Fittingly, lymphatic fluid is able to coagulate. However, heart tissue contains high concentrations of tissue factor, presumably enabling bleeding to be stopped immediately in this vital organ. The distribution of pro- and anti-coagulatively active factors in human heart tissue has now been determined in relation to the types of microvessels. Samples of healthy explanted hearts and dilated cardiomyopathic hearts were immunohistochemically stained. Albumin was found throughout the interstitial space. Tissue factor was packed tightly around arterioles and capillaries, whereas the tissue surrounding venules and small veins was practically free of this starter of coagulation. Thrombomodulin was present at the luminal surface of all vessel segments and especially at venular endothelial cell junctions. Its product, the anticoagulant protein C, appeared only at discrete extravascular sites, mainly next to capillaries. These distribution patterns were basically identical in the healthy and diseased hearts, suggesting a general principle. | Venular extravasation of plasma proteins probably would not bring prothrombin into intimate contact with tissue factor, avoiding interstitial coagulation in the absence of injury. Generation of activated protein C via thrombomodulin is favored in the vicinity of venular gaps, should thrombin occur inside coronary vessels. This regionalization of distribution supports the proposed physiological heterogeneity of the vascular barrier and complies with the passage of plasma proteins into the lymphatic system of the heart. | closed_qa |
Is presurgical nasoalveolar molding therapy more effective in unilateral or bilateral cleft lip-cleft palate patients? | The purpose of this study was to compare the efficacy of presurgical nasoalveolar molding in treating unilateral versus bilateral cleft lip–cleft palate patients. A blinded, retrospective study was conducted with 16 unilateral and 13 bilateral cleft lip–cleft palate patients. Pretreatment and posttreatment facial and intraoral impressions were used to compare soft- and hard-tissue changes. Nasoalveolar molding therapy improves nasal angle in unilateral (p = 0.010) and bilateral cleft lip–cleft palate (p = 0.001) patients, and improves nostril width in unilateral (p = 0.005) and bilateral cleft lip–cleft palate (p = 0.028) patients. Treatment significantly improves nostril breadth only in unilateral cleft lip–cleft palate patients (p = 0.005). Compared with bilateral cleft lip–cleft palate patients, unilaterally affected patients were more asymmetric before and after nasoalveolar molding therapy. Nasoalveolar molding more effectively increases columellar height (p = 0.002) and columellar width (p = 0.002) in the bilateral cleft lip–cleft palate group. Although starting bialar widths did not significantly differ between the two groups, nasoalveolar molding significantly decreased bialar width only in unilateral cleft lip–cleft palate patients (p = 0.032). When the intersegment alveolar cleft distances of the bilateral cleft lip–cleft palate patients were summed, an improvement similar to that in unilateral cleft lip–cleft palate patients was observed. Furthermore, nasoalveolar molding appeared to prevent alveolar width widening as patients continued to grow. | There are differences in efficacy between unilateral and bilateral cleft lip–cleft palate patients undergoing nasoalveolar molding. Understanding these differences may help physicians and dentists better shape expectations. | closed_qa |
The gastric sleeve: losing weight as fast as micronutrients? | Recently, the laparoscopic sleeve gastrectomy (LSG) has become popular as a single-stage procedure for the treatment of morbid obesity and its co-morbidities. However, the incidence of micronutrient deficiencies after LSG have hardly been researched. From January 2005 to October 2008, 60 patients underwent LSG. All patients were instructed to take daily vitamin supplements. Patients were tested for micronutrient deficiencies 6 and 12 months after surgery. Anemia was diagnosed in 14 (26%) patients. Iron, folic acid, and vitamin B12 deficiency was found in 23 (43%), eight (15%), and five (9%) patients, respectively. Vitamin D and albumin deficiency was diagnosed in 21 (39%) and eight (15%) patients. Hypervitaminosis A, B1, and B6 were diagnosed in 26 (48%), 17 (31%), and 13 (30%) patients, respectively. | Due to inadequate intake and uptake of micronutrients, patients who underwent LSG are at serious risk for developing micronutrient deficiencies. Moreover, some vitamins seem to increase to chronic elevated levels with possible complications in the long-term. Multivitamins and calcium tablets should be regarded only as a minimum and supplements especially for iron, vitamin B12, vitamin D, and calcium should be added to this regimen based on regular blood testing. | closed_qa |
Is a silastic radial head still a reasonable option? | The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of "overstuffing," cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial.QUESTIONS/ We asked whether intact or reconstructed primary elbow stabilizers permit use of silastic radial head implants without fragmentation, failure, and silicone synovitis. We retrospectively reviewed 23 patients with unreconstructable radial head fractures who were treated with silastic radial head arthroplasty and concomitant repair and/or reconstruction of the medial ulnar collateral ligament and/or lateral ulnar collateral ligament. Analysis included range of motion, pain, stability, and radiographic assessments; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and Mayo Elbow Performance Score (MEPS). The minimum followup was 16 months (average, 69.6 months; range, 16-165 months). At last followup, the mean elbow flexion was 145°, extension 11°, supination 80°, and pronation 83°. The mean MEPS score was 88.9. The mean DASH score was 11.8. There were eight reoperations, none resulting from failure of the radial head implants. | These results demonstrate silastic radial heads can be used with low complication rates and without evidence of synovitis when concomitant elbow ligament repair or reconstruction is performed. | closed_qa |
Is specific gravity a good estimate of urine osmolality? | Urine specific gravity (USG) is often used by clinicians to estimate urine osmolality. USG is measured either by refractometry or by reagent strip. We studied the correlation of USG obtained by either method with a concurrently obtained osmolality. Using our laboratory's records, we retrospectively gathered data on 504 urine specimens on patients on whom a simultaneously drawn USG and an osmolality were available. Out of these, 253 USG's were measured by automated refractometry and 251 USG's were measured by reagent strip. Urinalysis data on these subjects were used to determine the correlation between USG and osmolality, adjusting for other variables that may impact the relationship. The other variables considered were pH, protein, glucose, ketones, nitrates, bilirubin, urobilinogen, hemoglobin, and leukocyte esterase. The relationships were analyzed by linear regression. This study demonstrated that USG obtained by both reagent strip and refractometry had a correlation of approximately 0.75 with urine osmolality. The variables affecting the correlation included pH, ketones, bilirubin, urobilinogen, glucose, and protein for the reagent strip and ketones, bilirubin, and hemoglobin for the refractometry method. At a pH of 7 and with an USG of 1.010 predicted osmolality is approximately 300 mosm/kg/H(2)O for either method. For an increase in SG of 0.010, predicted osmolality increases by 182 mosm/kg/H(2) O for the reagent strip and 203 mosm/kg/H(2)O for refractometry. Pathological urines had significantly poorer correlation between USG and osmolality than "clean" urines. | In pathological urines, direct measurement of urine osmolality should be used. | closed_qa |
Triangulation of written assessments from patients, teachers and students: useful for students and teachers? | Many medical students in general practice clerkships experience lack of observation-based feedback. The StudentPEP project combined written feedback from patients, observing teachers and students.AIM: This study analyzes the perceived usefulness of triangulated written feedback. A total of 71 general practitioners and 79 medical students at the University of Oslo completed project evaluation forms after a 6-week clerkship. A principal component analysis was performed to find structures within the questionnaire. Regression analysis was performed regarding students' answers to whether StudentPEP was worthwhile. Free-text answers were analyzed qualitatively. Student and teacher responses were mixed within six subscales, with highest agreement on 'Teachers oral and written feedback' and 'Attitude to patient evaluation'. Fifty-four per cent of the students agreed that the triangulation gave concrete feedback on their weaknesses, and 59% valued the teachers' feedback provided. Two statements regarding the teacher's attitudes towards StudentPEP were significantly associated with the student's perception of worthwhileness. Qualitative analysis showed that patient evaluations were encouraging or distrusted. Some students thought that StudentPEP ensured observation and feedback. | The patient evaluations increased the students' awareness of the patient perspective. A majority of the students considered the triangulated written feedback beneficial, although time-consuming. The teacher's attitudes strongly influenced how the students perceived the usefulness of StudentPEP. | closed_qa |
Is the adiposity rebound a rebound in adiposity? | Early adiposity rebound ([AR], when body mass index [BMI]rises after reaching a nadir) strongly predicts later obesity. We investigated whether the upswing in BMI at AR is accompanied by an increase in body fat. Community-based cohort study. A total of 299 first-born children (49% male). Measurements. Six-monthly anthropometry and bioelectrical impedance, 4-6.5 years; lean and fat mass index (kg/m(2)) for direct comparison with BMI. Supplementary (0-2 years) weight and length measures (needed for growth curve modelling) were drawn from subjects' child health records. AR was estimated from individually modelled BMI curves from birth to 6.5 years. Two main analyses were performed: 1) cross-sectional comparisons of BMI, fat mass index (FMI), lean mass index (LMI) and percent body fat in children with early (<5 years) and later (>5 years) rebound; and 2) investigation of linear trends in BMI, FMI, LMI and percent body fat before and after AR. Results. The 81 children (27%) experiencing early AR had higher BMI, FMI, LMI and percent fat at 6.5 years. Overall, FMI decreased steeply pre-AR, at -0.56 (0.02) kg/m(2) per year (mean [Standard Error]), then flattened post-AR to 0.07 (0.05) kg/m(2) per year. In contrast, LMI increased pre-AR (0.34 [0.01]) and steepened post-AR (0.47 [0.03] kg/m(2) per year). | The 'adiposity rebound' is characterised by increasing lean mass index, coupled with cessation of the decline in fat mass index. Understanding what controls the dynamics of childhood body composition and mechanisms that delay AR could help prevent obesity. | closed_qa |
Are satisfaction with and self-management of personal assistance services associated with the life satisfaction of persons with physical disabilities? | To examine the relationships between satisfaction with and self-management of personal assistance services (PAS) and the quality of life (QoL) of persons with disabilities. To test the postulate that consumer-directed PAS can fulfil the human need for control and contribute to a satisfactory life. A survey compared the perspectives of persons using consumer-directed PAS versus those using agency-directed. A Personal Data Form obtained demographics and PAS characteristics. The Quality of Life Inventory measured life satisfaction. A PAS questionnaire measured perceptions about the management of, desire for control of, and satisfaction with PAS. Data were analysed using SPSS®- 14. Significant relationships were found between QoL and satisfaction with PAS (p < 0.001) and between perceived control of PAS and satisfaction with PAS (p < 0.001). Significant group differences were also found. Consumer-directed participants reported higher satisfaction with their PAS (p < 0.01), greater control over services (p < 0.001) and greater QoL than agency-directed participants, (p = 0.001). | The relationships found between self-management, PAS satisfaction, and QoL support the value of consumer-directed programmes. Rehabilitation professionals can use this knowledge to develop, implement and research practises that enable self-management. | closed_qa |
Large-angle strabismus: can a single surgical procedure achieve a successful outcome? | Large-angle strabismus is a gray zone for surgeons with various advocates for one, two-, three-, or even four-muscle surgeries. Very frequently, reoperations are required in these cases in order to achieve a successful outcome. In this article, the authors evaluate the outcome of concomitant large-angle strabismus after a single surgical procedure. A retrospective analysis of all operated cases of concomitant large-angle strabismus (50 prism diopters or more) during a 1.5-year period was performed from patient's case files. A successful outcome of surgery was defined as deviation within 10 prism diopters of orthophoria/tropia for both distance and near. Fifty patients met the inclusion criteria. The overall success rate was 60%, with the esotropia group having a higher success rate (68.75%) than the exotropia group (44.45%). Ten patients underwent recess-resect procedure, 20 had bimedial rectus recession, and 3 had bilateral lateral rectus recession, while 17 patients had surgery on 3 horizontal rectus muscles. Thirty-three patients had two-muscle surgery with a success rate of 57.58%, while 17 patients had three-muscle surgery with a success rate of 64.71%, the difference being statistically insignificant. There was no statistically significant difference between the various age groups analyzed for overall success rate, suggesting that age group is not a factor for positive outcome in large-angle strabismus surgery. A total of 12 patients were amblyopic at the time of strabismus surgery and they had a success rate of 33.33%, which was much poorer than the success rate (68.42%) of the remaining 38 patients who did not have amblyopia at the time of surgery. | A good surgical outcome can be obtained in large-angle strabismus with a single surgical procedure, though a randomized controlled study needs to be done to establish whether three-muscle surgeries give better results than two-muscle surgeries. | closed_qa |
