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Does the severity of primary sclerosing cholangitis influence the clinical course of associated ulcerative colitis? | Ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC) is usually clinically mild. The aim of the study was to assess whether there is an association between severity of PSC and activity of UC, comparing the course of UC in patients with PSC not needing liver transplantation (LT) and those eventually transplanted. Between 1990 and 2009, 96 consecutive patients with PSC/UC were seen in the authors' institution. Data were evaluated from a database regarding UC activity (median follow-up 144 months). Follow-up was censored at time of LT or last clinical review. Patients with PSC/UC were divided into two groups: 46 did not need LT (no-LT) and 50 were transplanted (LT). There were no significant differences concerning duration of UC or PSC and extent of UC. The LT group had significantly (p=0.002) more clinically quiescent UC compared with the no-LT group. The LT group had fewer UC flare-ups (p=0.04) and required fewer steroid courses (p=0.025) with shorter duration (p=0.022) and less use of azathioprine (p=0.003). There was an increased need for surgery in the no-LT group (p=0.006). Colon carcinoma and high grade dysplasia were more frequent in the no-LT group (p=0.004). The no-LT group had increased inflammation in the colonic mucosa at histology (p=0.011), but without visual difference at colonoscopy. | Clinically progressive PSC requiring LT is associated with a milder course of UC (reduced disease activity and less use of steroids, azathioprine and surgery). This is paralleled by less histological activity and reduced incidence of dysplasia and colon carcinoma. | closed_qa |
Do muscle fiber conduction slowing and decreased levels of circulating muscle proteins represent sensitive markers of steroid myopathy? | Glucocorticoids are known to decrease protein synthesis and conduction velocity of muscle fibers. However, the degree of impairment of muscle protein synthesis and conduction slowing in patients with Cushing's disease remains poorly characterized. Our objective was to investigate whether and to what extent chronic endogenous hypercortisolism could decrease the circulating levels of muscle proteins and modify myoelectric indexes of sarcolemmal excitability and fatigability. A total of ten patients with Cushing's disease and 30 healthy controls matched for age, sex, and body mass index were compared. Blood sampling and electrophysiological tests on vastus lateralis, vastus medialis, and tibialis anterior muscles were performed. Serum creatine kinase (CK) and plasma myoglobin were significantly lower in patients with respect to controls (P<0.001 and P<0.05 respectively): the mean relative difference between patients and controls was 48.9% for CK and 21.4% for myoglobin. Muscle fiber conduction velocity (MFCV) and myoelectric manifestations of fatigue were significantly decreased in all muscles of the patients with respect to controls. The mean relative difference in MFCV between patients and controls was 26.0% for vastus lateralis, 22.9% for vastus medialis, and 11.6% for tibialis anterior. These differences contrasted with the paucity of signs suggestive of myopathy that were obtained by needle electromyography in the patients. | Slowing of muscle fiber conduction and decreased levels of circulating muscle proteins are sensitive markers of impaired muscle function, which are suitable for use in combination with clinical assessment and standard electrodiagnostic tests for accurate identification and follow-up of myopathic patients. | closed_qa |
Cochlear implantation: is hearing preservation necessary in severe to profound hearing loss? | The goal of the cochlear implant surgery is to place the electrode array with minimal damage to preserve the residual hearing. Round-window insertion can be performed in a manner that is potentially less traumatic than the standard cochleostomy. The purpose of the study was to investigate audiological results of the round-window approach using standard electrode. A retrospective study was performed to evaluate our experience in patients with implanted through round window between January 2007 and March 2009. Sixty patients had undergone cochlear implant surgery through the round window with full insertion of a standard electrode array. Preoperative and postoperative pure-tone thresholds were measured for implanted ears in the range of 250 to 4000 Hz. Within these 60 cases, 31 patients had been evaluated. The population comprised 16 women and 15 men. The mean age was 15.96 years (range, 4-64 years). Follow-up times ranged from 6 to 26 months. Preservation of low-frequency hearing (250 and 500 Hz) was achieved in 27 (87%) of 31 patients. Complete hearing preservation (all frequencies) was accomplished in 11 patients (35.48%). No hearing could be determined postoperatively in 4 patients (12.9%), having preoperative thresholds of 120 dB at 250, 500, and 1000 Hz. | Round-window approach has been widely used for preservation of residual hearing. In our patients with severe to profound hearing loss, we preserved residual hearing. Although the residual hearing cannot be sufficient for using additional acoustic stimulation, the preserved residual hearing means minimal damage and a more convenient cochlea, so this is promising for future development. | closed_qa |
Can wedge osteotomy correct depression of the lateral tibial plateau mimicking posterolateral rotatory knee instability? | The literature suggests rotatory knee instability (pseudolaxity) can be associated with depressions of the lateral tibial plateau in patients despite an intact arcuate ligament complex. Correcting this bone deformity by an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone may restore knee stability.QUESTIONS/ We therefore asked whether: (1) knee stability is restored after this procedure; (2) Lysholm functional scores improve after this treatment; and (3) the limb alignment changes. We retrospectively evaluated 12 patients who underwent a subchondral open-wedge osteotomy of the lateral tibial plateau combined with a knee arthroscopic procedure for the treatment of a knee rotational instability secondary to a lateral compartment bone deficit between 2000 and 2007. Eleven patients with a mean age of 35 years were available for followup at a minimum of 2 years (average, 5.4 years; range, 2-9 years). Preoperatively and at last followup, patients were clinically and radiographically evaluated by the Lysholm score and with comparative knee radiographs. Complications were recorded. At last followup all patients rated their knees as stable. All osteotomies healed uneventfully. The Lysholm score improved from 62 to 87. Followup radiographs showed no changes in the femorotibial axis as result of the osteotomy. | Patients with chronic depression of the posterolateral tibial plateau may exhibit symptoms of posterolateral knee instability, a sort of pseudolaxity. In these patients, an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone, and tensioning posterolateral structures improves this secondary posterolateral knee instability. | closed_qa |
Do less medialized reverse shoulder prostheses increase motion and reduce notching? | Cuff tear arthropathy is the primary indication for total reverse shoulder arthroplasty. In patients with pseudoparalytic shoulders secondary to irreparable rotator cuff tear, reverse shoulder arthroplasty allows restoration of active anterior elevation and painless shoulder. High rates of glenoid notching have also been reported. We designed a new reverse shoulder arthroplasty with a center of rotation more lateral than the Delta prosthesis to address this problem.QUESTIONS/ Does reduced medialization of reverse shoulder arthroplasty improve shoulder motion, decrease glenoid notching, or increase the risk of glenoid loosening? We retrospectively reviewed 76 patients with 76 less medialized reverse shoulder prostheses implanted for pseudoparalytic shoulder with rotator cuff deficiency between October 2003 and May 2006. Shoulder motion, Constant-Murley score, and plain radiographs were analyzed. Minimum followup was 24 months (mean, 44 months; range, 24-60 months). The absolute Constant-Murley score increased from 24 to 59, representing an increase of 35 points. The range of active anterior elevation increased by 61°, and the improvement in pain was 10 points. The gain in external rotation with elbow at the side was 15°, while external rotation with 90° abduction increased by 30°. Followup showed no glenoid notching and no glenoid loosening with these less medialized reverse prostheses. | Less medialization of reverse shoulder arthroplasty improves external and medial rotation, thus facilitating the activities of daily living of older patients. The absence of glenoid notching and glenoid loosening hopefully reflects longer prosthesis survival, but longer followup is necessary to confirm these preliminary observations. | closed_qa |
Does adding FDG-PET to MRI improve the differentiation between primary cerebral lymphoma and glioblastoma? | It is sometimes difficult to distinguish between primary central nervous system lymphomas (PCNSL) and glioblastoma multiforme (GBM). The aim of this study was to investigate whether the addition of (18)F-2-fluoro-2-deoxy-D: -glucose positron emission tomography ([(18)F]FDG-PET) and apparent diffusion coefficients (ADC) to conventional MRI improves diagnostic accuracy for distinguishing between PCNSL and GBM with similar MRI findings. We used conventional- and diffusion-weighted MRI and FDG-PET scans of 21 patients with histologically confirmed brain tumors exhibiting similar MRI findings (PCNSL, n = 14, GBM, n = 7) in our observer performance study that consisted of 3 interpretation sessions. ADC and maximum standard uptake values (SUV(max)) of the tumors were calculated. Three radiologists first interpreted conventional MRI (1st session), then they read images to which the ADC value had been added (2nd session), and finally they interpreted images supplemented with SUV(max) (3rd session). Observer performance was evaluated using κ statistic and receiver operating characteristics analyses. The addition of ADC values to conventional MRI failed to improve the differentiation between PCNSL and GBM. The addition of SUV(max) at the third session improved the diagnostic accuracy of all 3 readers and resulted in higher interobserver agreement; mean accuracy was 95% (range 93-100%). In one observer the accuracy of tumor differentiation was significantly improved at the third compared to the second session (p = 0.017). | In a selected group of PCNSL and GBM with similar MRI findings, the addition of quantitative FDG-PET to MRI may improve their differentiation. ADC measurement did not allow further discrimination. | closed_qa |
Blunt splenic trauma in children: are we too careful? | There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT. The data of all patients<18 years with radiologically proven blunt splenic injury admitted between 1988 and 2007 were retrospectively analyzed. Mechanism of injury, type of treatment, ICU stay, total hospital stay, morbidity and mortality were assessed. Patients suffering isolated splenic injuries were assessed separately from patients with multiple injuries. Patients were subsequently divided into those admitted before and after 2000. There were 64 patients: 49 males and 15 females with a mean age of 13 years (range 0-18). 3 patients died shortly after admission due to severe neurological injury and were excluded. In the remaining 61 patients concomitant injuries, present in 62%, included long bone fractures (36%), chest injuries (16%), abdominal injuries (33%) and head injuries (30%). Mechanisms of injury were: car accidents (26%), motorcycle (20%), bicycle (19%), fall from height (17%) and pedestrians struck by a moving vehicle (8%). A change in treatment strategy was evident for the pre- and post-2000 periods. Significantly more patients had NOT after 2000 in both the isolated splenic injury group and the multi-trauma group [4/11 (36%) before vs. 10/11 (91%) after (p=0.009); 15/19 (79%) before vs. 8/20 (40%) after 2000 (p=0.03)]. There was also a significant shift to spleen-preserving operations. All life-threatening complications occurred within<24 h after injury. Mortality for the entire cohort was 7%; all of these patients were treated operatively. When comparing the median ICU and hospital stay before and after 2000 it was found to be significantly higher in the isolated injury group and remained statistically the same in the multi-trauma group. | Splenic injury in children is associated with substantial mortality. This is due to concomitant injuries and not to the splenic injury. Non-operative treatment is increasingly preferred to operative procedures when treating splenic injuries in hemodynamically, stable children. ICU and hospital stay have, despite the change from OT to NOT, remained the same. Complications after NOT are rare. We are still observing children in hospital for a longer period than is necessary. | closed_qa |
Is the MiniScan a useful psychiatric intervention? | Psychiatric classification based on clinical judgement is not very reliable. Reliability can be increased by the use of standardised interviews. Maximum standardisation of the classification process can both improve reliability and affect treatment.AIM: To determine the effect that the use of a highly standardised and automated classification procedure (MiniScan) can have on the length of stay in hospital and on the course of symptoms. Participants were allocated to a test group and a control group. The test group was classified via the MiniScan, the control group on the basis of clinical judgement. Length of hospital stay and symptom course were determined. The use of the MiniScan had no effect on the length of hospital stay, but seemed to play a role in symptom reduction. | There are indications that the use of the MiniScan contributes to symptom reduction. | closed_qa |
Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? | To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding. Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred. The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stone free rate in groups A and B (92.58% ± 5.97 versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P<.001). | In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not pose patients at any additional risk. | closed_qa |
Is there an association between female urinary incontinence and decreased genital sensation? | A retrospective consecutive chart review was conducted for all women who were referred to our tertiary female urology clinic with a primary complaint of sexual dysfunction between October 1999 and January 2009. Our study sample included 177 women, all of whom underwent a thorough clinical evaluation. Urinary incontinence was diagnosed based on clinical history and physical examination by a urogynecologist. The Genital Thermal and Vibratory Sensory Analyzer (GSA) was used for sensory testing in the genital area. Independent t-test and multivariate linear regression were used for statistical analysis. Of the 177 study patients (median age 34, range 18-68), 63 (36%) had urinary incontinence. Women with urinary incontinence were found to be less sensitive to warm, cold, and vibratory thresholds at both the anterior and the posterior vaginal wall and the clitoral area (P<0.05). | Women with urinary incontinence and sexual dysfunction are less sensitive to all sensory testing in the genital region than women with sexual dysfunction alone. This relationship may be attributable to afferent nerve damage and the critical role it may play in the etiology of urinary incontinence. | closed_qa |
Can the outcome of autoaugmentation omentocystoplasty be improved? | A total of 24 animals were included in the study. Three different techniques of autoaugmentation cystoplasty were applied to surgically reduced bladders of 14 sheep. Five sheep underwent surgical reduction of bladder capacity as control group and five sheep underwent sham operation. In Group DIB (detrusor incision with balloon), standard whole thickness incisions on bladder wall were performed and a silicon balloon was inflated intravesically postoperatively. Group DMB (detrusorotomy with balloon) and Group DM (detrusorotomy) underwent standard detrusorotomy. After measuring capacities and compliances, animals were sacrificed on 90th postoperative day. Bladders were histopathologically evaluated. Expression of vascular endothelial growth factor (VEGF), CD31, and microvessel density (MVD) was noted. Quantification of collagen subtypes was also performed. The mean capacity and compliance for Group DM and control were not significantly different and both were lower than other augmentation groups and sham. In Groups DMB and DM fibrosis was significantly increased. The VEGF expression was lower in Group DIB with respect to other augmentation groups whereas MVD was not significantly different. Measurement of total collagen and collagen subtypes revealed an increase in total collagen of groups DMB and DM when compared to other groups. Quantification of collagen subtypes demonstrated that types I and III were significantly increased in aforementioned groups. | Autoaugmentation omentocystoplasty in sheep model does not result in a reliable increase in bladder capacity and compliance. Intravesical balloon inflation makes the achievement more pronounced and significantly increases the bladder capacity and compliance. | closed_qa |
Can Asperger syndrome be distinguished from autism? | The question of whether Asperger syndrome can be distinguished from autism has attracted much debate and may even incur delay in diagnosis and intervention. Accordingly, there has been a proposal for Asperger syndrome to be subsumed under autism in the forthcoming Diagnostic and Statistical Manual of Mental Disorders, fifth edition, in 2013. One approach to resolve this question has been to adopt the criterion of absence of clinically significant language or cognitive delay--essentially, the "absence of language delay." To our knowledge, this is the first meta-analysis of magnetic resonance imaging (MRI) studies of people with autism to compare absence with presence of language delay. It capitalizes on the voxel-based morphometry (VBM) approach to systematically explore the whole brain for anatomic correlates of delay and no delay in language acquisition in people with autism spectrum disorders. We conducted a systematic search for VBM MRI studies of grey matter volume in people with autism. Studies with a majority (at least 70%) of participants with autism diagnoses and a history of language delay were assigned to the autism group (n = 151, control n = 190). Those with a majority (at least 70%) of individuals with autism diagnoses and no language delay were assigned to the Asperger syndrome group (n = 149, control n = 214). We entered study coordinates into anatomic likelihood estimation meta-analysis software with sampling size weighting to compare grey matter summary maps driven by Asperger syndrome or autism. The summary autism grey matter map showed lower volumes in the cerebellum, right uncus, dorsal hippocampus and middle temporal gyrus compared with controls; grey matter volumes were greater in the bilateral caudate, prefrontal lobe and ventral temporal lobe. The summary Asperger syndrome map indicated lower grey matter volumes in the bilateral amygdala/hippocampal gyrus and prefrontal lobe, left occipital gyrus, right cerebellum, putamen and precuneus compared with controls; grey matter volumes were greater in more limited regions, including the bilateral inferior parietal lobule and the left fusiform gyrus. Both Asperger syndrome and autism studies reported volume increase in clusters in the ventral temporal lobe of the left hemisphere. We assigned studies to autism and Asperger syndrome groups for separate analyses of the data and did not carry out a direct statistical group comparison. In addition, studies available for analysis did not capture the entire spectrum, therefore we cannot be certain that our findings apply to a wider population than that sampled. | Whereas grey matter differences in people with Asperger syndrome compared with controls are sparser than those reported in studies of people with autism, the distribution and direction of differences in each category are distinctive. | closed_qa |
