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General and specific cognitive deficits in schizophrenia: Goliath defeats David? | Our earlier work suggested that the cognitive performance impairment in individuals with schizophrenia relative to healthy control subjects was generalized, cutting across narrower cognitive ability dimensions. Current analyses sought to extend these findings. Seventeen neuropsychological variables, available for 148 schizophrenia subjects and 157 control subjects, were subjected to structural equation modeling. Analyses incorporated a hierarchical model, grouping the variables into six familiar cognitive domains and linking these to a higher-order, general cognitive ability factor. We added diagnosis to the model as a grouping factor and estimated loadings from diagnosis to the general cognitive factor and, separately, to the domain factors. The fit of the final model was good (e.g., Non-Normed Fit Index [NNFI] = .988). Approximately 63.6% of the diagnosis-related variance in cognitive performance was mediated through the general factor, with smaller direct effects on verbal memory (13.8%) and processing speed (9.1%). | The schizophrenia cognitive deficit is largely generalized across performance domains, with small, direct effects of diagnostic group confined to selected domains. This generalized deficit sometimes has been seen as a function of the psychometric limitations of traditional cognitive test batteries. Alternatively, it may be a fundamental manifestation of schizophrenia, with similarly general neurobiological underpinnings. | closed_qa |
Are auditory-evoked frequency and duration mismatch negativity deficits endophenotypic for schizophrenia? | Mismatch negativity (MMN) is a negative-going event-related potential (ERP) component that occurs in response to intermittent changes in constant auditory backgrounds. A consistent finding across a large number of studies has been impaired MMN generation in schizophrenia, which has been interpreted as evidence for fundamental deficits in automatic auditory sensory processing. The aim of this study was to investigate the extent to which dysfunction in MMN generation might represent an endophenotypic marker for schizophrenia. We measured MMN to deviants in duration (25 msec, 1000 Hz) and deviants in pitch (50 msec, 1200 Hz) relative to standard tones (50 msec, 1000 Hz) in 45 chronic schizophrenia patients, 25 of their first-degree unaffected biological relatives, 12 first-episode patients, and 27 healthy control subjects. In line with previous work, MMN amplitudes to duration deviants (but not to pitch deviants) were significantly reduced in patients with chronic schizophrenia compared with control subjects. However, both duration and pitch MMNs were completely unaffected in the first-degree biological relatives and this was also the case for the first-episode patients. Furthermore, length of illness did not predict the extent of MMN deficit. | These findings suggest that the MMN deficit seen in schizophrenia patients is most likely a consequence of the disease and that MMN, at least to basic auditory feature deviants, is at best only weakly endophenotypic for schizophrenia. | closed_qa |
Do stillborns with no identifiable pathology have leaner cords than liveborns? | To evaluate whether stillbirths with no explanation found at autopsy have thinner cords than live, gestational-age-matched controls. Stillbirth autopsies performed at University Hospital, Newark, New Jersey, from January 1995 to October 2002 were reviewed. Cases with no explanation for the death at autopsy had their umbilical cord diameters compared to those in 3 groups of age-matched controls: stillbirths with an identifiable cause of death, liveborns with placentas submitted for pathology evaluation and liveborns from which the placentas were not submitted to pathology. Age-adjusted ANOVAs were performed for comparisons. Of 181 autopsies performed during the review period, 21 cases (11.6%) provided no information at autopsy that would explain or contribute to an understanding of the death. There was no significant difference in cord diameters between either group ofstillbirths or the pathology-submitted controls. Third-trimester placentas from liveborns without placental submission to pathology had significantly greater cord diameters (p = 0.001). | This study does not support the theory that a cord accident or decreased umbilical blood flow resulting from a leaner umbilical cord can explain a significant number of stillbirths with no other findings at autopsy. However, it supports the literature in that leaner cords appear to be associated with a wide variety of adverse perinatal conditions. | closed_qa |
Does pelvic organ prolapse reduction affect abdominal leak point pressures? | To determine if pelvic organ prolapse reduction decreases cystometric leak point pressure. A retrospective review was performed of women with pelvic organ prolapse points Aa, Ba or C>or = -1 cm that leaked with and without vaginal support (barrier testing) during multichannel urodynamic investigation (N=44). An analysis of the mean and difference between leak point pressure (LPP) (vesicle pressure) with and without prolapse reduction was used to determine significance. Among 460 possible study subjects, 15% (71/460) leaked only with and 4% (17/460) only without prolapse reduction. Among the 44 women who leaked both with and without prolapse reduction, prolapse reduction was associated with a mean decrease in LPP of 16.1 cm H2O (95% CI 7.4-24.7, p = 0.0005). | Reduction of pelvic organ prolapse is associated with a mean decrease in LPP of 16.1 cm H2O. | closed_qa |
Does interventional radiological treatment (transcatheter arterial chemoembolization/transarterial infusion) improve the prognosis of patients with unresectable and recurrent hepatocellular carcinomas? | We report herein the usefulness of interventional radiological treatment( IVR) for hepatocellular carcinomas( HCCs), based on the results of transcatheter arterial chemoembolization( TACE) and transarterial infusion( TAI). The study included 256 cases of HCC. TACE and TAI were performed for durations permitted by the degree of liver damage. Results(: 1) TACE was performed in 224 cases( average: 4.5 times, range: 1-14 times), and TAI was performed in 32 cases( average: 2.3 times, range: 1-8 times).( 2) The 3- and 5-year survival rates for all cases were 45.5% and 31.6%, respectively.( 3) We classified all cases according to the number of HCCs, solitary, 2-4, and multiple HCCs, and found no significant differences in the survival rate between the 3 groups( p=0.207),( 4) TAI was followed by TACE in non-responsive cases, and the median survival time of the TAI group was 8.5 months. | We can expect benefits from repeated TACE treatment in the multiple HCCs group, compared to the solitary HCC group. TAI followed by TACE might improve the prognosis of unresectable and recurrent HCCs. Therefore, we conclude that IVR has clinical benefit as local treatment for HCC. | closed_qa |
Is standard radical mastectomy still a treatment option for select patients with breast cancer ? | Currently, minimal surgery is the treatment of choice for most breast cancer patients. However, some patients with locally advanced breast cancer( LABC) require standard radical mastectomy( SRM) before or after systemic therapy. We reviewed the medical records of 7 patients with breast cancer who underwent SRM in our hospital between January 2007 and April 2013 and examined their clinicopathological features and prognostic outcomes. The average patient age was 68 years. SRM was performed because of muscle invasion( n=6), Rotter lymph node metastases( n=3), and level III lymph node metastases( n=3). After SRM, the wound was closed by skin grafting in 2 of the 7 patients. With regard to postoperative complications, 2 patients required rehabilitation for shoulder joint stiffness, whereas wound infection and arm edema were encountered in 1 and 2 patients, respectively. During the median follow-up time of 26 (range; 4-69) months, 3 patients experienced recurrence. The metastatic sites in the 3 patients were the supraclavicular lymph nodes, the chest wall, and the liver, respectively. | Quality of life( QOL) following SRM was acceptable in the patients examined. SRM could be considered as a treatment option in select patients with LABC. | closed_qa |
Is the antioxidative effectiveness of a bilberry extract influenced by encapsulation? | Bilberries (Vaccinium myrtillus L.) have been suggested to have preventive properties against diseases associated with oxidative stress such as colon cancer or inflammatory bowel diseases. Therefore the gastrointestinal tract is regarded as a potential target for prevention. In this study the antioxidative properties of a commercially available anthocyanin-rich bilberry extract (BE) were investigated in comparison with four different BE-loaded microcapsule systems. As markers to describe the antioxidant status in this cellular system, intracellular reactive oxygen species (ROS) levels, oxidative DNA damage and total glutathione (tGSH) levels were monitored. Incubations with the BE-loaded capsule systems showed an increase in cellular glutathione levels and reduction of ROS levels at high BE concentrations (100-500 µg mL(-1) ) and a positive effect on the formation of DNA strand breaks (5-10 µg mL(-1) BE). The biological properties of BE-loaded pectin amide core-shell capsules, whey protein matrix capsules and coated apple pectin matrix capsules were comparable to those of the non-encapsulated BE. | Overall, the BE and the encapsulated BE types tested have antioxidative activity under the studied assay conditions in terms of the prevention of oxidative DNA damage, the reduction of intracellular ROS and the enhancement of cellular tGSH. | closed_qa |
Is the coefficient of variation a valid measure for variability of stable isotope abundances in biological materials? | The isotopic compositions of low-mass elements such as carbon are commonly expressed on the δ scale, relative to the isotopic ratio of an international standard (RST). Carbon stable isotope measurements of plant material are interpreted with an apparently biological meaning as an estimator of water use efficiency, and this has been used widely in recent years to screen plant material for variation. To compare the observed variability with other traits, the coefficient of variation (CV) is often used as an intrinsic variability measure. Theoretical considerations as well as an example dataset were used to test the independence of the CV from the RST on which the values of isotopic composition on the δ scale are based. It can be shown mathematically that the CV of a dataset of δ(13)C values is directly dependent on RST. The exploration of the example dataset confirmed this but also showed that the conversion of absolute isotopic ratios into atom fraction does not change the resulting CV. Similarly, a discrimination calculated between two δ(13)C values is independent of RST, but depends on accurate knowledge of both δ(13)C values. It was also shown that results of statistics (e.g. ANOVA) are robust among different units of isotopic composition. | As CVs estimated from isotopic compositions expressed on the δ scale depend on the underlying standard, they should not be compared with those of other traits, and even comparisons of CVs among isotopic datasets should be interpreted with care. | closed_qa |
An mHealth model to increase clinic attendance for breast symptoms in rural Bangladesh: can bridging the digital divide help close the cancer divide? | To demonstrate proof of concept for a smart phone-empowered community health worker (CHW) model of care for breast health promotion, clinical breast examination (CBE), and patient navigation in rural Bangladesh. This study was a randomized controlled trial; July 1 to October 31, 2012, 30 CHWs conducted door-to-door interviews of women aged 25 and older in Khulna Division. Only women who disclosed a breast symptom were offered CBE. Arm A: smart phone with applications to guide interview, report data, show motivational video, and offer appointment for women with an abnormal CBE. Arm B: smart phone/applications identical to Arm A plus CHW had training in "patient navigation" to address potential barriers to seeking care. Arm C: control arm (no smart phone; same interview recorded on paper). Outcomes are presented as the "adherence" (to advice regarding a clinic appointment) for women with an abnormal CBE. This study was approved by Women's College Hospital Research Ethics Board (Toronto, Ontario, Canada) and district government officials (Khulna, Bangladesh). Funded by Grand Challenges Canada. In 4 months, 22,337 women were interviewed;<1% declined participation, and 556 women had an abnormal CBE. Control group CHWs completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence. | CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group. CHW "navigators" were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance. | closed_qa |
Is the presence of medical trainees associated with increased mortality with weekend admission? | Several studies have demonstrated increased inhospital mortality following weekend admission. We hypothesized that the presence of resident trainees reduces the weekend mortality trends. We identified all patients with a non-elective hospital admission from 1/1/2003 through 12/31/2008. We abstracted vital status on discharge and calculated the Charlson comorbidity score for all inpatients. We compared odds of inpatient mortality following non-elective admission on a weekend day as compared to a weekday, while considering diagnosis, patient characteristics, comorbidity, hospital factors, and care at hospitals with resident trainees. Data were available for 48,253,968 patient discharges during the six-year study period. The relative risk of mortality was 15% higher following weekend admission as compared to weekday admission. After adjusting for diagnosis, age, sex, race, income level, payer, comorbidity, and weekend admission the overall odds of mortality was higher for patients in hospitals with fewer nurses and staff physicians. Mortality following a weekend admission for patients admitted to a hospital with resident trainees was significantly higher (17%) than hospitals with no resident trainees (p<0.001). | Low staffing levels of nurses and physicians significantly impact mortality on weekends following non-elective admission. Conversely, patients admitted to hospitals with more resident trainees had significantly higher mortality following a weekend admission. | closed_qa |
Are there any relationships between umbilical artery Pulsatility Index and macrosomia in fetuses of type I diabetic mothers? | To establish whether there are relationships between umbilical artery Pulsatility Index (PI) and fetal macrosomia in pregnancies complicated by type I diabetes. In a retrospective observational study, 102 singleton pregnant women with type I diabetes were considered. Umbilical artery PI was measured by Doppler ultrasonography within one week from delivery and related to neonatal weight. Pregnancies were grouped according to birtweight in macrosomic group (≥4000 g) and normal growth group (<4000 g). Relationships between umbilical artery PI and birth weight and birth weight centile were tested by Pearson's correlation analysis. Further umbilical artery PI values were compared between macrosomic and normally grown fetuses. Birth weight was ≥4000 g in 24 pregnancies (23.5%). A significant relationship was found between umbilical artery PI and neonatal weight (r = 0.512; p < 0.01) and neonatal weight centile (r = 0.400; p < 0.01). Umbilical artery PI were significantly lower (t = -6.013; p < 0.001) in the macrosomic group (0.78; 95% confidence interval (CI) 0.73-0.84) than in the normal growth group (1.00; 95% CI 0.97-1.04). | In pregnancies complicated by type I diabetes there is a significant relationship between umbilical artery PI value before delivery and absolute birth weight and birth weight centile. Macrosomic fetuses show a significant reduction in umbilical artery PI when compared with diabetic pregnancies without fetal overgrowth. | closed_qa |
Do pregnant women prefer timing of elective cesarean section prior to versus after 39 weeks of gestation? | To evaluate women's preferences for timing of elective cesarean section (ECS) scheduled prior to versus after 39 completed weeks. Secondary analyses from a randomized controlled open-label trial were conducted at seven Danish tertiary hospitals from March 2009 to June 2011 with inclusion of singleton pregnant women with a healthy fetus. The women were allocated by a computerized telephone system to ECS scheduled at 38(+3) weeks or 39(+3) weeks of gestation. Dissatisfaction with timing of ECS and preferred timing of the procedure in a proposed future ECS delivery were evaluated. Data analyses were done by intention-to-treat, using logistic regression. A total of 1196 women (94%) completed an online questionnaire at follow-up eight weeks postpartum. In the 38 weeks group, 61 (10%) women 601 were dissatisfied with the timing of their ECS, whereas in the 39 weeks group 157 (26%) of 595 were dissatisfied (adjOR 3.18, 95% CI 2.30; 4.40). The proportion of women who preferred the same timing in a future ECS were 272 (45%) in the 38 weeks group compared to 232 (39%) in the 39(+3) weeks group (adjOR 0.75, 95% CI 0.60; 0.95). | The women in this trial preferred ECS scheduled prior to 39 weeks of gestation. | closed_qa |
Can total knee arthroplasty be safely performed in patients with chronic renal disease? | The prevalence of chronic renal disease (CRD) is rising worldwide. Patients with CRD are more likely to have associated medical problems and are at greater risk of postoperative morbidity and mortality. We evaluated patient characteristics and risk of early revision, surgical site infection (SSI), thromboembolic events, mortality, and re-admission of patients with CRD undergoing total knee arthroplasty (TKA). We hypothesized that this patient population would have higher rates of complications. We conducted a retrospective analysis of data that had been prospectively collected by a Total Joint Replacement Registry. All primary TKAs performed from 2005 through 2010 were included. 41,852 primary TKA cases were evaluated, of which 2,686 (6.4%) TKA procedures had been performed in CRD patients. Patient characteristics, comorbidities, and general health status were evaluated. Cox proportional hazard regressions and logistic regressions were used to evaluate the association of CRD with outcomes while adjusting for confounding variables. Results - The mean age of the CRD cohort was 67 years and approximately two-thirds of the patients were female. The median follow-up time was 2.1 years. Compared to TKA patients without CRD the CRD patients were older, had poorer general health, and had a higher prevalence of comorbidities. They had a higher incidence of deep SSI (0.9% vs. 0.7%), superficial SSI (0.5% vs. 0.3%), deep vein thrombosis (0.6% vs. 0.4%), any-time mortality (4.7% vs. 2.4%), 90-day mortality (0.4% vs. 0.2%), and 90-day re-admission (10% vs. 6.0%) than patients without CRD. However, after adjustment for confounding variables, CRD patients were at 1.9 times (95% CI: 1.1-3.5) increased risk of superficial SSI, 1.3 times (CI: 1.1-1.6) increased risk of re-admission within 90 days, and 1.5 times (CI: 1.2-1.8) increased risk of mortality at any point after the procedure. The risks of all other complications were not statistically significantly different in patients with CRD compared to patients without CRD. | CRD patients undergoing TKA have more comorbidities and a higher risk for superficial SSI, 90-day re-admission, and any-time mortality. | closed_qa |