Preterm infants with chronic lung disease: are protein and energy intakes after discharge sufficient for optimal growth? | Protein and energy intakes of preterm infants with CLD were quantified through detailed analysis of measured food and fluid intakes at four corrected age (CA) assessments, post-discharge. Most of the infants were in hospital for the term assessment. Milk intake from breastfeeding was determined by test weighing. Protein and energy intakes were compared with the Australian and New Zealand Nutrient Reference Values (NRV) for healthy term-born infants, and CA z-scores for weight, length and head circumference were calculated using Australian national gestational growth data and Centre for Disease Control 2000 growth data. Ten of the 28 CLD infants who were exclusively receiving expressed breast milk in hospital were transitioned to infant formula within 1 month of discharge. Complementary foods were introduced at a median CA of 3.6 months. Protein intakes almost always exceeded the NRV for healthy term-born infants, and at each assessment, at least 63% of infants met the energy NRV. Longitudinal growth data are available for 20 infants, four of whom had been small for gestational age. At the 12-month assessment, 10 of these infants weighed less than the 10th percentile. | Preterm infants who develop CLD do not always achieve reference growth in their first year following discharge, despite protein and energy intakes being mostly comparable to those recommended for healthy term-born infants. | closed_qa |
Japanese spotted fever with acute hepatic failure: was it associated with Epstein-Barr virus? | An 81-year-old female experiencing high fever, fatigue, and loss of appetite was admitted to our hospital and diagnosed with acute cholecystitis. Her condition did not improve and an eschar and erythema subsequently appeared. We then diagnosed Japanese spotted fever (JSF). She recovered immediately after the administration of minocycline. This case differed from other cases because the patient had a remarkably acute hepatic failure. Considering that the present case might be associated with other factors, we performed a repeat polymerase chain reaction (PCR) test on the patient's blood that had been collected on admission and stored. Epstein-Barr virus (EBV) was detected in her blood by PCR. | We consider this case might be associated with EBV. | closed_qa |
Are all metabolic syndrome components responsible for penile hemodynamics impairment in patients with erectile dysfunction? | Erectile dysfunction (ED) is a common disease that is mostly vasculogenic in nature. ED correlates with cardiovascular risk factors, with endothelial dysfunction being the common link. Hypertension (HTA) and insulin resistance are the most important determinants of arteriogenic ED, and are also components of the metabolic syndrome (MetS), which supports a strong association between MetS and ED. However, MetS and, specifically, obesity interference on penile hemodynamics is still controversial.AIM: To evaluate the impact of independent MetS criteria and obesity on penile duplex Doppler ultrasound (PDDU) parameters in men with ED. Consecutive patients (n = 212) referred to a unit of PDDU were evaluated for cardiovascular risk factors and MetS (ATP III criteria). Body mass index and body fat percentage (BF%) were calculated. Each patient underwent a PDDU by the same investigator. Data are expressed as mean ± standard deviation, and statistical significance was considered at P level<0.05. Statistical analysis of clinical, laboratory, and PDDU parameters was performed with SPSS® software. To evaluate the individual power of MetS clusters and obesity as predictive factors for penile hemodynamic changes namely mean peak systolic velocity (mPSV). MetS was present in 24.8% of men, and 80.8% of them presented penile hemodynamics alterations, with mPSV significantly lower comparatively to no MetS patients (29.0 vs. 35.4 cm/s, P = 0.004). Multivariate analysis demonstrated that, considering all MetS parameters, only HTA was significantly associated with diminished mPSV. However, after further adjustment for all cardiovascular risk factors, BF% remained the sole independent clinical factor for penile hemodynamics impairment. | There is a strong association between MetS and ED, but within MetS criteria, only HTA was independently associated with the deterioration of penile hemodynamics parameters. Although the classical methods of evaluating obesity in MetS were not individually associated with PDDU impairment, BF% represented by itself an excellent predictor of vascular ED. | closed_qa |
Is metabolic syndrome a useless category in subjects with high cardiovascular risk? | Although several studies have demonstrated that MetS is associated with a two-fold increase in the risk of cardiovascular (CV) diseases, this risk does not appear to be greater than the sum of risks associated with each of its individual components.AIM: To determine the association of men with ED and individual components of MetS and their subsequent relationship to CV risk, and, more specifically whether the sum of the MetS components is greater than the individual components in predicting CV risk. We longitudinally studied a consecutive series of 1,687 (mean age 52.9±12.8; range 17-88 years) patients attending our clinic for ED and evaluated different clinical and biochemical parameters. Information on major adverse CV event (MACE) was obtained through the City of Florence Registry Office. One hundred thirty-nine MACE, 15 of which were fatal, occurred during a mean follow-up of 4.3±2.6 years. Subjects with MetS at baseline showed a higher incidence of MACE (hazard ratio [HR]=1.77), after adjusting for age, however, the association disappeared in an alternative Cox model, adjusting both for age and for individual MetS components (HR=1,525 [0,564-4,123]; P=0.408). The two most predictive MetS components of CV risk were low high-density lipoprotein (HDL) cholesterol and high triglycerides. Exploring possible interactions between individual components of MetS and their effect on CV risk using two alternative approaches indicates that the effect of MetS components on CV risk is additive, but not synergistic. Among subjects with hypertension, after adjusting for age, elevated glycemia, and low HDL cholesterol confer relevant additional risk, while in subjects with high triglycerides, hyperglycemia increased the risk of incident MACE. | With regards to CV risk, the MetS construct seems to add little or nothing to the careful assessment of its components. Thus, there is no reason to recommend the use of MetS as a diagnostic category in patients with ED. | closed_qa |
Peroxisome proliferator-activated receptor activators protect sebocytes from apoptosis: a new treatment modality for acne? | The main function of the human sebaceous gland is sebum excretion. Increased sebum levels combined with follicular hyperkeratinization are a prerequisite of acne vulgaris. As peroxisome proliferator-activated receptors (PPARs) are known to control lipid metabolism in several human tissues they have been considered to be involved in the pathogenesis of acne vulgaris. To investigate the effect of activators of PPAR-α (WY14643), PPAR-γ (rosiglitazone) and PPAR-δ (L-165.041) on basal and staurosporine-induced apoptosis in the human sebocyte cell line SZ95 in vitro. After defining the basal effects of PPAR activators on membrane integrity (lactate dehydrogenase release) and DNA synthesis (5-bromodeoxyuridine incorporation), apoptosis was determined by the release of histone-associated DNA fragments. The underlying signalling events were detected by Western blotting and the use of specific inhibitors against p44/42 and protein kinase B (PKB)/Akt. PPAR activators of all three subsets offer antiapoptotic effects, with L-165.041 being the most potent. This compound induced the activation of PKB/Akt and p44/42, two kinases involved in antiapoptosis and proliferation, respectively. An inhibition of these kinases by specific inhibitors reversed the suppression of histone-associated DNA fragments by L-165.041, indicating that these signalling pathways participate in the observed antiapoptotic effect. | The present data suggest that activators of PPAR, in particular of the δ subset, might have beneficial effects on acne vulgaris by inhibiting the release of lipids in the context of sebocyte apoptosis. | closed_qa |
Endothelin-1: a predictor of extracapsular extension in clinically localized prostate cancer? | To assess the value of endothelin-1 (ET-1) expression in predicting extracapsular extension (ECE) in clinically localized prostate cancer (PCa). ET-1 expression was determined by immunohistochemistry on archival needle biopsies (NBs) from 94 patients (49 pT2 and 45 pT3a) who underwent radical prostatectomy (RP) for clinical T1-T2 PCa. Each sample was analysed independently by two pathologists blinded to the clinical data. In univariate analysis, high ET-1 expression in NBs, pre-operative prostate-specific antigen (PSA) level>10 ng/ml, percentage of positive biopsy cores and NB Gleason score ≥7 were significantly associated with ECE as determined on subsequent RP. No significant association was found between clinical stage and ECE. In multivariate analysis, there was a significant association with high ET-1 expression in NBs (p = 0.006), pre-operative PSA level>10 ng/ml (p = 0.049), and NB Gleason score ≥7 (p = 0.002). These three pre-operative factors combined provided the best model for predicting ECE with 93.3% sensitivity, 49% specificity, 62.5% positive predictive value, 88.9% negative predictive value. The combination yielded a higher concordance index (0.760 vs 0.720) and offered a higher log partial likelihood than the same model without ET1 (112.8 vs 105.7, p = 0.01). | ET-1 expression was strongly associated with ECE and, when combined with pre-operative PSA level and Gleason score, improved the predictive accuracy of pre-operative NBs. Its assessment in patients with localized PCa might be useful when making treatment decisions. Further studies with standardisation of immunohistochemical staining and multi-institutional validation are now needed to establish the appropriate use of ET-1 staining in PCa staging and to evaluate inter-observer reproducibility. | closed_qa |
Doing masculinity, not doing health? | Being female is a strong predictor of health promoting behaviours. Workplaces show great potential for lifestyle interventions, but such interventions do not necessarily take the gendered background of lifestyle behaviours into account. A perspective analyzing how masculine gender norms affect health promoting behaviours is important. This study aims to explore men's health beliefs and attitudes towards health promotion; in particular, it explores workplace physical activity in relation to masculine ideals among male employees. In the Fall of 2008, we interviewed 13 white Dutch male employees aged 23-56 years. The men worked in a wide range of professions and occupational sectors and all interviewees had been offered a workplace physical activity program. Interviews lasted approximately one to one-and-a-half hour and addressed beliefs about health and lifestyle behaviours including workplace physical activity, as well as normative beliefs about masculinity. Thematic analysis was used to analyze the data. Two normative themes were found: first, the ideal man is equated with being a winner and real men are prepared to compete, and second, real men are not whiners and ideally, not vulnerable. Workplace physical activity is associated with a particular type of masculinity - young, occupied with looks, and interested in muscle building. Masculine norms are related to challenging health while taking care of health is feminine and, hence, something to avoid. Workplace physical activity is not framed as a health measure, and not mentioned as of importance to the work role. | Competitiveness and nonchalant attitudes towards health shape masculine ideals. In regards to workplace physical activity, some men resist what they perceive to be an emphasis on muscled looks, whereas for others it contributes to looking self-confident. In order to establish a greater reach among vulnerable employees such as ageing men, worksite health promotion programs including workplace physical activity may benefit from greater insight in the tensions between health behaviours and masculinity. | closed_qa |
Should helical tomotherapy replace brachytherapy for cervical cancer? | Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied. A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up. | CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted. | closed_qa |
Does epigenetic polymorphism contribute to phenotypic variances in Jatropha curcas L.? | There is a growing interest in Jatropha curcas L. (jatropha) as a biodiesel feedstock plant. Variations in its morphology and seed productivity have been well documented. However, there is the lack of systematic comparative evaluation of distinct collections under same climate and agronomic practices. With the several reports on low genetic diversity in jatropha collections, there is uncertainty on genetic contribution to jatropha morphology. In this study, five populations of jatropha plants collected from China (CN), Indonesia (MD), Suriname (SU), Tanzania (AF) and India (TN) were planted in one farm under the same agronomic practices. Their agronomic traits (branching pattern, height, diameter of canopy, time to first flowering, dormancy, accumulated seed yield and oil content) were observed and tracked for two years. Significant variations were found for all the agronomic traits studied. Genetic diversity and epigenetic diversity were evaluated using florescence Amplified Fragment Length Polymorphism (fAFLP) and methylation sensitive florescence AFLP (MfAFLP) methods. Very low level of genetic diversity was detected (polymorphic band<0.1%) within and among populations. In contrast, intermediate but significant epigenetic diversity was detected (25.3% of bands were polymorphic) within and among populations. More than half of CCGG sites surveyed by MfAFLP were methylated with significant difference in inner cytosine and double cytosine methylation among populations. Principal coordinates analysis (PCoA) based on Nei's epigenetic distance showed Tanzania/India group distinct from China/Indonesia/Suriname group. Inheritance of epigenetic markers was assessed in one F1 hybrid population between two morphologically distinct parent plants and one selfed population. 30 out of 39 polymorphic markers (77%) were found heritable and followed Mendelian segregation. One epiallele was further confirmed by bisulphite sequencing of its corresponding genomic region. | Our study confirmed climate and practice independent differences in agronomic performance among jatropha collections. Such agronomic trait variations, however, were matched by very low genetic diversity and medium level but significant epigenetic diversity. Significant difference in inner cytosine and double cytosine methylation at CCGG sites was also found among populations. Most epigenetic differential markers can be inherited as epialleles following Mendelian segregation. These results suggest possible involvement of epigenetics in jatropha development. | closed_qa |