Coping with uncertainty: T1a,bN0M0 HER2-positive breast cancer, do we have a treatment threshold? | Recent retrospective studies have suggested that patients with T1a,bN0M0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a higher risk for recurrence and might benefit from adjuvant trastuzumab. The absolute benefits associated with treating this subgroup are uncertain. We reviewed recent studies examining the prognostic value of HER2 in patients with node-negative T1a,b HER2-positive breast cancer. We calculated the number needed to treat (NNT) using baseline risk estimates for untreated T1a,bN0M0 breast cancer and the number needed to harm (NNH) using the incidence of cardiac events in each of the adjuvant trastuzumab clinical trials. Several studies were identified, each with limitations inherent to retrospective database analyses: small cohort sizes, lack of systematic HER2 testing in older specimens, variations in the use of adjuvant therapy and definitions of study end points, and lack of information relating to comorbidities. The 5-year disease-free survival in the pre-trastuzumab era ranged from 77% to 95%. Comparisons between small HER2 -positive and small HER2 -negative cancers showed numerically worse outcome for the HER2-positive cohort in some but not all studies. In many instances, the NNH was larger (26-250) than the NNT (13-35); however, in a subset of patients, the NNH was lower (6) than the NNT (13-35). | Better prediction tools to estimate more precisely the risk for death due to comorbid illness versus breast cancer are needed. In some patients, the risks of therapy could outweigh the benefits. Treatment selection for T1a,bN0 HER2-positive cancers remains in the transition area between evidence- and subjective judgment-based medicine. | closed_qa |
Can strain rate imaging predict recovery of contraction after acute myocardial infarction? | To assess whether strain rate imaging (SRI) can serve to evaluate myocardial viability in patients with acute coronary syndrome (ACS). In 23 patients with ACS, we measured longitudinal tissue Doppler strain and strain rate values from left ventricular basal, mid, and apical segments (n = 414). These segments were grouped according to their acute end-systolic strain values (S(ES)) into those with normocontraction (S(ES)≤-13%), hypocontraction (S(ES) between -13 and -7%), and severe contraction abnormality (S(ES)>-7%). At 8 months, we evaluated the recovery of contraction: Segments with acutely severe contraction abnormality that improved their strain values to ≤-7% were defined as viable, and those that failed to do so as non-viable. In the acute phase, S(ES), post-systolic strain, as well as systolic, early, and late diastolic strain rate values were significantly better in the viable than in the non-viable segments. Post-systolic strain had the best AUC 0.78, and a cut-off value of -3.8% predicted recovery from severe contraction abnormality with a sensitivity of 85% and specificity of 62%. The transmurality of the infarction, assessed by magnetic resonance imaging with delayed enhancement, was significantly larger in the non-viable than in the viable segments (P = 0.006). Acute global S(ES) and systolic strain rate showed the best correlations with final global S(ES) and global infarction percentage after recovery. | SRI can serve to evaluate myocardial viability in patients with ACS, and to assess the recovery of segmental as well as global left ventricular function. | closed_qa |
Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? | To retrospectively evaluate whether magnetic resonance (MR) imaging findings can be used to differentiate necrotizing infectious fasciitis (NIF) from nonnecrotizing infectious fasciitis (non-NIF). Institutional review board approval was obtained, but patient consent was not required for this retrospective review of records and images because patient anonymity was preserved. Thirty patients (seven with NIF, 23 with non-NIF) were included in the study. The following imaging findings were analyzed on fat-suppressed T2-weighted MR images: (a) signal intensity in the deep fascia (low, high, or mixed high and low), (b) thickness of abnormal signal intensity in the deep fascia (≥3 mm or<3 mm), (c) pattern of abnormal signal intensity in muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity), (d) degree of deep fascia involvement (partial or extensive), and (e) degree of compartment involvement (fewer than three compartments or three or more compartments). On contrast material-enhanced fat-suppressed T1-weighted images, the contrast enhancement patterns of the abnormal deep fascia (no enhancement, enhancement, or enhancement with nonenhancing portion) and the muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity) were evaluated. The presence of abscesses in the subcutaneous fat layer was evaluated with all sequences. The patients with NIF had a significantly greater frequency of (a) thick (≥3 mm) abnormal signal intensity on fat-suppressed T2-weighted images, (b) low signal intensity in the deep fascia on fat-suppressed T2-weighted images, (c) a focal or diffuse nonenhancing portion in the area of abnormal signal intensity in the deep fascia, (d) extensive involvement of the deep fascia, and (e) involvement of three or more compartments in one extremity (P<.05). | MR imaging is potentially helpful for differentiating NIF from non-NIF. | closed_qa |
Tumor angiogenesis change estimated by using diffuse optical spectroscopic tomography: demonstrated correlation in women undergoing neoadjuvant chemotherapy for invasive breast cancer? | To investigate if changes in tumor angiogenesis associated with complete pathologic response (pCR) or partial pathologic response (pPR) to treatment can be demonstrated by using diffuse optical spectroscopic (DOS) tomography. All participants in this prospective, HIPAA-compliant, institutional review board-approved study provided written informed consent. Eleven women with invasive breast carcinoma were imaged with DOS tomography prior to, during, and at completion of neoadjuvant chemotherapeutic regimens. By using region of interest (ROI) analysis, the DOS measure of total tissue hemoglobin (Hb(T)) was temporally correlated with quantitative measures of existing (CD31-expressing) and tumor-induced (CD105-expressing) vessels, in pretreatment and posttreatment tissue specimens, to assess change. Quantified angiogenesis alone in pretreatment core biopsy specimens did not predict treatment response, but mean vessel density (MVD) and mean vessel area (MVA) of CD105-expressing vessels were significantly decreased in women with pCR (n = 7) (P<.001 and P = .003, respectively). MVA of CD105-expressing vessels was also significantly reduced at comparison of pre- and posttreatment residual tumor for women with pPR (n = 4) (P = .033). A longitudinal analysis showed significant decreases (P = .001) in mean Hb(T) levels during neoadjuvant chemotherapy in breast abnormality ROIs for women with pCR but not women with pPR. For women with pCR, but not women with pPR, pretreatment MVD of CD105-expressing vessels correlated with pretreatment Hb(T) (P ≤ .001). | DOS tomographic examinations in women with breast cancer who are receiving neoadjuvant chemotherapy show a mean decrease in Hb(T) with time in patients with pCR only. Observed pretreatment and posttreatment correlates with quantified angiogenesis markers confirm the likely biologic origin for this DOS signature and support its potential to predict angiogenic tissue response early in the treatment cycle. | closed_qa |
A diabetic foot ulcer pilot study: does silicone gel sheeting reduce the incidence of reulceration? | Silicone gel sheeting is an effective therapeutic intervention in the management of scar tissue. This pilot study was designed to examine the effect of silicone gel sheeting in preventing reulceration at former wound sites in diabetic patients. Thirty patients with diabetes and a healed plantar neuropathic foot ulcer were enrolled and investigated in this randomized controlled trial. Participants with a newly healed ulcer were assigned to use either silicone gel sheeting or emollient cream daily for 3 months. Compared with emollient cream use, the use of silicone gel sheeting did not diminish and may have potentially increased the risk of reulceration. | Silicone gel sheeting does not seem to reduce the risk of reulceration in diabetic patients. The results of this trial should be viewed with caution given the small sample size. | closed_qa |
Does enteral contrast increase the accuracy of appendicitis diagnosis? | Several approaches traditionally have helped opacify the bowel when computed tomography (CT) is used to diagnose appendicitis. With the development of multidetector row CT (MDCT), the need for enteral contrast agents is less obvious. Purpose The objective of this study was to evaluate retrospectively the accuracy of MDCT demonstration of appendicitis using enteral contrast agents. We reviewed radiologic reports of all 246 adult patients with suspected appendicitis who underwent 16-slice MDCT during 2005-2006 at our department. The use of enteral contrast agents and the route of administration were documented by one investigator. A radiologist evaluated whether the responses in the reports were consistent with diagnosis of appendicitis. The accuracy of the radiologic reports was assessed using the results of surgery, histopathology and 3 to 21 months of follow-up. Of patients studied, 14.6% received no enteral contrast agent, 8.5% received both oral contrast and rectal contrast (enema), 46.7% received oral contrast and 30.1% received rectal contrast enemas. The accuracies for the CT diagnosis of appendicitis with different combinations of agents ranged from 95% to 100%, with no significant difference among groups. | Our study shows that the accuracy for diagnosis of appendicitis by abdominal 16-slice MDCT is high regardless of enteral contrast use. Therefore, further use of enteral contrast agents for CT diagnosis of appendicitis in adults cannot be recommended. | closed_qa |
Does reflux monitoring with multichannel intraluminal impedance change clinical decision making? | Multichannel intraluminal impedance with pH (pH-MII) has become the criterion standard test for the evaluation of gastroesophageal reflux disease, but it is not clear whether the results of this test change clinical decision making. The goal of the present study was to determine the differences in clinical decision making by attending physicians based on the pH probe results versus MII results. We conducted a prospective study in which physicians were initially given pH probe results and asked how they would change the patient's clinical management based on these results. Physicians were then given the MII results and asked how their management would change. Physicians then were asked whether they believed MII affected their clinical decision making overall. pH probe results changed clinical management 40% of the time and MII results changed clinical management an additional 22% of the time. Clinical decision making was not influenced by the performance of pH-MII on or off acid suppression. The escalation of acid suppression therapy was the main management change that occurred based on the pH-MII results. | The addition of MII to the standard pH probe resulted in a change in management in approximately 25% of the patients, suggesting that there may be a role for pH-MII in clinical practice. | closed_qa |
Do athletes excel at everyday tasks? | Cognitive enhancements are associated with sport training. We extended the sport-cognition literature by using a realistic street crossing task to examine the multitasking and processing speed abilities of collegiate athletes and nonathletes. Pedestrians navigated trafficked roads by walking on a treadmill in a virtual world, a challenge that requires the quick and simultaneous processing of multiple streams of information. Athletes had higher street crossing success rates than nonathletes, as reflected by fewer collisions with moving vehicles. Athletes also showed faster processing speed on a computer-based test of simple reaction time, and shorter reaction times were associated with higher street crossing success rates. | The results suggest that participation in athletics relates to superior street crossing multitasking abilities and that athlete and nonathlete differences in processing speed may underlie this difference. We suggest that cognitive skills trained in sport may transfer to performance on everyday fast-paced multitasking abilities. | closed_qa |
Is the PIK3CA gene expression level in FNAB washouts equivalent to that in postoperative tissue specimens of papillary thyroid carcinoma? | Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid gland. The pathogenesis of PTC remains still mostly enigmatic, although PI3K/PTEN/AKT pathway has been proposed to play a role in development of PTC. Moreover, the significance of genetic analysis in the material from fine-needle aspiration biopsy (FNAB) in PTC patients has recently been demonstrated. Hereby, we present a study analyzing expression of PIK3CA in FNAB washouts of PTC and a comparison of the level of that expression with respective expression in postoperative PTC tissue. Furthermore, we have assessed correlation between tumor size, evaluated according to pTNM scale, and level of PIK3CA gene expression in postoperative PTC tissue. Total RNA was extracted by use of an RNeasy Micro Kit (Qiagen, Hilden, Germany) in FNAB material, and RNeasy Midi Kit (Qiagen, Hilden, Germany) in tissue material. The purity of total RNA was assessed by NanoDrop® ND-100 spectrophotometr. One hundred nanograms of total RNA were used in the first strand cDNA synthesis with TaqMan® Reverse Transcripton Reagents (Applied Biosystems, Branchburg, New Jersey, USA). The gene expression level of PIK3CA was analyzed by real-time PCR in the ABI PRISM ®7500 Sequence Detection System in the 21 (17 women, 4 men) FNAB and 20 (16 women, 4 men) postsurgical specimens of PTC. pTNM staging of PTC was assessed based on UICC classification. Overexpression of PIK3CA was confirmed in FNAB washout specimens and in postoperative tissues of PTC, in comparison to macroscopically unchanged thyroid tissue. Furthermore, statistically significant differences in PIK3CA gene expression levels between both examined groups were not confirmed. Moreover, correlation between pTNM staging and level of PIK3CA gene expression in PTC samples was not found. | The genetic analysis of overexpression of PIK3CA in FNAB washout specimens may be equivalent of postsurgical PTC tissue. A possibility of its future clinical application in FNAB specimens - adequate or undetermined for cytological analysis - awaits for evaluation. The level of expression of PIK3CA is independent of primary thyroid tumour size, evaluated according pTNM scale. | closed_qa |
Expression of somatostatin receptor subtypes in primary and recurrent gonadotropinomas: are somatostatin receptors involved in pituitary adenoma recurrence? | Surgical treatment of pituitary macroadenomas often fails because of tumor recurrence after the operation. The causes of tumor recurrence are complex, but one of them may be the high growth potential of the adenoma. As somatostatin receptors mediate antiproliferative, anti-angiogenic and pro-apoptotic actions, it seemed reasonable to investigate their expression in dependence on the adenoma recurrence. Samples of primary and recurrent gonadotropinomas excised surgically from patients were examined. This type of pituitary adenomas was chosen because of its relatively high recurrence rate. The adenoma phenotype and expression of somatostatin receptor subtypes 1-5 (SSTR 1-5) were investigated by immunohistochemistry, and the level of SSTR expression was semiquantitatively scored. It was found that the adenomas undergoing the early recurrence have lower expression of SSTR 2A and 3 in comparison to those which did not recur during 5 years lasting observation. On the other hand, the recurrent tumors show higher expression of SSTR 1, 2A, 3 and 5 subtypes than their primary counterparts. | It is hypothesized that SSTR may, at least in part, counteract adenoma recurrence. On the other hand, it can be also presumed that the recurrent gonadotropinomas may be more sensitive to somatostatin analog treatment than primary ones. These hypotheses need to be confirmed in further studies. | closed_qa |
Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? | Endoscopic resection (ER) including endoscopic submucosal dissection has been widely accepted for treatment of early gastric cancer (EGC) in Japan. Additional surgery is recommended when ER is non-curative histologically. Many elderly patients, however, do not undergo radical surgery due to comorbid disease or limited life expectancy. The aim of this study is to assess the survival outcomes of radical surgery compared with observation only in elderly patients after non-curative ER. We reviewed existing data of all elderly patients (older than 75 years) who had undergone ER for EGC at the National Cancer Center Hospital between January 1999 and December 2005. We compared the overall and disease-free survival rates between three patients groups: curative ER, non-curative ER with additional surgery, and non-curative ER without additional surgery. In total, 428 patients underwent ER; 308 (72%) curative ER and 120 (28%) non-curative ER. Of the 120 non-curative ER patients, 38 patients (31.7%) underwent additional surgery and 82 patients (68.3%) were followed without surgery. There was no significant difference in American Society of Anesthesiologist score between three groups. Patients who did not undergo surgery tended to be older. Overall 5-year survival rates in the curative ER, non-curative ER with surgery, and non-curative ER without surgery were 85, 92, and 63%, respectively. There was no significant difference in overall and disease-free survival between patients in the curative ER and non-curative ER with surgery groups. On the contrary, a significant difference in overall and disease-free survival was evident between the curative ER and non-curative ER without surgery groups (hazard ratio (95% confidence interval): 1.89 (1.08-3.28), 2.30 (1.35-3.94)). | In our elderly patient cohort, additional surgery following non-curative ER improved overall and disease-free survival compared with non-surgical observation only. Thus, surgery should be considered following non-curative ER in EGC patients>75 years of age. | closed_qa |
Inhibin/activin expression in human and rodent liver: subunits α and βB as new players in human hepatocellular carcinoma? | Activins and inhibins belong to the TGFβ-superfamily, which controls cell proliferation and differentiation in many organs. Activin A, the dimer of inhibin βA subunit, acts strongly anti-proliferative in hepatocytes. Little is known on the other activin/inhibin subunits in human liver and hepatocellular carcinoma (HCC). We studied the expression of the complete inhibin family α, βA, βB, βC, βE in normal liver, tumour-adjacent and HCC tissue, 12 additional organs and rodent liver. A total of 16 HCC and 10 disease-free livers were analysed. Expression of inhibin subunits was determined by qRT-PCR, normalised to RNA input and by geNorm algorithm, and confirmed by immunohistochemistry. Remarkably, βA expression was not decreased in HCC. Similarly, βC and βE exhibited no major changes. In contrast, inhibin α, barely detectable in normal liver, was strongly increased in tumour-adjacent liver and dramatically enhanced in HCC. βB was strongly enhanced in some HCC. At variance with human liver, rodent liver showed higher inhibin α and βC expression, but βA was somewhat, and βB dramatically lower. | Upregulation of inhibin α - and possibly of βB - may shield HCC cells from anti-proliferative effects of activin A. Dramatic variations between humans and rodents may reflect different functions of some inhibins/activins. | closed_qa |