Is the one-step nucleic acid amplification assay better for intra-operative assessment of breast sentinel nodes? | Intra-operative assessment of sentinel lymph nodes in breast cancer offers the opportunity to prevent two-stage surgical procedures. At our institution we employ touch imprint cytology (TIC), which lacks sensitivity. In this study we compare the one-step nucleic acid amplification (OSNA) assay to TIC. Imprints were taken from 63 lymph nodes from 35 patients. The lymph nodes were sectioned at 2-mm intervals and alternate slices submitted for either histology or OSNA assay, with histology as the reference standard. Seven patients were histologically positive. Nine and five patients were positive by OSNA and TIC, respectively. Sensitivity, specificity, positive and negative predictive value for the OSNA assay were 85.7%, 85.7%, 63.6% and 96.6% and for TIC were 70.0%, 96.6%, 87.5% and 90.3%. | In this study OSNA had a higher sensitivity than TIC. Fewer patients assessed by the OSNA assay would have required a two-stage procedure. The OSNA assay appears to be a highly cost-effective method for providing rapid and reliable intra-operative assessment of sentinel lymph nodes. | closed_qa |
Semiologic classification of psychogenic non epileptic seizures (PNES) based on video EEG analysis: do we need new classification systems? | Different studies have described useful signs to diagnose psychogenic non-epileptic seizure (PNES). A few authors have tried to describe the semiologic groups among PNES patients; each group consisting of combination of features. But there is no uniformity of nomenclature among these studies. Our aim was to find out whether the objective classification system proposed by Hubsch et al. was useful and adequate to classify PNES patient population from South India. We retrospectively analyzed medical records and video EEG monitoring data of patients, recorded during 3 year period from June 2010 to July 2013. We observed the semiologic features of each PNES episode and tried to group them strictly adhering to Hubsch et al. classification. Minor modifications were made to include patients who were left unclassified. A total of 65 patients were diagnosed to have PNES during this period, out of which 11 patients were excluded due to inadequate data. We could classify 42(77.77%) patients without modifying the defining criteria of the Hubsch et al. groups. With minor modification we could classify 94.96% patients. The modified groups with patient distribution are as follows: Class 1--dystonic attacks with primitive gestural activities [3(5.6%)]. Class 2 – paucikinetic attacks with or without preserved responsiveness [5(9.3%)]. Class 3--pseudosyncope with or without hyperventilation [21(38.9%)]. Class 4--hyperkinetic prolonged attacks with hyperventilation, involvement of limbs and/or trunk [14(25.9%)]. Class 5--axial dystonic attacks [8(14.8%)]. Class 6--unclassified type [3(5.6%)]. | This study demonstrates that the Hubsch's classification with minor modifications is useful and adequate to classify PNES patients from South India. | closed_qa |
CTX-M-15-D-ST648 Escherichia coli from companion animals and horses: another pandemic clone combining multiresistance and extraintestinal virulence? | To discern the relevance of ST648 extended-spectrum β-lactamase (ESBL)-producing Escherichia coli as a putative new group of multiresistant and extraintestinal pathogenic strains in animals, its frequency, ESBL types, antimicrobial resistance patterns and virulence gene (VG) profiles should be determined and compared with ST131 strains from the same collection of strains. ESBL-producing E. coli isolates (n = 1152), consecutively sampled from predominantly dogs, cats and horses between 2008 and 2011, were assigned to a phylogenetic group by PCR. Partial multilocus sequence typing was performed for group D and B2 strains and strains presumed to be D-ST648 and B2-ST131 were fully typed. ESBL genes and extraintestinal pathogenic E. coli (ExPEC)-like VGs were characterized by PCR and sequence analysis and antimicrobial resistance was determined by broth dilution. Clonal analysis was done by PFGE. Forty (3.5%) ESBL-producing E. coli were determined as D-ST648, whereas B2-ST131 isolates occurred less frequently (2.8%). Although the predominant ESBL type in both groups was CTX-M-15 (72.5% versus 46.9%), ST648 strains from companion animals and horses displayed a lower variety of ESBL types (CTX-M-1, -3, -14, -15 and -61 versus CTX-M-1,-2,-14,-15,-27 and -55 and SHV-12). In contrast to ST131 strains, a higher proportion of ST648 strains showed resistance to most non-β-lactam antibiotics. Overall, VGs were less abundant in ST648 strains, although some strains had VG profiles comparable to those of ST131 strains. ExPEC-associated serotype O1:H6 was predominant (46.8%) among the ST648 strains. Some PFGE clusters comprised ST648 isolates from pets, horses and wild birds and humans included from previous studies. | Our findings demonstrate that certain subgroups of E. coli D-ST648-CTX-M may represent a novel genotype that combines multiresistance, extraintestinal virulence and zoonotic potential. | closed_qa |
Is there a relation between emergency department and inpatient lengths of stay? | Emergency departments (EDs) are key entry points to hospital care, and issues of overcrowding and poor patient flow have become a priority in Canada. Studies have sought to determine factors that influence ED wait times in an effort to improve patient flow. We sought to identify the impact of factors such as patient age, triage level, comorbid factor level and sex to determine their effects on length of stay (LOS) and the role that they play in the ED and in an inpatient setting. We analyzed 2 years of data from 2007 to 2009. We conducted a repeated-measures analysis of variance to measure the effects of age, triage level, comorbid level and sex as they relate to ED and inpatient LOS. Our analysis resulted in a final sample of 4743 patient visits. A longer LOS in the ED was correlated with a longer inpatient LOS. Age, comorbidity level and sex were shown to have an influence on LOS. | Continued efforts to further reduce ED LOS are crucial, because this has the potential to influence outcomes, efficiency of EDs and succession to inpatient status, which may affect costs to the health care system. Patient-specific factors need to be considered when formulating and refining policies and processes to improve patient flow. | closed_qa |
Is it possible to eliminate sutures in open (Lichtenstein technique) and laparoscopic (totally extraperitoneal endoscopic) inguinal hernia repair? | The morbidity linked to the use of sutures in inguinal hernioplasty is well known. Tissue adhesives may be an alternative, so as to be able to improve levels of postoperative comfort, but clinical experience using them is limited. The aim of this study is to evaluate the efficiency of cyanoacrylate as a substitute for sutures in the treatment of inguinal hernias. Randomized clinical trial in abdominal wall unit. A total of 208 patients were operated upon for inguinal hernias of which 102 were unilateral hernias via open surgery using the Lichtenstein technique, randomized to receive prolene sutures (n = 52) or n-hexyl-α-cyanoacrylate glue (n = 50) and 106 were patients with bilateral inguinal hernias operated upon via totally extraperitoneal laparoscopy and randomized to receive either tackers (n = 54) or glue (n = 52). The primary endpoints were pain and recurrence. Secondary endpoints were operating time, postoperative morbidity, pain, and analgesic consumption. No morbidity associated with the use of the glue existed. The use of glue significantly reduced the mean of surgical time (12 minutes in open surgery, 13 minutes in laparoscopic surgery), pain, and analgesics consumption, both via the open and laparoscopic approaches (P<.001). After 1 year the adhesive did not change the recurrence rate in either of the approaches. The economic analysis shows potential yearly savings of 123 916.3 Euros. | Substituting sutures with glue (n-hexyl-α-cyanoacrylate) in open or laparoscopic inguinal hernioplasty is safe with less postoperative pain and the same possibilities of recurrence. | closed_qa |
Can intramuscular glucose levels diagnose compartment syndrome? | Compartment syndrome is difficult to diagnose, particularly in patients who are not able to undergo adequate clinical examination. Current methods rely on pressure measurements within the compartment, have high false-positive rates, and do not reliably indicate presence of muscle ischemia. We hypothesized that measurement of intramuscular glucose and oxygen can identify compartment syndrome with high sensitivity and specificity. Compartment syndrome was created in 12 anesthetized adult mixed-sex beagles, in the craniolateral compartment of a lower leg, by infusion of lactated Ringer's solution with normal serum concentration of glucose. The contralateral leg served as a control. Hydrostatic pressure, oxygen tension, and glucose concentration were recorded with commercially available probes. Compartment syndrome was maintained for 8 hours, and the animals were recovered. Two weeks later, compartment and control legs underwent muscle biopsy. Specimens were reviewed by a blinded pathologist. Within 15 minutes of creating compartment syndrome, glucose concentration and oxygen tension in the experimental limb were significantly lower than in the control limb (glucose, p = 0.02; oxygen, p = 0.007; two-tailed t test). Intramuscular glucose concentration of less than 97 mg/dL was 100% sensitive (95% confidence interval [CI], 73-100%) and 75% specific (95% CI, 40-94%) for the presence of compartment syndrome. Partial pressure of oxygen less than 30 mm Hg was 100% sensitive (95% CI, 72-100%) and 100% specific (95% CI, 69-100%) for the presence of compartment syndrome. Pathology confirmed compartment syndrome in all experimental limbs. | Our results show that intramuscular glucose concentration and partial pressure of oxygen rapidly identify muscle ischemia with high sensitivity and specificity after experimentally created compartment syndrome in this animal model. | closed_qa |
Elective laparoscopic cholecystectomy for symptomatic uncomplicated gallstone disease: do the symptoms disappear? | Symptomatic gallstone disease is considered an indication for cholecystectomy. A considerable proportion of patients may experience persistent symptoms after surgery. The purpose of the present study was to find out the rate of symptom persistence after elective laparoscopic cholecystectomy (LC) performed for symptomatic uncomplicated gallstone disease and, in particular, to clarify whether the recurrence rate differs according to the severity of preoperative symptoms. During a 10-year period (1992-2001), 1,101 patients underwent elective LC at Turku City Hospital for Surgery. A questionnaire concerning the intensity of preoperative symptoms, persistence of symptoms postoperatively, and overall satisfaction with the outcome of the procedure was sent to patients. A total of 677 patients [mean age (range) 59 (21-94) years; 554 (83.1%) females] with uncomplicated gallstone disease returned the completed form. Overall, 380 (57%) patients reported attacks of intense upper abdominal pain, and 287 (43%) reported episodic mild abdominal symptoms as the prevailing preoperative symptom. Two hundred and forty-eight (37%) patients continued to have abdominal symptoms after the operation. Among those with predominantly mild abdominal symptoms preoperatively, 119 (41%) reported the persistence of symptoms after the operation, while in the group with mainly severe upper abdominal pain attacks, 129 (33%) patients had recurrences (p = 0.052). | According to our data, more than one-third of patients with symptomatic uncomplicated gallstone disease experienced persistent symptoms after elective LC. Patients with mild preoperative symptoms seemed to have more recurrences than those with severe symptoms, although the difference was not statistically significant. | closed_qa |
Simulation of early after-depolarisation in non-failing human ventricular myocytes: can this help cardiac safety pharmacology? | Identified as being the primary mechanism involved in the induction of torsades de pointes (TdP), early after-depolarisation (EAD) formation is an important parameter in cardiac safety pharmacology. Easily observed experimentally at the cellular or tissue level, EAD can also be simulated by computer algorithms using animal or human models. During the last decade, confidence in these algorithms has greatly increased. We investigated the putative usefulness of EAD simulation for cardiac safety pharmacology. EAD simulations were performed in non-failing human ventricular myocytes using the O'Hara-Rudy dynamic model. The role of each cardiac current was investigated by modifying the amplitude of its activity in the model. Prediction of EAD induction by drugs was based on the ratio of their 50% inhibitory concentration values for various cardiac ionic currents to their maximal effective free therapeutic plasma concentration (EFTPCmax). In the ventricular endocardial myocytes, EAD was only induced by at least 85% inhibition of the rapid delayed rectifier K(+) current (IKr). The other currents can either induce or prevent EAD under sub- (80% IKr inhibition) or up-threshold conditions (87% IKr inhibition) of EAD. The study of the ability of drugs to induce EAD resulted in a classification which was in agreement with the Tdp risk classification. | Based on EAD computer simulation within the human situation, the present study identified the role of various cardiac currents in the EAD formation and suggested that prediction of EAD formation can be useful for early cardiac safety pharmacology. | closed_qa |
Is vocational reintegration of young cancer patients possible? | Besides an improvement in quality of life, one of the major targets of rehabilitation programmes is to preserve the ability to work and to integrate the patient into working life again. Cancer in particular is often associated with a loss of employment and joblessness, frequently caused by incomplete rehabilitation. The programme is aimed at young cancer patients aged between 18 and 40 years. In addition to medical rehabilitation, they undergo a specially developed programme which they complete in groups of no more than 5 persons. At baseline and at the end of the 3 weeks rehabilitation, tests on physical and mental capacity are conducted. During rehabilitation, different training programmes concerning mobility at work, fine motor skills and cognitive abilities are held, complemented by an intensive psycho-social training programme. Additionally, patients receive individual social counselling. So far, 34 patients with an average age of 31.8 years have participated in the programme, 65% of them suffering from malignant haematological diseases. The combination of a medical and a vocational rehabilitation programme was judged extremely positively by the participants, which remained the case 6 months after completion of the programme. The rehabilitation programme significantly reduced work incapacity periods: at baseline, only 6% of the participants had not experienced such periods, but after 3 and 6 months, this rate had increased to 61% and 62% respectively. This was accompanied by an increased health-related quality of life and reduced fatigue. | With our pilot project we were able to show that such a programme is feasible, can be well integrated into clinical routine and is successful. | closed_qa |
Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics? | Doubts remain about atherosclerotic disease and risk stratification of asymptomatic type-2 diabetic patients (T2DP). This study aims to evaluate the usefulness of calcium score (CS) and coronary computed tomography (CT) angiography (CTA) to predict fatal and non fatal cardiovascular events (CVEV) in T2DP. Eighty-five consecutive T2DP undergoing CT (Phillips Brilliance, 16-slice) with CS and CTA were prospectively enrolled in a transversal case-control study. Patients were followed for 48 months (range 18 - 68) to assess CVEV: cardiovascular death, acute coronary syndrome, revascularisation and stroke. Potential predictors of CVEV were identified. Predictive models based on clinical features, CTA and CS were created and compared. Performing CT impacted T2DP treatment. Cardiovascular risk was lowered during follow-up but metabolic control remained suboptimal. CVEV occurred in 11.8% T2DP (3.1%/year). CS ≥86.6 was predictor of CVEV over time, with a high negative predictive value, an 80% sensitivity and 74.7% specificity. Although its prognostic value was not independent of the presence/absence of obstructive CAD, adding CS and CTA data to clinical parameters improved the prediction of CVEV: the combined model had the highest AUC (0.888, 95%CI 0.789-0.987, p<0.001) for the prediction of the study endpoints. | CS showed great value in T2DP risk stratification and its prognostic value was further enhanced by CTA data. Information provided by CT may help predict CVEV in T2DP and potentially improve their outcome. | closed_qa |
Stereo-acuity in patients implanted with multifocal intraocular lenses: is the choice of stereotest relevant? | A randomized and double-blinded study design was implemented to assess the stereo-acuity in patients symmetrically implanted with four types of multifocal intraocular lenses (MIOLs), compared to a monofocal lens (control group). In addition, the influence of the type of test employed for the evaluation of stereo-acuity was explored. Six months after cataract intervention, stereo-acuity was measured with the Titmus and TNO stereotests in 143 patients implanted with one of the following MIOL lens types: hybrid spherical SN60D3, hybrid aspheric SN6AD1, diffractive aspheric ZMA00 and refractive spherical NXG1. A control group implanted with the monofocal aspheric ZA9003 (in which stereo-acuity was measured with a near addition) was also included in the study. Statistically significant better stereo-acuity was found in the monofocal group with both stereotests (except for the SN60D3 group with the Titmus test) (all p < 0.001). No significant differences in stereo-acuity between MIOLs were found using the Titmus test. However, with the TNO, patients implanted with hybrid diffractive MIOLs exhibited statistically significant worse stereo-acuity than those with the refractive design (SN60D3, p < 0.001; SN6AD1, p = 0.006). | Patients implanted with MIOLs have worse stereo-acuity than those implanted with monofocal IOLs due to the decrease in retinal image contrast originating in the simultaneous presence of two images. A wavelength-based stereotest such as the TNO induces large differences in image contrast between fellow eyes implanted with diffractive-based MIOLs, which may result in an underestimation of the real stereo-acuity of the patient. | closed_qa |
Does clinical teacher training always improve teaching effectiveness as opposed to no teacher training? | Teacher training may improve teaching effectiveness, but it might also have paradoxical effects. Research on expertise development suggests that the integration of new strategies may result in a temporary deterioration of performance until higher levels of competence are reached. In this study, the impact of a clinical teacher training on teaching effectiveness was assessed in an intensive course in emergency medicine. As primary study outcome students' practical skills at the end of their course were chosen. The authors matched 18 clinical teachers according to clinical experience and teaching experience and then randomly assigned them to a two-day-teacher training, or no training. After 14 days, both groups taught within a 12-hour intensive course in emergency medicine for undergraduate students. The course followed a clearly defined curriculum. After the course students were assessed by structured clinical examination (SCE) and MCQ. The teaching quality was rated by students using a questionnaire. Data for 96 students with trained teachers, and 97 students with untrained teachers were included. Students taught by untrained teachers performed better in the SCE domains 'alarm call' (p<0.01) and 'ventilation' (p = 0.01), while the domains 'chest compressions' and 'use of automated defibrillator' did not differ. MCQ scores revealed no statistical difference. Overall, teaching quality was rated significantly better by students of untrained teachers (p = 0.05). | At the end of a structured intensive course in emergency medicine, students of trained clinical teachers performed worse in 2 of 4 practical SCE domains compared to students of untrained teachers. In addition, subjective evaluations of teaching quality were worse in the group of trained teachers. Difficulties in integrating new strategies in their teaching styles might be a possible explanation. | closed_qa |