Socialization to the model: the active component in the therapeutic alliance? | Therapeutic alliance has been found to be a significant predictor of outcome in psychotherapy yet what constitutes therapeutic alliance remains unclear. Examining the common constructs of therapeutic alliance, it is possible that there may be a conceptual overlap between active components of therapeutic alliance and socialization to the treatment model.AIM: To investigate the relationship between socialization to the model and therapeutic alliance. Participants (N = 43) were taken from the active treatment arm in a RCT for the treatment of chronic fatigue syndrome (CFS/ME). Therapeutic alliance was measured using a 5-item questionnaire (brief CALPAS) and socialization to the model was extracted from therapy tapes using a novel coding system. Key findings were that when patients and therapists agreed about goals of treatment, there were higher levels of concordance, less evidence of applying principles incongruent to the model, and less resistance during the treatment sessions. | The outcome of this preliminary study contributes to the potential understanding of active components in the therapeutic alliance, and supports further research to achieve a more detailed picture of "non-specific" factors in therapy, including the active process of socialization in therapeutic alliance. | closed_qa |
Supports used for positioning of patients in hip arthroplasty: is there an infection risk? | Infection after joint arthroplasty is a disastrous complication. Implants used in hip arthroplasty increase the risk of infection from organisms of low pathogenicity. Potential reservoirs, that have not been assessed as yet, are the supports used for patient positioning in hip arthroplasty. The purpose of this study was to assess these supports for presence of bacterial pathogens. We studied 40 supports used in 20 hip arthroplasty procedures. Tryptone soya agar plates were used to sample these supports. All agar plates were incubated at 37 °C for 48 h. Of the 20 anterior supports, 17 (85%) showed bacterial colonisation; of the 20 posterior supports, 10 (50%) had bacterial colonisation. Fourteen (52%) supports were contaminated with one organism, 9 (33%) with two organisms, three (11%) with three organisms and one (4%) with four organisms. Coagulase-negative staphylococci were the most common isolated organisms (61%) followed by coryneforms (10%) and bacilli (10%). Anterior supports had two times more colony forming units compared to the posterior supports. | This study showed contamination of supports used for positioning patients during hip arthroplasty. It reflects poor cleaning practice and certainly raises the possibility that a high bacterial load on these supports may contribute to higher infection rates in hip arthroplasties. The study raises concerns related to contamination of supports, as there is a potential for cross-infection, wound problems, and deep sepsis around implants which could be disastrous. While colonisation does not equate with infection, we suggest thorough cleaning of the supports before and after every surgical procedure. | closed_qa |
Pre-operative cardiac workup after anthracycline-based neoadjuvant chemotherapy. Is it really necessary? | In patients receiving pre-operative anthracyclines for locally advanced breast cancer, early cardiotoxicity is a well-recognised complication that may interfere with surgery. The aim of this study was to assess the safety of breast surgery after neoadjuvant treatment with Doxorubicin. A retrospective study of breast cancer patients treated with Doxorubicin as part of their neoadjuvant protocol. All patients were subsequently operated in our institution. Intra-operative and postoperative haemodynamic, cardiac or respiratory events were collected. A total of 83 patients were included. All patients had a normal left ventricular ejection fraction before starting on chemotherapy. Doxorubicin was given in conjunction with Cyclophosphamide and Paclitaxel. The cumulative dose of Doxorubicin was 240 mg/m(2). All patients completed their chemotherapy less than a year before surgery and were clinically asymptomatic. Of the patients, 2.3% displayed a significant reduction in cardiac function to meet cardiotoxicity criteria, although not clinically apparent. No complications occurred intra-operatively or postoperatively. | Breast surgery can be safely performed after breast neoadjuvant chemotherapy with Doxorubicin. The risk of early cardiotoxicity does not mandate a cardiac function assessment after completion of treatment. Work-up should be individualised according to the anthracycline regimen, patient's cardiac risk factors and functional status before surgery. | closed_qa |
Food consumption patterns of young preschoolers: are they starting off on the right path? | To describe the food consumption patterns of US children aged 2 and 3 years. Descriptive analysis of data collected in the Feeding Infants and Toddlers Study 2008 based on a single 24-hour dietary recall collected by telephone. A national random sample of children aged 2 and 3 years (n=1,461). The percentage of children consuming foods from specific food groups was estimated for the full sample of children aged 2 and 3 years and separately by year of age. About a third of 2-year-olds and a quarter of 3-year-olds consumed whole milk at least once in a day. About 70% of 2- and 3-year-olds consumed vegetables as a distinct food item at least once in day. French fries and other fried potatoes were the most commonly consumed vegetable. Almost three quarters of children (73%) consumed fruit as a distinct food item at least once in a day, and 59% consumed 100% juice. Fresh fruit was the most commonly consumed type of fruit. About 85% of children consumed some type of sweetened beverage, dessert, sweet, or salty snack in a day. Percentages of children consuming such foods were consistently higher for 3-year-olds than for 2-year-olds. | Parents and caregivers should be encouraged to expose young children to a wide variety of fruits and vegetables, whole grains, low-fat dairy products, and healthier fats, and to limit consumption of low-nutrient, energy-dense foods and beverages. Dietary guidance should stress the fact that children in this age group have high nutrient needs and relatively low energy requirements, leaving little room for such foods. Parents need advice that is specific, practical, and actionable. | closed_qa |
Multicenter early experience with extended aortic repair in acute aortic dissection: is simultaneous descending stent grafting justified? | In acute type A aortic dissection, the extension of repair to downstream aorta has been controversially discussed. We present the early results of a multicenter study using a hybrid stent graft prosthesis. Between January 2005 and January 2010, the data from 191 patients after combined proximal aortic replacement and antegrade stent grafting were collected in the database of the International E-vita open Registry. Of the 191 patients, 68 underwent surgery for acute aortic dissection and were included in the present study. Hypothermic circulatory arrest and selective cerebral perfusion were routinely used. Computed aortic imaging was performed for false lumen evaluation during follow-up. The in-hospital mortality rate was 13% (9/68). Along the stent graft, the rate of immediate complete false lumen thrombosis was 86% (51/59) and increased during follow-up (23 ± 17 months) to 94% (46/49). Distally, complete or partial false lumen thrombosis was initially observed in 61% (36/59) and in 82% (40/49) after follow-up. The 1- and 3-year actuarial survival rate was 82% and 74%, respectively. | Extended thoracic aortic repair of acute aortic dissection with a hybrid stent graft is feasible at acceptable early mortality and promotes false lumen thrombosis around the stent graft and below. | closed_qa |
Does the dilated ascending aorta in an adult with congenital heart disease require intervention? | There is increasing attention to prophylactic replacement of the moderately dilated ascending aorta at aortic valve surgery. Moderate ascending aortic dilatation is common in adult patients with conotruncal anomalies. There are no data outlining actual risk of progressive ascending aortic dilatation or dissection to provide management guidelines. From December 1973 through January 2008, 81 consecutive adults (median age, 34 years; range, 18--59 years) with conotruncal anomalies underwent operation on the aortic root, ascending aorta, or aortic valve. Primary cardiac diagnoses included tetralogy of Fallot with or without pulmonary atresia in 60 patients, truncus arteriosus in 12, double-outlet right ventricle in 6, and other in 3. Indications for operation included aortic regurgitation in 69 patients, supracoronary ascending aneurysm in 16, aortic stenosis in 5, and other in 8. Median ascending aortic size was 45 mm (23--80 mm). Operations included isolated aortic valve repair/replacement in 63 patients, combined aortic valve replacement and reduction aortoplasty in 9, aortic root replacement in 7, and isolated ascending aortic replacement in 2. Four patients required reoperation during a median follow-up of 3.8 years (maximum 31 years). There were no ascending aortic reoperations after previous reduction aortoplasties or supracoronary ascending aortic grafts, and there were no late aortic dissections. | Moderate ascending aortic enlargement is common among patients with conotruncal anomalies coming to operation, but aortic dissection is rare, as is subsequent need for aortic reoperation. Despite current enthusiasm for prophylactic operations on the ascending aorta in patients with acquired disease, these data suggest that the moderately dilated aorta in this setting may be observed. | closed_qa |
The Bentall procedure: is it the gold standard? | We compared aortic root reconstructions using conduits with biological valves and mechanical valves. Of 597 patients (1995-2008), 307 (mean age 71 years [23-89 years]) had biological valves and 290 (mean age 51 years [21-82 years]) had mechanical valves. The subgroup of 242 patients aged 50 to 70 years included 133 with biological and 109 with mechanical valves. Overall hospital mortality was 3.9% with biological valves (n = 15; elective: 3.7% [n = 10]) versus 2.8% with mechanical valves (n = 8; elective: 1.4% [n = 3]). In patients 50 to 70 years, age greater than 65 years (relative risk: 3.3 [P = .0001]), clot (relative risk: 2.5 [P = .05]), coronary artery disease (relative risk:3.5 [P<.0001]), and degenerative etiology (relative risk: 0.4 [P = .006]) were independent risk factors for long-term survival (after postoperative day 30); there was no difference in long-term survival between biological and mechanical valves (relative risk: 0.9 [P = .74]). The linearized rate for valve/ascending aorta reoperation was 0.86%/pt-y (2 in 2310 pt-y) after mechanical valves and 2.5%/pt-y (4 in 1586 pt-y) after Bentall procedures with the biological valve. | The choice of valve for aortic root reconstruction seems to have no influence on long-term outcome. Emergency operation and the presence of clot/atheroma have a significant impact on short-term outcome. Reoperation for either ascending aorta and/or aortic valve is low. | closed_qa |
Does rapid maxillary expansion increase nasopharyngeal space and improve nasal airway resistance? | To evaluate the effect of rapid maxillary expansion (RME) on the dimension of the nasopharyngeal space and its relation to nasal airway resistance. Twenty-five school-age children (from 7 to 10 year-old) with mouth and/or mixed breathing, with mixed dentition and uni- or bilateral posterior crossbite involving the deciduous canines and the first permanent molars, were evaluated. RME was placed and remained during 90 days. Rhinomanometry and orthodontic documentation were performed at four different times, i.e., before (T(1)), immediately after (T(2)), 90 days (T(3)) and 30 months (T(4)) after RME. Differences in nasopharyngeal area and in nasal airway resistance were observed only 30 months after RME, and could be explained by facial growth, and not because of the orthodontic procedure. | RME does not influence on nasopharyngeal area or nasal airway resistance in long-term evaluation. | closed_qa |
Can prolonged QTc and cTNT level predict the acute and long-term prognosis of stroke? | Previous studies in patients with stroke indicate that QTc prolongation and elevated cTNT are related to increased risk of all-cause and cardiovascular mortality. We analysed the importance of electrocardiographic (ECG) abnormalities and elevated serum cardiac troponin (cTNT)--at baseline examination--as potential predictors for acute and long-term mortalities after stroke in a follow-up of 478 patients with a mean age of 78 years. In a multivariate analysis, strong predictors for poor prognosis during the acute phase were: elevated cTNT (p=0.001); stroke severity (p=0.004); ischemia on ECG (p=0.044); and age (p=0.050). Prolonged QTc interval was on the limit to statistical significance (p=0.050) when using multivariate analysis, while clearly significant in a Cox-regression (when corrected for missing cTNT values). One year after stroke, when adjusted for covariates (gender, diabetes mellitus, hypertension, and ischemic heart disease), elevated cTNT (p=0.001), stroke severity (p=0.014), and age (p=0.031) retained a significant relation with mortality. Moreover, atrial fibrillation was strongly correlated with poor survival (p=0.009). Cox regression confirmed the predictive value of QTc, cTNT, age, and stroke severity, as markers of acute mortality in relation to stroke. | Prolonged repolarization time independently predicts poor prognosis during the acute phase, but not one year after stroke. In the absence of acute myocardial infarction, elevated initial cTNT is strongly related to poor outcome, both during the acute phase and one year after stroke. | closed_qa |
Inflammatory bowel disease and lower limb lymphedema: a fortuitous association? | Extra-intestinal manifestations of chronic inflammatory bowel disease (CIBD) are various. Cases of genital lymphedema has previously been reported in Crohn's disease. We report two women aged 57 and 68 years who presented with a lower limb lymphedema 8 and 20 years after a diagnosis of CIBD (Crohn's disease and ulcerative colitis), respectively. At the time of diagnosis of lymphedema, CIBD was asymptomatic. | Pathophysiological mechanisms of this rare manifestation are unclear and lymphedema outcome is unrelated to CIBD activity. | closed_qa |
Should patient setup in lung cancer be based on the primary tumor? | Evaluation of the dose distribution for lung cancer patients using a patient setup procedure based on the bony anatomy or the primary tumor. For 39 patients with non-small-cell lung cancer, the planning fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan was registered to a repeated FDG-PET/CT scan made in the second week of treatment. Two patient setup methods were analyzed based on the bony anatomy or the primary tumor. The original treatment plan was copied to the repeated scan, and target and normal tissue structures were delineated. Dose distributions were analyzed using dose-volume histograms for the primary tumor, lymph nodes, lungs, and spinal cord. One patient showed decreased dose coverage of the primary tumor caused by progressive disease and required replanning to achieve adequate coverage. For the other patients, the minimum dose to the primary tumor did not significantly deviate from the planned dose: -0.2 ± 1.7% (p = 0.71) and -0.1 ± 1.7% (p = 0.85) for the bony anatomy setup and the primary tumor setup, respectively. For patients (n = 31) with nodal involvement, 10% showed a decrease in minimum dose larger than 5% for the bony anatomy setup and 13% for the primary tumor setup. The mean lung dose exceeded the maximum allowed 20 Gy in 21% of the patients for the bony anatomy setup and in 13% for the primary tumor setup, whereas for the spinal cord this occurred in 10% and 13% of the patients, respectively. | In 10% and 13% of patients with nodal involvement, setup based on bony anatomy or primary tumor, respectively, led to important dose deviations in nodal target volumes. Overdosage of critical structures occurred in 10-20% of the patients. In cases of progressive disease, repeated imaging revealed underdosage of the primary tumor. Development of practical ways for setup procedures based on repeated high-quality imaging of all tumor sites during radiotherapy should therefore be an important research focus. | closed_qa |