Is economic growth associated with reduction in child undernutrition in India? | Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India. Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992-93, 1998-99, and 2005-06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%-20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization-determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes. | We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India. Please see later in the article for the Editors' Summary. | closed_qa |
Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? | This systematic literature review analysed the change in range of knee flexion from pre-operative values, following conventional posterior stabilised (PS) and high-flexion (H-F) PS total knee arthroplasty (TKA). We calculated the weighted mean differences of pre- and postoperative flexion using meta-analysis with random effect modelling. Eighteen studies met our inclusion criteria. These data included a total of 2,104 PS knees that received conventional implants and 518 knees that received H-F implants. The pooled gain in flexion was 4.70° in the conventional group (p<0.0001) and 4.81° in the H-F group (p = 0.0008). In the subgroup analysis, the Western patient group showed significant difference in the gain of flexion with both implants. In contrast, no significant gain in flexion was observed in the Asian patient group. | These results suggest that improvement of preoperative flexion after TKA using current H-F PS prostheses is similar to that of conventional PS prostheses. | closed_qa |
Is inflammatory bowel disease an important risk factor among older persons with colorectal cancer in the United States? | While ulcerative colitis (UC) and Crohn's disease (CD) are thought to predispose to colorectal cancer (CRC), the association has not been well studied in an older population. The objective of our study was to evaluate the association of ulcerative colitis and Crohn's disease and colorectal cancer in a population-based, case-control study. We also wished to estimate the incidence rates of colorectal cancer among older individuals with UC/CD. All cases of colorectal cancer in persons 67 and older in the SEER catchment area and in the Medicare claims database were compared with cancer-free controls residing in the same geographic area. We used multivariable logistic regression models adjusted for demographic and other factors. We identified 47,543 cases of CRC and 142,273 controls. We found a modest association between UC and CRC (OR 1.93; 95% CI 1.54-2.49; P-value<0.001) and a significant, albeit modest, association between CD and CRC (OR 1.45; 95% CI 1.08-1.91; P-value 0.01). We found the incidence of CRC to be 8.2 per 10,000 person-years (95% CI 6.5-10.1/10,000 person-years) among those with UC/CD, and 6.1 per 10,000 person-years (95% CI 4.6-7.8/10,000 person-years) among those without UC/CD, resulting in an incidence rate ratio of 1.34. | Among older persons ulcerative colitis and Crohn's disease are modest risk factors for CRC, and the incidence rate ratio for CRC is modest, suggesting that risk of CRC in patients with IBD may be lower than previously thought. | closed_qa |
Can complications of titanium elastic nailing with end cap for clavicular fractures be reduced? | We found treatment of clavicular midshaft fractures using titanium elastic nails (TENs) in combination with postoperative free ROM was associated with a complication rate of 78%. The use of end caps reduced the rate to 60%, which we still considered unacceptably high. Thus, we explored an alternative approach.QUESTIONS/ We investigated whether (1) the complication rate could be reduced by cautious lateral advancement of the TENs, intraoperative oblique radiographs to rule out lateral perforation, and limited ROM postoperatively; (2) fluoroscopy time could be reduced; and (3) shoulder function would be reasonable. From March 2006 to December 2009, we treated 44 patients with midshaft clavicular fractures with TENs and end caps. In the first group (n = 15), the TEN was advanced laterally using an oscillating drill. The patients were permitted free ROM. In the second group (n = 29), the TEN was advanced by hand, conversion to open reduction followed two failed closed attempts and lateral perforation was checked with an intraoperative oblique radiograph. Furthermore, anteversion and abduction of the shoulder were limited to 90° for the first 6 weeks. Minimum followup was 12 months (mean, 16.7 months; range, 12-28 months). The total complication rate was reduced from nine of 15 in the first group to five of 29 in the second group. Medial perforations ceased with the use of the end cap. Fluoroscopy time was reduced from a mean of 10 to 4 minutes by converting to open reduction after two failed closed attempts. All but three patients exhibited full shoulder ROM at three months and these three had a slight deficit of 10° to 20° in anteversion and/or abduction. At last followup, the mean American Shoulder and Elbow Surgeons score was 92 (range, 88-100) and the Disability of the Arm, Shoulder, and Hand score 1.4 (range, 0-12.5). | Cautious insertion of the TENs, intraoperative oblique radiographs, and limiting the ROM for 6 weeks postoperatively reduced the complication rate. Using TENs with end caps for midshaft clavicular fractures is minimally invasive while associated with comparable complication rates and function to plate osteosynthesis. | closed_qa |
Can patients really participate in sport after high tibial osteotomy? | The possibility to return to sporting activity can be an important consideration in the decision-making process in femorotibial osteoarthritis. We analyzed functional outcomes and sport participation in a continuous series of HTO and asked whether this procedure could match expectations in active and motivated patients. We retrospectively investigated activities, sports participation, and the level of satisfaction in 139 patients with unilateral noncomplicated HTO. The study included 41 women and 98 men with a mean age of 59 years and a mean 50 months of follow-up. Eighty-seven patients (63%) reported that their knee was "normal," and eighty-six patients (62%) felt that their activities were limited by their knee. A total of 78 patients (56%) reported that they were as active as they expected to be before the intervention. Of these patients, 98% were satisfied. Of the patients who were not as active as they thought they would be, 51% were satisfied (P < 0.0001). The duration of preoperative pain, the age at evaluation, and the number of previous surgeries did not influence the subjective result. Among patients under 75 years, 28% regularly participated in strenuous sports, but 40% were motivated for these activities. 66% of the motivated patients regularly participated in at least one impact sport. | This study shows that young motivated patients are able to resume strenuous activities following HTO. However, patients must be informed that they will typically not recover their pre-pathology level and that residual pain during strenuous sports is not exceptional. | closed_qa |
Stentless pediatric ureteroscopic holmium: YAG laser stone disintegration: is gravels retrieval an issue? | To evaluate the safety and efficacy of stentless pediatric ureteroscopic holmium laser stone disintegration without gravels retrieval. From Feb 2007 to Feb 2010, 21 children (12 boys and 9 girls) with unilateral single stone ureter, with an average age of 8.5 years (range 4-12 years), were treated with 6.9 Fr semirigid ureteroscope for a stone size ranged from 5 to 10 mm (mean 6.5 mm). All the stones were radioopaque, located in the upper ureter in 2 cases (9.5%), in the middle ureter in 5 cases (24%), and in the lower ureter in 14 cases (66.5%). Complete holmium laser stone disintegration was applied in all cases without gravels removal. No postoperative ureteral stent was inserted in any case. The stones were successfully approached and completely disintegrated in a single session in 20 cases (95.2%). All the procedures were done without ureteral orifice dilatation apart from 3 cases where another working guide wire was applied. No intraoperative complications were recorded in the form of mucosal injury, ureteral perforation, or urinary extravasation. There is no early postoperative complication in the form of urinary tract infection or colic apart from single case of hematuria which was successfully treated conservatively. Two weeks postoperatively, KUB (kidney, ureter, and bladder) films were completely free from any significant gravel (>3 mm) and US showed no hydronephrosis. | Stentless ureteroscopic holmium laser disintegration without gravels removal is a safe and effective method for pediatric ureteral stone less than 10 mm in diameter. | closed_qa |
Is laparoscopic surgery a contraindication in patients with severe senile kyphosis? | The japanese population have the longest-life expectancy in the world. Accordingly, older patients with colorectal cancer with senile kyphosis caused by aging or osteoporosis also increase. Laparoscopic surgery is minimally-invasive, and performance on severe kyphotic patients may cause difficulty to approach a narrow abdomen. To determine whether laparoscopic surgery is safe and feasible in patients with severe senile kyphosis. Laparoscopic operations under general anesthesia were undertaken with the patients in lithotomy position. Intraoperative difficulties were compared with normal laparoscopic approach. Working space was divided by right costal arch during right hemicolectomy for right sided colon cancer. For sigmoid colon cancer, dissection of lymph node and anastomosis were completed with much difficulty because the pelvic space was occupied with small intestine. However, the postoperative course was uneventful despite impaired lung function in all cases. | Severe senile kyphosis is not a contraindication for minimally invasive technique applied to colorectal cancer patients. | closed_qa |
Do young dyspeptic patients consider upper gastro-intestinal endoscopy useful? | Carefully planned strategies for selecting patients to upper gastro-intestinal (GI) endoscopy may reduce the number of procedures. However, the impact of the examination and the potential value of being reassured by a negative endoscopy has yet to be evaluated. 280 young dyspeptic patients were classified to have either peptic ulcer disease, non ulcer dyspepsia (NUD), gastro esophageal reflux disease (GERD) with or without erosive esophagitis after upper gastro-intestinal endoscopy. At one year follow-up, the patients evaluated their symptoms and were asked what they considered the main reason for improvement, if any, when given six alternatives. 242 returned the one year follow-up questionnaire. 82% of the peptic ulcer group reported symptom improvement and the eradication therapy as the main reason for it. In the NUD group 63% had improved, weighting change in life-style and diet as the main reasons. Only 16% reported the reassurance by a negative endoscopy as important for improvement. The two GERD groups scored similar and recorded acid reducing medication as the far most important reason for improvement. | Young dyspeptic patients, patients with peptic ulcer disease seems to be the only group where endoscopy has significant value for choosing the optimal therapeutic option. Neither the reassurance by a negative endoscopy in the NUD group nor the detection of esophagitis in patients with GERD is of importance to subjective improvement. | closed_qa |
Is timed up and go better than gait speed in predicting health, function, and falls in older adults? | To assess whether the Timed Up and Go (TUG) is superior to gait speed in predicting multiple geriatric outcomes. Prospective cohort study. Medicare health maintenance organization and Veterans Affairs primary care clinics. Adults aged 65 and older (N=457). Baseline gait speed and TUG were used to predict health decline according to EuroQol and Medical Outcomes Study 36-item Short Form Survey (SF-36) global health; functional decline according to National Health Interview Survey (NHIS) activities of daily living (ADLs) score and SF-36 physical function index; hospitalization; and any falls and multiple falls over 1 year. Mean age was 74, and 44% of participants were female. Odds ratios for all outcomes were equivalent for gait speed and TUG. Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability, gait speed and TUG each alone predicted decline in global health, new ADL difficulty, and falls, with no difference in predictive ability between performance measures. Neither performance measure predicted hospitalization, EuroQol decline, or physical function decline. As a continuous variable, TUG did not add predictive ability to gait speed for any outcome. | Gait speed predicts most geriatric outcomes, including falls, as does TUG. The time taken to complete TUG may not add to information provided by gait speed, although its qualitative elements may have other utility. | closed_qa |
The Hispanic Americans Baseline Alcohol Survey (HABLAS): is the "prevention paradox" applicable to alcohol problems across Hispanic national groups? | The "prevention paradox," a notion that most alcohol-related problems are generated by nonheavy drinkers, has significant relevance to public health policy and prevention efforts. The extent of the paradox has driven debate over the type of balance that should be struck between alcohol policies targeting a select group of high-risk drinkers versus more global approaches that target the population at-large. This paper examines the notion that most alcohol problems among 4 Hispanic national groups in the United States are attributable to moderate drinkers. A general population survey employing a multistage cluster sample design, with face-to-face interviews in respondents' homes was conducted in 5 metropolitan areas of the United States. Study participants included a total of 2,773 current drinkers 18 years and older. Alcohol consumed in the past year (bottom 90% vs. top 10%), binge drinking (binge vs. no binge), and a 4-way grouping defined by volume and binge criteria were used. Alcohol-related harms included 14 social and dependence problems. Drinkers at the bottom 90% of the distribution are responsible for 56 to 73% of all social problems, and for 55 to 73% of all dependence-related problems reported, depending on Hispanic national group. Binge drinkers are responsible for the majority of the social problems (53 to 75%) and dependence-related problems (59 to 73%), also depending on Hispanic national group. Binge drinkers at the bottom 90% of the distribution are responsible for a larger proportion of all social and dependence-related problems reported than those at the top 10% of the volume distribution. Cuban Americans are an exception. | The prevention paradox holds when using volume-based risk groupings and disappears when using a binge-drinking risk grouping. Binge drinkers who drink moderately on an average account for more harms than those who drink heavily across all groups, with exception of Cuban Americans. | closed_qa |
Do rates of arthritis and chorea predict the incidence of acute rheumatic fever? | Acute rheumatic fever (ARF), a major cause of acquired heart disease worldwide, remains a significant public health problem. However, the precise incidence of ARF in Africa, where a large number of cases occur, remains unknown. We hypothesize that focused attention on non-cardiac features of ARF, namely joint manifestations and chorea, might enhance its detection in settings with limited resources. This hypothesis was tested by reviewing the medical records at Vanderbilt Children's Hospital from 1998 to 2008. In addition, an extensive literature review of published studies was performed to assess rates of joint findings or chorea in confirmed cases of ARF. Fifty-nine new cases of ARF were diagnosed in children at Vanderbilt from 1998 to 2008. Of these cases, 91% presented with joint manifestations or chorea, and 80% satisfied major Jones criteria findings of polyarthritis or chorea. These findings are consistent with literature published from our region and internationally. | Most patients presenting with ARF have either joint symptoms or chorea, features that could be recognized by community health workers and individuals with limited medical training. The referral of patients presenting with these manifestations for further evaluation might improve detection rates of ARF in resource-limited countries and lead to improved estimates of disease burden. | closed_qa |
Management of phototherapy for neonatal hyperbilirubinemia: is a new radiometer applicable for all wavelengths and light source types? | To evaluate the clinical effects of phototherapy for neonatal hyperbilirubinemia, it is necessary to measure the rate of cyclobilirubin production, which represents the main photochemical pathway of bilirubin metabolism. Since the Atom Phototherapy Analyzer can be used to calculate the theoretical relative light energy of irradiance as a means of assessing the cyclobilirubin production rate for each wavelength spectrum, the clinical effect of phototherapy can be evaluated regardless of the light source type. Using the Atom Phototherapy Analyzer, the correlation between the irradiance of various light sources with different peak wavelengths and the rate of cyclobilirubin production was investigated in vitro. We also investigated the utility of green LED in vitro. A bilirubin-albumin complex solution was prepared, poured into tubes, and irradiated using various light sources. All light sources used were bed-type phototherapy devices; that is, green and blue LED and green and blue fluorescence tubes. The concentrations of photoisomers were measured after irradiation and compared with the irradiance of the light sources. The irradiance measured by the Atom Phototherapy Analyzer decreased in the following order: blue fluorescence tube>green LED>blue LED>green fluorescence tube. The cyclobilirubin production rates and irradiance values of the light sources were significantly positively correlated (R(2) = 0.93, P<0.05). | Our data indicate that the Atom Phototherapy Analyzer can be used to objectively evaluate the effects of phototherapy using various light sources. Further, the effects of green LED were similar to those of other light sources in vitro. | closed_qa |
Do best practice guidelines improve the legibility of pharmacy labels for the visually impaired? | Reading pharmacy labels on medications is a challenging task for visually impaired people. Design for Patient Safety (DfPS) best practice guidelines exist on the presentation of information on pharmacy labels, but it is unclear to what extent current labels follow the guidance. It is also unclear whether labels produced to DfPS guidelines are more accessible to patients with impaired vision. Twenty-four sample labels were obtained from six different pharmacy chains. Experimental labels were constructed reflecting a typical pharmacy label, an ideal label constructed to DfPS guidelines, and a large print label. 20 normally-sighted subjects read labels under habitual conditions (mean VA -0.14 log MAR, Snellen equivalent 6/4.4), and under two conditions of simulated visual impairment (mean VA +0.41 and +0.69 logMAR, Snellen equivalents 6/15.4 and 6/29.4). Outcome measures were speed and accuracy of label reading. Median font size for the primary directions on the sample labels was 9.5 point (range 8-10 point), rather than the recommended minimum size of 12 point. In the mild visual impairment condition, using the ideal label improved accurate reading speed by 58% over the typical label, and using the large print label improved accurate reading speed by about 100%. In the moderate visual impairment condition, 65% of subjects were able to see sufficient of the directions to be able to take the medication appropriately with the ideal label, and 80% with the large print label, as compared to 20% with the typical label. | DfPS best practice guidelines were not fully met by any of the pharmacy labels in this sample. With unimpaired vision, label design had little impact on legibility. However, the results provide evidence that preparing pharmacy labels according to DfPS guidelines improves their relative legibility in simulated visual impairment. These findings need extending to those with actual visual impairment, but the current results strengthen the argument for conformance to DfPS guidelines. | closed_qa |