Is group A thawed plasma suitable as the first option for emergency release transfusion? | Group AB plasma, which lacks anti-A and anti-B isohemagglutinins, is issued for emergency transfusion when a patient's ABO group is unknown, but the relative scarcity of group AB blood donors limits its availability. We sought to establish a thawed plasma inventory to improve the rapid availability of plasma in the emergency release setting but were concerned about potential wastage of group AB plasma. Recognizing that plasma-incompatible apheresis platelets are routinely transfused and only rarely result in hemolytic reactions if the donor is blood group O, and considering that group A plasma would be compatible with approximately 85% of our patient population, we instituted an emergency release policy whereby thawed group A plasma is issued to all patients of unknown blood group or if compatible plasma is not available. ABO-compatible plasma is then issued, if needed, once the patient's blood group is determined. We prospectively assessed the outcomes of all patients who received incompatible plasma under our policy. During the first 5 years under this policy, 385 emergency release requests for plasma were received by our blood bank. Among them, 23 group B or AB patients met criteria for receiving a median of 2 units of incompatible group A plasma. No hemolytic transfusion reactions or other adverse events related to transfusion were seen in any of these 23 patients. | We propose that group A plasma may be an acceptable alternative to AB plasma as the first option in the emergency release setting. | closed_qa |
Does methamphetamine use increase violent behaviour? | To determine whether violent behaviour increases during periods of methamphetamine use and whether this is due to methamphetamine-induced psychotic symptoms. A fixed-effects (within-subject) analysis of four non-contiguous 1-month observation periods from a longitudinal prospective cohort study. Sydney and Brisbane, Australia. A total of 278 participants aged 16 years or older who met DSM-IV criteria for methamphetamine dependence on entry to the study but who did not meet DSM-IV criteria for life-time schizophrenia or mania. Violent behaviour was defined as severe hostility in the past month on the Brief Psychiatric Rating Scale (BPRS) (corresponding to assault/damage to property). Days of methamphetamine and other substance use in the past month were assessed using the Opiate Treatment Index. Positive psychotic symptoms in the past month were identified using the BPRS. There was a dose-related increase in violent behaviour when an individual was using methamphetamine compared with when they were not after adjusting for other substance use and socio-demographics [cf. no use in the past month: 1-15 days of use odds ratio (OR) = 2.8, 95% confidence interval (CI) =1.6-4.9; 16+ days of use OR = 9.5, 95% CI = 4.8-19.1]. The odds of violent behaviour were further increased by psychotic symptoms (OR = 2.0, 95% CI = 1.1-3.6), which accounted for 22-30% of violent behaviour related to methamphetamine use. Heavy alcohol consumption also increased the risk of violent behaviour (OR = 3.1, 95% CI = 1.4-7.0) and accounted for 12-18% of the violence risk related to methamphetamine use. | There is a dose-related increase in violent behaviour during periods of methamphetamine use that is largely independent of the violence risk associated with psychotic symptoms. | closed_qa |
We can treat Alzheimer's disease successfully in mice but not in men: failure in translation? | Animal models closely resembling the etiopathogenesis of Alzheimer's disease (AD) are needed for research on disease mechanisms and for drug development. No natural model of AD is available, so big hopes arose from transgenic and knockout technology, expecting that modulation and expression of pathogenetically important proteins resemble human brain pathology and functional deficits in the expected morphological and temporal pattern. The real usefulness of these models should be discussed from an objective point of view. Not a single one of the published transgenic rodent models fulfils this hope, and even complex multiple transgenic animals do not suffer from real AD. It is crucial to be aware that all of the commonly used mice and rats are just models, and therefore results from drug efficacy testing have to be interpreted with care. Repeated experience with failed trials of new treatments that previously had been published as successful in animals has led to the wrong conclusion that animal models are of low predictive value or even of no use. Often clinical trials replicate exactly what was shown in the animal proof-of-concept studies. | The value of animal models depends mainly on the careful experimentation and correct interpretation of results. Appropriate planning of experiments will help to increase the predictive value in drug development programs, though this may also increase negative findings. However, the early failure may enable a faster focus on more promising strategies. | closed_qa |
Is soluble mesothelin-related protein an upfront predictive marker of pleural mesothelioma? | Soluble mesothelin-related peptide (SMRP) may be useful in the diagnosis and detection of early stage mesothelioma. We investigated the SMRP upfront predictive role for mesothelioma in asbestos-exposed workers. A total of 1,715 subjects underwent a first visit and were invited for a follow-up after 1 and 2 years, with a clinical examination and blood sampling. SMRP was measured by an ELISA assay. Median SMRP at the first visit was 0.45 [interquartile range (IQR) i.e. 25th-75th percentile: 0.30-0.67 nmol/l]. In all, 1,676 subjects (97.8%) were followed up for a median period of 47.1 months. SMRP was measured at the first visit and at both follow-up visits in 1,536 subjects. At follow-up, 3 subjects were diagnosed with an epithelioid mesothelioma. In these cases, SMRP at the first visit ranged from 0.17 to 0.52 nmol/l. Malignant pleural mesothelioma was diagnosed 9-17 months after the last SMRP evaluation. No SMRP variation was observed during the follow-up. Other 61 miscellaneous cancers were diagnosed (median SMRP at first visit: 0.50 nmol/l, IQR: 0.34-0.71 nmol/l). | Our results did not support the usefulness of SMRP as an early marker for the detection of the disease for a time interval of 1 year. | closed_qa |
Looking upstream to prevent HIV transmission: can interventions with sex workers alter the course of HIV epidemics in Africa as they did in Asia? | High rates of partner change in 'upstream' sex work networks have long been recognized to drive 'downstream' transmission of sexually transmitted infections (STIs). We used a stochastic microsimulation model (STDSIM) to explore such transmission dynamics in a generalized African HIV epidemic. We refined the quantification of sex work in Kisumu, Kenya, from the 4-cities study. Interventions with sex workers were introduced in 2000 and epidemics projected to 2020. We estimated the contribution of sex work to transmission, and modelled standard condom and STI interventions for three groups of sex workers at feasible rates of use and coverage. Removing transmission from sex work altogether would have resulted in 66% lower HIV incidence (range 54-75%) and 56% lower prevalence (range 44-63%) after 20 years. More feasible interventions reduced HIV prevalence from one-fifth to one-half. High rates of condom use in sex work had the greatest effect, whereas STI treatment contributed to HIV declines at lower levels of condom use. Interventions reaching the 40% of sex workers with most clients reduced HIV transmission nearly as much as less targeted approaches attempting to reach all sex workers. Declines were independent of antiretroviral therapy rollout and robust to realistic changes in parameter values. | 'Upstream' transmission in sex work remains important in advanced African HIV epidemics even in the context of antiretroviral therapy. As in concentrated Asian epidemics, feasible condom and STI interventions that reach the most active sex workers can markedly reduce the size of HIV epidemics. Interventions targeting 'transactional' sex with fewer clients have less impact. | closed_qa |
Prematurity and school readiness in a nationally representative sample of Australian children: does typically occurring preschool moderate the relationship? | This study aims to examine the relationship between indicators of prematurity and children's cognitive and behavioral school readiness in a nationally representative sample and to investigate whether typically occurring preschool enrollment moderates this relationship, particularly for children from disadvantaged families in Australia. The Longitudinal Study of Australian Children is a nationally representative prospective sample of two cohorts of children with sequentially obtained indicators of child health and developmental outcomes. We analyzed information on 8060 children aged 4-5 years who had complete data on birth weight, gestational age, prenatal risks, social factors, and cognitive and behavioral outcomes of school readiness. Multivariate regressions were used to relate three indicators of prematurity (low birth weight, preterm birth, and small for gestational age) to cognitive and behavioral school readiness. Children born preterm, small for gestational age, or with low birth weight have significantly lower cognitive school readiness after controlling for social factors and prenatal risks. None of the premature indicators were associated with behavioral school readiness. All children benefited from attending preschool. Yet, preschool enrollment did not moderate the relationship between prematurity and school readiness. The only exception is for small for gestational age survivors with low educated mothers. Preschool enrollment was associated with an increase in cognitive school readiness skills. | Prematurity was associated with lower cognitive school readiness skills. Typical occurring preschool did not eliminate this association. Findings suggest that simply expanding the preschool enrollment is inadequate to address the developmental needs of premature children from disadvantaged backgrounds. | closed_qa |
Does online haemodiafiltration reduce intra-dialytic patient symptoms? | Patients often suffer from symptoms during dialysis. Haemodiafiltration (HDF) therapy has been suggested to be superior to standard haemodialysis (HD). To understand patients' experiences, we quantified the burden and duration of dialysis-associated symptoms to determine whether there was any difference between the modalities. Symptom questionnaires (83.3%) were returned by 623 dialysis outpatients. Symptom scores were analysed using a visual analogue score. We compared symptom burdens during HD and HDF treatments and also whether the scores changed following a modality change to HDF. Among the patients, 55.7% were men, the median age was 65 years, 39.7% were diabetic, 26.4% were treated by HDF and the median unadjusted Charlson co-morbidity score was 6 (IQR 4-8). Fatigue (77.3%), intra-dialytic hypotension (76.4%), cramps (74.3%) and dizziness (63%) were the commonest symptoms reported, followed by headache (53.6%) and pruritus (52.2%). Although most symptoms were reported less frequently with HDF [median headache frequency score: HD: 1 (IQR 1-4) vs. HDF: 0 (IQR 0-2), p<0.005]. There was no evidence of a reduction in symptom scores in patients switching from HD to HDF compared to those remaining on HD. | Patient self-reporting shows that most patients frequently suffer symptoms. There was no evidence that switching to HDF improved symptoms in patients established on HD. | closed_qa |
Investigating the role of cardiovascular biomarkers in children with pre-dialysis chronic kidney disease: a substitute to echocardiography to detect increased left ventricular mass? | Children with chronic kidney disease (CKD) are at increased risk of future cardiovascular (CV) events. Our aim in this prospective single-centre cross-sectional analysis was to assess the relationship of a novel panel of CV biomarkers with left ventricular hypertrophy (LVH). A panel of five CV biomarkers (asymmetric dimethyl arginine, high sensitivity C-reactive protein, homocysteine, N-terminal pro-B type natriuretic peptide and uric acid) were measured on the same day as an echocardiogram assessment, in paediatric patients with pre-dialysis stages 3-5 of CKD. Of 73 children aged 5-18 years, LVH, all eccentric, was identified in 38%. Systolic blood pressure (BP), glomerular filtration rate (GFR) and higher intake of calcium-based phosphate binders were significantly worse in children with LVH. In multivariate models analysing each biomarker one at a time with confounders [GFR, systolic BP z-score, anti-hypertensive medication (yes/no) and elemental calcium intake], clinic systolic BP z-score and elemental calcium intake consistently displayed a significant relationship with indexed left ventricular mass (LVMI). None of the evaluated CV biomarkers displayed a significant relationship with LVMI. | In our cohort of children with moderately severe pre-dialysis CKD we have identified no suitable biomarkers to detect LVH. We would therefore recommend that echocardiographic determination of LVMI remains the technique of choice for detection of LVH in children with CKD. | closed_qa |
Does effect of rehabilitation based on sensory conflicts in patients with vestibular deficits exceed learning effect? | The purpose was to assess learning and rehabilitation effect and their influence on Sensory Organization Test results in young and elderly patients with peripheral, central and mixed vestibular pathology. 26 patients with different vestibular system deficits participated in this study. Rehabilitation was held five days a week, for two weeks. To assess learning effect, SOT was administered to each patient twice and compared: 1) on the day preceding the beginning of rehabilitation (SOT1), and 2) on the first day of rehabilitation (SOT2). To evaluate rehabilitation effect, results of SOT2 were compared to SOT3 (administered on the last day of rehabilitation). Learning effect showed similar improvement in CS in all groups but young. Rehabilitation caused further improvement in CS in all groups but central pathology. This improvement was similar between those groups. There was no significant difference found between learning and rehabilitation effect in CS. | The results of our study indicate that none of the groups achieved significant benefit from rehabilitation based on sensory conflicts that would overcome the learning effect. However, the lack of significant advantage of rehabilitation over learning does not mean that it does not exist. | closed_qa |
Is renal dysfunction associated with adverse stroke outcome after thrombolytic therapy? | Renal dysfunction is a prevalent comorbidity in acute stroke patients requiring thrombolytic therapy. Reports studying the relationship between renal dysfunction and risk of postthrombolytic symptomatic intracerebral hemorrhage (SICH) are contradictory. We aimed to compare the safety and effectiveness of thrombolytic therapy in acute stroke patients with and without renal dysfunction. Based on the prospective stroke registries of 4 hospitals in Taiwan from 2007-2012, we identified acute stroke patients who received thrombolytic therapy. Clinically significant renal dysfunction was defined as an estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m(2). Renal dysfunction was further defined as stage 3 (30 ≤ eGFR<60 ml/min/ 1.73 m(2)), stage 4 (15 ≤ eGFR<30 ml/min/1.73 m(2)) and stage 5 (<15 ml/min/1.73 m(2)). The rates of SICH and poor outcome (defined as modified Rankin scale score ≥4) at 3 months after thrombolytic therapy were compared in patients with and without renal dysfunction. SICH was determined according to the definition of the National Institute of Neurological Disorders and Stroke. Multivariable logistic regression was used to determine the effect of renal dysfunction on outcome. Patients with different stages of renal dysfunction were further analyzed to determine the effect of disease severity on outcome. Of the 657 stroke patients with thrombolysis, 239 (36%) had renal dysfunction, including 212 patients in stage 3, 17 patients in stage 4 and 10 patients in stage 5 of renal dysfunction. Patients with renal dysfunction were older and more likely to have hypertension, ischemic heart disease, congestive heart failure and prior antiplatelet use than those without. There were no differences in SICH (8 vs. 7%, p = 0.580) and poor outcome (41 vs. 39%, p = 0.758) between patients with and without renal dysfunction. After multivariable analysis, renal dysfunction was not associated with SICH (odds ratio: 1.03, 95% confidence interval: 0.55-1.92) and poor outcome. Pretreatment stroke severity was the only factor significantly associated with both SICH and poor outcome at 3 months. When stratifying renal dysfunction into stage 3 and stage ≥4, there was no significant increase in SICH as the severity of renal dysfunction increased after multivariable adjustment. | Renal dysfunction did not increase the risk of SICH and poor outcome at 3 months after stroke thrombolysis. Further study comparing directly the risk and benefit of thrombolytic therapy versus no therapy in stroke patients with renal dysfunction is warranted. | closed_qa |
Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? | Anastomotic leaks after colorectal resections for cancer are a leading cause of postoperative morbidity, mortality, and long hospital stay. Few data exist on the potentially deleterious effect of the anastomotic leaks after proctectomy for cancer on patient health-related quality of life. The aim of this study was to explore the effect of clinically evident anastomotic leaks on health-related quality of life after rectal cancer excision. This is a case-matched study. This study was conducted in a Greek academic surgical department. Included were 25 patients undergoing low anterior resection complicated by an anastomotic leak (Clavien classification II, n = 14, and III, n = 11) and 50 patients undergoing low anterior resection with an uncomplicated course. Health-related quality-of-life data were prospectively collected at fixed assessment time points (baseline, 3, 6, and 12 months postoperatively) by the use of validated questionnaires (Medical Outcomes Study Short Form 36, Gastrointestinal Quality of Life Index, European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30, and European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-CR29). "Leak" patients required a longer hospitalization. Although the numbers of initially constructed defunctioning loop ileostomies were not significantly different between cases and controls, "leak" patients were required to remain with a stoma significantly more often at all postoperative assessment time points. No differences were observed in the baseline scores between the 2 groups. Physical function of "leak" patients was significantly worse at all postoperative assessment time points. At 6 and 12 months, their emotional and social function and overall quality-of-life scores were significantly decreased in comparison with the patients with an uncomplicated course. "Leak" patients experienced significantly more "stoma-related problems" and "sore skin" around the stoma site. Limited number of patients, restriction of follow-up to the end of the first year, and heterogeneity in terms of the presentation, severity, and management of anastomotic leaks were the limitations of this study. | Anastomotic leaks have an adverse effect on postoperative health-related quality of life. | closed_qa |
Does a history of suicide attempt predict higher antipsychotic dosage in schizophrenia? | Antipsychotic dosage is generally adjusted by physicians depending on the stability of the patient and the response to that particular drug. Our hypothesis is that patients with previous suicide attempt are prescribed higher doses of antipsychotics. We examined the dosage and patterns of antipsychotic use in regard to past suicidal behaviour. For this study, 304 subjects with schizophrenia spectrum disorders between the ages of 18 and 75 were recruited. A cross-sectional assessment was used for this study, in which data were collected from each patient through an interview and self-report questionnaires. The percentages of the Compendium of Pharmaceuticals and Specialties (CPS) maximum recommended daily dose were applied to standardize antipsychotic dosages across different treatments. We compared the standardized dosage of antipsychotics in schizophrenics with previous suicide attempts and those who have never attempted suicide. Applying the ANCOVA, our preliminary results show no significant difference (P = 0.467) in antipsychotic dosage in the attempters and non-attempters. The prescribed clozapine dosage fails to show a significant relationship with suicidal history (P >0.05). | In summary, our analysis does not show antipsychotic dosage adjustment based on past suicide attempt, after controlling for the current suicidal ideation and hopelessness. | closed_qa |