Are electrodiagnostic study findings related to a patient's response to epidural steroid injection? | To determine if improvements in pain after epidural steroid injections (ESIs) were related to electromyographic (EMG) findings in patients with radicular symptoms and clinical findings consistent with radiculopathy. Retrospective chart review. Multisite spine clinic. Data were analyzed from 89 patients who had needle EMG within 6 months of ESI between 2005 and 2008. Clinical and demographic data and results of EMG testing from qualified patients were recorded from patient charts at least 10 days after ESI. Evidence of radiculopathy on EMG reports was classified as positive, normal, or equivocal. In all 3 EMG groups, the percentage of patients who had 50% improvement in leg pain after ESI was noted. As a secondary analysis, improvement in pre-ESI to post-ESI leg and back pain scores in the EMG groups were compared. The clinical outcome measurements were visual analog scale (VAS) scores assessing leg and back pain. ESI relief was defined as at least 50% improvement in the VAS score assessing leg pain after the injection. EMG findings were normal in 47.2%, positive in 31.5%, and equivocal in 21.3% of patients. No significant differences were found in the percentages of patients experiencing a positive response to the ESI with respect to EMG findings. Forty-three percent of patients with normal EMG findings (18/42), 25.0% of patients with positive EMG findings (7/28), and 31.6% patients with equivocal EMG findings (6/19) had relief after ESI. In all 3 EMG groups, a statistically significant improvement in mean VAS scores was found after ESI. | Mean leg and back pain scores improved significantly after ESI in all 3 EMG groups: those with positive, normal, and equivocal findings. Results of this study do not suggest that ESI is contraindicated in patients with normal EMG findings. | closed_qa |
Influenza vaccine for healthy adult workers: an issue for health authorities or employers? | To contribute to the debate whether extending public coverage of influenza vaccination to healthy workers is cost-effective, particularly in the perspective of EU countries. First, we reviewed the recent international literature on the extension of vaccination to subjects aged 50-64 years in highly developed countries. Second, we estimated the broad economic impact of influenza vaccination on the Italian healthy adult working population. Finally, we ran a pilot observational study to assess the healthcare and labour outcomes of influenza vaccination on the employees of our organization. The methodological weaknesses of the studies reviewed, all built on models, undermine the credibility of their optimistic results. The more cautious the model design, the less favourable the final results, as our conservative analysis on the Italian setting confirmed. The only common result was a steady relationship between potential vaccination benefits and indirect costs of absenteeism from work. This "modelling-based evidence" was confirmed by our internal survey: vaccinated workers showed less tendency to stay at home during influenza-like illness episodes and their relapses. | The economic advantage of extending public influenza vaccination to healthy adult workers is still uncertain and mainly relates to the indirect costs of productivity losses, making the extension strategy more a labour than a health issue. | closed_qa |
Is there any association between esophagogastric endoscopic findings and laryngeal cancer? | The aim of the study was to survey the association between prevalence of acid-related inflammation in the upper digestive tract and laryngeal cancer. A case-control study was done in an otolaryngology ward at an academic university. Totally, 65 patients with laryngeal cancer and 65 cancer-free matched controls underwent esophagogastroduodenoscopy, and endoscopic findings were collected. In the case group, positive endoscopic findings were significantly higher than the control group (87.7% vs 58.5%; P<.001). Laryngeal cancer patients had erosive esophagitis, and gastritis ± other findings more than the control group (48 vs 29 cases) and the difference was statistically significant. | The difference between endoscopic findings in cases and controls was statistically significant. Severe inflammation and erosion existed in patients with laryngeal cancer that could be due to increased acid secretion. Our study supported the hypothesis that gastric acid and pepsin play a role in laryngeal cancer. | closed_qa |
Are patients in clinical trials representative of the general population? | In our institution, adjuvant taxanes are currently offered to fit, node positive breast cancer patients who are either Her2 positive (any ER/PR) or triple negative (ER/PR/Her2 negative). The FE(100)C-D (FE(100)C × 3→docetaxel 100mg/m(2) × 3) regime, based on the PACS 01 trial [Roche H, Fumoleau P, Spielmann M, et al. Sequential Adjuvant Epirubicin-Based and Docetaxel Chemotherapy for node positive Breast Cancer Patients: The FNCLCC PACS 01 Trial. J Clin Oncol 2006;24:5664-5671] is used. We retrospectively audited our experience with FE(100)C-D at The Beatson West of Scotland Cancer Centre and one representative district general hospital (DGH), Falkirk and District Royal Infirmary (FDRI). Over a two year period, 101 patients commenced adjuvant FE(100)C-D chemotherapy. Data was matched with the FE(100)C-D arm of the PACS 01 trial. Median age was 54 years. Twenty-six patients (26%) had ≥ 1 episode of febrile neutropaenia (FN), including one fatal episode. Twenty-nine percent of patients required treatment interruption ≥ 1 week. Thirty percent of patients had dose reductions. Thirty percent of patients received<90% dose intensity of docetaxel. | The FN rate was substantially higher and docetaxel dose intensity substantially lower in our unselected sample of patients than in the reference study.(1) This 'real-life' data illustrates the problems of applying clinical trial data to the more generalised patient population. | closed_qa |
Vimentin expression and myofibroblast infiltration are early markers of renal dysfunction in kidney transplantation: an early stage of chronic allograft dysfunction? | The objective of this study was to show the morphologic characteristics of allograft renal biopsies in renal transplant patients with stable renal function, which can potentially be early markers of allograft dysfunction, after 5 years of follow-up. Forty-nine renal transplant patients with stable renal function were submitted to renal biopsies and simultaneous measurement of serum creatinine (Cr). Histology was evaluated using Banff scores, determination of interstitial fibrosis by Sirius red staining and immunohistochemical study of proximal tubule and interstitial compartment (using cytokeratin, vimentin, and myofibroblasts as markers). Biopsies were evaluated according to the presence or absence of the epitheliomesenchymal transition (EMT). The interstitial presence of myofibroblasts and tubular presence of vimentin was also analyzed simultaneously. Renal function was measured over the follow-up period to estimate the reduction of graft function. Median posttransplant time at enrollment was 105 days. Patients were followed for 64.3 ± 8.5 months. The mean Cr at biopsy time was 1.44 ± 0.33 mg/dL, and after the follow-up it was 1.29 ± 0.27 mg/dL. Nine patients (19%) had a reduction of their graft function. Eleven biopsies (22%) had tubulointerstitial alterations according to Banff score. Seventeen biopsies (34%) presented EMT. Fifteen biopsies (32%) had high interstitial expression of myofibroblasts and tubular vimentin. Using Cox multivariate analysis, HLA and high expression of interstitial myofibroblasts and tubular vimentin were associated with reduction of graft function, yielding a risk of 3.3 (P = .033) and 9.8 (P = .015), respectively. | Fibrogenesis mechanisms occur very early after transplantation and are risk factors for long-term renal function deterioration. | closed_qa |
Does model for end-stage liver disease score predict the short-term outcome of living donor liver transplantation? | The objective of this study was to evaluate the predictive ability of the Model for End-Stage Liver Disease (MELD) score for short-term outcomes after living donor liver transplantation (LDLT). The 135 consecutive patients who underwent LDLT did not include prisoners or their organs. Patients were divided into a low (group A; MELD score<15), a moderate (group B; MELD score ≥15 but<25), and a high MELD score (group C; MELD score ≥25) group according to their preoperative score. We retrospectively analyzed the data concerning complications, biochemical parameters, and survival over 90 postoperative days. Complications were similar among patients with a low, moderate, or high MELD score. The 90-day survival rates of group A, B, and C were 88%, 90%, and 90%, respectively (P = .960). Compared with groups A and B, group C showed a longer mean intensive care unit (ICU) stay. | Preoperative MELD score may not help to predict short-term outcomes of LDLT. However, a high MELD score may be related to a prolonged ICU stay. | closed_qa |
Does arterialisation time influence biliary tract complications after orthotopic liver transplantation? | In the cardiac death donor era, many reports deal with biliary tract complications and concerns about ischemic reperfusion injury owing to the exclusive arterial vascularization of the biliary tree, the warm ischemia time has been implicated as responsible for biliary lesions during organ procurement. We defined the arterialization time as the second warm ischemia time. Our purpose was to study the correlation between the arterialization time during liver implantation and the appearance of biliary lesions. We retrospectively collected data from the last 5-years of orthotopic liver transplantation: namely, indications, cold perfusion fluid, cold ischemia time, operative procedure times, and acute rejection events. We excluded split-liver transplantations, retransplantations, pediatric patients, transplantations for cholestatic disease, cases where hepatic artery thrombosis happened before biliary complications, or patients with posttransplant cytomegalovirus infection. We defined 2 groups: A) without biliary complications; and B) with biliary complications. We compared the mean arterialization time using Student t test to define whether the warm ischemic time during implantation was responsible for biliary tract complications. A P value of<.05 was considered to be significant. Between 2004 and the end of 2008, we grafted 402 patients among whom 243 met the inclusion criteria: 198 in group A and 45 in group B. Only the cold ischemia time was significantly different between the 2 groups (P = .039). | After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage. | closed_qa |
Is the surgical repair of unruptured atherosclerotic aneurysms at a higher risk of intraoperative ischemia? | The incidence of ischemia might be increased in the surgical repair of atherosclerotic unruptured aneurysms compared to non-atherosclerotic aneurysms. The atherosclerotic wall might increase the occurrence of thrombembolic events or its rigidity might endanger the occlusion of perforators within the aneurysm vicinity. 87 patients (53 patients without and 34 patients with atherosclerotic unruptured aneurysms, 50.5 ± 9.7 years) were analyzed for severity of atherosclerosis within the aneurysm and the aneurysm bearing vessel, surgical maneuvers, intraoperative alterations in evoked potentials and clinical and neuroradiological results. Temporary vessel occlusion (25% vs. 50%, p = 0.021), repositioning of a permanent clip (21% vs. 56%, p = 0.001) and aneurysm remnants (2% vs. 18%, p = 0.012) occurred more often in patients with atherosclerotic aneurysms. At 6 months, 3/34 patients with atherosclerosis (8.8%) had an unfavorable outcome, all patients without atherosclerosis had a favorable outcome (p = 0.056). | The surgical repair of unruptured aneurysms is safe but patients with atherosclerotic altered vessels and aneurysms accounted to a minor increase in unfavorable outcome and an increased risk of morbidity at 6 months postoperatively. This factor should be taken into consideration when performing surgery of atherosclerotic, unruptured aneurysms. | closed_qa |
"Do GRACE (Global Registry of Acute Coronary events) risk scores still maintain their performance for predicting mortality in the era of contemporary management of acute coronary syndromes? | Although the GRACE risk scores (RS) are the preferred scoring system for risk stratification in acute coronary syndromes (ACS), little is known whether these RS still maintain their performance in the current era. We aimed to investigate this issue in a contemporary population with ACS. The study population composed of patients enrolled in the MASCARA national registry. The GRACE RS were calculated for each patient. Discrimination and calibration were evaluated with the C statistic and the Hosmer-Lemeshow test, in the whole population and according to the type of ACS, risk strata, and whether the patient had a history of diabetes and/or chronic renal failure. We determined if left ventricular ejection fraction (LVEF) provides incremental prognostic information above that established by the RS and whether percutaneous coronary intervention (PCI) during admission affects the performance of the score for predicting 6-month mortality. The 5,985 patients constituted the validation cohort for the in-hospital mortality RS and 5,635 the validation cohort for the 6-month mortality RS. Overall, both GRACE RS demonstrated excellent discrimination (C>0.80) and calibration (all P values in Hosmer-Lemeshow>.1). Although similar results were seen in all subgroups, the 6-month mortality RS performed significantly less well in patients undergoing PCI compared to those patients who did not (C = 0.73 vs 0.76, P<.004). Adding LVEF to the RS did not convey significant prognostic information. | The GRACE RS for predicting in-hospital and 6-month mortality still maintain their excellent performance in a contemporary cohort of patients with ACS. Further studies are needed to investigate the performance of the 6-month mortality GRACE score in patients undergoing in-hospital PCI. Left ventricular ejection fraction did not convey significant information over that provided by the RS. | closed_qa |