Randomized controlled study comparing misoprostol moistened with normal saline and with acetic acid for second-trimester pregnancy termination. Is it different? | To compare the efficacy and adverse effects of 400 µg intravaginal misoprostol for second-trimester pregnancy termination in live fetuses between two groups: one in which misoprostol was moistened with normal saline solution (NSS) and the other in which misoprostol was moistened with acetic acid. A total of 179 pregnant women between 14 and 28 weeks of gestation with live fetuses indicated for pregnancy termination were recruited. They were randomly allocated to receive 400 µg intravaginal misoprostol either moistened with NSS (n = 96) or moistened with acetic acid (n = 83). The same dosage was then repeated every 3 h if adequate uterine contractions were not achieved until 48 h after the initiation of misoprostol. The main outcomes were mean abortion time, success rate, and adverse effects. The mean abortion time was not significantly different between the groups (24.98 ± 16.42 h vs 25.89 ± 10.34 h, P>0.05). The rates of abortion within 24 h and 48 h and the adverse effects were also comparable between the groups. Chills and fever were the most common adverse effects in this study. | Intravaginal misoprostol either moistened with NSS or acetic acid was comparable in terms of efficacy and adverse effects. | closed_qa |
Lichen planus and hepatitis virus infections: causal association? | The causal association between hepatitis virus infections and lichen planus (LP) remains a matter of controversy. Reliable figures for German patients are still lacking. We analyzed the prevalence of serum antibodies against hepatitis B and C viruses (HBV, HCV) in 265 LP patients and compared the results to 257 patients with chronic urticaria (URT) and 222 patients with malignant melanoma (MM). Additionally, we analyzed age- and sex-specific differences. The prevalence of HBV (13.2 % or 14.7 %) antibodies was significantly higher in patients with LP and URT patients than in the MM control group (HBV: 5.4 %, p<0.001). The prevalence of HCV antibodies among LP and URT patients (2.6 % or 0.8 %) was not significantly greater (p>0.05) than in MM patients (0.4 %). The prevalences of HBV and HCV in the MM control group were comparable to those in the general German population (HBV: 5-8 %, HCV: 0.4-0.7 %). An analysis by sub-groups showed that these differences resulted from sex- and age-dependent prevalences. HBV antibodies were significantly more common only in male LP patients (16.1 %) and in male (20.0 %) and female URT patients (15.6 %) aged 31-60 years. The greater prevalence of HCV in female LP patients older than 60 years of age was not significant. | LP is not specifically associated with hepatitis B or C antibodies in the Caucasian population of Germany. The higher prevalences of HBV antibodies found in LP and URT patients may be a reflection of age- and sex-related factors rather than disease-specific exposure to HBV infections. The increased prevalences seen in patients with LP or URT compared to MM patients may suggest that HBV infection serves as an unspecific trigger for a specific immune reaction of another origin. | closed_qa |
Positive margin during partial nephrectomy: does cancer remain in the renal remnant? | To examine the outcomes of patients with a positive surgical margin by gross and/or frozen examination during partial nephrectomy, in whom a re-resection of the margin or a completion nephrectomy was performed. Patients with renal cancer who underwent partial nephrectomy were considered. If the patient had a positive margin and underwent completion nephrectomy or re-excision of the margin, they were included. Patients with planned enucleation were excluded from the study. Clinical and pathologic information were reviewed to examine for residual cancer in the additionally resected tissue. In the final cohort, 29 patients with a positive margin and subsequent complete parenchymal re-resection or completion nephrectomy were identified. Eight patients underwent nephrectomy, after which no residual cancer was found in the renal remnant. Twenty-one patients underwent total re-resection of the margin, of which two were found to have carcinoma. Renal functional outcomes revealed a decrease in estimated glomerular filtration rate of 25 mL/min/1.73 m(2) in patients who underwent radical nephrectomy, and 4 mL/min/1.73 m(2) in patients who underwent re-resection of the margin with preservation of the renal unit. | A positive surgical margin does not necessarily mean that cancer remains in the renal remnant in most cases. Therefore, radical nephrectomy or re-resection of the margin is overtreatment in many cases, but a small percentage of patients will harbor residual malignancy. Clinical correlation is recommended before reexcision or completion nephrectomy after a positive surgical margin, with careful consideration of the impact on subsequent renal function weighed against the possibility of residual disease. | closed_qa |
Radical fimbriectomy: a reasonable temporary risk-reducing surgery for selected women with a germ line mutation of BRCA 1 or 2 genes? | Bilateral salpingo-oophorectomy (BSO) is the gold standard prophylactic surgery for BRCA1 or 2 mutation carriers. However, due to the resulting early menopause and fertility desires, young women are reluctant to undergo this procedure. In view of the recent literature on ovarian carcinogenesis, we wish to report a novel conceptual surgical procedure we called "radical fimbriectomy." This procedure is aimed to protect this subset of high-risk women from high-grade serous pelvic carcinoma, while preserving their ovarian function. Women with BRCA mutation, who were scheduled for BSO, were informed of the procedure approved by our local review board. Radical fimbriectomy consists of removing all the tube and the fimbrio-ovarian junction, step immediately followed in this developmental phase by completion oophorectomy. Four methods of partial ovarian transsection were prospectively compared: sharp division, stapler, bipolar division and harmonic scalpel. Surgical safety and pathological alterations were assessed. All specimens underwent extensive pathological evaluation using both SEE-FIM protocol and serial sections. Fourteen women were enrolled in the study. Sharp and EndoGIA® appeared to be the safest methods of ovarian resection providing the best specimen quality for pathological examination. | We believe this technique could be suggested to young mutation carriers reluctant to undergo BSO. This approach is preferable to no prophylactic surgery at all. However, until the safety and validity of this procedure is confirmed by a multi-institutional study, women who undergo radical fimbriectomy should continue to receive regular multimodal evaluation and be advised of the risks involved until they finally accept secondary castration. | closed_qa |
Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients? | The benefits of Roux-en-Y gastric bypass (RYGB) for the control of type 2 diabetes mellitus (T2DM) in morbidly obese patients are well known, although the implicated mechanisms have not yet been elucidated. However, little is known about the remission of T2DM after sleeve gastrectomy (SG). The aim of our study was to compare the outcomes of T2DM after both procedures. We performed a retrospective analysis of diabetic morbidly obese patients who had undergone RYGB or SG. The variables analyzed included weight, fasting glycemia, and glycosylated hemoglobin. A total of 90 patients were included (60 RYGB and 30 SG). The body mass index was 46.22 kg/m(2) for the RYGB group and 56.80 kg/m(2) for the SG group. The fasting glycemia was 10.63 mmol/L and 8.05 mmol/L and the glycated hemoglobin was 8.1% and 7.3% in the RYGB and SG groups, respectively. No significant differences were seen in the amount of weight loss after 2 years between the 2 techniques. Similarly, no significant differences were found in T2DM control after either 1 year (91.8% versus 82.3%) or 2 years (91.8% versus 88.9%). No significant differences were found in the duration of T2DM in either group nor in the percentage of patients treated with insulin and oral hypoglycemic drugs before and 2 years after surgery. | We did not find any significant differences in weight loss or T2DM resolution between the 2 techniques. Our results highlight that 1 of the mechanisms implicated in T2DM remission after bariatric surgery is weight loss. The role of other factors, such as incretins, that we have not studied cannot be ruled out and should be analyzed further. | closed_qa |
Stage IIA1 versus stage IIA2 cervical cancer: does the new staging criteria predict survival? | (1) To determine the correlation of 2008 International Federation of Gynecology and Obstetrics staging system with survival in patients with stage IIA cervical cancer, (2) to elucidate the treatment patterns in stage IIA1 and stage IIA2 cervical cancer, and (3) to investigate whether radical hysterectomy or radiation influenced overall survival. Data were extracted from the Surveillance, Epidemiology and End Results database between 1988 and 2005. Statistical analysis used χ test, Kaplan-Meier method, Cox regression, and logistic regression. Of the 560 women, 271 (48.4%) had stage IIA1, and 289 (51.6%) had stage IIA2 cervical cancer. Stage IIA2 patients were younger than stage IIA1 patients (mean age, 49 years vs 54 years; P = 0.01). Stage IIA1, compared with stage IIA2, differed significantly regarding the administration of primary radiation (47.2% vs 64.7%, P<0.001) and adjuvant radiation (60.5% vs 77.5%, P = 0.006). The following variables were significantly associated with the performance of radical hysterectomy: patient age, 65 years or younger, tumor size, ≤ 2 cm or lesser, high tumor grade, and nonsquamous tumor histology. The incidence of adjuvant radiation after radical hysterectomy was high (48% [tumor size, ≤ 2 cm] to 86% [tumor size,>6 cm]). The 5-year overall survival was not significantly different between stages IIA1 and IIA2 (65.8% vs 59.5%, P = 0.2). Only patient age (P = 0.01), tumor size (P = 0.02), and lymph node status (P = 0.002) were independent predictors of survival. When controlled for other contributing factors, there was no significant difference in survival between patients treated by radical hysterectomy and primary radiation. | The 2008 International Federation of Gynecology and Obstetrics staging criteria is not an independent predictor of survival in stage IIA cervical cancer. Given the equivalent efficacy of radical hysterectomy and radiation, attention should be paid to the high risk of adjuvant radiation in these patients. | closed_qa |
Is activity loss predictive for development of upper limb oedema after stroke? | To investigate the disuse hypothesis as an explanation for upper limb oedema in patients with stroke. Longitudinal observational study. Patients with acute hemiparetic stroke were recruited from 2006 to 2009 (n=139). Patients wore 2 uni-axial accelerometers, 1 on each wrist, for 2 periods of 48 h with a 1-week interval. Activity performed by the patients with acute stroke was measured by determining total activity, measured as a total sum of raw counts, and calculating the ratio variable. The National Institute of Health Stroke Scale (NIHSS), Fügl-Meyer Assessment and modified Rankin Scale were used. During a 3-month follow-up, patients underwent 3 assessments of upper limb oedema. The incidence of upper limb oedema range for the objective evaluation was 7.7-14.7%, while the incidence for the subjective evaluation ranged from 11.5% to 18.1%. No significant differences were found between patients with and without oedema concerning the activity variables; therefore no prognostic value could be determined. | No difference in upper limb activity was found between patients with and without oedema after stroke. It is doubtful that loss of activity of the paretic limb is solely responsible for the development of upper limb oedema after stroke. | closed_qa |
Post-ERCP pancreatitis in 2364 ERCP procedures: is intraductal ultrasonography another risk factor? | Acute pancreatitis is considered a relevant major complication following endoscopic retrograde cholangiopancreatography (ERCP); according to literature data, the incidence varies between 1.5 % and 17 %. In the present study, we aimed to identify potentially new, hitherto unknown risk factors for post-ERCP pancreatitis. A total of 2364 ERCP procedures performed in 1275 patients during the years 2004 - 2008 were included in the study. Post-ERCP pancreatitis was defined as acute abdominal pain within 48 hours following ERCP with at least 3-fold elevated levels of serum lipase and a requirement for analgesic drugs for at least 24 hours. The severity of the pancreatitis was determined using the Imrie score. In our cohort study a total of 54 different patients (2.3 %) developed post-ERCP pancreatitis. In 50 of these patients (92.6 %) the pancreatitis was mild; in 54 (7.4 %) it was severe. Patients with post-ERCP pancreatitis had highly significantly lower bilirubin levels than patients who did not have post-ERCP pancreatitis ( P<0.001). Length of hospital stay, duration of analgesics, and need for analgesic drugs were significantly higher in patients suffering from severe pancreatitis ( P ≤ 0.01). In multivariate analysis, among other, already well-described risk factors we identified intraductal ultrasonography as another risk factor for post-ERCP pancreatitis, with a hazard ratio of 2.41 ( P = 0.004). | According to our retrospective data, intraductal ultrasonography seems to be another independent risk factor for developing post-ERCP pancreatitis, which needs to be further elucidated in prospective studies. | closed_qa |
Does normal fetal brain ultrasound predict normal neurodevelopmental outcome in congenital cytomegalovirus infection? | We evaluated the neuropsychological outcome of children with proven congenital cytomegalovirus (CMV) infection and normal consecutive fetal neurosonographic examinations. We retrospectively reviewed laboratory and imaging findings of children with congenital CMV infection. The study group consisted of children with a positive polymerase chain reaction (PCR) in amniotic fluid and virus isolation in urine in the first week of life, and normal fetal ultrasonographic (US) examination findings, including a normal multiplanar neurosonographic evaluation. Patients with abnormal magnetic resonance (MR) findings were not excluded. The study and control groups were evaluated for cognitive, language, and motor development at one follow-up examination conducted at 11-81 months of age. Children with congenital CMV infection and normal fetal brain findings in the US examination did not differ from the control group in terms of cognitive, language, motor, emotional-behavioral, and executive functioning. There were no differences between congenitally infected children who had a normal fetal brain MR examination and children whose fetal brain MR examination raised suspicion of a possible brain insult. | Normal neurosonographic examinations during pregnancy appear to predict a normal early neuropsychological outcome in fetuses with congenital CMV infection. Outcome did not correlate with suspected abnormal white matter on fetal MR imaging. | closed_qa |
Is fetal cardiac function gender dependent? | An increased nuchal translucency (NT) is more common in males. A delayed diastolic cardiac function maturation has been proposed to explain this and the reported gender-related differences in ductus venosus (DV) flow. To investigate gender-related differences in fetal cardiac function. One hundred and ninety karyotypically/phenotypically normal fetuses with structurally normal hearts and known NT measurement, (104>95th percentile), were prospectively included between 1 October 2003 and 1 April 2009. They had been referred for fetal echocardiography. Three hundred and nine echocardiograms were performed between 11 and 35 weeks' gestation. The atrioventricular valve E- and A-wave peak velocity, E/A-velocity ratio and E/TVI ratio, myocardial performance index, semilunar valves acceleration time (AT) and peak velocity, stroke volume and cardiac output as well as DV pulsatility index for veins at 11-14 weeks' gestation, were measured. A multilevel analysis was performed using the NT (multiples of the median) as a continuous variable. The male : female ratio was 1.56:1. The tricuspid valve E/TVI was significantly higher and pulmonary valve AT significantly lower in females compared to males. No other significant differences in cardiac function were found. | Our findings suggest better right ventricular (RV) relaxation and increased RV afterload in female fetuses, independent of NT thickness, between 11 and 35 weeks' gestation. | closed_qa |
Androgenetic alopecia and insulin resistance: are they truly associated? | Controversies exist regarding the association of androgenetic alopecia (AGA) with insulin resistance. Are they truly associated, or is insulin resistance just related to aging, obesity, or to the presence of metabolic syndrome? To assess insulin resistance in young nonobese patients with AGA with and without metabolic syndrome. The study included four equally distributed groups of age-, sex-, and body mass index-matched young, nonobese subjects: 30 patients with AGA and metabolic syndrome (group 1); 30 patients with AGA and no metabolic syndrome (group 2); 30 patients with metabolic syndrome and no AGA (group 3); and 30 healthy controls (group 4). Insulin resistance based on fasting insulin levels and homeostasis model assessment of insulin resistance (HOMA-IR) was assessed in all groups. Twenty-three patients in group 1, four patients in group 2, 25 patients in group 3, and three healthy controls had insulin resistance with statistically significant differences in fasting insulin and HOMA-IR levels between all groups, between groups 1 and 2, groups 1 and 4, groups 2 and 3, and groups 3 and 4. No significant differences existed between groups 2 and 4 or groups 1 and 3. Correlations between insulin resistance parameters, age of patients, disease duration, and stages of AGA in males and females revealed nonsignificant differences. | Patients with metabolic syndrome, with or without AGA, were significantly more insulin resistant compared with patients with AGA with no metabolic syndrome and with healthy subjects and, therefore, no true association exists between AGA and insulin resistance. | closed_qa |