Breast clinic referrals: can mastalgia be managed in primary care? | Centralisation of breast cancer services in Ireland has resulted in a significant increase in the number of patients attending symptomatic breast units (SBU). A considerable proportion of patients referred to SBU present with non-suspicious symptoms and fall into a "low-risk" category for breast cancer. It has been proposed that consideration be given to a primary care-delivered service for these patients.AIM: To evaluate SBU attendances and correlate with diagnosis to identify a cohort of patients who may be suitable for management in the primary care setting. Data were collected from a prospectively maintained database on patients attending SBU at two tertiary referral centres (Beaumont Hospital and University College Hospital Galway) from January 2011 to 2012. Reasons for attendance, outcome of triple-assessment and incidence of malignancy were analysed. 14,325 patients underwent triple assessment at the SBU in this time period. 5,841 patients were referred with mastalgia, of whom 3,331 (57 %) reported mastalgia as the only symptom. The incidence of breast cancer in patients presenting with mastalgia alone was 1.2 %. All patients diagnosed with breast cancer in this cohort were over 35 years of age. | The incidence of breast cancer in patients referred to SBU with mastalgia as an isolated symptom is extremely low. Patients under 35 years of age, with mastalgia as an isolated symptom do not require breast imaging and have a sufficiently low risk of breast cancer that they may be suitable for management in the primary care setting. | closed_qa |
Is disorganized schizophrenia a predictor of treatment resistance? | To investigate whether inpatients with disorganized schizophrenia are more resistant to treatment. Eighty-five inpatients were assessed at admission and at discharge for schizophrenia subtype, symptom severity, and treatment resistance criteria. Disorganized patients were significantly more treatment-resistant than paranoid patients (60%, p = 0.001), and presented worse scores on the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI-S), and the Global Assessment of Functioning Scale (GAF) (p<0.001). Although the difference was not significant, 80% of treatment-resistant patients with disorganized schizophrenia responded to clozapine. | Patients with the disorganized subtype of schizophrenia should benefit from clozapine as a second-line agent. | closed_qa |
Is obesity a marker of robustness in vulnerable hospitalized aged populations? | The "obesity paradox" is poorly understood in vulnerable older hospitalized populations. To prospectively analyze the impact of body mass index (BMI) and comorbidities on early (6-week), one- and two-year mortality. Prospective multicenter study with a two-year follow-up of old patients participating in the SAFES cohort study. Nine university hospitals in France. Patients aged 75 or older hospitalized in medical divisions through the emergency department. Inpatients' characteristics were obtained through a comprehensive geriatric assessment of inpatients, conducted in the first week of hospitalization. All-cause mortalities at 6-week, one- and two-year were determined using bivariable and multivariable Cox proportional hazard model. The SAFES cohort included 1,306 patients, aged 85±6 years, with a majority of women (65%). One- and two-year mortality were inversely associated with BMI ≥30 kg/m2 while early mortality was not, and positively associated with age, burden of comorbidities, walking disorders, level of dependency and presence of a dementia syndrome. Survival rates between patients in low (<18.0 kg/m2) and intermediate (18-24.9 and 25-29.9 kg/m2) BMI categories were not significant. | While our findings seem to confirm the reality of the "obesity paradox" in vulnerable older hospitalized population, the exact understanding of underlying mechanisms and even the truthfulness of this paradoxical relationship are still fraught with considerable methodological, epidemiological and metabolic challenges. | closed_qa |
Does single ventricle physiology affect survival of children requiring extracorporeal membrane oxygenation support following cardiac surgery? | Improved survival with postoperative extracorporeal membrane oxygenation (ECMO) has expanded its application to children with single ventricle (SV) anomalies. We examine current-era outcomes of postoperative ECMO with special focus on patients with SV. Demographic, anatomic, surgical, and support details of 100 consecutive children requiring postoperative ECMO (2007-2012) were included into multivariable regression models to identify factors affecting survival. Median age was 73 days (4 days-16.2 years), 31 patients had SV physiology. The ECMO indication was failure to wean cardiopulmonary bypass (34%) and postoperative low cardiac output (66%) including 37% having extracorporeal cardiopulmonary resuscitation (ECPR). Median ECMO duration was four days (1-21). The ECMO decannulation and survival to hospital discharge were 62% and 37%. In SV group, decannulation and survival rates were 55% and 32%. The SV-ECMO outcomes were best in ECPR subgroup (54%), following shunt (57%) or Norwood (46%) and worst following Glenn, Fontan, or total anomalous pulmonary venous connection repair (0% survival). On multivariable analysis, factors affecting odds of survival were performing angiogram (odds ratio [OR]: 15.28, confidence interval [CI]: 2.34-99.89, P = .004), prolonged ECMO duration (OR: 0.64, CI: 0.47-0.88 per day, P = .005), leaving cannulation snares (OR: 28.41, CI: 2.65-304.70, P = .006), higher HCO3 (OR: 1.19, CI: 1.04-1.36, P = .01), renal failure requiring hemodialysis (OR: 0.21, CI: 0.06-0.76, P = .02), bleeding requiring re-exploration (OR: 0.21, CI: 0.06-0.75, P = .02), ECPR in patients with SV (OR: 11.84, CI: 1.11-126.07, P = .04), delayed lactate normalization (OR: 0.95, CI: 0.90-0.99 per hour, P = .02), and elevated liver enzymes (OR: 0.97, CI: 0.95-1.00 per 10 unit/L, P = .05). | The ECMO is valuable in patients with SV however results depend on anatomy, procedure, and support indication. Persistent markers of poor perfusion, end-organ injury, and prolonged ECMO duration are associated with mortality. Those factors could be modified by early ECMO application before organ damage, meticulous homeostasis to ensure adequate perfusion, early diagnosis, and reoperation on residual lesions to expedite weaning. | closed_qa |
Is health aid reaching the poor? | To determine the extent to which the narrowing of child mortality across wealth gradients has been related to foreign aid to the health sector in low- and middle-income countries. Mortality and wealth data on 989,901 under-5 children from 957,674 households in 49 aid recipient countries in Africa, Asia, South America, and the Caribbean between 1993 and 2012 were used in the analysis. Declines in under-5 mortality in the four poorest wealth quantiles were compared to the decline among the wealthiest at varying levels of health aid per capita using fixed effects multivariable regression models and controlling for maternal education, urbanization, and domestic spending on health among recipient countries. Each additional dollar in total health aid per capita was associated with 5.7 fewer deaths per 10,000 child-years among children in the poorest relative to the wealthiest households (p<0.001). This was also true when measured in percent declines (1.90% faster decline in under-5 mortality among the poorest compared with the wealthiest with each dollar in total health aid, p = 0.008). The association was stronger when using health aid specifically for malaria than total health aid, 12.60% faster decline among the poorest compared with the wealthiest with each dollar in malaria aid, p = 0.001. | Foreign aid to the health sector is preferentially related to reductions in under-5 mortality among the poorest compared with the wealthiest. Health aid addressing malaria, which imposes a disproportionate burden among the poor, may explain the observed effect. | closed_qa |
Do we need to detect isoniazid resistance in addition to rifampicin resistance in diagnostic tests for tuberculosis? | Multidrug-resistant tuberculosis (MDR-TB) is resistant to both rifampicin (RIF) and isoniazid (INH). Whereas many TB diagnostics detect RIF-resistance, few detect INH-monoresistance, which is common and may increase risk of acquired MDR-TB. Whether inclusion of INH-resistance in a first-line rapid test for TB would have an important impact on MDR-TB rates remains uncertain. a rapid molecular test for TB, the same test plus RIF-resistance detection ("TB+RIF"), and detection of RIF and INH-resistance ("TB+RIF/INH"). Our primary outcome was the prevalence of INH-resistant and MDR-TB at ten years. Compared to the TB test alone and assuming treatment of all diagnosed MDR cases, the TB+RIF test reduced the prevalence of MDR-TB among all TB cases from 5.5% to 3.8% (30.6% reduction, 95% uncertainty range, UR: 17-54%). Despite using liberal assumptions about the impact of INH-monoresistance on treatment outcomes and MDR-TB acquisition, expansion from TB+RIF to TB+RIF/INH lowered this prevalence only from 3.8% to 3.6% further (4% reduction, 95% UR: 3-7%) and INH-monoresistant TB from 15.8% to 15.1% (4% reduction, 95% UR: (-8)-19%). | When added to a rapid test for TB plus RIF-resistance, detection of INH-resistance has minimal impact on transmission of TB, MDR-TB, and INH-monoresistant TB. | closed_qa |
Bigger helpers in the ant Cataglyphis bombycina: increased worker polymorphism or novel soldier caste? | The mechanisms by which development favors or constrains the evolution of new phenotypes are incompletely understood. Polyphenic species may benefit from developmental plasticity not only regarding ecological advantages, but also potential for evolutionary diversification. For instance, the repeated evolution of novel castes in ants may have been facilitated by the existence of alternative queen and worker castes and their respective developmental programs. Cataglyphis bombycina is exceptional in its genus because winged queens and size-polymorphic workers occur together with bigger individuals having saber-shaped mandibles. We measured seven body parts in more than 150 individuals to perform a morphometric analysis and assess the developmental origin of this novel phenotype. Adults with saber-shaped mandibles differ from both workers and queens regarding the size of most body parts. Their relative growth rates are identical to workers for some pairs of body parts, and identical to queens for other pairs of body parts; critical sizes differ in all cases. | Big individuals are a third caste, i.e. soldiers, not major workers. Novel traits such as elongated mandibles are combined with a mix of queen and worker growth rates. We also reveal the existence of a dimorphism in the queen caste (microgynes and macrogynes). We discuss how novel phenotypes can evolve more readily in the context of an existing polyphenism. Both morphological traits and growth rules from existing queen and worker castes can be recombined, hence mosaic phenotypes are more likely to be viable. In C. bombycina, such a mosaic phenotype appears to function both for defense (saber-shaped mandibles) and fat storage (big abdomen). Recycling of developmental programs may have contributed to the morphological diversity and ecological success of ants. | closed_qa |
Does liver damage explain the inverse association between vitamin D status and mortality? | Several observational studies have linked vitamin D deficiency with an increased risk of all cause mortality. Vitamin D deficiency is common among patients with liver diseases. In a random sample of the general population, we investigated whether the inverse association between vitamin D status and all-cause mortality could be explained by liver damage as reflected by increased levels of liver enzymes. We included a total of 2649 persons examined in 1993e1994. Vitamin D status was assessed as serum 25-hydroxyvitamin D and liver enzyme levels were measured. Information on all-cause mortality was obtained from the Danish Central Personal Register until July 2011. Median follow-up time was 17.0 years, and there were 736 deaths. Multivariable Cox regression analyses with age as underlying time axis and delayed entry showed lower mortality risk with higher vitamin D levels and this was essentially unaffected by adjustment for liver enzyme levels with hazard ratio, 0.96 (95% confidence interval, 0.93e0.99) for a 10 nmol/L higher vitamin D level. | The present study did not support our hypothesis that the well-known association between low vitamin D status and mortality is explained by liver damage as reflected by levels of liver enzymes. | closed_qa |
Onsite provision of specialized contraceptive services: does Title X funding enhance access? | This article presents the extent to which providers enrolled in California's Family Planning, Access, Care, and Treatment (Family PACT) program offer contraceptive methods onsite, thus eliminating one important access barrier. Family PACT has a diverse provider network, including public-sector providers receiving Title X funding, public-sector providers not receiving Title X funding, and private-sector providers. We explored whether Title X funding enhances providers' ability to offer contraceptive methods that require specialized skills onsite. Data were derived from 1,072 survey responses to a 2010 provider-capacity survey matched by unique identifier to administrative claims data. A significantly greater proportion of Title X-funded providers compared to non-Title X public and private providers offered onsite services for the following studied methods: intrauterine contraceptives (90% Title X, 51% public non-Title X, 38% private); contraceptive implants (58% Title X, 19% public non-Title X, 7% private); vasectomy (8% Title X, 4% public non-Title X, 1% private); and fertility-awareness methods (69% Title X, 55% public non-Title X, 49% private) (all p<0.0001). The association between onsite provision and Title X funding remained after stratifying individually by clinic specialty, facility capacity to provide reproductive health services (based on staffing), and rural/urban location. | Extra funding for publicly funded family-planning programs, through mechanisms such as Title X, appears to be associated with increased onsite access to a wide range of contraceptive services, including those that require special skills and training. | closed_qa |
Predicting women at risk for developing obstetric fistula: a fistula index? | To ascertain if a predictor of obstructed labour and obstetric fistula (OF) occurrence could be devised. Observational study of two cohorts. Selian Lutheran Mission Hospital, Arusha, Tanzania and Aberdeen Women's Centre, Freetown, Sierra Leone. All women presenting with OF caused by obstructed labour and all women having a normal vaginal delivery (NVD) at both institutions were eligible for the study. All women with OF and those delivering normally had their height in centimetres measured and their intertuberous space measured by the number of examiner's knuckles admitted. The dimensions for OF and normal delivery were examined individually and multiplied to gain a 'fistula index'. Dimensions and index were compared statistically between OF and NVD women using t tests. Sensitivity, specificity and predictive values from receiver operating characteristic curves were obtained for predicting OF. There were statistical differences between the groups with OF women being significantly shorter, having a smaller intertuberous space and lower fistula index than those undergoing NVD (each P<0.001). Sensitivity was high for fistula index ≤ 507.5 (94.9%, 95% confidence interval 83.1-98.6%) and for intertuberous space of at least three knuckles (92.3%, 95% CI 79.7-97.3%) alone. | A simple antenatal measurement of intertuberous space could screen those women at higher risk of needing medical intervention to prevent OF. | closed_qa |
Can diagnostic injections predict the outcome in foot and ankle arthrodesis? | Intra-articular anesthetic drug injections are claimed to confirm the localization of the pain in order to treat the pain. The aim of the present study was to evaluate whether a positive effect of injection could be indicative for a successful outcome of future arthrodesis. 74 Patients underwent fluoroscopically guided and contrast confirmed anesthetic joint injections for diagnostic reasons. Before and after injection, pain was measured by use of the Visual Analogue Scale (VAS) in rest and after exercise. Pain reduction was expressed as delta VAS (dVAS). Also, the Foot Function Index (FFI) was obtained. Based on the effect of the diagnostic injection and various clinical factors, patients were advised a conservative treatment (conservative group, n = 34) or an arthrodesis of the affected joint (operative group, n = 40). After a median follow-up period of 3.6 years (range 2.1 to 4.3 years) patients were again invited to complete the FFI and VAS in rest and after exercise. For data-analysis purposes the patients were assigned to four different groups, based on the result of injection and the occurrence of surgery. Wilcoxon signed rank tests and Mann Whitney U tests were used for statistical analysis. Based on the analysis of the four groups we found that surgery, irrespective of the presence of pain reduction after injection, was related to improvement of VAS and FFI. Patients with conservative treatment always showed worse VAS and FFI scores, even when previous injections showed an improvement of VAS. | Fluoroscopically-guided anesthetic injections of the supposed painful foot-ankle joint seem not to be indicative for a successful outcome of an arthrodesis of the affected joint. However, the sole occurrence of surgery shows a significant difference in VAS and FFI scores, where conservative treatment does not. The local hospital review board granted permission for this study. Ethical approval was not required for this study. | closed_qa |
Metformin usage in type 2 diabetes mellitus: are safety guidelines adhered to? | This retrospective study reviewed all patients with a diagnosis of T2DM and taking metformin who was admitted to a major teaching hospital over an 8-month period. Data including demographics, medical conditions, medications at admission and discharge, and relevant pathology results were extracted from medical records. A total of 301 patients (209 medical patients, 92 surgical patients) taking metformin were included. According to guidelines, approximately 31% and 21% of patients received metformin inappropriately (in the presence of contraindications or in excessive dosage) at admission and discharge, respectively. At admission, 65 patients (n = 301, 21.6%) on metformin had at least one contraindication to its use, and 42 patients (n = 254, 16.5%) were prescribed an excessive dosage according to their renal function. At discharge, 43 patients (n = 301, 14.3%) continued on metformin with at least one contraindication and 21 patients (n = 191, 11%) received an excessive dosage according to their renal function. Four patients had evidence of LA (plasma lactate concentration>5.0 mmol/L and pH<7.35) without clinical diagnosis. | Metformin was often used in patients with contraindications to its use, or in higher than recommended dosages. Reconsideration of the official prescribing information for metformin may be warranted as the risk of harm appears to be very low. | closed_qa |