Can an elderly woman's heart be too strong? | Coronary artery disease is the leading cause of death in women. We sought to validate previous clinical experience in which we have observed that elderly women with a very high left ventricular ejection fraction (LVEF) are at increased risk of death compared with elderly women with acute coronary syndromes with a normal LVEF. Data from 5,127 elderly female patients (age>65 years) enrolled in the Global Registry of Acute Coronary Events were collected. Patients were divided into 3 groups based on their LVEF: group I had a low ejection fraction (<55%), group II had a normal ejection fraction (55%-65%), and group III had a high ejection fraction (>65%). χ² test and multiple logistic regression analysis were performed. The main outcome measures were death in-hospital and death, stroke, rehospitalization, and myocardial infarction at 6-month follow-up. Hospital mortality was 12% in group I. Patients in group III were more likely to die in-hospital than those in group II (P = .003). Multivariable logistic regression showed that high ejection fraction was an independent predictor of hospital death (odds ratio [OR] 2.5, 95% CI [CI]1.2-5.2, P = .01), 6-month death (OR 2.0, 95% CI 1.1-3.4, P = .01), and cardiac arrest/ventricular fibrillation (OR 2.5, 95% CI 1.2-5.0, P = .01) compared with the normal ejection fraction group. | Having a very high LVEF (>65%) is associated with worse survival and higher rates of sudden cardiac death than an LVEF considered to be in the reference range. | closed_qa |
Do high-risk infants have a poorer outcome from primary repair of coarctation? | Balloon angioplasty for infant coarctation is associated with a high recurrence rate, making operative repair the gold standard for low-risk infants. Debate exists as to whether high-risk infants might be better served with primary angioplasty. We compared the outcome in high-risk versus low-risk infants over 20 years, in a center that always used surgical repair as the primary intervention. Of 192 infants from 1986 to 2005, 56 were considered "high-risk," defined as requiring prostaglandin infusion together with either epinephrine infusion for 24 hours preoperatively, or ventilation and milrinone infusion for 24 hours preoperatively. All high-risk patients had a period of ventricular dysfunction prior to surgery, ranging from mild to severe. Outcomes were compared using Bonferroni comparison of means or the Fischer exact test as appropriate. Although the high-risk patients were smaller (3.3 ± 0.1 vs 4.2 ± 0.2 kg, p<0.01), younger (18 ± 4 vs 57 ± 7 days, p<0.01), and more often required a concomitant pulmonary artery band (25% vs 15%, p = 0.05), their cross-clamp times were the same as the low-risk patients (18.9 ± 0.9 vs 18.0 ± 0.4 minutes, p = 0.27) and there was no difference in postoperative morbidity (7% vs 3%, p = 0.11). However, there was a trend toward higher perioperative mortality (7% vs 2%, p = 0.07). When compared with the published studies of primary angioplasty in comparable high-risk infants, the mortality rate in our surgically treated high-risk group is much lower. Additionally, only 11% of our high-risk group required reintervention, with two-thirds treated successfully with a single angioplasty at 3.8 ± 2.2 years later, far lower than recurrence rates with primary angioplasty. | We propose that primary surgical repair of coarctation in infants who are high risk should be the primary treatment, with angioplasty reserved for recurrent coarctation. | closed_qa |
Does type of bolus insulin matter in the hospital? | Poor glycemic control in hospitalized patients has been associated with increased morbidity and mortality. Research suggests that analogue bolus insulin may be more effective in achieving blood glucose (BG) control compared with human bolus insulin. This study compares mortality, length of stay (LOS), costs, and BG control in hospitalized patients receiving either analogue or human bolus insulin. This retrospective cohort analysis used data from January 1, 2004, to December 31, 2007, within the Health Facts database (Cerner Corporation, Kansas City, Missouri). Nonsurgical adult patients who received exclusively analogue or human bolus insulin during hospitalization were included in the study. Propensity score matching and multivariate regression analyses were used to compare patients treated with analogue versus human bolus insulin. The study outcomes were in-hospital mortality, hospital LOS among survivors (to avoid potentially short hospitalizations among nonsurvivors distorting results), and hospitalized BG control (present vs absent), defined as having a mean BG of 70 to<200 mg/dL during hospitalization. In total, 35,049 participants met the inclusion criteria and 5568 of 7754 patients in the analogue group were matched by their propensity scores to patients in the human bolus group (mean age, 67.1 years; 53% women; 77% white). On propensity score analysis, analogue bolus insulin was associated with lower mortality (relative risk [RR] = 0.52; 95% CI, 0.45-0.61) and shorter LOS (0.668-day reduction; 95% CI, 0.44-0.89) compared with human bolus insulin. However, analogue insulin was associated with only a modest benefit for BG control (RR = 0.88; 95% CI, 0.81-0.95). The multivariate regression analysis produced similar findings. | In this cohort of hospitalized patients, analogue bolus insulin was associated with lower mortality, shorter LOS, and modestly better BG control compared with patients treated with human bolus insulin. These results highlight the need for a randomized controlled clinical trial comparing outcomes by bolus insulin type in the hospital setting to determine a true mortality benefit. | closed_qa |
Are personality patterns and clinical syndromes associated with patients' motives and perceived outcome of orthognathic surgery? | A study of surgical-orthodontic patients was performed to assess whether signs of personality patterns and psychologically defined clinical syndromes influenced patients' motives for treatment, perceived oral function, self-concept, social interaction, and overall satisfaction with treatment. The sample consisted of 92 adult surgical-orthodontic patients. They filled out 3 questionnaires from Kiyak et al: one on motives for treatment; another on perceived oral function, self-concept, and social interaction; and a third on satisfaction with treatment outcome. The Millon Clinical Multiaxial Inventory III was used for classification of personality patterns and clinical syndromes. Patients with signs of a schizoid personality pattern expressed stronger presurgical motives than other patients. Concerning self-concept and social interaction, the patients showing signs of personality patterns and clinical syndromes, in general, perceived themselves as worse than the other patients. However, differences were only evident before treatment. Overall satisfaction was independent of the psychological profile. Histrionic and narcissistic personality patterns seemed to be overrepresented among surgical-orthodontic patients compared with the general population. | Patients who showed signs of certain personality patterns and clinical syndromes improved most from treatment in terms of self-concept and social interaction, and such traits did not influence their degree of satisfaction. | closed_qa |
Does a plain X-ray of the pelvis predict arterial complications in renal transplantation? | It is unknown whether if a plain X-ray of the iliac arteries (pelvic X-ray) is a reliable tool to detect calcifications and predict vascular complications. In a prospective study, a pelvic X-ray was performed before transplantation in patients without evidence of peripheral vascular disease (n = 109) and vascular calcifications were scored. Vascular calcifications in the iliac arteries and complications were scored by the transplant surgeon during the operation (gold standard). Vascular calcifications were found on the pelvic X-ray in 33 patients (30.2%). The transplant surgeon identified vascular calcifications in 35%. Sensitivity and specificity of the pelvic X-ray for vascular calcifications in the iliac arteries were 48 and 82%, respectively. Technical problems with the arterial anastomosis due to vascular calcifications were observed in five patients. The negative predictive value and positive predictive value of a pelvic X-ray for complications with the arterial anastomosis were 99 and 14%, respectively. | A pelvic X-ray is not a reliable tool to detect vascular calcifications. Technical problems with the arterial anastomosis due to calcifications are infrequent in the absence of vascular calcifications on the pelvic X-ray. | closed_qa |
Delay before the hepatocyte phase of Gd-EOB-DTPA-enhanced MR imaging: is it possible to shorten the examination time? | Four hundred ninety-five malignant focal liver lesions observed on Im-20 in 265 patients were included. The hepatocyte phase was obtained 10 min (Im-10) and 20 min (Im-20) after Gd-EOB injection. Liver enhancement was evaluated using a 4-point scale [excellent/good/poor/non-diagnostic; visual liver-spleen contrast (V-LSC)] and a quantitative liver-spleen contrast ratio (Q-LSC). Two radiologists evaluated lesion conspicuity for assessing the sensitivity of lesion detection. As Im-20 was used as the standard of reference for the lesions, Im-20 artificially had 100% sensitivity. The results showed that although sensitivities and Q-LSC significantly increased from Im-10 to Im-20 (sensitivity/mean Q-LSC: Im-5, 81%/1.4 Im-10, 96%/1.7: Im-20, 100%/1.9), the sensitivity of Im-10 achieved 100% (the same as Im-20) in patients with good/excellent V-LSC or Q-LSC of more than 1.5. On Im-10, 202 patients (77%) were assigned as having good/excellent V-LSC (78%), and 161 (61%) were assigned as having Q-LSC of more than 1.5. | We concluded that Im-20 can be omitted in at least 61% of the patients. | closed_qa |
Is sex associated with the outcome of patients treated with radiation for nonsmall cell lung cancer? | Lung cancer is the leading cause of cancer death for both men and women, but the disease course differs between the sexes. To the authors' knowledge, sex-based differences in outcomes among the population of nonsmall cell lung cancer (NSCLC) patients receiving radiation have not been well defined. Data for 831 patients (319 women and 512 men) with stage I to III NSCLC and treated with>or =45 Gray of radiation between March 1985 and November 2003 were retrospectively analyzed (grading determined according to the 1997 American Joint Committee on Cancer grading system). Women were more likely to have earlier stage disease, to have smoked<50 pack-years, and to have adenocarcinoma or large-cell carcinoma (all P<or = .001). For each stage, treatment did not differ between women and men. Five-year survival rates were significantly better for women than for men: overall survival (OS), 28.6% versus 16.1% (P<.001); disease-free survival, 31.2% versus 20.1% (P = .02); and distant metastasis-free survival, 48.8% versus 37.6% (P<.02). Among patients with medically inoperable stage I NSCLC, women had improved 5-year OS compared with men (30.0% vs 13.1%; P = .004). On multivariate analysis, male sex, weight loss, age>or =65 years, and stage III disease were found to be associated with poorer OS (all P<0.02). | Although women are more likely to have earlier stage disease, among patients with medically inoperable stage I NSCLC, women still have a better OS. Along with known prognostic factors, including age, weight loss, and stage, sex remained significant on multivariate analysis of OS, suggesting that sex is a determinant of outcome in NSCLC patients receiving radiation. | closed_qa |
Dermatologic disorders of the athlete: a report of 30 cases? | Participation in athletic activities is associated with a variety of skin problems. We aimed to precise the most important sports related dermatoses in athletes. We conducted transversal study on 30 athletes of 2 teams: one of soccer and the other of basketball players. For each athlete dermatological exam was practiced. 18 soccer players and 12 basketball players were enrolled; the mean age was about 25.3 years [18-35 years]. The results suggest that athletic activity seems to be a predisposing factor for cutaneous infections (87%) especially fungal infections (90%). Traumatic lesions were also frequent in our athletes (20/30), dominated by calluses and nail disorders (80%). | Sports-related dermatoses include infections, traumatic entities, allergic contact dermatitis, environmental encounters, exacerbation of preexisting dermatoses, thus regular dermatological screening of athletes is critical for rapid identification and treatment of dermatoses distrusting sport performance. | closed_qa |
Postoperative analgesia after laparoscopic cholecystectomy: comparison of the preoperative administration of celecoxib with paracetamol? | The goal of this study was to evaluate the preventive analgesic effectiveness of paracetamol and celecoxib in laparoscopic cholecystectomy. Randomized prospective study was undertaken, 75 patients of class ASA I and II were included, divided into three groups: P (Paracetamol 1000 mg), C (Celecoxib 200 mg) given orally one hour before induction and group T (without preoperative analgesia). The VAS at rest and effort was noted on arrival in the recovery room then with regular intervals (T(30mn) to T(h24). A morphine titration was carried out during the first 12 postoperative hours. Hemodynamic parameters, Ramsay score and the adverse effects were noted. The three groups were comparable for the demographic data, the duration of anesthesia and peroperative morphine consumption. The evolution of VAS scores shows a significant difference between the groups P and T with the effort of cough at t24h (p = 0.04), and between the groups C and T at postoperative T 4h (p = 0.016). In our study the group C consumed to a significant degree less morphine 5.44 +/- 3.00 Mg against 7.83 +/- 4.00 Mg for the group P (p<0.03) and 8.04 +/- 3.00 Mg for the group T (p<0.008). | The administration of 200 Mg of celecoxib in the preoperative period of a laparoscopic cholecystectomy allows a significant decrease in morphine consumption in the postoperative period and a reduction in the scores of the VAS at rest and at the effort of cough compared to the groups which received only one placebo or paracetamol. | closed_qa |
Is robot assistance affecting operating room time compared with pure retroperitoneal laparoscopic radical prostatectomy? | To compare operating room times between retroperitoneal robot-assisted laparoscopic radical prostatectomy (RALRP) and pure retroperitoneal laparoscopic radical prostatectomy (LRP). From March 2007 to April 2008, 288 patients underwent an extraperitoneal LRP in our institution. Eighty-three LRPs were performed with robot assistance using the da Vinci Surgical System (RALRP) whereas 205 pure LRPs were performed. Operating room times were compared between the two groups. Both groups were statistically equal concerning age (P = 0.95), body mass index (P = 0.52), prostate-specific antigen level (P = 0.40), prostate volume (P = 0.49), clinical stage (P = 0.11), and Gleason score on biopsy (P = 0.57). Total operating room time was not significantly different between the two groups (223.6 vs 215.7 minutes in LRP and RALRP groups, respectively; P = 0.23). Mean patient installation was longer in the RALRP group (33.2 vs 24.0 minutes, P<0.01). Mean operative time was significantly shorter by about 20 minutes in the RALRP group (145.6 vs 164.7 minutes, P<0.01). Mean estimated blood loss was significantly lower in the RALRP group (469 mL vs 889 mL in the LRP group, P<0.01). No statistical differences were observed regarding hospital stay, bladder catheterization, and complication rate between the two groups. | Occupation times of the operating room are equivalent during pure retroperitoneal LRP and RALRP. For a trained team performing four procedures per week, the use of the robot for LRP with no lymph node dissection decreases actual operative time at the expense of an increase in installation time, compared with pure laparoscopy. | closed_qa |