Should we say NO to body piercing in children? | The popularity of body piercing procedures is increasing around the world. The trend for body ornamentation is not free from risks. The percentage of various complications following such procedures is growing. The aim of this paper is to present a rare complication after earlobe piercing, which happened to a child. A 7-year-old girl was admitted to the Department of Plastic, Reconstructive and Aesthetic Surgery complaining of inflammatory lesions, caused by the presence of foreign bodies in both of her earlobes, which developed after the body piercing procedure. Her earlobes had been pierced in a beauty parlor six weeks earlier. With regard to the child's age, the embedded parts of the earrings were removed in the operating theatre. In our description, the hind parts of the earrings started to embed five weeks after the piercing procedure. Too strong and constant pressure caused by fixing clips led to skin ischemia, followed by inflammation and decubitus ulcer, and consequently to the penetration of clips into the earlobes. | Complications after body piercing are observed in adults, as well as in children, in whom the decision of piercing performance should be carefully considered and rather postponed until self care is achievable. | closed_qa |
Does medication adherence lower Medicare spending among beneficiaries with diabetes? | To measure 3-year medication possession ratios (MPRs) for renin-angiotensin-aldosterone system (RAAS) inhibitors and statins for Medicare beneficiaries with diabetes, and to assess whether better adherence is associated with lower spending on traditional Medicare services controlling for biases common to previous adherence studies. Medicare Current Beneficiary Survey data from 1997 to 2005. Longitudinal study of RAAS-inhibitor and statin utilization over 3 years. The relationship between MPR and Medicare costs was tested in multivariate models with extensive behavioral variables to control for indication bias and healthy adherer bias. Over 3 years, median MPR values were 0.88 for RAAS-I users and 0.77 for statin users. Higher adherence was strongly associated with lower Medicare spending in the multivariate analysis. A 10 percentage point increase in statin MPR was associated with U.S.$832 lower Medicare spending (SE=219; p<.01). A 10 percentage point increase in MPR for RAAS-Is was associated with U.S.$285 lower Medicare costs (SE=114; p<.05). | Higher adherence with RAAS-Is and statins by Medicare beneficiaries with diabetes results in lower cumulative Medicare spending over 3 years. At the margin, Medicare savings exceed the cost of the drugs. | closed_qa |
Is anybody listening? | To explore nurses' perceptions of the reality of practice based on data from the Nurses and Midwives e-cohort Study which examined the workforce characteristics, work-life balance and health of nurses. Recruitment and retention of the nursing workforce is of international concern as demands increase due to demographic changes, political pressure and community expectations, in a climate of economic constraint. Qualitative analysis of data from a cohort of Australian, New Zealand and UK nurses. Of the 7604 participants in the electronic cohort, 1909 provided qualitative comments of which 162 related to nursing practice; thematic analysis resulted in four high order themes. The analytical discussion is structured around 'care' as the organising construct. Four themes emerged: 'embodied care' which discusses the impact of work on the nurse's physical and emotional health; 'quantity/quality care' which addresses increasing pressures of work and ability to provide quality care; 'organisational (non)care' raising the seeming lack of support from management; and '(un)collegial/self care' where bullying and professional relationships were raised. | Issues raised by participants have been discussed in the nursing literature for several years yet nurses still experience these negative aspects of nursing. It appears there is a significant gap between what is known about the practice environment, recommendations for change and change occurring: the management equivalent of the theory-practice gap, resulting in nurses intending to leave the profession. | closed_qa |
Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? | Knee range of motion (ROM) at the point of discharge from acute care is used as a clinical indicator to benchmark performance between hospital services after total knee replacement (TKR). The utility of the current benchmark, including whether discharge ROM varies between hospitals, is unknown. This study aimed to determine whether the benchmark [≥80 degrees flexion and ≤5 degrees fixed flexion (extension)] is realistic and whether the service provider is a predictor of knee ROM. A prospective, observational cohort study was conducted involving 176 TKR patients from four hospitals. Knee ROM was photographically assessed preoperatively and at discharge. 'Hospital', typical patient demographic data and preoperative ROM were identified a priori as potential predictors of knee ROM. Overall, 2% [95% CI (confidence interval) 1-6] of patients attained the ROM benchmark. Individual hospital attainment of the benchmark ranged 0-7% with a significant difference (P = 0.047) evident between the best performer and the remaining hospitals. The overall rates of attainment of the individual flexion (25%, 95% CI 19-32) and extension (15%, 95% CI 10-21) components were similarly low, although the scatter between hospitals was large [flexion (2-47%); extension (8-44%)]. Preoperative flexion and hospital were significant (P = 0.002) predictors of discharge flexion, explaining 21% of the variance. Similarly, hospital and preoperative extension together with gender were significant (P<0.001) predictors of discharge extension, explaining 26% of the variance. | A small minority of patients attained the knee ROM benchmark, indicating the existing standard is unrealistic. Nevertheless, that 'hospital' is an important predictor confirms the potential of ROM for benchmarking purposes. Differences in physiotherapy practices may contribute to inter-hospital variation in discharge knee ROM together with other undefined factors. The causal relationships explaining the variation and the relationship between discharge ROM and longer-term outcome are avenues for future exploration which will help define the clinical relevance of the indicator. | closed_qa |
Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? | Knee range of motion (ROM) at discharge from acute care is used as a clinical indicator following total knee replacement (TKR) surgery. This study aimed to assess the clinical relevance of this indicator by determining whether discharge knee ROM predicts longer-term knee ROM and patient-reported knee pain and function. A total of 176 TKR recipients were prospectively followed after discharge from acute care. Outcomes assessed included knee ROM and Oxford knee score post rehabilitation and 1 year post surgery. Discharge ROM and other patient factors were identified a priori as potential predictors in multiple linear regression modelling. A total of 133 (76%) and 141 (80%) patients were available for follow-up post rehabilitation [mean postoperative week 8.1 (SD 2.7)] and at 1 year [mean postoperative month 12.1 (SD 1.4)], respectively. Greater discharge knee flexion was a significant (P<0.001) predictor of greater post-rehabilitation flexion but not 1-year knee flexion (P<0.083). Better discharge knee extension was a significant predictor of better post-rehabilitation (P = 0.001) and 1-year knee extension (P = 0.013). Preoperative Oxford score and post-rehabilitation knee flexion independently predicted post-rehabilitation Oxford score, and gender predicted 1-year Oxford score. Discharge ROM did not significantly predict Oxford score in either model. | The finding that early knee range predicts longer-term range provides clinical evidence favouring the relevance of discharge knee ROM as a clinical indicator. Although longer-term patient-reported knee pain and function were not directly associated with discharge knee ROM, they were associated with ROM when measured concurrently in the sub-acute phase. No causal effect has been demonstrated, but the findings suggest it may be important for physiotherapists to maximize range in the early and sub-acute periods. | closed_qa |
Is maternal education level associated with diet in 10-year-old children? | To examine the associations between maternal education level and diet in 10-year-old children. Three-day diet diaries (child completed with parental help) were collected. Height and weight were measured in research clinics. Maternal education level was derived from a questionnaire completed during pregnancy and classified into low, medium or high. One-way ANOVA was undertaken to compare maternal education groups for nutrient intakes and the Kruskal-Wallis test used for food consumption. Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. Children (n 7474) who provided dietary data at age 10 years. A large proportion (60 %) of the sample was classified as plausible reporters, with under-reporting accounting for 36 %. No clear differences were found for intakes of energy or macronutrients between maternal education groups for plausible reporters. However, there were marked differences in micronutrient intakes especially for vitamin C, retinol equivalents and folate, highlighting lower diet quality with lower maternal education level. Intakes of fruit and vegetables showed a positive gradient with increasing maternal education (57 % v. 79 % consumed fresh fruit in low and high educational groups, respectively). A trend towards higher intake in the lower educated group was shown for less healthy foods (meat pies P<0·001; sausages, burgers and kebabs P<0·001). | The quality of children's diet at 10 years was related to maternal education level. Lower maternal education was associated with less healthy food choices that could be detrimental to health. Further research is needed to establish if these associations can be explained by other socio-economic factors. | closed_qa |
School-located immunization programs: do parental preferences predict behavior? | Little is known about parental attitudes regarding school-located immunization programs and their effect on program participation behaviors. To determine the relationship between attitudes of middle school parents regarding school-located immunization programs and subsequent consent behaviors when such a program becomes available. Primarily Hispanic, middle school parents completed questionnaires about school-located immunization programs. After questionnaire collection, immunization consent/refusal packets (English/Spanish) for a program providing Tdap and MCV4 vaccines were distributed at five Houston middle schools in low-income, urban areas. Responses regarding demographics, enrollment in a medical home, immunization location preferences, and knowledge of immunization recommendations were analyzed from questionnaires returned by those who later returned consent or refusal forms for school-located program participation. Frequency and chi square statistics were calculated using SPSS 18.0. Of 475 parents who completed the questionnaire and later sent a consent or refusal form, 289 (61%) consented to ≥1 vaccines for their child. Among those who consented: 71% were enrolled in a medical home; 42% had previously indicated that they did NOT prefer school as an immunization location; 32% had stated that they wanted to be present for their child's shots. Of those who sent refusal forms indicating they would access the vaccines from their own providers, 70% stated they wanted to be present for their child's vaccination. | A significant proportion of Hispanic, low-income middle school parents participating in a school-located immunization program had previously indicated that schools were not a preferred immunization site. Despite the availability of a medical home, a lack of preference for schools as a site, and the desire to be present during their child's injections when asked prior to program availability, these parents participated in the program when it was made available. Preferences noted in pre-program questionnaires may not predict parental consent behaviors for school-located immunizations. | closed_qa |
Does a decrease in avoidance behavior and focusing on fatigue mediate the effect of cognitive behavior therapy for chronic fatigue syndrome? | Cognitive behavior therapy (CBT) leads to a significant reduction in fatigue severity and impairment in patients with chronic fatigue syndrome (CFS). The purpose of the present study was to determine whether the effect of CBT for CFS on fatigue and impairment is mediated by a decrease in avoidance behavior and focusing on fatigue. For this purpose, we reanalyzed a randomized controlled trial which was previously conducted to test the efficacy of CBT for CFS. Two hundred nineteen patients completed assessment prior and subsequent to treatment or a control group period. Mediation analysis revealed that a decrease in focusing on fatigue mediated the effect of CBT for CFS on fatigue and impairment. Avoidance of activity and avoidance of aversive stimuli were not significantly changed by treatment and were therefore excluded from mediation analysis. | A decrease in the focus on fatigue seems to contribute to the treatment effect of CBT for CFS. | closed_qa |
Is amount of food intake in overweight and obese children related to their psychopathology and to maternal eating behavior? | To explore the relationship among the amount of food intake of 8- to 12-years old overweight children, their psychopathology (internalizing, externalizing and attention problems) and the mothers' amount of food intake. In a previous trial designed to test the influence of a preload on food intake, overweight to obese children and their mothers participated in a taste test thereby consuming a preweighed amount of a mousse-like dessert, which was reweighed again at the end. In the current study, we reanalyzed these data by assessing the relationship between children's amount of food intake and their psychopathology, as measured with the Child Behavior Checklist. We found that children with high scores for attention problems consumed larger amounts of food. No such relationship could be observed for children's externalizing problems. Additionally, a positive and direct effect of mother's amount of food intake on children's energy food intake was present even when accounting for children's psychopathology. | Results suggest that besides mothers' influence on children's food intake, children's problems to self-regulate impulses may be related to uncontrolled eating behavior and weight gain. | closed_qa |
Is the international normalised ratio a prognostic factor of mortality in intracerebral haemorrhage? | Oral anticoagulant therapy (ACO) is considered an independent predictor of mortality in patients with intracerebral haemorrhage (ICH), with the role of the international normalised ratio (INR) being unclear. The aim of this work is to evaluate the relationship between ACO and the INR value and the ICH volume, and to determine the relationship between both variables and mortality. Patients were retrospectively analysed using the Private Community Cerebrovascular Hospital Register (Registro Cerebrovascular del Hospital Privado de Comunidad), between December 2003 and May 2009. Volumes of the haematomas (dependent variable) were calculated from the first image performed, using the abc/2 method. Independent variables were age, gender, vascular risk factors, site of bleeding, intraventricular dump, clinical severity (Glasgow scale), time to image, antiplatelet drugs, and INR value on admission. An analysis of the relationship between all these variables and mortality was also performed. A total of 327 patients with HIC were identified (35 with ACO). Median volume was higher in the anticoagulated patients (55ml vs 24ml P<.05), with no statistically significant relationship between volume and the other variables. In the multivariate analysis, a statistically significant higher mortality associated to volume was observed, but not with anticoagulation. | Oral anticoagulation was associated with a higher initial volume of the haematoma, with no correlation between the INR value and volume. The HIC volume was directly related to mortality, however, like the volume, the INR was not associated with increased mortality. | closed_qa |
Is fasting necessary for elective cerebral angiography? | In order to prevent unexpected events such as aspiration pneumonia, cerebral angiography has been performed under fasting in most cases. We investigated prospectively the necessity of fasting before elective cerebral angiography. The study is an open-labeled clinical trial without random allocation. In total, 2554 patients who underwent elective cerebral angiography were evaluated on development of nausea, vomiting, and pulmonary aspiration during and after angiography. Potential risks and benefits associated with fasting were provided in written documents and through personal counseling to patients before the procedure. The patients chose their fasting or nonfasting option. No restriction in diet was given after angiography. The patients were observed for 24 hours. Nausea and vomiting during and within 1 hour after angiography was considered as a positive event associated with cerebral angiography. The overall incidence of nausea and vomiting during and within 1 hour after angiography was 1.05% (27/2554 patients). There was no patient with pulmonary aspiration. No statistical difference in nausea and vomiting development between the fasting and the diet groups was found. | The incidence of nausea and vomiting associated with cerebral angiography is low and not affected by diet or fasting. Pulmonary aspiration had no difference between the diet and the fasting group. Our study suggests that fasting may not be necessary for patients who undergo elective cerebral angiography. | closed_qa |
Does integrated emergency care reduce mortality and non-elective admissions? | The authors reconfigured the emergency care system of Addenbrookes Hospital, Cambridge. The medical admissions unit and the emergency department (ED) have been combined into one emergency assessment unit. This paper aims to determine if reconfiguration has reduced non-elective hospital admissions and reduced mortality for non-elective admissions. A retrospective 'before and after' study in a teaching hospital. Routinely collected data were used to evaluate the effectiveness of this approach. Setting One acute trust in the UK. Main outcome measures Inhospital mortality rates and standardised admission ratios (SAR) between 2003 and 2009. There was a significant trend towards improved survival, both for non-elective admissions and deaths in the ED (z=-3.92; p>0.001), despite the age and acuity of patients increasing. There was a marked decrease in the SAR. Formal complaints, incident reports and the proportion of patients leaving before treatment declined, whereas the proportion of patients re-admitted as an emergency within 28 days did not change. | Integrating emergency care within a hospital reduces hospital admissions, is associated with reduced inhospital mortality and a better quality of care. | closed_qa |
Publication of abstracts submitted to the annual meeting of the Pediatric Orthopaedic Society of North America: is there a difference between accepted versus rejected abstracts? | The purpose of this study was to determine publication rates of all abstracts submitted for presentation at the annual conference of the Pediatric Orthopaedic Society of North America (POSNA) comparing papers accepted for presentation with those that were not accepted and to determine the median times to publication and the mean impact factor of journals that published papers from the 2 groups. The titles and authors of all abstracts submitted for presentation to the POSNA for the years 2003 to 2005 were identified. To determine publication status, we conducted a computerized Pubmed search using the first author's name. If multiple publications were identified, the Boolean search operator AND was used to combine author names with key words. The title of each located published article was compared with the title of the abstract. If differences were noted, the abstract content was compared with the final publication. The journals, impact factor was determined using the journal citation report. The median time from conference presentation to publication was determined using a Kaplan-Meier survival analysis. Of 1191 abstracts submitted to the annual meetings of POSNA from the years 2003 through 2005, 440 (37%) were accepted for presentation. Acceptance of submitted abstracts increased from 30% in 2003 to 40% in 2005. Of the 1191 abstracts 599 (50%) were subsequently published by August 2009. The mean publication rate for abstracts accepted for presentation was 58.9% (259 of 440) compared with 45% (339 of 751) for rejected abstracts. The median time to publication of accepted abstracts was not significantly different when compared with that of rejected abstracts. The mean journal impact factor for accepted articles was 2.2 compared with 1.5 for rejected abstracts. | The publication rates of abstracts submitted to POSNA is high compared with those of other international orthopaedic associations. The mean publication rate for accepted abstracts and rejected abstracts has increased substantially from 45% and 38% in 1991 to 1994 to 58.9% and 45% in 2003 to 2005, respectively. The journal in which most of the abstracts are ultimately published is the Journal of Pediatric Orthopaedics[corrected]. | closed_qa |