Process evaluation of a task-shifting strategy in hormonal contraception: does training translate into practice? | Since 2000, the Province of Quebec has experienced a shortage of physicians and a decrease in access to prescription contraceptives. A task-shifting strategy was launched in 2007 to allow trained nurses, in collaboration with community pharmacists, to start healthy women on hormonal contraception for a six-month period without a medical consultation. This study examined the proportion of trained nurses effectively involved in this innovative practice to determine which factors are associated with it. We performed a cross-sectional study in which all nurses who had been trained in hormonal contraception since 2007, who were registered with the College of Nurses of Quebec, and who were employed as nurses in the Quebec Health System were asked to respond to a postal or electronic survey. A total of 3043 nurses were invited to participate in the study. Fifty-seven percent (57.3%) of 745 respondents were involved in this new practice. The major determinant was the adoption of the Collaborative Agreement in Hormonal Contraception by health organizations. The other influential factors were having been trained before 2011, being a permanent employee, working in a youth clinic of a centre for health and social services, and working in a rural or remote area. | Despite a modest response rate, this study provides support for formalizing the training of nurses in hormonal contraception by integrating it into nursing education at all levels, and for implementing it in other health organizations such as family medicine groups, which are widespread in Quebec. | closed_qa |
Does the presence of glenoid bone loss influence coracoid bone graft osteolysis after the Latarjet procedure? | Coracoid bone graft osteolysis and fibrous union are the principal causes of failure in patients treated with the Latarjet procedure. This study aims to investigate the hypothesis that coracoid bone graft osteolysis is more pronounced in cases without glenoid bone loss, which may be due to a diminished mechanotransduction effect at the bone healing site. We prospectively followed up 34 patients, treated with a mini-plate Latarjet procedure, divided into 2 groups (group A patients had glenoid bone loss>15% and group B patients had no glenoid bone loss). A computed tomography scan evaluation with 3-dimensional reconstruction was then performed on all patients to evaluate coracoid bone graft osteolysis according to our coracoid bone graft osteolysis classification. The computed tomography scan analysis showed a different distribution of osteolysis between group A and group B. The statistical analysis showed a significant difference (P<.01, Bonferroni test) between groups A and B for the following sections: proximal/lateral/superficial, proximal/medial/deep, distal/lateral/superficial, and distal/lateral/deep. On average, the coracoid grafts in group A patients showed less osteolysis than the coracoid grafts in group B patients (39.6% vs 65.1%). The coracoid bone graft underwent much less osteolysis in patients with significant glenoid bone loss (>15%) than in those without it. Because factors of blood supply, compression, and surgical technique were the same for both groups, we believe that the mechanotransduction effect from the humeral head on the graft influences its remodeling. | The results of this study suggest that the bone graft part of the Latarjet procedure plays a role in patients with significant coracoid bone loss but much less so when there is no bone loss. | closed_qa |
Is oral chemotherapy prescription safe for patients? | Oral chemotherapies are increasingly prescribed. Yet wide variations in prescription practices and in monitoring of toxicity have been underlined despite existing guidelines. There is little recent information available as regard to these practices. We aimed to obtain exhaustive information on oral chemotherapy prescription practices and safety monitoring in French hospitals. A cross-sectional multicentre survey was carried out to collect information on drug prescription, administration and surveillance: prescribing practices, coordination and monitoring of adherence, safety monitoring and side-effects occurrence prevention. Participants were a large sample of the French oncologists prescribing oral chemotherapy (20%). One hundred and fifty-seven oncologists from 112 hospitals (public, comprehensive cancer centres and private) replied (23.7% of cancer hospitals). The majority (56.1%) of the prescriptions were hand-written on a blank sheet. Eighty-four physicians (53.5%) included dose information and 36 (23%) declared having no monitoring procedures for adherence. Only 84 responders (54%) provided education material at first prescription of oral chemotherapy in way to limit avoidable side-effects. Sixty-one (39%) responders stated that they recalled at least one serious adverse event in the previous year declared in their centre. | In this 2012 study, the majority of prescribers followed no standards in prescription writing, safety monitoring and toxicity prevention. The implementation of the international recommendations for oral chemotherapy administration should be considered as a top priority-for both prescribers and health authorities-as regards to the dynamic of development of these molecules and their potential side-effects. | closed_qa |
Computer-designed PEEK implants: a peek into the future of cranioplasty? | Polyetheretherketone (PEEK) is a synthetic material that was used initially in spine and hip surgery. It has the properties of being biocompatible, resistant to thermal and ionizing radiation, and resembles cortical bone biomechanically. These favorable characteristics have led to the increasing use of PEEK implants for calvarial defects which remain a significant reconstructive challenge. This study is a retrospective review of patients who underwent PEEK cranioplasty by a single surgeon. PEEK implants were fashioned from high-resolution CT scans of each patient and sterilized preoperatively before cranioplasty was performed using standard techniques. The mean follow-up period was 7 months (range 1-22). Twelve consecutive patients (75% males; mean age = 43, range 16-67) underwent PEEK cranioplasty between January 2011 and December 2012 after a mean time interval of 10 months (range 3-40) following initial craniectomy. The mean defect size was 11 × 8 cm (range 7 × 6 to 14 × 8 cm) and no additional contouring of PEEK implants was necessary intraoperatively. The scalp was closed primarily in all patients, and no complications of implant breakdown, wound infection, or cerebrospinal fluid leak were appreciated during follow-up. | Computer-designed, patient-specific PEEK implants for cranioplasties are a viable alternative when autologous bone grafts are unavailable or unsuitable. Such prefabrication reduces operative times through minimal to no intraoperative adjustments. Although initial results are promising, longer-term follow-up and further comparative studies including randomized control trials to evaluate outcomes between different alloplastic materials for cranioplasty are necessary. | closed_qa |
Using commercial video games for falls prevention in older adults: the way for the future? | Falls in older adults are an increasingly costly public health issue. There are many fall prevention strategies that are effective. However, with an increasing population of older people and ever-decreasing availability of health practitioners and health funding, novel modes of intervention are being developed, including those relying on computer technologies.The aim of this article was to review the literature on the use of exergaming to prevent falls in older adult persons living in the community. The Cochrane, Medline, and Embase databases were searched using prespecified search terms. To be included, studies had to investigate the effect of using commercially available consoles and video games on outcome measures such as a decrease in falls, improvements in balance control or gait parameters, decreased fear of falling, and attitude to exercise in older adult persons living in the community. All study designs with the exception of single-person case studies were included. Articles had to be published in peer-reviewed journals in the English language. Nineteen studies fulfilled the inclusion criteria. The following outcomes were observed: (1) using computer-based virtual reality gaming for balance training in older adults was feasible; (2) the majority of studies showed a positive effect of exergaming on balance control; (3) some studies showed a positive effect on balance confidence and gait parameters; (4) the effect was seen across the age and sex spectrum of older adults, including those with and without balance impairment. | There is as yet no evidence that using virtual reality games will prevent falls, but there is an indication that their use in balance training may improve balance control, which in turn may lead to falls prevention. | closed_qa |
Does upper limb coordination predict walking speed in older adults? | Walking speed is a measure of physical function in older adults. Older adults are sometimes nonambulatory, however, and proxy measures for walking speed may be indicated. Since limb coordination tests can be conducted in non-weight-bearing positions, they may provide that capability. The purpose of this study was to examine the relationship between timed limb coordination and preferred and maximum walking speed, controlling for other known determinants of walking speed. A total of 84 healthy adults (60 women and 24 men) older than 60 years participated. Preferred and maximum walking speed were measured during 10-Meter Walk Tests. Upper limb coordination performance was measured during a timed 5-repetition finger-to-nose test. Other variables measured included isometric knee extension strength, cognition (Montreal Cognitive Assessment), limits of stability (Functional Reach Test), the number of comorbidities (Functional Comorbidity Index), age, height, and sex. Multiple regression and partial correlation analyses (α = .05) were used to identify which variables predicted preferred and maximum walking speed, controlling for all other variables. Participants' mean preferred walking speed was 129 (24) cm·s⁻¹, and mean maximum walking speed was 176 (37) cm·s⁻¹. Finger-to-nose coordination performance, 4.8 (1.3) seconds, correlated negatively with preferred (r = -0.403) and maximum (r = -0.429) walking speed. Those bivariate correlation coefficients, however, were attenuated by other variables in the regression models (partial r = -0.031, P = .786, and partial r = -0.075, P = .513, for preferred and maximum walking speed, respectively). Variance in age, comorbidities, functional reach, knee extension strength, and height accounted for 55.4% of the variance in preferred walking speed. Variance in knee extension strength, cognition, functional reach, age, and comorbidities accounted for 63.5% of the variance in maximum walking speed. After removing knee extension strength and functional reach from the models--those variables that may be difficult or contraindicated to measure in some patient populations--finger-to-nose coordination was not a statistically significant predictor of preferred walking speed. Variance in age, comorbidities, cognition, height, and finger-to-nose coordination accounted for 55.9% of the variance in maximum walking speed. The change in R² attributed to finger-to-nose coordination performance, however, was only 2.9%. While knee extension strength, functional reach, comorbidities, and age were most predictive of walking speed, after removing knee extension strength and functional reach from the regression models, finger-to-nose coordination remained a potentially modifiable marker of neuromuscular control that only weakly predicted maximum walking speed in older adults. | The timed finger-to-nose test would not appear to be a valid proxy for walking speed when weight-bearing clinical examination procedures are contraindicated. | closed_qa |
Do physicians disclose uncertainty when discussing prognosis in grave critical illness? | Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. We included physicians and surrogates of 12 incapacitated, critically ill patients. We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. | We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. | closed_qa |
Could the Food Neophobia Scale be adapted to pregnant women? | The Food Neophobia Scale (FNS) is widely used in different countries, however appropriate psychometric analyses are required to allow cross-cultural comparisons. To our knowledge, most studies have been conducted among children and adult populations, with no reference to pregnant women. The objective of this study was to translate and test the psychometric properties of a Portuguese version of the FNS, and to identify clusters of food neophobia during pregnancy. The FNS was translated into Portuguese by three health researchers, and back-translated into English by an independent native English speaker and professional translator. The scale was self-administered in a sample of 219 women from the baseline evaluation of the Taste intervention study (HabEat project: http://www.habeat.eu/), who attended medical visits in two hospitals from Porto, Portugal, reporting food neophobia during the last trimester of pregnancy. The FNS consists of 10 items with a 7-point rating scale. An exploratory analysis was performed to evaluate the scale's dimensionality, followed by a confirmatory factor analysis to test the fit of the previous model by using different indexes. Cronbach's alpha coefficient was calculated to evaluate the internal reliability of the scale. The construct validity was assessed by comparing the FNS scores by categories of education, age and fruit and vegetables intake by ANOVA. A Model-based clustering was used to identify patterns of food neophobia; the number of latent classes was defined according to the Bayesian information criterion. A two-factor model solution was obtained (after excluding item 8 with a factor loading<0.4), explaining 51% of the total variance. Cronbach's alpha was 0.75 for factor 1 (5 items) and 0.71 for factor 2 (4 items). Items 1, 4, 6, 9 and 10 loaded into the first factor (i.e. more willingness to try new foods; less neophobic traits) and items 2, 3, 5 and 7 loaded into a second factor (i.e. more neophobic traits). A good global of fitness of the model was confirmed by fit indexes: TLI=0.876, CFI=0.911, RMSEA=0.088 and SRMR=0.051. The higher the education, age, and fruit and vegetables intake the lower the neophobic tendency, measured by the Portuguese FNS. Three patterns (i.e. clusters) of food neophobia, characterizing neophobia traits of pregnant women were identified: Moderate Neophilic, Moderate Neophobic, and Extreme Neophilic (cut-off points were provided). | The Portuguese version of the FNS has the basic requirements of a valid and reliable measure of food neophobia and permits the identification of clusters of neophobic traits during pregnancy. | closed_qa |
Is antiepileptic drug withdrawal status related to quality of life in seizure-free adult patients with epilepsy? | This study aimed to determine factors that influence the quality of life (QOL) of seizure-free adult patients with epilepsy in western China and address whether these determinants vary by antiepileptic drug (AED) withdrawal. A cross-sectional study was conducted in the epilepsy outpatient clinic of West China Hospital, Sichuan University. Patients with epilepsy who were aged at least 18years and seizure-free for at least 12months were interviewed using the Quality of Life in Epilepsy Inventory-31 (QOLIE-31); the National Hospital Seizure Severity Scale (NHS3); the Liverpool Adverse Events Profile (LAEP); the Social Support Rating Scale (SSRS); the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Questionnaire; and the Scale of Knowledge and Attitudes Toward Epilepsy. Eligible patients were divided into two groups: the nonwithdrawal group and the withdrawal group. The independent-samples t-test was used to compare the QOL between the groups, and linear regression analysis was used to explain the variance of their QOL. One hundred and eighty-seven (135 nonwithdrawal and 52 withdrawal) patients were included in the analysis. The QOLIE-31 overall score of the nonwithdrawal group was lower than that of the withdrawal group (p<0.01). The LAEP score was the strongest predictor of the QOLIE-31 overall score of all subjects, explaining 26.9% of the variance. The second strongest predictor was the SSRS score, explaining 12.9%, and the other predictors were the NHS3 score (5.2%), education level (2.3%), age (1.5%), and marriage (1.0%). Furthermore, the strongest predictors in the nonwithdrawal group were the LAEP and SSRS scores, while in the withdrawal group, the strongest predictors were stigma scores and employment. | Among the seizure-free adult patients with epilepsy, those with AED withdrawal experienced better QOL than those continuing AED treatment. Furthermore, the determinants of QOL varied by AED withdrawal. Individual strategies to optimize QOL should be developed based on these differences. | closed_qa |
Do young patients have different clinical presentation of colorectal cancer causing delay in diagnosis? | The incidence of colorectal cancer is increasing among young patients. In these patients, colorectal cancer is believed to have a poorer prognosis because it is more aggressive and diagnosed at later stages; however, the behavior of these tumors in young patients remains to be elucidated. We investigated the impact of time interval between onset of symptoms and diagnosis (TISD) at the pathologic stage of colorectal cancer in young patients. The medical records of 215 patients with colorectal adenocarcinoma were reviewed. Patients were divided into two groups according to age. The young group (age < 50 years) consisted of 66 patients, and the older group (age ≥ 50 years) of 149 patients. Clinical variables, TISD, pathologic stage, operative mortality, and oncologic outcomes were compared between groups. The older group had less abdominal pain (74.0 vs. 56.0 %, p = 0.0129). In multivariate analysis, the following variables were independently associated with tumor pathologic stage: personal history of inflammatory bowel disease (p < 0.0001), family history of familial adenomatous polyposis (p = 0.00100), and smoking (p = 0.0070). Both groups had similar rates regarding pathologic stage (I, 15 vs. 22 %; II, 22 vs. 24 %; III, 27 vs. 16 %; IV, 37 vs. 38 %, p = 0.3380). There was no difference in overall survival [45 (69 %) vs. 84 (61 %), p = 0.2482] and cancer-free survival [36 (63 %) vs. 83 (62 %), p = 0.9218]between groups. | Young patients with colorectal cancer had clinical and pathological presentation similar to that of older patients. | closed_qa |
Can smaller-scale comprehensive cancer centers provide outstanding care in abdominal and thoracic pediatric solid tumor surgery? | Quality of care and its measurement represent a considerable challenge for pediatric smaller-scale comprehensive cancer centers (pSSCC) providing surgical oncology services. It remains unclear whether center size and/or yearly case-flow numbers influence the quality of care, and therefore impact outcomes for this population of patients. We performed a 14-year, retrospective, single-center analysis, assessing adherence to treatment protocols and surgical adverse events as quality indicators in abdominal and thoracic pediatric solid tumor surgery. Forty-eight patients, enrolled in a research-associated treatment protocol, underwent 51 cancer-oriented surgical procedures. All the protocols contain precise technical criteria, indications, and instructions for tumor surgery. Overall, compliance with such items was very high, with 997/1,035 items (95 %) meeting protocol requirements. There was no surgical mortality. Twenty-one patients (43 %) had one or more complications, for a total of 34 complications (66 % of procedures). Overall, 85 % of complications were grade 1 or 2 according to Clavien-Dindo classification requiring observation or minor medical treatment. Case-sample and outcome/effectiveness data were comparable to published series. Overall, our data suggest that even with the modest caseload of a pSSCC within a Swiss tertiary academic hospital, compliance with international standards can be very high, and the incidence of adverse events can be kept minimal. | Open and objective data sharing, and discussion between pSSCCs, will ultimately benefit our patient populations. Our study is an initial step towards the enhancement of critical self-review and quality-of-care measurements in this setting. | closed_qa |