Testing the children: do non-genetic health-care providers differ in their decision to advise genetic presymptomatic testing on minors? | Within Europe many guidelines exist regarding the genetic testing of minors. Predictive and presymptomatic genetic testing of minors is recommended for disorders for which medical intervention/preventive measures exist, and for which early detection improves future medical health.AIM: This study, which is part of the larger 5th EU-framework "genetic education" (GenEd) study, aimed to evaluate the self-reported responses of nongenetic health-care providers in five different EU countries (Germany, France, Sweden, the United Kingdom, and the Netherlands) when confronted with a parent requesting presymptomatic testing on a minor child for a treatable disease. A cross-sectional study design using postal, structured scenario-based questionnaires that were sent to 8129 general practitioners (GPs) and pediatricians, between July 2004 and October 2004, addressing self-reported management of a genetic case for which early medical intervention during childhood is beneficial, involving a minor. Most practitioners agreed on testing the oldest child, aged 12 years (81.5% for GPs and 87.2% for pediatricians), and not testing the youngest child, aged 6 months (72.6% for GPs and 61.3% for pediatricians). After multivariate adjustment there were statistical differences between countries in recommending a genetic test for the child at the age of 8 years. Pediatricians in France (50%) and Germany (58%) would recommend a test, whereas in the United Kingdom (22%), Sweden (30%), and the Netherlands (32%) they would not. | Even though presymptomatic genetic testing in minors is recommended for disorders for which medical intervention exists, EU physicians are uncertain at what age starting to do so in young children. | closed_qa |
Cancer nurses narrating after conversations with cancer outpatients: how do nurses' roles and patients' perspectives appear in the nurses' narratives? | Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow-up after patient-physician conversations about assessment and medical treatment. Little is known about nurses' experiences of conversations in the ambulatory context. This study reports the experiences of initial patient-nurse consultations. Data were collected in 2006-2007. A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses' conceptualizations of their roles as an information provider, or patient-centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses' perceptions and experiences of conversations are explained by different attitudes and role appreciations. | Cancer nurses' role appreciation and meaning horizons are guiding their perceptions of patient-nurse communication. Feeling free to act in interplay with patients' voices, the patients' perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice. | closed_qa |
Does smoking influence outcome after intravenous thrombolysis for acute ischaemic stroke? | It remains uncertain whether current smoking influences outcome in patients with acute ischaemic stroke. To evaluate the effect of current smoking in routinely tissue plasminogen activator (tPA)-treated stroke patients on the 3-month functional outcome and the occurrence of symptomatic intracerebral hemorrhage (ICH). We analyzed data from a single stroke care unit registry of 345 consecutive patients with ischaemic stroke, treated with tPA. Logistic regression models were used to assess if smoking was independently associated with 3-months good outcome defined as a modified Rankin Scale score of<or =2, and the occurrence of symptomatic ICH. In the multivariable models, smoking was not associated with a good outcome or a decreased risk of symptomatic ICH. | Current smoking did not affect functional outcome at 3 months or the risk of symptomatic ICH in patients routinely treated with tPA for ischaemic stroke. | closed_qa |
Peritumoral edema on MRI at initial diagnosis: an independent prognostic factor for glioblastoma? | Peritumoral brain edema in glioblastoma patients is a frequently encountered phenomenon that strongly contributes to neurological signs and symptoms. The role of peritumoral edema as a prognostic factor is controversial. This multi-centre clinical retrospective study included 110 patients with histologically proven glioblastoma. The prognostic impact on overall survival of pre-treatment peritumoral edema detected on MRI-scans was evaluated. All patients had preoperative MRI, surgery, histology, and received standard treatment regimens. Edema on MRI-scans was classified as minor (<1 cm), and major (>1 cm). Our results confirm that peritumoral edema on preoperative MRI is an independent prognostic factor in addition to postoperative Karnofsky performance score (KPS), age, and type of tumor resection. Patients with major edema had significant shorter overall survival compared to patients with minor edema. | This easily applicable early radiological characterization may contribute to a more subgroup oriented treatment in glioblastoma patients for future trials, as well as in clinical routine. | closed_qa |
Anxiety disorders in patients with idiopathic priapism: risk factor and pathophysiologic link? | A scientific explanation remains elusive for many presentations of recurrent ischemic priapism.AIM: The aim of this article was to evaluate the possible clinical association between idiopathic priapism and anxiety disorders. Twenty-one patients without identifiable, presumed etiologies for their priapism disorders presented consecutively to a single practitioner's clinical practice and underwent clinical history evaluation and management over a 2(1/2)-year interval. The main outcome is the documentation of patient demographics and clinical profiles relating to medical history and priapism presentations. Anxiety disorders including generalized anxiety, attention-deficit hyperactivity disorder, and obsessive-compulsive disorder were self-reported in 10 patients. | The possible association between idiopathic priapism and anxiety disorders lends support for a central neurobiologic pathophysiology for the erectile disorder. Further neuropsychiatric studies of this clinical population is required to confirm the hypothesis. | closed_qa |
Vascular impairment of erection in patients with diabetes and Peyronie's disease: is that accumulative? | The vascular impairment of erection has been shown in diabetic patients as well as in patients with Peyronie's disease (PD). However, the impact of both conditions together on vascular impairment has not been well addressed.AIM: The aim of this study was to assess the impact of type 2 diabetes mellitus (DM) and PD solely, and together, on impairment of vascular status of erection in patients with erectile dysfunction (ED). Three hundred four male patients with a clinical diagnosis of ED who visited our Andrology clinic and who had DM and/or PD were enrolled in this study. Of the patients, 214, 28, and 62 had DM, PD, and both DM and PD, respectively. Patients were interviewed for ED using the International Index of Erectile Function. All patients were also interviewed for sociodemographic data and medical comorbidities including DM. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Color Doppler ultrasonography was used to evaluate the hemodynamics of erection in all patients. We assessed the impact of type 2 DM and PD on erectile function (EF) domain and on deterioration of Doppler parameters of erection. Age, obesity, smoking, and medical comorbidities were significantly higher in patients with both DM and PD than in patients with any of the conditions alone. The means of EF domain, Q3, and Q4 were significantly lower in patients with both DM and PD than in patients with any of the conditions alone. Patients with DM only had significantly lower means of EF domain, Q3, and Q4 than patients with PD only. The means of peak systolic velocity and resistive index were significantly lower, and the means of end-diastolic velocity were significantly higher in patients with both DM and PD than in patients with any of the conditions alone. | Type 2 DM and PD solely, and together, negatively affect the vascular status of erection. Type 2 DM demonstrated the principal effect; however, presence of PD has an additive impairment effect on erection and Doppler parameters. | closed_qa |
Can comprehensive background knowledge be incorporated into substitution models to improve phylogenetic analyses? | Whenever different data sets arrive at conflicting phylogenetic hypotheses, only testable causal explanations of sources of errors in at least one of the data sets allow us to critically choose among the conflicting hypotheses of relationships. The large (28S) and small (18S) subunit rRNAs are among the most popular markers for studies of deep phylogenies. However, some nodes supported by this data are suspected of being artifacts caused by peculiarities of the evolution of these molecules. Arthropod phylogeny is an especially controversial subject dotted with conflicting hypotheses which are dependent on data set and method of reconstruction. We assume that phylogenetic analyses based on these genes can be improved further i) by enlarging the taxon sample and ii) employing more realistic models of sequence evolution incorporating non-stationary substitution processes and iii) considering covariation and pairing of sites in rRNA-genes. We analyzed a large set of arthropod sequences, applied new tools for quality control of data prior to tree reconstruction, and increased the biological realism of substitution models. Although the split-decomposition network indicated a high noise content in the data set, our measures were able to both improve the analyses and give causal explanations for some incongruities mentioned from analyses of rRNA sequences. However, misleading effects did not completely disappear. | Analyses of data sets that result in ambiguous phylogenetic hypotheses demand for methods, which do not only filter stochastic noise, but likewise allow to differentiate phylogenetic signal from systematic biases. Such methods can only rely on our findings regarding the evolution of the analyzed data. Analyses on independent data sets then are crucial to test the plausibility of the results. Our approach can easily be extended to genomic data, as well, whereby layers of quality assessment are set up applicable to phylogenetic reconstructions in general. | closed_qa |
Combined anti-platelet therapy with aspirin and clopidogrel: risk factor for thrombolysis-related intracerebral hemorrhage in acute ischemic stroke? | To date, pre-treatment with anti-platelet agents does not constitute a contraindication for thrombolysis in acute ischemic stroke. We tested the hypothesis that combined pre-treatment with aspirin and clopidogrel is a risk factor for thrombolysis-related symptomatic intracerebral hemorrhage (sICH). We retrospectively studied patients with acute ischemic stroke receiving standard i.v. thrombolytic therapy with rt-PA in our institution. Exclusion criteria were thrombolysis initiated later than 3 h from symptom onset or with non-tPA-agents, no follow-up imaging was performed and data on prior medication was missing. We recorded clinical baseline variables including known risk factors for ICH. Our outcome measure was the incidence of ICH defined as parenchymal hematoma type 2 with>or = 4 points deterioration on the National Institute of Health Stroke Scale score. We performed univariate analysis to determine risk factors for sICH. We identified 102 patients receiving any thrombolysis of which 63 fulfilled the inclusion criteria. Mean age was 69 years, onset-to-treatment-time 138 min, 56% male, median NIHSS score was 10, and 3 patients received additional intra-arterial interventions. A total of 3 patients had received combined aspirin and clopidogrel treatment before thrombolysis. SICH occurred in 3/63 (4.7%) of patients. Out of these, 2 patients had received the combined anti-platelet treatment. In univariate analysis, only combined pre-treatment with aspirin and clopidogrel treatment were associated with the occurrence of sICH. | In our retrospective study, only pre-treatment with aspirin and clopidogrel was associated with thrombolysis-related intracerebral hemorrhage. This finding should be further validated in large prospective databases like the SITS-MOST registry. | closed_qa |
Does the entire uterus need to be treated in cancer of the cervix? | To evaluate local control and toxicity by use of a method of adaptive cervical brachytherapy (ACB). From 1998 to 2008, we identified 65 cervical cancer patients with FIGO (International Federation of Gynecology and Obstetrics) Stage IB1-IVA disease who received definitive external beam radiation therapy and high-dose rate brachytherapy with tandem and ovoid applicators. As tumors regressed, 45 of 65 patients had the tandem source retracted from the uterine fundus at successive brachytherapy insertions, thus decreasing the number of (192)Ir dwell positions. Tests of trend and Fisher's exact test were used to identify the effect of ACB on disease control and toxicity. Kaplan-Meier analyses were performed to evaluate disease control and late complications. The median follow-up was 24.5 months. Of the patients, 92% received chemotherapy. The 3-year overall survival, 3-year disease-free survival, 3-year distant metastasis-free survival, and local control rates were 67%, 76%, 79%, and 97%, respectively. There was only 1 isolated local failure, and there were no local failures beyond 1 year. Distant failure was involved in 93% of recurrences. No significant trend was identified regarding the extent of retraction of the tandem source start position with either failure or toxicity. Acute and actuarial 3-year late Grade 3 toxicity or greater occurred in 24.6% and 17% of patients, respectively. | ACB determined by clinical response yielded excellent local control rates. These data indicate that ACB may be useful in decreasing late toxicities from high-dose rate brachytherapy. With the advent of three-dimensional image-guided brachytherapy, additional methods to adapt treatment technique to changes in tumor volume warrant investigation. | closed_qa |