Do stable patients with a premorbid depression history have a worse outcome after deep brain stimulation for Parkinson disease? | Deep brain stimulation (DBS) has been associated with mood sequelae in a subset of patients operated on in either the subthalamic nucleus or the globus pallidus internus for the treatment of Parkinson disease. To compare mood and motor outcomes in those with and without a presurgical history of depression. Unilateral subthalamic nucleus or unilateral globus pallidus internus DBS patients followed up for a minimum of 6 months were included. All patients underwent a comprehensive outpatient psychiatric evaluation by a board-certified psychiatrist. Psychiatric diagnoses were based on Diagnostic and Statistical Manual, fourth edition, text revision, nomenclature (American Psychiatric Association, 2000). Motor and mood outcomes were compared. A total of 110 patients were included. There were no significant differences in baseline variables between the 2 groups. Those with a preoperative history of depression had significantly higher Beck Depression Inventory scores than the nondepression group after DBS (8.97 ± 7.55 vs 5.92 ± 5.71; P = .04). Patients with a depression history had less improvement (11.6%) in pre/post-DBS change when Unified Parkinson Disease Rating Scale motor scores were compared (P = .03) after adjustment for stimulation site and baseline demographic and clinical variables. Patients with a higher levodopa equivalent dose had a worse clinical motor outcome. | Patients with a preoperative depression history had higher Beck Depression Inventory scores after DBS and significantly less (albeit small) improvement in pre/post-DBS change in Unified Parkinson Disease Rating Scale motor scores than patients without a history of depression. | closed_qa |
Does total mesorectal excision require a learning curve? | The procedure of total mesorectal excision (TME) is the gold standard in the treatment of rectal cancer. However, quality control of TME is still under debate. The present study was conducted to determine whether TME requires a learning curve to allow the surgeon to grasp the necessary technical expertise. We performed a retrospective review of patients with rectal cancer who underwent TME with curative intention between August 1998 and December 2003; 195 consecutive patients were enrolled. From the first patient of the cohort, the first 50 patients were categorized into group 1, the next 50 into group 2, the next 50 into group 3, and the final 45 patients into group 4. Local recurrence rates were compared between the four groups. No significant difference in clinicopathological features was observed between the four groups, except for age, operative time, and grade of mesorectum. The local recurrence (LR) rate decreased from 22.3% in the inadequate TME group (G1) to 9.1% in the adequate TME group (G2-4) (p=0.035). In multivariate analysis, regional lymph node metastasis, mesorectal grade (incomplete or nearly complete), and early period of learning curve were independent predictors of local recurrence. | Our results suggest that a learning curve is necessary for the development of technical expertise in the performance of TME for treatment of rectal cancer. | closed_qa |
Precontoured plating of clavicle fractures: decreased hardware-related complications? | Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal.QUESTIONS/ We compared the outcomes after precontoured and noncontoured superior plating of acute displaced midshaft clavicle fractures. Primary outcomes were rate of plate prominence, rate of hardware removal, and rate of complications. Secondary outcomes were ROM and pain and function scores. We retrospectively reviewed 52 patients with 52 acute, displaced midshaft clavicle fractures treated with either noncontoured or precontoured superior clavicle plate fixation. Fourteen patients with noncontoured plates and 28 with precontoured plates were available for followup at a minimum of 1 year postoperatively. Postoperative assessment included ROM, radiographs, and subjective scores including visual analog scale for pain, American Shoulder and Elbow Surgeons questionnaire, and Simple Shoulder Test. Patients complained of prominent hardware in nine of 14 in the noncontoured group and nine of 28 in the precontoured group. Hardware removal rates were three of 14 in the noncontoured group and three of 28 in the precontoured group. Postoperative ROM and postoperative subjective scores were similar in the two groups. | Precontoured plating versus noncontoured plating of displaced midshaft clavicle fractures results in a lower rate of plate prominence in patients who do not undergo hardware removal. | closed_qa |
Socio-economic inequities in children's injury rates: has the gradient changed over time? | Changing socio-economic gradients in adult health over time have been documented, but little research has investigated temporal changes in child health gradients. Childhood hospitalizations for injury have fallen over the last two decades; whether the socio-economic gradient in childhood injury has changed is unknown. Population-based hospital discharge data were used to calculate rates of hospitalization for injury from 1986/87 through 2005/06 for all children under 20 years of age in Manitoba (average yearly number of hospitalizations = 326,357). Information on socio-economic status (SES) came from area-level census data and was assigned by residential postal codes. Generalized linear models with generalized estimating equations were employed to describe the relation between SES and injury rates and whether this relation changed over time. All-cause injuries were examined as well as injuries for motor vehicle collisions (MVCs), other vehicle injuries, self-inflicted injuries, assault, poisoning, injuries caused by machinery, sports injuries and falls. Injury hospitalizations for children decreased steadily over the study period, from 1.07% to 0.51%. SES significantly predicted injury hospitalizations (p<0.0001), children with lower SES showing higher rates. A significant SES by year interaction (p<0.0001) indicated that the SES gradient for injury hospitalizations increased over time. Analysis by type of injury found a significant SES by year interaction for MVCs, self-inflicted injuries and falls; for MVCs and self-inflicted injuries the pattern (increasing SES gradient) was similar to that of hospitalization for all-cause injury. The pattern for falls was inconsistent. | Despite the overall drop in injury hospitalizations over time, the SES gradient in hospitalized injury rates has increased. | closed_qa |
Does scapular elevation occur with glenohumeral flexion and abduction? | This study aims to reveal whether there is an elevation in scapula during flexion and abduction of the glenohumeral joint. In the first stage of our study 32 subjects were randomly divided into two groups. The mobility of the scapular notch was examined using open magnetic resonance imaging (MRI) assay when the glenohumeral joint was in flexion in the first group (5 males, 10 females; mean age 21.1 years; range 18 to 24 years) and in abduction in the second group (8 males, 9 females; mean age 22.1 years; range 18 to 27 years) and the motion range was found to be between 0 and 150 degrees. In the second stage of our study, the mobilities of the scapular notch was examined on autopsy during passive humeral mobility. According to the open MRI results, there was no elevation or depression during the passive flexion and abduction of the glenohumeral joint. While the scapular notch migrated slightly to the medial side during abduction of the glenohumeral joint, it did not move during flexion. Also in an autopsy study, we observed that scapula did not move in vertical direction during the glenohumeral abduction and flexion mobilities. | There is no vertical mobility in the scapula during glenohumeral flexion and abduction. Also, there is no medial mobility during flexion except during abduction. | closed_qa |
Do type 2 diabetes patients without diabetic retinopathy or subjects with impaired fasting glucose have impaired colour vision? | To investigate associations between fasting plasma glucose level and the prevalence of acquired colour vision impairment in type 2 diabetes patients without diabetic retinopathy. Participants in this cross-sectional study of male officials aged 20-60 yr in the Japanese Self Defence Force, underwent colour vision testing, ophthalmic examination, a standardized interview and examination of venous blood samples. Ishihara plates, a Lanthony 15-hue desaturated panel and Standard Pseudoisochromatic Plates Part 2 were used to examine colour vision. The Farnsworth-Munsell 100-hue test was performed to define acquired colour vision impairment. Cardiovascular disease risk factors were determined from serum blood samples, physical records and an interview. We performed logistic regression analysis adjusted for age, diagnosed hypertension, dyslipidaemia, cataract, glaucoma, being overweight, smoking status and alcohol intake. Crude and adjusted odds ratios were calculated for three glucose levels, which included normal fasting glucose, impaired fasting glucose and diabetes. Out of a total of 1042 men enrolled, 872 were eligible for the study, and 31 were diagnosed with acquired colour vision impairment. As compared with the subjects with normal fasting glucose (<5.6 mmol/l), the crude odds ratio for acquired colour vision impairment was 0.93 (95% CI 0.32-2.74) for the subjects with impaired fasting glucose (5.6-6.9 mmol/l) and 8.07 (95% CI 2.48-26.22) for the patients with type 2 diabetes. The multiple-adjusted odds ratios were 0.77 (95% CI 0.25-2.34) for the subjects with impaired fasting glucose and 5.89 (95% CI 1.55-22.40) for the patients with type 2 diabetes. | Our findings suggest that there is a dramatically increased prevalence of acquired colour vision impairment in type 2 diabetes patients without diabetic retinopathy which might be attributable to another pathogenesis associated with diabetic retinopathy. | closed_qa |
Diabetes inpatients: a case of lose, lose, lose. Is it time to use a 'diabetes-attributable hospitalization cost' to assess the impact of diabetes? | The UK National Health Service in England pays for inpatients using a formula ('tariff'). The appropriateness of the tariff for people with diabetes is unknown. We have compared the tariff paid and costs for inpatients with/without diabetes and tested the concept of a 'diabetes-attributable hospitalization cost'. This was a cross-sectional, retrospective 12-month audit in a single teaching hospital assessing mortality, bed days per annum and 'diabetes-attributable hospitalization cost' (i.e. the proportion of costs for all patients with diabetes in excess of that paid for comparable patients without diabetes). There were 64 829 inpatient admissions, with 4864 of those coded as having diabetes; 12.9% was estimated to be the number of patients having diabetes but not coded. People with diabetes occupied 13.9% of all bed days and were 18.1% (1.3-37.8%) more likely to die (age adjusted). The mean bed days per annum were greatest among those with (vs. without) diabetes (men 10.9 ± 17.0 vs. 6.3 ± 12.8; women 11.4 ± 19.4 vs. 5.9 ± 11.6; P<0.001). The greatest excess admission rates were among those aged 25-64 years. The annual mean tariff was greater for those with diabetes (5380 ± 8740) than those without diabetes (3706 ± 6221) (P<0.001). The overall cost was even higher among those with diabetes: 5835 ± 11 246 vs. 3567 ± 7238 (P<0.001). The diabetes-attributable hospitalization cost was 46.5% (9 125 085). An HbA(1c)>10.0% (>86 mmol/mol) was associated with excess hospitalization. | Those with diabetes cost more and are more likely to die when inpatients. The tariff paid for diabetes is high, but in this centre less than the actual costs. Approaches known to reduce hospitalization are urgently required. | closed_qa |
Is the temporal artery thermometer a reliable instrument for detecting fever in children? | We aimed to study the diagnostic accuracy of the temporal artery thermometer vs. rectal temperature in a large group of children with and without fever, aged 0-18 years. Many have studied the diagnostic accuracy of the temporal artery thermometer in children compared with a reference method, with contradictory outcomes. No studies have been carried out in a large group of children of all ages. Diagnostic accuracy/validation study. Children (0-18 years) with fever (T>38·0°C) were recruited through the emergency department and children with normal temperatures through the day-care department of the Children's Hospital. All children routinely had rectal temperature recordings. Temporal artery temperature was recorded shortly after the rectal recording. The mean absolute difference in temperature, the level of agreement (intraclass correlation coefficient) and the sensitivity and specificity of detecting fever were calculated. A total number of 198 children (121 boys) participated, with a mean age of 5·1 (SD 4·7) years. Of those children, 81 had fever according to the rectal recording. Mean difference between temporal artery temperature and rectal temperature was -0·11 (SD 0·63)°C, with an agreement of 0·812. The sensitivity and specificity of the temporal artery thermometer for detecting fever were 67·9 and 98·3%, respectively. | The diagnostic accuracy of the temporal artery thermometer in detecting fever in children of all ages is low. | closed_qa |
P300 auditory event-related potentials in children with obesity: is childhood obesity related to impairment in cognitive functions? | To investigate alterations in P300 auditory event-related potentials in children with obesity to detect changes in cognitive functions. A total of 50 children with obesity and 23 age- and sex-matched healthy control subjects were included in the study. Laboratory tests were performed to detect dislipidemia and insulin resistance (IR). The latencies and amplitudes of P300 waves were measured in healthy and obese subjects with or without IR. The oddball paradigm was used in recordings of P300 auditory event-related potentials. A significant difference was observed between groups regarding latency and amplitude of P300 component obtained from central (Cz) electrode. The grand means of P300 latency were longer, and amplitude decreased significantly in obese group compared to that of healthy controls. When the obese group was divided into two different subgroups, those with IR and without IR, the grand means of P300 latency were longer and the amplitude decreased significantly in subjects with IR compared to those without IR. | Both decreased amplitude and prolonged latency of P300 are associated with IR in children with obesity, which shows the impairment of neural activity associated with sensory and cognitive information processing in these children. Further studies are necessary to strengthen the current findings and to determine the exact mechanism of cognitive impairment in obese children. | closed_qa |
Is there any cardioprotective role of Taurine during cold ischemic period following global myocardial ischemia? | The aim of the present study was to investigate the cardioprotective effect of Taurine on the donor hearts during cold ischemic period. 32 rats were divided into four groups (sham, taurine, ischemia, treatment group, 8 rats in each). All rats were fed with rat food for three weeks. Taurine and treatment groups were given a 200 mg/kg/day dose of Taurine by oral gavage besides rat feed. Cardiectomy was performed in all rats after three weeks. In ischemia and treatment groups, harvested hearts were kept in 0.9% sodium chloride at +4 degrees C for 5 hours. Tissue samples were taken from left ventricle in all groups. These samples were evaluated by histopathologic and biochemical examination. In the present study results of the biochemical and histopathological examination reveals the protective effects of Taurine. As a marker of lipid peroxidation, Malondialdehyde (MDA) levels in ischemia group were significantly higher than both Sham and Taurine groups. MDA values were recorded; 3.62 ± 0.197 in the sham group, 2.07 ± 0.751 in the Taurine group, 9.71 ± 1.439 in the ischemia group and 7.68 ± 1.365 in the treatment group. MDA levels decreased in treatment group. (p<0.05) In accordance with MDA findings, while superoxide dismutase and glutathione peroxidase levels decreased in ischemia group, they increased in treatment group. (p<0.05) There was no differences in Catalase (CAT) enzyme level between treatment and ischemia group (p = 1.000). CAT level results were recorded; 7.08 ± 0.609 in the sham group, 6.15 ± 0.119 in the Taurine group, 5.02 ± 0.62 in the ischemia group, and 5.36 ± 0.384 in the treatment group. Less intracellular edema and inflammatory cell reaction were observed in histologic examination in favor of treatment group. (p<0.01) | Taurine decreased myocardial damage during cold ischemic period following global myocardial ischemia. | closed_qa |
Poland's syndrome and recurrent pneumothorax: is there a connection? | Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy) and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis) due to the recurrent state of their pneumothorax. The patients had good results with total expansion of the affected lung. | Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases. | closed_qa |
Does monitoring need for care in patients diagnosed with severe mental illness impact on Psychiatric Service Use? | Effectiveness of services for patients diagnosed with severe mental illness (SMI) may improve when treatment plans are needs based. A regional Cumulative Needs for Care Monitor (CNCM) introduced diagnostic and evaluative tools, allowing clinicians to explicitly assess patients' needs and negotiate treatment with the patient. We hypothesized that this would change care consumption patterns. Psychiatric Case Registers (PCR) register all in-patient and out-patient care in the region. We matched patients in the South-Limburg PCR, where CNCM was in place, with patients from the PCR in the North of the Netherlands (NN), where no CNCM was available. Matching was accomplished using propensity scoring including, amongst others, total care consumption and out-patient care consumption. Date of the CNCM assessment was copied to the matched controls as a hypothetical index date had the CNCM been in place in NN. The difference in care consumption after and before this date (after minus before) was analysed. Compared with the control region, out-patient care consumption in the CNCM region was significantly higher after the CNCM index date regardless of treatment status at baseline (new, new episode, persistent), whereas a decrease in in-patient care consumption could not be shown. | Monitoring patients may result in different patterns of care by flexibly adjusting level of out-patient care in response to early signs of clinical deterioration. | closed_qa |
Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness? | Idiopathic Toe Walking (ITW) is present in children older than 3 years of age still walking on their toes without signs of neurological, orthopaedic or psychiatric diseases. ITW has been estimated to occur in 7% to 24% of the childhood population. To study associations between Idiopathic Toe Walking (ITW) and decrease in range of joint motion of the ankle joint. To study associations between ITW (with stiff ankles) and stiffness in other joints, muscle strength and bone density. In a cross-sectional study, 362 healthy children, adolescents and young adults (mean age (sd): 14.2 (3.9) years) participated. Range of joint motion (ROM), muscle strength, anthropometrics sport activities and bone density were measured. A prevalence of 12% of ITW was found. Nine percent had ITW and severely restricted ROM of the ankle joint. Children with ITW had three times higher chance of severe ROM restriction of the ankle joint. Participants with ITW and stiff ankle joints had a decreased ROM in other joints, whereas bone density and muscle strength were comparable. | ITW and a decrease in ankle joint ROM might be due to local stiffness. Differential etiological diagnosis should be considered. | closed_qa |
Do biologics-naïve patients with rheumatoid arthritis respond better to tocilizumab than patients for whom anti-TNF agents have failed? | To determine responses to tocilizumab between patients with rheumatoid arthritis (RA) who switched to anti-TNF agents and those who are biologics-naïve. This retrospective study investigated 107 patients with RA who were treated with tocilizumab. At baseline, 61 of them had already been treated with anti-TNF agents (switched group; 46 for inefficacy and 15 for adverse events), and 46 were biologics-naïve (naïve group). Treatment responses to tocilizumab at week 12 and 24 were compared between the switched and naïve groups using the disease activity score 28 (DAS28). Forty-two (91.3%) and 50 (82.0%) patients in the naïve and switched groups, respectively, completed 24 weeks of tocilizumab treatment. The DAS28-ESR and DAS28-CRP values (means±SD) at weeks 12 and 24 compared to baseline decreased significantly for the naïve and switched groups. The DAS28-ESR and DAS28-CRP values at weeks 12 and 24 were significantly decreased in the naïve group, compared to the switched group. Disease activity was improved in the naïve patients compared to the switched patients. | Tocilizumab was safe, tolerable, and clinically effective for patients with inadequate responses to anti-TNF therapy and for those who were biologics-naïve, and it was more effective among the latter. | closed_qa |
Perinatal outcomes in women with preeclampsia and superimposed preeclampsia: do they differ? | The purpose of this study was to determine whether superimposed preeclampsia results in worse perinatal outcomes than preeclampsia. We conducted a retrospective cohort study using our perinatal database (1990-2008). Perinatal outcomes among women with chronic hypertension (n = 1032), superimposed preeclampsia (n = 489), and preeclampsia (n = 4217) were compared with outcomes of control subjects (n = 57,103). Outcomes among women with superimposed preeclampsia were also compared with outcomes of women with preeclampsia. Multivariable analysis was used to control for confounders. Rates of small-for-gestational age, abruption, stillbirth, and eclampsia were not significantly different with superimposed preeclampsia compared with preeclampsia. Delivery at<34 weeks' gestation (17.3% vs 8.7%; P<.001), cesarean delivery (46.2% vs 36.3%; P<.001), and neonatal intensive care unit admission (16.3% vs 11.4%; P<.002) were significantly higher among women with superimposed preeclampsia. These risks persisted after we controlled for confounders. | Women with superimposed preeclampsia have higher risks of intervention-related events compared with those with preeclampsia. | closed_qa |
Treatment of early pregnancy failure: does induced abortion training affect later practices? | The objective of the study was to examine the relationship between induced abortion training and views toward, and use of, office uterine evacuation and misoprostol in early pregnancy failure (EPF) care. We surveyed 308 obstetrician-gynecologists on their knowledge and attitudes toward treatment options for EPF and previous training in office-based uterine evacuation. Sixty-seven percent of respondents reported training in office uterine evacuation, and 20.3% reported induced abortion training. Induced abortion training was associated with strongly positive views toward both office-based uterine evacuation and misoprostol as treatment for EPF compared with those with office uterine evacuation training in other settings (odds ratio [OR], 2.64; P<.004 and OR, 3.22; P<.003, respectively). Furthermore, induced abortion training was associated with the use of office uterine evacuation for EPF treatment compared with those with office evacuation training in other settings (OR, 2.90; P = .004). | Training experiences, especially induced abortion training, are associated with the use of office uterine evacuation for EPF. | closed_qa |
Recurrent endometrioma and ovarian reserve: biological connection or surgical paradox? | Cumulative evidence supports the view that ovarian endometriomas originate from ovulatory events and that the ovarian reserve is reduced following surgery. On these bases, we have hypothesized that the risk of recurrence may be related to the residual ovarian reserve of the operated ovary. We retrospectively selected 45 women scheduled for in vitro fertilization who previously underwent surgical excision of monolateral endometriomas and compared ovarian responsiveness in those who did (n = 24) and did not (n = 21) have a recurrent endometrioma. In the intact ovaries, the mean ± SD number of codominant follicles in women with and without recurrences was 3.5 ± 1.7 and 3.7 ± 2.2, respectively (P = NS). In the affected ovaries, the mean ± SD number of follicles in gonads with and without recurrences was 2.5 ± 2.3 and 1.1 ± 1.5, respectively (P<.05). | Ovarian responsiveness is higher in gonads that developed recurrent endometriomas. | closed_qa |
Does hormone therapy exacerbate the adverse effects of radiotherapy in men with prostate cancer? | We examined whether short course androgen deprivation therapy as an adjunct to radiotherapy would impact health related quality of life outcomes in patients with localized prostate cancer treated definitively with external beam radiation therapy or permanent brachytherapy. From 1999 to 2003 patients were enrolled in a prospective study at our institution and completed validated health related quality of life surveys at defined pretreatment and posttreatment intervals. A total of 81 men received radiotherapy alone and 67 received radiotherapy plus androgen deprivation therapy. Median androgen deprivation therapy duration was 4 months. Univariate and multivariate analysis was done to compare time to return to baseline in 6 distinct health related quality of life domains. On univariate analysis the radiotherapy plus androgen deprivation therapy group achieved baseline urinary symptoms more rapidly than the radiotherapy group (5 months, p = 0.002). On multivariate analysis time to return to baseline in any of the 6 health related quality of life domains was not significantly affected by adding androgen deprivation therapy. Factors associated with longer time to return to baseline mental composite scores on multivariate analysis included nonwhite ethnicity, cerebrovascular disease history and alcohol abuse history. Men treated with permanent brachytherapy monotherapy experienced longer time to return to baseline for urinary function and symptoms. Baseline sexual function and lack of a partner were associated with longer time to sexual recovery. | Adding androgen deprivation therapy to definitive radiotherapy does not significantly impact the time to return to baseline health related quality of life. These data may be valuable for patients and physicians when weighing the toxicity and benefits of androgen deprivation therapy when added to definitive radiotherapy. | closed_qa |
Does a difference exist in inferior alveolar canal displacement caused by commonly encountered pathologic entities? | The aim of the present study was to investigate whether a difference exists in the location of the displaced inferior alveolar canal (IAC) and neurovascular bundle (toward the buccal or lingual cortex) among odontogenic tumors and vascular lesions. If some consistency exists in the manner in which the canal and bundle are displaced on radiographic examination, the nature of the mandibular lesion under examination could be anticipated. This information would assist the surgical team in treatment planning, diagnostic biopsy, and resection, especially in cases of intraosseous vascular pathologic findings. A retrospective review of the computed tomography images obtained for odontogenic tumors and vascular anomalies treated at the Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, from January 2000 to June 2010 was undertaken. The IAC and neurovascular bundle were traced from the lingula to the mental foramina, and its location within the mandible was recorded at 3 specific points. In the odontogenic tumor group, we found that the canal with the neurovascular bundle was displaced either toward the buccal cortex of the mandible or the inferior border, but it was never identified lingually. In contrast, all the vascular anomalies had displaced the structures toward the lingual aspect of the mandible at all selected points. | To our knowledge, this is the first study to have examined the potential differences in the displacement of the inferior alveolar neurovascular bundle caused by the 2 commonly encountered pathologic entities in the maxillofacial skeleton: odontogenic tumors and vascular anomalies. We identified a striking difference in the manner of the IAC and its contents that was consistent among the tumors in the 2 groups. The location of the IAC in relationship to the pathologic entity under investigation could prove valuable in the differential diagnosis and assist with planning the biopsy. Additional investigation with a larger number of cases of these 2 groups of lesions involving the mandible is warranted to confirm our preliminary findings. | closed_qa |
3-Dimensional imaging for lower third molars: is there an implication for surgical removal? | Surgical removal of impacted third molars may be the most frequent procedure in oral surgery. Damage to the inferior alveolar nerve (IAN) is a typical complication of the procedure, with incidence rates reported at 1% to 22%. The aim of this study was to identify factors that lead to a higher risk of IAN impairment after surgery. In total 515 surgical third molar removals with 3-dimensional (3D) imaging before surgical removal were retrospectively evaluated for IAN impairment, in addition to 3D imaging signs that were supposed predictors for postoperative IAN disturbance. Influence of each predictor was evaluated in univariate and multivariate analyses and reported as odds ratio (OR) and 95% confidence interval (CI). The overall IAN impairment rate in this study was 9.4%. Univariate analysis showed narrowing of the IAN canal (OR, 4.95; P<.0001), direct contact between the IAN and the root (OR, 5.05; P = .0008), fully formed roots (OR, 4.36; P = .045), an IAN lingual course with (OR, 6.64; P = .0013) and without (OR, 2.72; P = .007) perforation of the cortical plate, and an intraroot (OR, 9.96; P = .003) position of the IAN as predictors of postoperative IAN impairment. Multivariate analysis showed narrowing of the IAN canal (adjusted OR, 3.69; 95% CI, 1.88 to 7.22; P = .0001) and direct contact (adjusted OR, 3.10; 95% CI, 1.15 to 8.33; P = .025) to be the strongest independent predictors. | Three-dimensional imaging is useful for predicting the risk of postoperative IAN impairment before surgical removal of impacted lower third molars. The low IAN impairment rate seen in this study-compared with similar selected study groups in the literature of the era before 3D imaging-indicates that the availability of 3D information is actually decreasing the risk for IAN impairment after lower third molar removal. | closed_qa |
Nasal inspiratory pressure: an alternative for the assessment of inspiratory muscle strength? | Inspiratory muscle strength is usually assessed thorough the determination of static mouth pressure (PImax). However, since this manoeuvre presents certain problems, alternative techniques have been developed over the last few years. One of the most promising is determination of sniff nasal inspiratory pressure (SNIP).AIM: To evaluate SNIP assessment as an alternative for the evaluation of the inspiratory muscle strength. Subjects were consecutively included and assigned to one of three different groups: control (8), COPD patients (23) and patients with neuromuscular disorders (21). Different maximal inspiratory pressures were determined: (a) dynamic in the esophagus (maximal sniff Pes, reference variable), (b) PImax, and (c) SNIP. Both SNIP and MIP showed an excellent correlation with Pes (r=0.835 and 0.752, respectively, P<0.05 for both). SNIP/Pes intra-class correlation coefficients were 0.585 (CI 95%: −0.097 to 0.901) in controls, 0.569 (CI 95%: −0.048 to 0.836) in COPD patients, and 0.840 (CI 95%: 0.459 to 0.943) in neuromuscular disorders, respectively. For PImax/Pes, these values were 0.602 CI 95%: −0.108 to 0.933), 0.418 (CI 95%: −0.108 to 0.761), and 0.712 (CI 95%: 0.378 a 0.882). Moreover, both SNIP and PImax showed 100% sensitivity in the three groups of subjects, although specificities were 100%, 69% and 75% for SNIP, and 83%, 54% and 75% for PImax, respectively. | SNIP is a good physiological marker of inspiratory muscle strength. Its role is likely to complement that of PImax. | closed_qa |
Inflammation and oxidative stress in testicular torsion: do they deserve intensive treatment to save both guilty and innocent testes? | To investigate at the molecular level, whether the combined use of an antioxidant (L-carnitine) and a selective cyclooxygenase-2 (COX-2) inhibitor (meloxicam) is effective in the treatment of cellular damage caused by testicular torsion. A total of 30 male Wistar rats were randomly divided into 5 groups. The control group underwent a sham operation, and the second group underwent torsion/detorsion for 90 minutes. Groups 3 and 4 received L-carnitine (500 mg/kg/d) and meloxicam (3 mg/kg/d), respectively. Group 5 also received these 2 agents, in addition to the same torsion/detorsion procedure. Bilateral orchiectomy was performed 96 hours after the operation in all groups. cDNA was synthesized after isolation of total RNA from the tissues. The relative expression of interleukin (IL)-1a, COX-2, and β-actin genes was measured by real-time polymerase chain reaction. The COX-2 and IL-1a mRNA levels had significantly decreased in groups 3, 4, and 5 compared with group 2 (P<.05). COX-2 and IL-1a mRNA levels were significantly great in the torsion/detorsion group (P=.007). The COX-2 and IL-1a mRNA levels significantly decreased in the torsion/detorsion testis after maximal treatment (P<.001). | Meloxicam seems to exert its inhibitory effect on the expression of specific genes of inflammation, as well as the combination therapy. Because the effects of these inflammatory genes are still evident 4 days after detorsion, combination therapy using these agents could be administered until late postoperative period to prevent the initiation of autoimmune activity against sperm cells and protect the innocent contralateral testis from the insult of antisperm antibodies. | closed_qa |
Does patent foramen ovale closure have an anti-arrhythmic effect? | Atrial tachyarrhythmias are associated with patent foramen ovale. The objective was to determine the anti-arrhythmic effect of patent foramen ovale closure on pre-existing atrial tachyarrhythmias. Medline, EMBASE, Cochrane Library, and Google Scholar databases were searched between 1967 and 2010. The search was expanded using the 'related articles' function and reference lists of key studies. All studies reporting pre- and post-closure incidence (or prevalence) of atrial tachyarrhythmia in the same patient population were included. Random and fixed effect meta-analyses were used to aggregate the data. Six studies were identified including 2570 patients who underwent percutaneous closure. Atrial fibrillation was in fact the only AT reported in all studies. Meta-analysis using a fixed effects model demonstrated a significant reduction in the prevalence of atrial fibrillation with an OR of 0.43 (95% CI 0.26-0.71). When using the random-effects model, OR was 0.44 (95% CI 0.18-1.04) with a statistically significant trend demonstrated (test for overall effect: Z=1.87, p=0.06). | Closure of a patent foramen ovale may be associated with reduction in the prevalence of atrial fibrillation. | closed_qa |
Urinary symptoms and urodynamic findings in women with pelvic organ prolapse: is there a correlation? | International official guidelines recommend urodynamic (UDS) evaluation in patients with pelvic organ prolapse (POP). However, the real benefit of this examination is still the subject of heated and controversial debate. Therefore, we aimed to assess the correlation between urinary symptoms and UDS findings in women with POP through the implementation of a sophisticated computer-based technology in the outpatient workup. A prospective cohort study was performed in a single, tertiary, urogynaecologic referral department, enrolling consecutive women seeking care for pelvic floor dysfunctions. Patients underwent clinical and urodynamic evaluation. Data regarding baseline characteristics, symptoms, anatomic, and urodynamic findings were gathered for each patient. Multiple linear regression (MLR) and artificial neural networks (ANNs) were performed to design predicting models. A total of 802 women with POP were included. POP quantification stages and baseline data poorly correlated to final UDS findings. Stress urinary incontinence and overactive bladder were both independently associated to each UDS diagnosis, including detrusor overactivity (DO), urodynamic stress incontinence (USI), and mixed urinary incontinence (USI plus DO). Receiver operating characteristic comparison confirmed that ANNs were more accurate than MLR in identifying predictors of UDS diagnosis, but none of these methods could successfully overcome UDS. Case-control studies are needed to confirm our findings. | Despite the current debate based on the actual value of UDS in women with POP, even the implementation of ANN, a sophisticated computer-based technology, does not permit an accurate diagnosis just on the basis of symptoms or avoiding UDS. Therefore, in women with POP, especially if scheduled for surgery, UDS should be considered as mandatory, since misleading counselling could result in unpleasant unexpected events. | closed_qa |