Reproductive endocrine health in pubertal females with epilepsy on antiepileptic drugs: time to screen? | Although previous studies suggest that valproate (VPA) may induce reproductive endocrine disorders, the effects of newer antiepileptic drugs (AEDs) on reproductive endocrine health have not been widely investigated and compared with those of older AEDs. Therefore, this multicenter cross-sectional study aimed to evaluate the prevalence of reproductive endocrine dysfunctions in pubertal females with epilepsy receiving VPA, lamotrigine (LTG), or levetiracetam (LEV) monotherapy. Pubertal girls on VPA (n = 11), LTG (n = 8), or LEV (n = 13) monotherapy for at least 6 months were recruited. Healthy sex-matched and age-matched subjects were enrolled as controls (n = 32). Each participant underwent a comprehensive physical examination concerning signs of hyperandrogenism. The Ferriman-Gallwey score of hirsutism was assessed. In addition, all patients completed a standardized questionnaire regarding epilepsy, menstrual cycle, and hirsutism features. Adiposity indices were measured and weight gain was documented for each subject. Hirsutism score, occurrence of hyperandrogenism features, and adiposity indices were significantly higher in the VPA group when compared with LEV and control groups. VPA therapy was more frequently associated with weight gain when compared with LTG and controls, whereas no significant differences with regard to signs of hyperandrogenism were found between VPA and LTG groups. Furthermore, no differences in menstrual disorders were observed between groups. | Pubertal girls with epilepsy receiving VPA monotherapy were more likely to develop signs of hyperandrogenism, that is, hirsutism and acanthosis, than those on LEV or controls. However, no differences in occurrence of menstrual disorders and other reproductive dysfunctions were found between VPA, LTG, LEV, and control groups. These findings do not allow us to clearly determine whether or not VPA, LEV, and LTG monotherapies considerably affect reproductive endocrine health in pubertal girls with epilepsy. Therefore, further prospective studies of larger sample sizes are needed to establish if screening tests should be recommended. | closed_qa |
Prospective evaluation of 18F-fluorodeoxyglucose positron emission tomography-computed tomography for response evaluation in recurrent carcinoma cervix: does metabolic response predict survival? | This study aimed to assess the role of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) in response assessment of patients with recurrent carcinoma cervix and in evaluating the predictive value of metabolic response for progression-free survival (PFS) and overall survival (OS). Thirty-six patients with histopathologically or clinically evident recurrent cervical carcinoma underwent a pretherapy and a posttherapy (18)F-FDG PET-CT for treatment response evaluation. Positron emission tomography-CT images were analyzed by 2 experienced nuclear medicine physicians. Response was categorized using European Organization for Research and Treatment of Cancer (EORTC) criteria into complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD). Clinical/imaging follow-up (minimum of 6 months) and/or histopathologic findings were taken as reference standard. Patients were categorized into 2 groups, those with PMD and those without PMD (ie, CMR, PMR, and SMD). Progression-free survival and OS based on PET-CT response were measured from the date of posttherapy PET-CT to the first documentation of progression of disease and death, respectively. On the basis of metabolic response on posttherapy PET-CT, 6 patients had CMR, 12 patients had PMR, 7 patients had SMD, and 11 patients had PMD. Progression-free survival for patients with cervical carcinoma ranged from 0.5 to 26.5 months (mean [SD], 6.7 [6.1]months). Median PFS for patients with PMD was 3.1 months, whereas median PFS for those without PMD was not reached. Patients who did not show PMD on posttherapy PET-CT had a significantly better PFS than those patients who showed PMD (P<0.0001; HR, 0.14). There was no statistically significant difference in OS between the 2 groups (P = 0.187; HR, 0.39). | (18)F-fluorodeoxyglucose PET-CT is an effective tool for treatment response evaluation in recurrent carcinoma cervix. Patients with metabolically progressive disease on posttherapy (18)F-FDG PET-CT have a significantly shorter PFS. | closed_qa |
Is the area under an ROC curve a valid measure of the performance of a screening or diagnostic test? | The area under a receiver operating characteristic (ROC) curve (the AUC) is used as a measure of the performance of a screening or diagnostic test. We here assess the validity of the AUC. Assuming the test results follow Gaussian distributions in affected and unaffected individuals, standard mathematical formulae were used to describe the relationship between the detection rate (DR) (or sensitivity) and the false-positive rate (FPR) of a test with the AUC. These formulae were used to calculate the screening performance (DR for a given FPR, or FPR for a given DR) for different AUC values according to different standard deviations of the test result in affected and unaffected individuals. The DR for a given FPR is strongly dependent on relative differences in the standard deviation of the test variable in affected and unaffected individuals. Consequently, two tests with the same AUC can have a different DR for the same FPR. For example, an AUC of 0.75 has a DR of 24% for a 5% FPR if the standard deviations are the same in affected and unaffected individuals, but 39% for the same 5% FPR if the standard deviation in affected individuals is 1.5 times that in unaffected individuals. | The AUC is an unreliable measure of screening performance because in practice the standard deviation of a screening or diagnostic test in affected and unaffected individuals can differ. The problem is avoided by not using AUC at all, and instead specifying DRs for given FPRs or FPRs for given DRs. | closed_qa |
Living alone and psychological well-being in mid-life: does partnership history matter? | Previous studies have found that the duration since a union dissolution and the number of union dissolutions are associated with psychological well-being. However, these two aspects of partnership history have rarely been considered jointly in models of mental health. This study aims to investigate how the time since the most recent union dissolution and the number of union dissolutions are related to two indicators of psychological well-being-life satisfaction and the General Health Questionnaire-among middle-aged solo-living British men and women. Data from the United Kingdom Household Longitudinal Study from 2009 to 2010 are analysed for 1201 50-64 year olds who were living alone and have ever been in a co-resident union (472 men and 729 women). Logistic regression analysis is used to investigate how life satisfaction and General Health Questionnaire 12 (GHQ-12) caseness are associated with partnership characteristics. GHQ-12 caseness is significantly and positively associated with the number of union dissolutions and negatively with the duration since the most recent union dissolution. This is the case among both genders, in models in which these partnership characteristics are entered separately and jointly, and in models controlling for parenthood status, socioeconomic status and physical health. | The results suggest that there is a short-term deterioration in mental health after a partnership break-up and that experiencing multiple union dissolutions is detrimental for psychological well-being. The association between partnership characteristics and the two measures of psychological well-being differs, which is in line with previous research showing that negative affect and life satisfaction are two separate constructs. | closed_qa |
Is the macromolecule signal tissue-specific in healthy human brain? | The macromolecule signal plays a key role in the precision and the accuracy of the metabolite quantification in short-TE (1) H MR spectroscopy. Macromolecules have been reported at 1.5 Tesla (T) to depend on the cerebral studied region and to be age specific. As metabolite concentrations vary locally, information about the profile of the macromolecule signal in different tissues may be of crucial importance. The aim of this study was to investigate, at 7T for healthy subjects, the neurochemical profile differences provided by macromolecule signal measured in two different tissues in the occipital lobe, predominantly composed of white matter tissue or of grey matter tissue. White matter-rich macromolecule signal was relatively lower than the gray matter-rich macromolecule signal from 1.5 to 1.8 ppm and from 2.3 to 2.5 ppm with mean difference over these regions of 7% and 12% (relative to the reference peak at 0.9 ppm), respectively. The neurochemical profiles, when using either of the two macromolecule signals, were similar for 11 reliably quantified metabolites (CRLB < 20%) with relatively small concentration differences (<0.3 μmol/g), except Glu (± 0.8 μmol/g). | Given the small quantification differences, we conclude that a general macromolecule baseline provides a sufficiently accurate neurochemical profile in occipital lobe at 7T in healthy human brain. | closed_qa |
Ferritin in dialysis-related arthropathy: could it be a possible biochemical indicator of articular chronic pain? | The aim of our study was to evaluate laboratory data behaviour in two dialysis populations, with and without dialysis-related arthropathy and pain. We produced an elaboration of more than 160,000 items of biochemical data of 25 dialysis-related arthropathy patients with chronic articular pain, and 25 patients asymptomatic for joint pain and arthropathy. The pain visual analogue scale (VAS) was employed for pain intensity determination. The serum level of β-2 microglobulin was similar in the two groups of patients, while ferritin values were significantly higher in symptomatic patients. We excluded the possibility that the ferritin difference between the two groups was due to different iron storage and to an inflammatory profile. Furthermore, the pain VAS mean value was higher in patients who had higher ferritin and pain than in asymptomatic patients. | It is important to underline that the higher value of ferritin in patients with chronic pain due to dialysis- -related arthropathy could represent a new stimulus for a deeper investigation of this indicator, setting a periodic revelation of pain intensity. | closed_qa |
Fluridone: a combination germination stimulant and herbicide for problem fields? | Problem weeds in agriculture, such as Lolium rigidum Gaud., owe some of their success to their large and dormant seed banks, which permit germination throughout a crop-growing season. Dormant weed seed banks could be greatly depleted by application of a chemical that stimulates early-season germination and then kills the young seedlings. Fluridone, a phytoene desaturase-inhibiting herbicide that can also break seed dormancy, was assessed for its efficacy in this regard. The germination of fluridone-treated Lolium rigidum seeds was stimulated on soils with low organic matter, and almost 100% seedling mortality was observed, while the treatment was only moderately effective on a high-organic-matter potting mix. Seedlings from wheat, canola, common bean and chickpea seeds sown on fluridone-treated sandy loam were bleached and did not survive, but lupins and field peas grew normally. | This proof-of-concept study with fluridone suggests that it may be possible to design safe and effective molecules that act as germination stimulants plus herbicides in a range of crop and soil types: a potentially novel way of utilising herbicides to stimulate seed bank germination and a valuable addition to an integrated weed management system. | closed_qa |
Pregnancy with oocytes characterized by narrow perivitelline space and heterogeneous zona pellucida: is intracytoplasmic sperm injection necessary? | This retrospective study analyzed fertilization protocols and pregnancy outcomes for oocytes with with narrow perivitelline space and heterogeneous zona pellucid (NPVS/HZP). In 63 in-vitro fertilization cycles filled with NPVS/HZP oocytes (abnormal oocytes group) and 521 cycles with normal oocytes (normal oocytes group), major clinical and laboratory parameters were recorded and compared in different fertilization cycles (conventional IVF cycles, rescue ICSI cycles, and traditional ICSI cycles). NPVS/HZP oocytes meant lower MIIoocytes rates in both IVF and ICSI cycles compared with normal oocytes (p<0.05). The 2PN rates for abnormal oocytes were significantly lower than those for normal oocytes in both conventional IVF cycles (58.8% VS 71.3%, P<0.05) and rescue ICSI cycles (58.0% VS 78.0%, P = 0.0000). The high-quality embryo rates in normal oocytes groups were significantly higher than those in abnormal oocytes groups in different fertilization cycles (52.2% VS 35.0%, P<0.01; 42.9% VS 23.9%, P<0.001; 50.6% VS 31.0%, P = 0.0000, respectively). No clinical pregnancy was obtained from abnormal oocytes in 11 conventional IVF cycles. The clinical pregnancy rates in rescue ICSI and traditional ICSI cycles were comparatively lower in abnormal oocytes groups, but there was no significant difference as compared with normal oocytes groups (35.0% VS 48.1% and 26.7% VS 50.7%, P>0.05, respectively). | Retrieval of oocytes characterized by NPVS/PZP from cycle to cycle was one of the reasons for obscure infertility. ICSI may be the right way to avoid fertilization failure and get pregnancy in women with NPVS/HZP oocytes. | closed_qa |
Do body mass index and fat volume influence vocal quality, phonatory range, and aerodynamics in females? | To analyze the impact of body weight and body fat volume on selected parameters of vocal quality, phonatory range, and aerodynamics in females. Based on measurements of body mass index in combination with body fat volume, 29 normophonic female subjects were classified as normal weight, underweight, and obese. Voice quality was investigated via auditory-perceptual ratings of breathiness, roughness, and overall dysphonia severity, via various acoustic measures and a multiparametric index. Phonatory range performance was examined using selected measures of the voice range profile and speech range profile. Measures of vocally relevant aerodynamics included vital capacity (i.e., VC), expected VC, phonation quotient, and maximum phonation time (i.e., MPT). Significant differences between the three weight groups were found across several measures of intensity, VC, MPT, and shimmer. As compared to the other groups, significantly higher values of maximum and minimum intensity levels, as well as sound pressure level during habitual running speech were observed for the obese group (all p-values<0.05); whereas, the underweight group had significantly lower values for VC and ratio of expected to measured VC (p-values<0.01). Furthermore, underweight subjects differed significantly as compared to normal weight subjects with lower MPT (p=0.025) and higher lowest-F0 (p=0.035). Finally the obese group showed significantly lower shimmer values than the normal weight subjects (p<0.05). | Body weight and body fat volume appear to influence select objective measures of voice quality, vocal aerodynamics, and phonatory range performance. | closed_qa |
Is urinary incontinence the hidden secret complications after total hip arthroplasty? | We hypothesized that posterior approach (PA) dissecting the short external rotators and anterior approach (AA) not dissecting these have different influences on the pelvic floor muscles and subsequently affect urinary incontinence. The objective of this study was to investigate whether AA advantageously influences symptoms of urinary incontinence. The subjects were 76 female patients who underwent their primary total hip arthroplasty. The presence or absence of urinary incontinence before and after surgery was surveyed by a direct interview at the time of outpatient examination within a period from 1.5 year after surgery using the international consultation on incontinence questionnaire-short form. Urinary incontinence improved after surgery in eight patients (22.2%), slightly improved in one (2.8%), remained unchanged in 26 (72.2%), slightly aggravated in one (2.8%) in the AA group. In the PA group, urinary incontinence improved after surgery in one (2.5%), remained unchanged in 30 (75%), slightly aggravated in four (10%), and aggravated in five (12.5%). Symptoms of urinary incontinence were significantly improved in the AA group and aggravated in the PA group (Mann-Whitney U test, P = 0.0057). | As the anatomical characteristic of the short external rotators, the root of the internal obturator muscle is connected to the levator ani muscle. Among the pelvic floor muscles, this levator ani muscle is closely involved in supporting the pelvic organs. Since the short external rotators may have been atrophied due to hip joint dysfunction before surgery, if the strength of this muscle group recovers, support of the pelvic organs and urinary incontinence may be improved. It was assumed that surgery through AA improved external rotation contracture of the hip joint and leg length, which increased tension of the internal obturator muscle, with which tension of the pelvic floor muscle also increased and improved urinary incontinence. | closed_qa |
Does retirement reduce the risk of myocardial infarction? | Recent studies have suggested that retirement may have beneficial effects on health outcomes. In this study we examined whether the risk of myocardial infarction (MI) was reduced following retirement in a Danish population sample. Participants were 617 511 Danish workers, born between 1932 and 1948, entering the study at the age of 60, without previous known incidents of ischaemic heart disease. Information on retirement and MI were obtained from Danish national registers. A Cox proportional hazard model was used to address the relation between retirement and onset of MI, while adjusting for age, sex, income, occupational position, education, cohabitation and immigrant status. The participants were followed for up to 7 years. Of the study population, 3% were diagnosed with MI during follow-up. Retirement was associated with a modestly higher risk of MI with a hazard ratio of 1.11 (95% confidence interval: 1.06, 1.16) when comparing retirees with active workers of the same age. | This study does not support the hypothesis that retirement reduces risk of MI. On the contrary, we find that retirement is associated with a modestly increased risk of MI. | closed_qa |
Do Malassezia species play a role in exacerbation of scalp psoriasis? | Clinical expression of psoriasis is in part dependent on external factors, such as drugs, microorganisms or stress. However convincing evidence of the role of Malassezia species in the pathogenesis of the psoriasis is still lacking. Samples taken from scalp skin of 40 psoriatic patients and the same number of healthy individuals were observed under direct microsocopic examination and cultured on modified Dixon agar. Direct microscopy examination of psoriatic scalp scales was positive in 30 (75%) patients; while it was positive in only 12 (30%) healthy subjects (P=0.003). Half of the cultures from healthy subjects showed no growth of colonies, but only 8 (15%) of psoriatic patients were negative. When an exacerbation has occurred in the previous weeks, pseudohyphaes were observed in 12 (40%) patients, Malassezia globosa was isolated in 18 (45%) patients and Malassezia restricta was isolated in 12 (30%) patients. In the group of patients having stable lesion, without any exacerbation in the previous weeks, no pseudohypahes were observed, M. globosa was not isolated, M. restricta was isolated in 4 (10%), and cultures were negative in 6 of them (15%). | Malassezia species form an integral part of normal cutaneous microflora in humans, however we found that during the episodes of exacerbation of the disease the presence of these yeasts, and particularly M. globosa, was increased. | closed_qa |