Can compression be reduced for breast tomosynthesis? | To assess, in a voxelized anthropomorphic breast phantom, how the conspicuity of breast masses and microcalcifications may be affected by applying reduced breast compression in tomosynthesis. A breast tomosynthesis system was modeled by using a Monte Carlo program and a voxelized anthropomorphic breast phantom. The Monte Carlo program created simulated tomosynthesis projection images, which were reconstructed by using filtered back-projection software. Reconstructed images were analyzed for mass and microcalcification conspicuity, or the ratio of the lesion contrast to the anatomic and quantum noise surrounding the lesion. This analysis was performed at two compression levels (standard and 12.5% reduction) and for two breast compression thicknesses (4 and 6 cm). The change in conspicuity was analyzed for significance by using a bootstrap method and a paired Student t test. While keeping the glandular radiation dose constant with respective standard and reduced compression levels, the mean mass conspicuities were 1.39 +/- 0.15 (standard error of the mean) and 1.46 +/- 0.22 for a 4-cm breast compression phantom and 1.26 +/- 0.15 and 1.22 +/- 0.20 for a 6-cm breast phantom, and the mean microcalcification conspicuities were 16.2 +/- 2.87 and 18.6 +/- 2.63 for a 4-cm breast phantom and 11.4 +/- 1.11 and 10.6 +/- 1.18 for a 6-cm breast compression phantom. | For constant glandular dose, mass and microcalcification conspicuity remained approximately constant with decreased compression. Constant conspicuity implies that reduced compression would have a minimal effect on radiologists' performance, which suggests that there is justification for a measured reduction of breast compression for breast tomosynthesis, increasing the comfort of women undergoing the examination. | closed_qa |
Does arterial spin-labeling MR imaging-measured tumor perfusion correlate with renal cell cancer response to antiangiogenic therapy in a mouse model? | To determine whether arterial spin-labeling (ASL) magnetic resonance (MR) imaging findings at baseline and early during antiangiogenic therapy can predict later resistance to therapy. Protocol was approved by an institutional animal care and use committee. Caki-1, A498, and 786-0 human renal cell carcinoma (RCC) xenografts were implanted in 39 nude mice. Animals received 80 mg sorafenib per kilogram of body weight once daily once tumors measured 12 mm. ASL imaging was performed at baseline and day 14, with additional imaging performed for 786-0 and A498 (3 days to 12 weeks). Mean blood flow values and qualitative differences in spatial distribution of blood flow were analyzed and compared with histopathologic findings for viability and microvascular density. t Tests were used to compare differences in mean tumor blood flow. Bonferroni-adjusted P values less than .05 denoted significant differences. Baseline blood flow was 80.1 mL/100 g/min +/- 23.3 (standard deviation) for A498, 75.1 mL/100 g/min +/- 28.6 for 786-0, and 10.2 mL/100 g/min +/- 9.0 for Caki-1. Treated Caki-1 showed no significant change (14.9 mL/100 g/min +/- 7.6) in flow, whereas flow decreased in all treated A498 on day 14 (47.9 mL/100 g/min +/- 21.1) and in 786-0 on day 3 (20.3 mL/100 g/min +/- 8.7) (P = .003 and .03, respectively). For A498, lowest values were measured at 28-42 days of receiving sorafenib. Regions of increased flow occurred on days 35-49, 17-32 days before documented tumor growth and before significant increases in mean flow (day 77). Although 786-0 showed new, progressive regions with signal intensity detected as early as day 5 that correlated to viable tumor at histopathologic examination, no significant changes in mean flow were noted when day 3 was compared with all subsequent days (P>.99). | ASL imaging provides clinically relevant information regarding tumor viability in RCC lines that respond to sorafenib. | closed_qa |
Short-term memory (STM) constraints in children with specific language impairment (SLI): are there differences between receptive and expressive SLI? | Specific language impairment (SLI) is assumed to be causally related to deficits in auditory short-term memory (STM). Although verbal STM deficits have been consistently found in SLI, the results of visual STM tests are inconsistent. Do these inconsistencies reflect different study populations of expressive SLI (ELI) and receptive-expressive SLI (R/ELI)? Twenty-one children (ages 6-11) with ELI, 21 with R/ELI, and 21 controls (CG) matched on age and nonverbal intelligence were retrospectively compared with regard to their visual and auditory STM. ELI children and R/ELI children performed significantly poorer than the CG in auditory-verbal STM tests. On tests for visual STM (symbol sequences), the R/ELI children performed significantly poorer than the CG. For hand movements, children with R/ELI scored slightly poorer compared to both other groups but without reaching statistical significance. Correlation analyses showed significant associations between symbol sequences and receptive language measures. Regression analysis found that the scores of symbol sequences and digit sequences together accounted for 39% of the variance of the receptive language measures, whereas the scores for nonsense syllables accounted for 24% of the variance of the expressive language measures. | R/ELI children appear to have more complex STM deficits, as they showed visual STM constraints in addition to auditory STM constraints. | closed_qa |
Do state medical board applications violate the americans with disabilities act? | To determine whether medical licensing board application questions about the mental or physical health or substance use history of the applicant violate the Americans with Disabilities Act (ADA) of 1990. Content analysis of 51 allopathic licensing applications (50 states and District of Columbia) was performed at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in 2005. Questions referencing physical or mental health or substance use were identified by a team of physicians and reviewed and categorized based on the ADA and appropriate case law by legal counsel. Of the 51 applications reviewed, 49 (96%) contained questions pertaining to the physical or mental health or substance use history of the applicant. Thirty-four of the 49 (69%) state medical licensing applications contained at least one "likely impermissible" or "impermissible" item based on the ADA and appropriate case law. | Most state medical licensing applications contain questions that ask about the physical or mental health and substance use of physician applicants. Many licensing applications appear to be in violation of the ADA, even 19 years after enactment of the regulation. These questions do not elicit responses by which professional competence can be judged. The presence of these questions on licensing applications may cause physicians to avoid or delay treatment of personal illness. | closed_qa |
Is completion lymph node dissection needed in case of minimal melanoma metastasis in the sentinel node? | The purpose of this study was to evaluate the micromorphometric Starz-classification in melanoma patients. The micromorphometric Starz-classification suggests that melanoma patients with a sentinel node metastasis invading no more than 0.3 mm (S-I) or 0.31 to 1.0 mm (S-II) below the capsular level can be spared further surgery, while invasion of the metastasis of more than 1.0 mm (S-III) implies a need for completion dissection. Seventy patients with sentinel node metastases were studied. Twenty patients with an S-I or S-II classification were spared further surgery and 50 S-III patients underwent completion dissection. The median follow-up time was 33 months. No lymph node recurrences were detected in the 20 S-I, II patients. Six of the 50 S-III patients (12%) had additional involved nodes in the dissection specimen. In these patients no recurrences developed in the cleared regional basins. Overall 3-year survival was 100% in the S-I, II patients and 80% in the S-III patients (P = 0.04). Three-year disease-free survival rates were 83% and 60%, respectively (P = 0.40). | : This study suggests that further surgery is unnecessary in S-I and S-II patients, while it does seem prudent to carry out completion dissection in S-III patients. The distinct survival difference between the 2 groups of patients suggests that the S-classification also has prognostic implications. | closed_qa |
HLA class II polymorphism in children with coeliac disease in Tunisia: is there any influence on clinical manifestation? | To elucidate the HLA DRB1, DQB1 and DQA1 polymorphism in Tunisian children with typical form of coeliac disease (CD) in comparison with those from mass screening (atypical and silent CD). We recruited three groups: group I: 40 CD children diagnosed according to the ESPGHAN criteria. group II: 40 healthy controls matched with sex, age and geographic origin. group III: 38 CD children coming from mass screening in schoolchildren. HLA class II DRB1, DQB1 and DQA1 alleles were typed by PCR-sequence-specific primer. Comparing the groups I and II, we found a pronounced increase of the susceptible alleles HLA DRB1*03 (relative risk, RR = 4.18, Pc = 0.001), DQB1*02 (RR = 7.9, Pc<0.0001) and DQA1*0501 (RR = 4.1, Pc = 0.001). As for protective alleles, we detected a high frequency of DRB1*13 (RR = 0.059, Pc = 0.001), DQA1*0102 (RR = 0.071, Pc = 0.009) and DQB1*06 (RR = 0.125, Pc = 0.0042). Haplotype analysis showed that the main combination observed was the conformation of DQ2 (DQA1*0501-DQB1*02) in 36 patients from group I and 30 from group III. There was no statistically significant difference between the groups I and III according to the distribution of the different alleles. | We confirmed in this study the high frequency of DQ2 haplotype in CD patients and we identified new protective alleles DRB1*13, DQA1*0102 and DQB1*06. However, HLA polymorphism seems to have no evident impact on clinical outcome of CD. | closed_qa |
Does P-glycoprotein have a role in the lung clearances of inhaled 99mTc-sestamibi and 99mTc-tetrofosmin? | The clearance rate of inhaled 99mTc-sestamibi from the lungs of healthy nonsmoking individuals is much slower than would be expected from its physical properties. The clearance rate is even slower in healthy cigarette smokers. As 99mTc-sestamibi is a substrate for P-glycoprotein (P-gp), pulmonary P-gp may be influential in 99mTc-sestamibi clearance and may be upregulated in smokers. 99mTc-tetrofosmin is also a substrate for P-gp, therefore we hypothesized that it would display similar kinetics to 99mTc-sestamibi and support a role for P-gp. We also hypothesized that administration of P-gp modulators would accelerate clearance of 99mTc-sestamibi. We measured clearance rates of 99mTc-tetrofosmin in four healthy smokers and four healthy nonsmokers and of 99mTc-sestamibi in six otherwise healthy patients with psoriasis before and after 2 weeks of therapy with cyclosporine A (2.5-5 mg/kg/day) and two healthy women taking the oral contraceptive pill, as both cyclosporine and steroids are known to be P-gp modulators. The clearance rate of 99mTc-tetrofosmin in nonsmokers ranged from 0.38 to 0.63%/min, similar to the previously recorded rate for 99mTc-sestamibi [0.43 (SD 0.083)%/min], but it was not delayed in smokers (range 0.42-0.97%/min). Cyclosporine had no significant effect on 99mTc-sestamibi clearance, although clearance rates in the two women taking the oral contraceptive pill were both fast (0.58 and 0.62%/min). | Although the role of P-gp expression in the clearance of 99mTc-sestamibi remains unproven, we conclude that 99mTc-tetrofosmin is not as P-gp-avid as 99mTc-sestamibi. A role for P-gp expression in the clearance of 99mTc-sestamibi remains unproven. Higher doses of P-gp inhibitors will be required and clearance rates correlated with immunohistochemical expression of P-gp. | closed_qa |
Quality of life in systemic lupus erythematosus patients in Northeastern Brazil: Is health-related quality of life a predictor of survival for these patients? | To identify social, demographic and clinical characteristics that influence survival of patients with systemic lupus erythematosus (SLE). Sixty-three patients with a diagnosis of SLE were studied at our medical services in 1999 and then reviewed in 2005. We utilized a protocol to obtain demographic and clinical traits, activity and damage indices, and health-related quality of life via the SF-36. All statistical tests were performed using a significance level of 5%. Out of the 63 patients examined in 1999, six died, four were lost for the follow-up and the previous protocol was applied to the remaining 53 patients. The six patients who died presented the worst recorded health-related quality of life, in all aspects. The most important observed predictor of death was a mean lower score in the Role-Emotional Domain of the mental health component of the SF-36 (p<0.01). | Health-related quality of life may be used as possible predictive factor of mortality among patients with SLE. | closed_qa |
Comorbidity between CIDP and diabetes mellitus: only a matter of chance? | It is well known that chronic inflammatory demyelinating polyneuropathy (CIDP) and diabetes mellitus (DM) are often associated, but it is not clear if these two disorders are patogenetically correlated. An epidemiological study on CIDP in two Italian regions (population 4,334,225) was performed, using multiple concurrent sources of cases. The presence of DM was assessed on basis of the data reported in the clinical records of each patient. Standardized morbidity ratio (SMR) was calculated, using as reference the prevalence of DM in northern Italy. At the prevalence day 155 patients with CIDP resident in Piemonte and Valle d'Aosta were found. Of these, 14 were also affected by either type 1 or type 2 DM. The number of expected individuals with associated DM was 13.03, corresponding to a SMR of 1.07 [95% confidence intervals (CI), 0.58-1.80]. Patients with CIDP associated with DM had a higher level of CSF proteins and a longer delay from onset to diagnosis than patients without DM, but did not differ for age of onset, gender distribution, and type of clinical course. | Our epidemiological findings do not support a pathogenetic correlation between DM and CIDP. | closed_qa |
Does preoperative degree of aortic insufficiency influence early and midterm results of sparing surgery? | Aortic valve-sparing operations have shown excellent results in patients with aortic root and or ascending aorta aneurysm. Aortic valve regurgitation is frequently detected in these patients as a result of significant dilation of the aortic root.The aim of this study was to assess the impact of preoperative aortic incompetence degree on the early and midterm outcomes of sparing surgery. From September 2001 to July 2006, 84 patients with aortic root aneurysm underwent aortic valve-sparing surgery according to the reimplantation technique. Depending on preoperative grade of aortic insufficiency (AI), two groups were identified: 31 patients (study group, SG) with AI grade III-IV and 53 (control group, CG) with AI grade II or less. The Gelweave Valsalva prosthesis was used in 76 patients (90.5%). Intraoperative, perioperative variables and outcomes at follow-up were retrospectively compared between the groups. Patient demographics and types of operations were comparable between groups. Early mortality rates were almost identical in both groups (3.2% SG vs. 5.7% CG; P = 0.961); at follow-up (FU), no patient died in both groups. Grade III-IV AI was similar in both groups early postoperatively (6.4% SG vs. 3.8% CG; P = 0.981) and during follow-up (13.3% vs. 8%; P = 0.755). Reoperaton rate for AI was 3.3% in SG vs. 6% in CG (P = 0.980). | Preoperative degree of aortic regurgitation does not impair the outcomes of the valve-sparing operation which seem to depend on more factors. Early results were affected by the learning curve but midterm outcomes showed a progressive improvement. Patients with satisfactory reconstruction show stable results over time. | closed_qa |