Are depressive symptomatology and self-focused attention associated with subjective memory impairment in older adults? | Subjective memory impairment (SMI) refers to conditions in which people complain of memory problems despite intact cognition. The primary purpose of the present study was to examine the roles of self-focused attention and depressive symptomatology in subjective memory complaints. One hundred and eight patients who visited a memory disorder clinic with complaints of memory decline, but who were found on subsequent neuropsychological assessment to have normal cognitive function, were recruited to participate in the study. The severity of subjective memory complaints was measured with the modified Multifactorial Memory Questionnaire. In addition, neuropsychological functions, self-focused attention, and depressive symptomatology were also assessed. The results showed that the severity of SMI was not significantly correlated with any of the neuropsychological test scores except for the complex figure copy. The severity of SMI, however, was significantly correlated with self-focused attention and depressive symptomatology. Hierarchical regression analysis revealed that self-focused attention and depressive symptomatology significantly contributed to the severity of subjective memory complaints over and above the neuropsychological test performance. The interaction effects between self-focused attention/depressive symptomatology and objective memory performance on the severity of SMI were not significant. | In conclusion, self-focused attention and depressive symptomatology appear to play important roles in the severity of SMI, even though it is not clear how these factors interact with objective memory performance. Clinical implications as well as limitations of the present study were discussed. | closed_qa |
Is our residency program successful? | In an attempt to better define the success of our residency program with regard to resident development, we committed to develop an ongoing assessment of residency performance and devised an outcomes assessment system. We describe the process and structure that we used to construct an outcomes assessment system. We discuss the process we used to discern whether or not our program is successful as well as offer tips on what data to collect and track should other residency programs decide to devise a similar outcomes assessment database. | Taking time to "step back" to take inventory of a residency program and ensure year over year and at the end of training residents have developed and matured as planned is an educationally sound practice. Structuring an outcomes assessment system like the one that we discuss here can aid program directors with this important task. | closed_qa |
Should general surgery residents be taught laparoscopic pyloromyotomies? | The authors examine the ethical implications of teaching general surgery residents laparoscopic pyloromyotomy.DESIGN/ Using the authors' previously presented ethical framework, and examining survey data of pediatric surgeons in the United States and Canada, a rigorous ethical argument is constructed to examine the question: should general surgery residents be taught laparoscopic pyloromyotomies? A survey was constructed that contained 24 multiple-choice questions. The survey included questions pertaining to surgeon demographics, if pyloromyotomy was taught to general surgery and pediatric surgery residents, and management of complications encountered during pyloromyotomy. A total of 889 members of the American Pediatric Surgical Association and Canadian Association of Paediatric Surgeons were asked to participate. The response rate was 45% (401/889). The data were analyzed within the ethical model to address the question of whether general surgery residents should be taught laparoscopic pyloromyotomies. | From an ethical perspective, appealing to the ethical model of a physician as a fiduciary, the answer is no. | closed_qa |
Can leisure activities slow dementia progression in nursing home residents? | To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia. Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia. Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E ε4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group. | Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning. | closed_qa |
Current practice in the treatment of AO type 31-A2 hip fractures: does sub-specialty and experience of surgeon determine type of fixation? | Debate surrounds the optimal treatment of AO type 31-A2 fractures of the hip. Two principal treatment modalities are the compression hip screw (CHS) and cephallomedullary device (CMD). The use of CMD's is steadily increasing, for fixation of this fracture type, despite a lack of supportive evidence. 100 trauma consultants were asked for their opinion towards treatment of an AO type 31-A2 fracture. Subspecialty and length of time in post were also recorded. A significant proportion of consultants opted to use a CMD. Consultants who had been in post for a shorter time, and those in specialties other than lower limb were more likely to use a CMD. NICE guidelines suggest CHS for AO type 31-A2 fractures. | CMD accounts for a large percentage of treatment in our study, despite NICE guidelines, and other studies suggest their use is rising. We suggest there is a trend of less experienced consultants, and consultants whose specialties are those other than lower limb, using CMD more often. This may be creating an increased cost burden to the NHS, with no evidence to support their use. | closed_qa |
Can cognitive deficits differentiate between schizophrenia with and without obsessive-compulsive symptoms? | The frequent occurrence of obsessive-compulsive symptoms (OCS) in the course of schizophrenia and their impact on the functional outcome of the illness underlie the suggestion that the presence of OCS represents a separate subtype of schizophrenia, with a distinct clinical presentation and prognosis and specific neurobiological characteristics. This study investigated whether the presence of OCS in schizophrenia is associated with worse cognitive functioning in the domains of processing speed, executive functions and visuospatial memory. We also explored whether the degree of impairment in any of these cognitive domains could predict group membership (i.e. Schizophrenia with OCS [Sch-OCS] and Schizophrenia without OCS) and if there was a relationship between cognitive functioning and severity of OCS within the Sch-OCS group. Forty patients with schizophrenia, 20 with and 20 without OCS, individually matched for age, gender, years of education and severity of psychotic symptoms and 20 healthy controls underwent a comprehensive neuropsychological assessment. Only lower performance in processing speed discriminated patients with OCS from patients without OCS. Processing speed impairment not only classified patients in OCS or non-OCS group but was also independent of the severity of OCS symptoms. | The notion of additive effects of both schizophrenia and OCD on the structural and functional integrity of the brain circuits that support cognitive functions warrants further investigation in longitudinal neuropsychological and neuroimaging studies with larger samples and sufficient variation in the severity of OCS. | closed_qa |
Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy? | Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting>90 days post radiotherapy for prostate cancer. A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. | Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines. | closed_qa |
Widely used track and trigger scores: are they ready for automation in practice? | Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. | When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation. | closed_qa |
Oncologic colorectal resection after endoscopic treatment of malignant polyps: does endoscopy have an adverse effect on oncologic and surgical outcomes? | Early colorectal cancer is increasingly treated by endoscopic removal. In cases of incomplete resection or high-risk carcinoma, additional surgery is necessary. To evaluate the frequency of subsequent oncologic surgery after endoscopic resection of colorectal cancer, the rate of lymph node metastasis, residual cancer, and morbidity and mortality rates of the operation. Any eventual adverse effect of the prior endoscopic therapy on the surgical and oncologic outcome was assessed. Retrospective review of prospectively collected data. University hospital. Sixty-six consecutive patients with incomplete endoscopic treatment and need for additional surgery between 2004 and 2011. The data of these patients were compared with those of a group of patients with surgery for early colorectal cancer during the same period without prior endoscopic resection as the control group. Rate of lymph node metastasis and residual cancer, perioperative morbidity and mortality. The lymph node metastasis rate after oncologic resection was 8.6%, and the residual cancer rate was 41%. Risk factors for residual cancer were macroscopic incomplete resection (P<.0001), positive resection margins (P = .03), and piecemeal resection (P = .004). No mortality was observed. Perioperative morbidity, mortality, and oncologic outcome were not significantly different in the group with prior endoscopic resection compared with the primarily operated group. Retrospective study. | Endoscopic treatment of malignant polyps does not worsen surgical and oncologic outcomes in cases of subsequent surgery. Because mortality and morbidity are low, oncologic resection generally should be done in the presence of risk factors for residual cancer. | closed_qa |
Is it possible to discriminate between neoplastic and nonneoplastic lesions in ulcerative colitis by magnifying colonoscopy? | Colitis-associated cancer/dysplasia is an intestinal tract condition that can affect the life expectancy of patients with ulcerative colitis. It is often difficult to detect neoplastic lesions. This study evaluated whether any endoscopic features are effective for distinguishing colitis-associated cancer/dysplasia from nonneoplastic lesions in patients with ulcerative colitis. The study involved 52 patients with 61 lesions treated at Hiroshima University Hospital between September 1999 and May 2012: 10 patients with 11 dysplastic lesions, 5 patients with 5 intramucosal carcinomas, 3 patients with 3 submucosal carcinomas, and 34 patients with 42 nonneoplastic lesions. All patients had undergone targeted biopsy. Endoscopic findings were compared between patients with biopsy-determined neoplasia and those with biopsy-determined nonneoplasia. Multivariate regression analysis was performed to identify magnifying chromocolonoscopy features predictive of neoplasia. No significant difference was found in conventional endoscopy features between the neoplastic and nonneoplastic lesions. Under magnifying chromocolonoscopy, the pit density of the neoplastic lesions was found to be significantly greater than that of the nonneoplastic lesions (89% [17/19] versus 60% [25/42], respectively). Pit margins were more frequently irregular in the neoplastic lesions than in the nonneoplastic lesions (63% [12/19] versus 33% [14/42], respectively). | In differentiating between colitis-associated neoplastic and nonneoplastic lesions, focus should be on the high residual density of pits and irregular pit margins observed under magnifying chromocolonoscopy. | closed_qa |
Can the relationship between ethnicity and obesity-related behaviours among school-aged children be explained by deprivation? | It is unclear whether cultural differences or material disadvantage explain the ethnic patterning of obesogenic behaviours. The aim of this study was to examine ethnicity as a predictor of obesity-related behaviours among children in England, and to assess whether the effects of ethnicity could be explained by deprivation. Five primary care trusts in England, 2010-2011. Parents of white, black and South Asian children aged 4-5 and 10-11 years participating in the National Child Measurement Programme (n=2773). Parent-reported measures of child behaviour: low level of physical activity, excessive screen time, unhealthy dietary behaviours and obesogenic lifestyle (combination of all three obesity-related behaviours). Associations between these behaviours and ethnicity were assessed using logistic regression analyses. South Asian ethnic groups made up 22% of the sample, black ethnic groups made up 8%. Compared with white children, higher proportions of Asian and black children were overweight or obese (21-27% vs16% of white children), lived in the most deprived areas (24-47% vs 14%) and reported obesity-related behaviours (38% with obesogenic lifestyle vs 16%). After adjusting for deprivation and other sociodemographic characteristics, black and Asian children were three times more likely to have an obesogenic lifestyle than white children (OR 3.0, 95% CI 2.1 to 4.2 for Asian children; OR 3.4, 95% CI 2.7 to 4.3 for black children). | Children from Asian and black ethnic groups are more likely to have obesogenic lifestyles than their white peers. These differences are not explained by deprivation. Culturally specific lifestyle interventions may be required to reduce obesity-related health inequalities. | closed_qa |
Prognostic factors for primary gastrointestinal stromal tumours: are they the same in the multidisciplinary treatment era? | Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumour of the gastrointestinal tract. The introduction of tyrosine kinase inhibitors (TKIs) has lead to increasing use of combination of medical and surgical therapy. The aim of this study was to look at outcomes from a series of surgically treated GISTs and determine prognostic factors in the context of multimodal therapy. We analysed 104 single surgeon's patients with GIST. End points of the study were disease-specific survival (DSS), disease-free survival (DFS) and post-operative complications. Three- and 5-year DSS rates were 96.7 and 94.6 %. On univariate analysis, clear resection margins were predictive of DSS. Patients with R2 resection had a worse prognosis (3-year DSS rate of 83.3 %; 5-year DSS rate of 62.5 %) compared to patients with R0 (3-year DSS rate of 98 %; 5-year DSS rate of 98 %) or R1 resection (3-year DSS rate of 100 %; 5-year DSS rate of 100 %) (R0 vs R1 vs. R2 p = 0.001). Pre-operative factors associated with R2 resection were clinical metastatic disease (p<0.001), non-gastric tumour site (p = 0.002) and large tumour diameter (p = 0.031). Three- and 5-year DFS rates were 65.5 and 59.8 %. Serosal perforation (p = 0.013) and mitotic rate (p = 0.05) were found to be independently predictive of increased DFS. The presence of serosal perforation was associated with tumour site (p = 0.018), mitotic rate (p = 0.035), tumour diameter (p<0.001), growth pattern (p = 0.007) and age (p = 0.040). | In the multidisciplinary management of GIST, serosal perforation may represent an additional predictor of recurrence along with mitotic rate. Complete macroscopic surgical resection is the most reliable prognostic factor, and an aggressive surgical approach should be advocated. | closed_qa |
Increasing lateral tibial slope: is there an association with articular cartilage changes in the knee? | The geometry of the lateral tibial slope (LTS) plays an important role in the overall biomechanics of the knee. Through this study, we aim to assess the impact of LTS on cartilage degeneration in the knee. A retrospective analysis of 93 knee MRI scans (1.5 T or 3 T) for patients aged 20-45 years with no history of trauma or knee surgery, and absence of internal derangement. The LTS was calculated using the circle method. Chondropathy was graded from 0 (normal) to 3 (severe). Linear regression analysis was used for statistical analysis (p < 0.05). In our cohort of patients, a statistically significant association was seen between increasing LTS and worsening cartilage degenerative changes in the medial patellar articular surface and the lateral tibial articular surface (p < 0.05). There was no statistically significant association between increasing LTS and worsening chondropathy of the lateral patellar, medial trochlea, lateral trochlea, medial femoral, lateral femoral, and medial tibial articular surfaces. | Our results show a statistically significant association between increasing LTS and worsening cartilage degenerative changes in the medial patella and the lateral tibial plateau. We speculate that increased LTS may result in increased femoral glide over the lateral tibial plateau with subsequent increased external rotation of the femur predisposing to patellofemoral articular changes. Future arthroscopic studies are needed to further confirm our findings. | closed_qa |
Does a 3-min all-out test provide suitable measures of exercise intensity at the maximal lactate steady state or peak oxygen uptake for well-trained runners? | To examine whether a 3-min all-out test can be used to obtain accurate values for the maximal lactate steady state (vMLSS) and/or peak oxygen uptake (VO2peak) of well-trained runners. The 15 male volunteers (25 ± 5 y, 181 ± 6 cm, 76 ± 7 kg, VO2peak 69.3 ± 9.5 mL · kg-1 · min-1) performed a ramp test, a 3-min all-out test, and several submaximal 30-min runs at constant paces of vEND (mean velocity during the last 30 s of the 3-min all-out test) itself and vEND +0.2, +0.1, -0.1, -0.2, -0.3, or -0.4 m/s. vMLSS and vEND were correlated (r = .69, P = .004), although vMLSS was lower (mean difference: 0.26 ± 0.32 m/s, 95% CI -.44 to -.08 m/s, P = .007, effect size = 0.65). The VO2peak values derived from the ramp and 3-min all-out tests were not correlated (r = .41, P = .12), with a mean difference of 523 ± 1002 mL (95% CI 31 to 1077 mL). | A 3-min all-out test does not provide a suitable measure of vMLSS or VO2peak for well-trained runners. | closed_qa |
Is laparoscopy a safe approach for diffuse appendicular peritonitis? | Several studies have assessed feasibility and early outcomes of the laparoscopic approach for complicated appendicitis (CA). However, these studies suffer from limitations due to the heterogeneous definitions used for CA. No studies have assessed feasibility and early post-operative outcomes of the laparoscopic approach in the specific management of diffuse appendicular peritonitis (DAP). Consequently, outcomes of the laparoscopic approach for the management of DAP are poorly documented. The laparoscopic approach is the first-line standardised procedure used by our team for the management of DAP. All patients (aged>16 years) who underwent laparoscopy for DAP (CA with the presence of purulent fluid with or without fibrin membranes in at least a hemi abdomen) between 2004 and 2012 were prospectively included. Post-operative outcomes were analysed according to the Clavien-Dindo classification. Laparoscopy for DAP was performed for 141 patients. Mean age was 39.6 ± 20 (16-92) years. A total of 45 patients (31.9%) had pre-operative contracture. The mean pre-operative leukocyte count was 14,900 ± 4,380 mm(-3). The mean pre-operative C-reactive protein (CRP) serum concentration was 135 ± 112 (2-418) mg/dl. The conversion rate was 3.5%. The mean operative time was 80 ± 27 (20-180) min. There were no deaths. The rate of grade III morbidity was 6.5%. Ten patients (7.1%) experienced intra-abdominal abscess (IAA); seven of these cases were treated conservatively. The mean length of hospital stay was 6.9 ± 5 (2-36) days. A pre-operative leukocyte count>17,000 mm(-3), and CRP serum concentration>200 mg/dl were significant predictive factors for IAA in multivariate analyses [odds ratio (OR) 25.0, 95% confidence interval (CI) 2.4-250, p = 0.007 and OR 16.4, 95% CI 1.6-166, p = 0.02, respectively]. | The laparoscopic approach for DAP is a safe and feasible procedure with a low conversion rate and an acceptable rate of IAA in view of the severity of the disease. Pre-operative leukocyte counts>17,000 mm(-3) and pre-operative CRP serum concentrations>200 mg/dl indicate a high risk of IAA. | closed_qa |
Amphetamine-induced appetitive 50-kHz calls in rats: a marker of affect in mania? | Animal models aimed to mimic mania have in common the lack of genuine affective parameters. Although rodent amphetamine-induced hyperlocomotion is a frequently used behavioral model of mania, locomotor activity is a rather unspecific target for developing new pharmacological therapies, and does not necessarily constitute a cardinal symptom in bipolar disorder (BD). Hence, alternative behavioral markers sensitive to stimulants are required. Since D-amphetamine induces appetitive 50-kHz ultrasonic vocalizations (USV) in rats, we asked whether established or potential antimanic drugs would inhibit this effect, thereby possibly complementing traditional analysis of locomotor activity. Amphetamine-treated rats (2.5 mg/kg) were systemically administered with the antimanic drugs lithium (100 mg/kg) and tamoxifen (1 mg/kg). Since protein kinase C (PKC) activity has been implicated in the pathophysiology of bipolar disorder and the biochemical effects of mood stabilizers, the new PKC inhibitor myricitrin (10, 30 mg/kg) was also evaluated. We demonstrate for the first time that drugs with known or potential antimanic activity were effective in reversing amphetamine-induced appetitive 50-kHz calls. Treatments particularly normalized amphetamine-induced increases of frequency-modulated calls, a subtype presumably indicative of positive affect in the rat. | Our findings suggest that amphetamine-induced 50-kHz calls might constitute a marker for communicating affect that provides a useful model of exaggerated euphoric mood and pressured speech. The antimanic-like effects of the PKC inhibitors tamoxifen and myricitrin support the predictive and etiological validity of both drugs in this model and highlight the role of PKC signaling as a promising target to treat mania and psychosis-related disorders. | closed_qa |
Does the association between broken partnership and first time myocardial infarction vary with time after break-up? | Marriage is associated with lower risk of coronary heart disease, but it is unknown if the association depends on time since break-up with a partner. In this study we included both married and unmarried couples to study if the association between broken partnership (BP) and first time incident myocardial infarction (MI) changes with time since BP. Register study of the entire Danish population: the population was restricted to those aged 30 to 65 years with follow-up for incident MI between 1985 and 2006 with an annual record on each individual; in total 43 million records. The register data were used to identify MI events. Poisson regression was used to study associations between time since BP and MI adjusted for socio-demographic confounders and hospital admissions. Analyses were stratified by sex. Compared with unexposed (no BP), the incidence rate ratio (IRR) of MI in men with BP in the same year was 0.97 [95% confidence interval (CI) 0.90-1.05], year before BP was 1.25 (95% CI 1.17-1.34), 2-3 years after BP was 1.12 (95% CI 1.06-1.18), 4-8 years after BP was 1.09 (95% CI 1.05-1.14) and 9+ years since BP was 1.09 (95% CI 1.05-1.12). In women, the IRR same year as BP was 1.45 (95% CI 1.26-1.66), the year after BP was 1.30 (95% CI 1.14-1.50), 2-3 years after BP was 1.26 (95% CI 1.13-1.39), 4-8 years after BP was 1.17 (95% CI 1.08-1.26) and 9+ years since BP was 1.24 (95% CI 1.17-1.32). | We found both a short-term elevated risk of first time MI following BP and a weaker long-term elevated risk, in both men and women. | closed_qa |
Effectiveness of ritonavir-boosted protease inhibitor monotherapy in the clinical setting: same results as in clinical trials? | Ritonavir-boosted protease inhibitor monotherapy (PIMT) is a maintenance strategy that prevents nucleoside reverse transcriptase inhibitor toxicity and reduces costs. Some trials compare PIMT with combined antiretroviral therapy, but restricted selection criteria and low sample size hamper data extrapolation to routine practice. Here, we analyse the effectiveness and safety of PIMT in clinical practice. This was a retrospective, observational, multicentre study. Adult HIV-1 patients receiving PIMT with darunavir or lopinavir were included. A Cox regression model identified independent predictors for virological failure (VF). A total of 664 patients (435 on darunavir/ritonavir and 229 on lopinavir/ritonavir) [74% male, median age of 54 years, one-third with previous protease inhibitor VF, CD4 nadir 189 cells/mm(3) and 42% coinfected with hepatitis C virus (HCV)] were analysed. After a median follow-up of 16 months, 78% of patients (95% CI 74%-81%) remained free from therapeutic failure (TF) (change between ritonavir-boosted PIs not considered failure). At 12 months, by intention-to-treat analysis (change between ritonavir-boosted PIs equals failure), 83% of patients were free from TF (87% darunavir/ritonavir versus 77% lopinavir/ritonavir, P = 0.001). Regarding VF, 88% of patients maintained viral suppression at 12 months (93% darunavir/ritonavir versus 88% lopinavir/ritonavir, P = not significant). CD4 nadir<200 cells/mm(3) [hazard ratio (HR) 1.58, 95% CI 1.01-2.49] and undetectable viral load prior to PIMT<24 months (HR 1.86, 95% CI 1.20-2.91) were independent predictors for VF. Prior protease inhibitor failure, HCV coinfection and the protease inhibitor/ritonavir used were not associated with PIMT outcome. A total of 158 patients stopped PIMT, 6% due to adverse events. Two patients developed encephalitis. | PIMT effectiveness was consistent with data from clinical trials. Viral suppression duration prior to PIMT and CD4 cell count nadir were independent predictors for PIMT outcome. | closed_qa |
Do smokers support smoke-free laws to help themselves quit smoking? | A growing number of smokers support smoke-free laws. The theory of self-control provides one possible explanation for why smokers support laws that would restrict their own behaviour: the laws could serve as a self-control device for smokers who are trying to quit. To test the hypothesis that support for smoke-free laws predicts smoking cessation. We used longitudinal data (1999-2000) from a US national sample of adult smokers (n=6415) from the Current Population Survey, Tobacco Use Supplements. At baseline, smokers were asked whether they made a quit attempt in the past year. They were also asked whether they thought smoking should not be allowed in hospitals, indoor sporting events, indoor shopping malls, indoor work areas, restaurants, or bars and cocktail lounges. At 1-year follow-up, smokers were asked whether they had quit smoking. Smokers who supported smoke-free laws were more likely to have made a recent quit attempt. At 1-year follow-up, those who supported smoke-free laws in 4-6 venues were more likely to have quit smoking (14.8%) than smokers who supported smoke-free laws in 1-3 venues (10.6%) or smokers who supported smoke-free laws in none of the venues (8.0%). These differences were statistically significant in multivariate analyses controlling for demographics. | Support for smoke-free laws among smokers correlates with past quit attempts and predicts future quitting. These findings are consistent with the hypothesis that some smokers support smoke-free laws because the laws could help them quit smoking. | closed_qa |
Is serum zinc associated with pancreatic beta cell function and insulin sensitivity in pre-diabetic and normal individuals? | Cross sectional study of a random sample of older community-dwelling men and women in Newcastle, New South Wales, Australia. Beta cell function, insulin sensitivity and insulin resistance were calculated for normoglycaemic and prediabetes participants using the Homeostasis Model Assessment (HOMA-2) calculator. A total of 452 participants were recruited for this study. Approximately 33% (N = 149) had diabetes, 33% (N = 151) had prediabetes and 34% (N = 152) were normoglycaemic. Homeostasis Model Assessment (HOMA) parameters were found to be significantly different between normoglycaemic and prediabetes groups (p<0.001). In adjusted linear regression, higher serum zinc concentration was associated with increased insulin sensitivity (p = 0.01) in the prediabetic group. There was also a significant association between smoking and worse insulin sensitivity. | Higher serum zinc concentration is associated with increased insulin sensitivity. Longitudinal studies are required to determine if low serum zinc concentration plays a role in progression from pre-diabetes to diabetes. | closed_qa |
Generalized linear mixed models for binary data: are matching results from penalized quasi-likelihood and numerical integration less biased? | Over time, adaptive Gaussian Hermite quadrature (QUAD) has become the preferred method for estimating generalized linear mixed models with binary outcomes. However, penalized quasi-likelihood (PQL) is still used frequently. In this work, we systematically evaluated whether matching results from PQL and QUAD indicate less bias in estimated regression coefficients and variance parameters via simulation. We performed a simulation study in which we varied the size of the data set, probability of the outcome, variance of the random effect, number of clusters and number of subjects per cluster, etc. We estimated bias in the regression coefficients, odds ratios and variance parameters as estimated via PQL and QUAD. We ascertained if similarity of estimated regression coefficients, odds ratios and variance parameters predicted less bias. Overall, we found that the absolute percent bias of the odds ratio estimated via PQL or QUAD increased as the PQL- and QUAD-estimated odds ratios became more discrepant, though results varied markedly depending on the characteristics of the dataset. | Given how markedly results varied depending on data set characteristics, specifying a rule above which indicated biased results proved impossible. This work suggests that comparing results from generalized linear mixed models estimated via PQL and QUAD is a worthwhile exercise for regression coefficients and variance components obtained via QUAD, in situations where PQL is known to give reasonable results. | closed_qa |
Is there an alternative to continuous opioid infusion for neonatal pain control? | Continuous opioid infusion (COI) remains the mainstay of analgesic therapy in the neonatal intensive care unit (NICU). Parent/nurse-controlled analgesia (PNCA) has been accepted as safe and effective for pediatric patients, but few reports include use in neonates. This study sought to compare outcomes of PNCA and COI in postsurgical neonates and young infants. Twenty infants treated with morphine PNCA were retrospectively compared with 13 infants treated with fentanyl COI in a Midwestern pediatric hospital in the United States. Outcome measures included opioid consumption, pain scores, frequency of adverse events, and subsequent methadone use. The PNCA group (median 6.4 μg · kg(-1) · h(-1) morphine equivalents, range 0.0-31.4) received significantly less opioid (P<0.001) than the COI group (median 40.0 μg · kg(-1) · h(-1) morphine equivalents; range 20.0-153.3), across postoperative days 0-3. Average daily pain scores (based on 0-10 scale) were low for both groups, but median scores differed nonetheless (0.8 PNCA vs 0.3 COI, P<0.05). There was no significant difference in the frequency of adverse events or methadone use. | Results suggest PNCA may be a feasible and effective alternative to COI for pain management in postsurgical infants in the NICU. Results also suggest PNCA may provide more individualized care for this vulnerable population and in doing so, may potentially reduce opioid consumption; however, more studies are needed. | closed_qa |
Does the DVR(®) plate restore bony anatomy following distal radius fractures? | Fractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR(®) plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted 'normal' values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction. A retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR(®) plate was undertaken. Volar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon. | The DVR(®) plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt. | closed_qa |
Active or passive pulmonary vein in atrial fibrillation: is pulmonary vein isolation always essential? | The role of pulmonary veins (PVs) in persistent atrial fibrillation (AF) perpetuation appears less important than in paroxysmal AF. Electrogram-based substrate ablation is not widely performed as a stand-alone strategy. To evaluate PV activity in AF perpetuation and efficacy of our patient-tailored ablation strategy (electrogram-based substrate ablation with or without pulmonary vein isolation [PVI]). One hundred twenty-one patients with paroxysmal (n = 19; 15.7%), persistent (n = 77; 63.6%), or long-standing persistent (n = 25; 20.7%) AF underwent electrogram-based substrate ablation with AF termination end point: sinus rhythm or atrial tachycardia conversion. Before ablation, we classified PVs as "passive" if silent PV or if PV cycle length is greater than left atrial appendage cycle length. No PVI was performed in such cases. Passive PVs were observed in 52 of 121 patients (paroxysmal AF = 0%, persistent AF = 40%, and long-standing persistent AF = 76%; P<.0001]). Substrate ablation terminated AF in 95.6% (sinus rhythm conversion in 80.2%). Compared with patients with active PVs, patients with passive PVs had longer AF sustained duration (19.1 ± 29.7 months vs 4.9 ± 11.1 months; P<.0001), larger left atrial diameter (46.9 ± 7.3 mm vs 41.9 ± 6.0 mm; P = .0014), lower left ventricular ejection fraction (45.4% ± 13.5% vs 55.1% ± 9.4%; P<.0001), and more often structural heart disease (57% vs 33%; P = .02). After a follow-up of 20.39 ± 11.23 months (1.6 procedures per patient), 82% were arrhythmia free with this strategy. | PV activity during AF decreases with AF chronicity, left atrial dilatation, and left ventricular ejection fraction. Our patient-tailored ablation strategy without systematic PVI provides good results. | closed_qa |
An analysis of reported independent prognostic factors for survival in squamous cell carcinoma of the vulva: is tumor size significance being underrated? | To assess independent prognostic factors described in the literature. Thus, to identify different risk groups. Review of the records with a diagnosis of primary vulvar squamous cell carcinoma (January/1992-January/2012). depth of stromal invasion (DSI)>1mm, pathological tumor size>2 cm, and pathological tumor-free margin ≥ 8 mm. Patients who underwent neoadjuvant therapy due to locoregionally advanced vulvar cancer were excluded. All the patients underwent radical, both local and regional, surgery. Adjuvant radiation therapy was administered to all patients with positive nodes. Features of lymph nodes, tumor size, age, grade, lymphovascular space invasion (LVSI), DSI, type of radical surgery, pathological margin distance and stage were evaluated by univariate and multivariate analysis. 194 patients were included. Median age: 67 years. Median follow-up: 62 months. 5-year OS and DFS: 65.5% and 58.2%. Positive lymph nodes were found in 91 (46.9%) patients. After a multivariate analysis, the number of positive lymph nodes, extra-nodal growth, pathologic tumor size and DSI proved to be independent prognostic factors. A high risk group for failure to survive (5y-OS 24%) was identified: tumor size ≥ 6-7.9 cm and DSI>4mm or ≥ 8 cm irrespective of DSI; and extra-nodal growth or ≥2 positive lymph nodes irrespective of tumor size and DSI. | A new high-risk group was identified based on different cutoff values for tumor size, extra-nodal growth and number of positive lymph nodes. This could be very important in the tailored treatment of a specific group of patients with bulky primary tumors and a poorer prognosis. | closed_qa |
Can low-dose CT with iterative reconstruction reduce both the radiation dose and the amount of iodine contrast medium in a dynamic CT study of the liver? | To investigate whether low-dose dynamic CT of the liver with iterative reconstruction can reduce both the radiation dose and the amount of contrast medium. This study was approved by our institutional review board. 113 patients were randomly assigned to one of two groups. Group A/group B (fifty-eight/fifty-five patients) underwent liver dynamic CT at 120/100 kV, with 0/40% adaptive statistical iterative reconstruction (ASIR), with a contrast dose of 600/480 mg I/kg, respectively. Radiation exposure was estimated based on the manufacturer's phantom data. The enhancement value of the hepatic parenchyma, vessels and the tumor-to-liver contrast of hepatocellular carcinomas (HCCs) were compared between two groups. Two readers independently assessed the CT images of the hepatic parenchyma and HCCs. The mean CT dose indices: 6.38/4.04 mGy, the dose-length products: 194.54/124.57 mGy cm, for group A/group B. The mean enhancement value of the hepatic parenchyma and the tumor-to-liver contrast of HCCs with diameters greater than 1cm in the post-contrast all phases did not differ significantly between two groups (P>0.05). The enhancement values of vessels in group B were significantly higher than that in group A in the delayed phases (P<0.05). Two reader's confidence levels for the hepatic parenchyma in the delayed phases and HCCs did not differ significantly between the groups (P>0.05). | Low-dose dynamic CT with ASIR can reduce both the radiation dose and the amount of contrast medium without image quality degradation, compared to conventional dynamic CT without ASIR. | closed_qa |
Does excessive dynamic airway collapse have any impact on dynamic pulmonary function tests? | Excessive dynamic airway collapse (EDAC) represents pathologic obstruction, but the flow resistance it creates and the possible impact on pulmonary function tests is unclear. Our aims were to explore the flow resistance in a model, and in patients to relate observed EDAC to pulmonary function tests. Model study: A garden hose was compressed from 1 side to simulate the posterior tracheal wall bulging into the lumen for 2 lengths, 3 and 12 cm, in 8 steps. Resistance was measured at each step for airflows 1 L/s through 9 L/s. Digital photos of the luminal area at each obstruction step were analyzed by a computer to estimate the cross-sectional area reduction and the corresponding shortest distance between the bulging (posterior) and the opposite (anterior) wall (AP-distance). Patient study: A total of 104 stable chronic obstructive pulmonary disease patients studied by pulmonary function tests and bronchoscopy. The tracheal obstruction was observed during forced expiration and cough, and the cross-sectional area reduction was estimated from the observed AP-distance using the results from the model study. Model study: The flow resistance increases significantly when the cross-sectional area is reduced to>70% for an obstruction length of 3 cm. Patient study: EDAC was found in 18 patients during cough, none during forced expiration. There was no correlation between the obstructions found and the results from pulmonary function tests. | EDAC during peak pressure has negligible impact on pulmonary function tests and breathing symptoms. The importance of the severity, length, and duration of the EDAC is discussed. | closed_qa |
Is transcranial magnetic stimulation effective in treatment-resistant combat related posttraumatic stress disorder? | To examine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in patients with treatment-resistant posttraumatic stress disorder (PTSD) with co-occurring major depression. We examined data on 20 male combat related PTSD patients admitted to the Post Traumatic Stress Disorder Clinic of Gülhane Military Medical Academy, Ankara, Turkey between January 2011 and December 2012 that received rTMS in addition to medical therapy. We obtained the data by examining the case files and hospital computer records. Decreases in the Impact of Event Scale (IES) hyperarousal scores were statistically significant. However, there were no statistically significant differences between the total IES scores, IES intrusion scores, IES avoidance scores, Beck Depression Inventory, and Beck Anxiety Inventory scores before and after rTMS treatment. | The efficacy of rTMS on the hyperarousal symptoms indicated that rTMS could be used in the treatment of patients with treatment-resistant PTSD. The role of rTMS in the clinical management of PTSD should be identified in further comprehensive studies. | closed_qa |
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