Is covert medication in Norwegian nursing homes still a problem? | The practice of hiding medicines in nursing home patients' food or beverages is described in only a few scientific papers. An earlier study conducted in 1999/2000 showed that covert medication was common in Norwegian nursing homes, with 11% of patients in regular nursing home units (RUs) and 17% of those in special care units for patients with dementia (SCUs) receiving at least one covert medication during the last 7 days. However, that study included few details about the medications involved. Therefore, we designed a study to obtain more detailed information about the practice of covert medication. The objectives of the study were to describe how widespread the practice is, identify the reasons for giving the medicine in disguise, determine what kinds of medicine are given in disguise, and establish who makes the decision about covert medication. We collected data on 1,943 patients (623 in SCUs and 1,320 in RUs) in southeast Norway between October 2006 and February 2007. The information collected included what kind of drugs the patients received, what form the drugs were administered in and how the drugs were given. Patient characteristics such as age, sex, the patient's level of function in terms of activities of daily living (ADL), mental capacity and behavioural and psychological symptoms were also recorded. Ward characteristics such as the type of ward, the number of beds in the ward and the number of carers working on each shift were also documented. Descriptive statistics of the distribution of covert medication were obtained and the findings from SCUs and RUs were compared. The same approach was taken regarding information relating to who took the decision and how the practice was documented. A multilevel logistic regression analysis was performed to examine which patient and ward characteristics were associated with covert medication. Each patient was given on average 6.5 different medications on a regular basis every day. Nearly a quarter (23.5%) of patients who received medications had drugs mixed in food or beverages. Fourteen percent of the patients in SCUs and nearly 10% of the patients in RUs received medicine blended in food or beverages without their knowledge (covert medication). Compared with patients who were treated openly, a significantly higher proportion of patients who were treated covertly received antipsychotics (20% vs 30%, respectively; p<0.001). In most cases, the decision to administer covert medication was made by the staff together with the physician or by the physician alone (61.4% of occasions in SCUs and 52.8% in RUs). About two-thirds of cases of covert medication had been documented to some extent in the patients' records. Low mental capacity, low ADL function and the presence of agitation and learning disability were associated with covert medication. Of the ward characteristics, only staying in SCUs was associated with covert medication. | Our study presents evidence suggesting that the practice of covert medication may still be a problem in Norwegian nursing homes. The frequency of this practice has been only slightly reduced in the period 2000-7, but the practice is more frequently recorded in the patient's records and the physician is today more often involved in the decision to give medicine covertly compared with 7 years ago. | closed_qa |
Do serum biomarkers really measure breast cancer? | Because screening mammography for breast cancer is less effective for premenopausal women, we investigated the feasibility of a diagnostic blood test using serum proteins. This study used a set of 98 serum proteins and chose diagnostically relevant subsets via various feature-selection techniques. Because of significant noise in the data set, we applied iterated Bayesian model averaging to account for model selection uncertainty and to improve generalization performance. We assessed generalization performance using leave-one-out cross-validation (LOOCV) and receiver operating characteristic (ROC) curve analysis. The classifiers were able to distinguish normal tissue from breast cancer with a classification performance of AUC = 0.82 +/- 0.04 with the proteins MIF, MMP-9, and MPO. The classifiers distinguished normal tissue from benign lesions similarly at AUC = 0.80 +/- 0.05. However, the serum proteins of benign and malignant lesions were indistinguishable (AUC = 0.55 +/- 0.06). The classification tasks of normal vs. cancer and normal vs. benign selected the same top feature: MIF, which suggests that the biomarkers indicated inflammatory response rather than cancer. | Overall, the selected serum proteins showed moderate ability for detecting lesions. However, they are probably more indicative of secondary effects such as inflammation rather than specific for malignancy. | closed_qa |
Is adiponectin associated with acute myocardial infarction in Iranian non obese patients? | Adiponectin is an adipose tissue-derived mediator with significant anti-atherogenic properties. A few studies were done in acute phase of myocardial infarction especially in non obese patients. We design a study to investigate the association between adiponectin concentration and acute phase of myocardial infarction in non obese patients. This case-control study was done in Paymaneah Hospital (Jahrom, Iran) from Feb 2007 to May 2008. Plasma adiponectin levels were measured in 43 patients with AMI (mean age: 62.7 +/- 13.3 years, male: 67.4%) at the first 24 hours of admission and 43 normal controls (mean age: 62.1 +/- 12.3 years, male: 55.8%) matched for age, sex and other CAD risk factors. Adiponectin levels in patients with AMI (3.36 microg/mL) were significantly lower than that of the control group (5.03 microg/mL) (p<0.0001). Lower adiponectin were independently associated with higher risk of AMI (odds ratio = 8.97; 95% CIs: 2.3-34.5; p = 0.001). Adiponectin levels negatively correlated with triglyceride (r = -0.46, p = 0.002) and total cholesterol (r = -0.32, p = 0.03) in the case group and with body mass index (BMI) in control subjects. | The present study showed that adiponectin was associated with AMI in non obese patients but it is not related to sex, age and other CAD risk factors. | closed_qa |
Cognitive behavioural therapy for major psychiatric disorder: does it really work? | Although cognitive behavioural therapy (CBT) is claimed to be effective in schizophrenia, major depression and bipolar disorder, there have been negative findings in well-conducted studies and meta-analyses have not fully considered the potential influence of blindness or the use of control interventions. We pooled data from published trials of CBT in schizophrenia, major depression and bipolar disorder that used controls for non-specific effects of intervention. Trials of effectiveness against relapse were also pooled, including those that compared CBT to treatment as usual (TAU). Blinding was examined as a moderating factor. CBT was not effective in reducing symptoms in schizophrenia or in preventing relapse. CBT was effective in reducing symptoms in major depression, although the effect size was small, and in reducing relapse. CBT was ineffective in reducing relapse in bipolar disorder. | CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates. It is effective in major depression but the size of the effect is small in treatment studies. On present evidence CBT is not an effective treatment strategy for prevention of relapse in bipolar disorder. | closed_qa |
Surgical anatomy of the spinal accessory nerve: is the great auricular point reliable? | The study was to exam if the great auricular point is a dependable landmark for finding the spinal accessory nerve. A prospective study from January 2004 to August 2006 in a tertiary medical centre. A tertiary medical centre, Tzu Chi General Hospital. In the modified radical neck dissection, the topographic anatomy of spinal accessory was studied in 50 patients. The great auricular point (GAP) was identified and the length of sternocleidomastoid muscle (SCM) below was measured. The distance between the spinal accessory nerve and the greater auricular point was measured. The ratio of the length of the SCM below the nerve exiting point to the total length of the muscle was near 0.66. The mean distance between the GAP and the accessory nerve was 0.92 cm (SD +/- 0.27). | The great auricular point is a reliable landmark for identification of the accessory nerve during the neck dissection. | closed_qa |
Is routine postoperative chest x-ray necessary after fluoroscopic-guided subclavian central venous port placement? | Two uncommon but serious complications after subclavian central venous port (SCVP) placement are pneumothorax (PNX) and malposition of the catheter. Chest x-rays (CXR) are commonly obtained after SCVP placement to identify these complications, but their use is controversial. We performed a retrospective review of SCVP placements to establish the incidence of PNX or catheter malposition identified exclusively by postprocedure CXR. Between July 1, 2001, and June 30, 2006, 205 patients underwent elective SCVP placement. Although 4 patients (2%) sustained a PNX, none was identified by routine postprocedure CXR. Postprocedure clinical symptoms (3 to 72 hours later) prompted repeat CXR, which identified the PNX. Five patients (2.4%) had catheter malposition recognized by intraoperative fluoroscopy and corrected intraoperatively. No malpositioned catheters were identified on postprocedure CXR. | In our study, incidence of PNX after SCVP placement was low, and PNX was not detected by intraoperative fluoroscopy or by routine postprocedure CXR. We conclude that the practice of routine postprocedure CXR after SCVP placement is not necessary and should be replaced with diagnostic chest radiography only if symptoms develop. | closed_qa |
Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? | Pancreatic fistula (PF) is one of the most common complications after pancreaticoduodenectomy. There have been no large prospective randomized trials evaluating PF rates comparing invagination versus duct to mucosa pancreaticojejunostomy. We tested the hypothesis that a duct to mucosa pancreaticojejunostomy would reduce the PF rate. Between August 2006 and May 2008, 197 patients at two institutions underwent pancreaticoduodenectomy by a total of 8 experienced pancreatic surgeons as part of this prospective randomized trial (clinical trial no. NCT00359320). All patients were stratified by pancreatic texture and randomized to either an invagination or a duct to mucosa pancreaticojejunal anastomosis. Recorded variables included pancreatic duct diameter, operative time, blood loss, complications, and pathology. Primary end point was PF rate, as defined by the International Study Group on Pancreatic Fistula. Secondary end points included PF grade, postoperative length of hospital stay, other morbidities, and mortality. Rate of PF for the entire cohort was 17.8%. There were 23 fistulas (24%) in the duct to mucosa cohort and 12 fistulas (12%) in the invagination cohort (p<0.05). The greatest risk factor for a PF was pancreas texture: PF developed in only 8 patients (8%) with hard glands, and in 27 patients (27%) with a soft gland. There were two perioperative deaths (both in the duct to mucosa group), with the proximate causes of death being PF, followed by bleeding and sepsis. | This dual-institution prospective randomized trial reveals considerably fewer fistulas with invagination compared with duct to mucosa pancreaticojejunostomy after pancreaticoduodenectomy. Results confirm increased PF rates in soft as compared with hard glands. Additional studies are needed to define the optimal technique of pancreatic reconstruction after pancreaticoduodenectomy. | closed_qa |
African-American and low-socioeconomic status patients have a worse prognosis for invasive ductal and lobular breast carcinoma: do screening criteria need to change? | Determine the effect of race, socioeconomic status (SES) and other demographic variables on outcomes of patients with invasive ductal and lobular breast cancer. Florida cancer registry and inpatient hospital data were queried for patients diagnosed with invasive breast cancer from 1998 to 2002. A total of 63,472 patients with breast cancer were identified. Overall, 90.5% of patients were Caucasian, 7.6% African American, and 8.7% Hispanic. African-American patients presented at a younger age and with more-advanced disease, 10.5% presented with breast cancer before the age of 40 years, and 22.4% before 45 years of age. African-American patients were less likely to undergo operations. Similarly, low-SES patients were less likely to have operations and presented more often with larger tumors. Stepwise multivariate analysis revealed a substantial drop in the hazard ratio for African-American patients once correction for stage of presentation was made, suggesting that disparities in breast cancer outcomes are, in part, a result of advanced stage at presentation. Race and low SES were independent predictors of worse prognosis when controlling for patient comorbidities and treatment. | Dramatic disparities by patient race and SES exist in breast cancer. Our study integrates previous smaller studies, providing comprehensive insight into African-American patients and their outcomes for breast cancer. Earlier screening programs and greater access to cancer care for the poor and African Americans are needed. Successful institution of such programs will not completely erase disparities in outcomes for breast cancer in African-American patients. | closed_qa |
Capillary telangiectasias of the pons. Does diffusion-weighted MR increase diagnostic accuracy? | Capillary telangiectasias are benign lesions of the brainstem which are sometimes difficult to distinguish from other lesions in standard MRI. The purpose of this study was to evaluate if diffusion-weighted imaging (DWI) could help to improve diagnostic accuracy. 148 MR examinations of patients with pontine lesions were evaluated retrospectively and revealed capillary telangiectasia (n=18), presumed microvascular disease (n=20), encephalitis disseminata (n=21), pontine myelinolysis (n=16), tumor (n=20), acute infarction (n=20), subacute infarction (n=13) and chronic infarction (n=20). All patients were examined using identical measurement parameters for DWI, Fluid attenuated inversion recovery, T2-weighted turbo spin-echo, and T1-weighted spin-echo before and after application of contrast agent in transverse orientation. All capillary telangiectasias showed low signal intensity in DWI and significant contrast enhancement after application of gadolinium. Hypointense signal on DWI was very rare for the remaining lesions: only 1 pontine myelinolysis, 1 tumor, 4 subacute infarctions, and 19 chronic infarctions also revealed low signal intensity on DWI. The combination of high signal intensity on T1-weighted post-contrast images and low signal intensity on DWI was found for all capillary telangiectasias, but only for 1/20 tumor and for 4/13 subacute infarctions. These lesions could be differentiated by their clinical course and/or MRI follow-up examinations. The results of the visual assessment were confirmed by quantitative evaluation. | DWI seems to be a useful adjunct for the diagnosis of capillary telangiectasias which will facilitate the differential diagnosis concerning tumorous, inflammatory and ischemic lesions. | closed_qa |
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