Chemoresistance in non-small-cell lung cancer: can multidrug resistance markers predict the response of xenograft lung cancer models to chemotherapy? | In chemotherapy for non-small-cell lung cancer (NSCLC), some patients seem to exhibit an intrinsic resistance or develop an acquired resistance under treatment. Results on resistance markers for possible treatment failure as shown in studies on selected lung cancer cell lines could not be completely confirmed in clinical trials. As these conflicting data require further research, we created a model between cell culture and the clinical need to study this problem. Our study was based on patient-derived NSCLC xenografts in a mouse model, which revealed a high coincidence with the original tumour. Protein and messenger RNA (mRNA) expression of known resistance markers (breast cancer resistance protein (BCRP), multidrug resistance P-glycoprotein (MDR), lung cancer-related protein (LRP) and multidrug resistance protein 1 (MRP1)) were analysed by real-time polymerase chain reaction (PCR) and immunoblotting in 24 xenografts. Chemosensitivity to etoposide, carboplatin, gemcitabine, paclitaxel, cetuximab and erlotinib was determined in in vivo xenograft experiments and compared with the protein and mRNA expression of the multidrug resistance markers. With the exception of a single correlation between chemosensitivity and mRNA expression of etoposide and bcrp (mRNA expression of BCRP), we found no significant correlation between the response rates and protein- and mRNA expression levels in our 24 xenografts. The present results indicate that in vivo expression levels of multidrug resistance proteins and their mRNAs may not play a comparable role in chemoresistance of NSCLC, as pointed out in selected tumour cell lines. | Patient-derived xenografts allow detailed investigation of therapy-related markers and their dynamic regulation in a well-standardised and clinically related way. As a consequence of our investigations, we regard multidrug resistance to be a multifactorial phenomenon, in which more factors than the markers analysed by the present study may be involved. | closed_qa |
Can signal enhancement ratio (SER) reduce the number of recommended biopsies without affecting cancer yield in occult MRI-detected lesions? | We retrospectively determined if signal enhancement ratio (SER), a quantitative measure of contrast kinetics using volumetric parameters, could reduce the number of biopsy recommendations without decreasing the number of cancers detected when applied to suspicious lesions seen on breast magnetic resonance imaging (MRI). A retrospective review of Breast Imaging Reporting and Data System (BIRADS) 4 or 5 lesions seen on breast MRI in 2008 that were clinically and mammographically occult yielded a final sample size of 73 lesions in 65 patients. Images were processed with in-house software. Parameters used to predict benignity/malignancy included SER total tumor volume (lesion volume above a 70% initial enhancement level), SER partial tumor volume (volume with "washout" and "plateau" kinetics), SER washout tumor volume, peak SER, and peak percent enhancement. Thresholds were determined to retrospectively discriminate benign from malignant histopathology. Clinical impact was assessed through the reduction in the number of biopsies recommended (by eliminating benign lesions discriminated by SER). Based on the original radiologist interpretations, 73 occult lesions were called suspicious and biopsied with a predictive value of biopsies (PPV(3)) of 18/73 (25%). SER parameters were found to be significantly associated with histopathology (P<.05). Biopsy recommendations could be reduced using SER parameters of SER partial tumor volume (73 to 40), SER total tumor volume (73 to 45), and peak percent enhancement (73 to 55) without removing true positives. | The adjunctive use of SER parameters may reduce the number of recommended biopsies without reducing the number of cancers detected. | closed_qa |
Are bicuspid aortic valves a limitation for aortic valve repair? | To compare the mid-term results after aortic valve (AV) repair in bicuspid AVs with those in tricuspid AVs. Between 2000 and 2010, 100 patients (mean age 47.2 years) underwent AV repair procedures for insufficient bicuspid AV (n=43) and tricuspid AV (n=57). Aortic regurgitation (AR) more than moderate was present in 31/43 and 21/57 patients in the bicuspid AV and the tricuspid AV group, respectively. Concomitant root replacement by either the reimplantation or the remodeling technique was performed in 42 patients (bicuspid AV 17/43, tricuspid AV 25/57). All patients were prospectively studied with postoperative and further annual clinical assessment and echocardiography. Follow-up was 99% complete with a mean follow-up time of 22 months. Three patients died during the initial hospitalization, all due to postoperative cardiac failure. Overall actuarial 3 years' survival was 93±4.2% without significant differences between the two groups. Overall actuarial 3 years' freedom from AV-related reoperation was 86±5.1% without significant differences between the groups (85±9.7% for bicuspid AV, 86±6.0% for tricuspid AV; log-rank test: p=0.98). Overall actuarial 3 years' freedom from recurrent AR≥moderate was 100% and AR>trace was 71.3±8.2% without significant differences between the groups (76.5±11.7% for bicuspid AV, 71.4±9.4 for tricuspid AV; log-rank test: p=0.97). | The mid-term outcome in terms of survival, freedom from reoperation or recurrent AR is similar for both groups of patients after AV repair procedures. Therefore, we advocate valve repair also in patients presenting with an insufficient bicuspid AV. | closed_qa |
Neuropathological findings of PSP in the elderly without clinical PSP: possible incidental PSP? | We aimed to describe cases with incidental neuropathological findings of progressive supranuclear palsy (PSP) from the Banner Sun Health Research Institute Brain and Body Donation Program. We performed a retrospective review of 277 subjects with longitudinal motor and neuropsychological assessments who came to autopsy. The mean Gallyas-positive PSP features grading for subjects with possible incidental neuropathological PSP was compared to those of subjects with clinically manifest disease. There were 5 cases with histopathological findings suggestive of PSP, but no parkinsonism, dementia or movement disorder during life. Cognitive evaluation revealed 4 of the 5 cases to be cognitively normal; one case had amnestic mild cognitive impairment (MCI) in her last year of life. The mean age at death of the 5 cases was 88.9 years (range 80-94). All 5 individuals had histopathologic microscopic findings suggestive of PSP. Mean Gallyas-positive PSP features grading was significantly lower in subjects with possible incidental neuropathological PSP than subjects with clinical PSP, particularly in the subthalamic nucleus. | We present 5 patients with histopathological findings suggestive of PSP, without clinical PSP, dementia or parkinsonism during life. These incidental neuropathological PSP findings may represent the early or pre-symptomatic stage of PSP. The mean Gallyas-positive PSP features grading was significantly lower in possible incidental PSP than in clinical PSP, thus suggesting that a threshold of pathological burden needs to be reached within the typically affected areas in PSP before clinical signs and symptoms appear. | closed_qa |
Is pouch of Douglas obliteration a marker of bowel endometriosis? | To estimate the clinical significance of pouch of Douglas (POD) obliteration in women undergoing laparoscopic excision of endometriosis. Prospective study (Canadian Task Force Classification II-2). University-affiliated tertiary referral center for endometriosis. A total of 454 consecutive women who underwent laparoscopic surgery for treatment of pelvic pain or infertility-associated endometriosis between October 2004 and September 2008. Demographic, historical, and final surgical data were compared between women with and without POD obliteration at laparoscopy. Logistic regression analyses were performed to investigate the predictive value of POD obliteration at laparoscopy with regard to bowel endometriosis. One hundred consecutive women with POD obliteration at laparoscopy were included. 58% (95% confidence interval [CI] 0.48-0.67, n = 58/100) of the women with POD obliteration required bowel surgery compared with 20% (95% CI 0.16-0.25, 72/354) of women without POD obliteration (p<.001). Of the POD obliteration group, 66% (95% CI 0.53-0.76) required bowel shaving, 12% (0.06-0.23) full segmental rectal resection, 9% (0.04-0.19) wedge rectal resection, 5% (0.02-0.14) full segmental rectosigmoid resection and 9% (0.04-0.19) a combination of the above. Bowel endometriosis was histologically confirmed in all women. | POD obliteration at laparoscopy carries a high risk of bowel endometriosis and bowel surgery. This risk is three times higher than those without POD obliteration. Women with POD obliteration should be managed in tertiary referral centers for the treatment of endometriosis where colorectal input is available. | closed_qa |
Early stimulation in newborns with birth weight between 1,000 and 1,500 g: is it always necessary? | To determine whether the currently widespread practice of sending all premature infants with birth weight between 1,000 and 1,500 g to early care centres is necessary from a neurological point of view, or if it is possible to establish selection criteria. A retrospective study of newborns (NB) at our hospital between January 1998 and December 2004 with birth weight between 1,000 and 1,500 g, and followed up for at least two years in a paediatric neurology clinic. We analysed the prognostic significance of the different neurological variables in the neonatal period, and those of greater significance were set at a score for deciding the start of early stimulation treatment on discharge from neonatology. A total of 194 infants met the above criteria. The most significant neurological prognostic variables were: gestational age<28 weeks, male sex, intraventricular haemorrhage grade>I, history of high risk pregnancy, sepsis, anaemia with haemodynamic repercussion and fundamentally abnormal neurological examination at discharge (odds ratio of 16). A prognostic score was developed with a cut-off of 4 points, with an area under the curve of 88.3%. The positive predictive value and negative predictive value were 43.75% and 96.2%, respectively, with 84.8% sensitivity and 78.9% specificity. | The newborns with birth weight between 1,000 and 1,500 g and normal neurological examination at discharge, with a score of less than 4 points, do not require early stimulation treatment from a neurological standpoint, given its predictable good outcome. | closed_qa |
Do pregnant women have improved outcomes after traumatic brain injury? | Pregnant women, who have significantly elevated levels of estrogen and progesterone, might benefit from the neuroprotective effect of steroid hormones. Pregnant patients were identified and compared with their nonpregnant counterparts with respect to demographics and outcome. Of the 18,800 female, moderate to severe TBI patients, 71 were pregnant. Similar mortalities were noted in pregnant and nonpregnant TBI patients (9.9% vs 9.3%, P = .84). Adjusting for confounding variables, pregnant TBI patients had a trend toward increased mortality (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI], .9-5.1; P = .07). In patients aged 15 to 47 years (n = 8,854), similar mortalities were noted in pregnant and nonpregnant TBI patients (9.9% vs 6.8%, P = .34). After adjusting for risk factors, again there was a trend toward increased mortality in the pregnant TBI group (AOR = 2.0; 95% CI, .8-4.6; P = .12). | Pregnant patients with moderate to severe TBI show no statistically significant difference in mortality compared with their nonpregnant counterparts. | closed_qa |
Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care? | Accidental traumatic injury is the leading cause of morbidity and mortality in children. The authors hypothesized that no mortality difference should exist between children seen at ATC (adult trauma centers) versus ATC with added qualifications in pediatrics (ATC-AQ). The National Trauma Data Bank, version 7.1, was analyzed for patients aged<18 years seen at level 1 trauma centers. Bivariate analysis compared patients by ATC versus ATC-AQ using demographic and injury characteristics. Multivariate analysis adjusting for injury and demographic factors was then performed. A total sample of 53,702 children was analyzed, with an overall mortality of 3.9%. The adjusted odds of mortality was 20% lower for children seen at ATC-AQ (odds ratio, .80; 95% confidence interval, .68-.94). Children aged 3 to 12 years, those with injury severity scores>25, and those with Glasgow Coma Scale scores<8 all had significant reductions in the odds of death at ATC-AQ. | Improved overall survival is associated with pediatric trauma patients treated at ATC-AQ. | closed_qa |
Can intravascular ultrasound guidance modify the efficacy of drug-eluting stent over bare-metal stent in an aorto-ostial lesion? | We compared the efficacy of drug-eluting stents (DESs) versus bare-metal stents (BMSs) in de novo and native aorto-ostial lesions (AOLs) guided by intravascular ultrasound (IVUS). Thirty-eight patients underwent DES implantation for 38 AOLs; 35 with sirolimus-eluting stents, and three with paclitaxel-eluting stents (DES group). The control group was composed of 40 AOLs treated by BMS. The incidence of the primary composite end point of all-cause mortality, Q-wave myocardial infarction and target vessel revascularization (TVR) as TVR-major adverse cardiac event (TVR-MACE) was evaluated during a 1-year follow-up. Clinical and IVUS parameters were compared between the DES and BMS groups, and Cox hazards model was used to calculate hazard ratios of several factors for the 1-year TVR-MACE. Although the vessel, plaque, and stent volumes were significantly larger after the procedures in the DES group owing to longer lesions (18.3 ± 5.1 vs. 13.2 ± 5.9 mm, P<.001), the stent volume index (10.8 ± 2.6 vs. 12.4 ± 3.3, P=.024) was much smaller than that in the BMS group. During the 1-year follow-up, there were 13 TVR-MACEs in all patients (13% in DES vs. 20% in BMS, P=.4 by Kaplan-Meier analysis). The Cox hazards model did not indicate any specific unfavorable factor for the 1-year TVR-MACE. | The present study showed equality between DES and BMS on de novo and native AOLs about the 1-year TVR-MACE rate, even though a DES was used in longer and bulkier lesions as compared to BMS. | closed_qa |
Evidence of abnormal tyrosine phosphorylated proteins in the urine of patients with bladder cancer: the road toward a new diagnostic tool? | Since changes in protein phosphorylation are a common feature of cancer cells, we analyzed phosphoproteins in the tissue and urine of patients with bladder cancer and assessed the diagnostic relevance of abnormally phosphorylated proteins as tumor markers. Enrolled in this study were 66 patients and 82 healthy volunteers. From the first 14 patients with bladder cancer we obtained samples of malignant and normal bladder tissue. All patients and volunteers provided a urine sample. Protein extracts of tissue specimens were separated by 2-dimensional gel electrophoresis for comparative analysis of neoplastic and normal tissue. Phosphoproteins were studied by Western blot and characterized by mass spectrometry. Urine samples were analyzed by 1-dimensional gel electrophoresis. Phosphoproteins were measured by affinity dot blotting. Profound changes in the pattern of protein tyrosine phosphorylation were consistently, reproducibly observed in bladder cancer tissues. A total of 24 phosphorylated proteins were differentially expressed in cancer tissue and identified by mass spectrometry. Phosphoproteins were fairly stable in urine samples, leading to accumulation. Urinary tyrosine phosphoproteins showed the most remarkable changes in patients with cancer with an approximately 5-fold increase compared to levels in healthy controls. | To our knowledge we investigated for the first time the diagnostic potential of tissue and urinary tyrosine phosphoproteins for bladder carcinoma. Results indicate that phosphorylated proteins may represent a new, valuable class of urinary biomarkers for bladder cancer. | closed_qa |
Is there any relationship between coronary artery disease and postprandial triglyceride levels? | We aimed to evaluate the relationship between postprandial triglyceride (PPTG) levels and coronary artery disease (CAD). A total of 80 patients were included in this prospective cohort study. Oral lipid loading was used in order to measure PPTG levels. In the fasting state and after the high fat breakfast, triglyceride levels were measured by enzymatic methods at 2nd, 4th, 6th and 8th hours. We made subgroup analysis to show the effects of lipid loading on triglyceride levels in patients with and without fasting hypertriglyceridemia. We evaluated triglyceride levels and changes of triglyceride levels in percentages after lipid loading using a general linear model for repeated measures. Sample size analysis was performed. Baseline clinical, demographic and laboratory characteristics of both groups were similar. The peak triglyceride levels were seen at the 4th hour in both groups. Triglyceride levels were significantly increased after lipid-rich-breakfast loading compared to baseline levels in both groups (p<0.001) but these changes were not significant (p=0.279). In patients with elevated fasting triglyceride levels, the area under the plasma triglyceride concentration curve was significantly larger in CAD group than control group (334±103 vs. 233±58 mg/dl, p=0.02). | Our data show that in patients who have a high fasting triglyceride level, high levels of PPTG may be related to CAD, however high PPTG levels are not related to CAD in patients with normal fasting levels of triglyceride. | closed_qa |
Thinking about maintaining exercise therapy: does being positive or negative make a difference? | To investigate social-cognitive and exercise differences in individuals who think positively or negatively about upcoming exercise while engaged in programs of maintenance exercise therapy for cardiovascular disease and other chronic health conditions. Participants (n = 40) completed measures relative to exercise adherence. MANOVA revealed positive thinkers were significantly higher in exercise frequency, self-regulatory efficacy, positive affect, willingness to adapt and lower in decisional struggle than negative thinkers. | Thoughts about exercise therapy are related to social cognitions crucial to motivating self-regulatory actions influencing exercise. Negative thoughts may suggest less ability to adapt to maintenance exercise challenges. | closed_qa |
Do patients whose psychogenic non-epileptic seizures resolve, 'replace' them with other medically unexplained symptoms? | In clinical practice, it is sometimes observed that patients in whom psychogenic non-epileptic seizures (PNES) cease, develop another medically unexplained symptom (MUS). In order to determine how many patients develop new MUS post diagnosis and whether patients whose attacks cease are more likely to do so, new MUS were recorded 6-12 months after the diagnosis of PNES in 187 consecutive patients. Compared with baseline, the overall proportion of patients with MUS increased slightly, from 70.1% to 76.5%, with 44/187 patients (23.5%) developing new MUS. There were no significant differences between attack free and non-attack free patients. Binary logistic regression analysis showed that predictors of new MUS diverged between attack free and non-attack free patients. Among patients continuing to have attacks, those with previous health related psychological trauma were 18.00 times more likely to develop new MUS (p<0.0005). In patients who became attack free, patients drawing disability benefits were 5.04 times more likely to have new MUS (p = 0.011). | The results suggest that almost 25% of patients develop new MUS following a diagnosis of PNES, although most of those have MUS pre-diagnosis. Patients with a history of health related psychological trauma whose attacks continue after diagnosis are at particularly high risk of developing new MUS. The data do not support the hypothesis that PNES that resolve are likely to be 'replaced' by other MUS. | closed_qa |
Maternal unemployment and childhood overweight: is there a relationship? | Previous studies have shown a positive association between maternal work hours and childhood overweight. However, it is unclear what role job instability plays in this relationship; therefore, this study examined whether children whose mothers experienced unemployment were more likely to have greater increases in body mass index (BMI) as compared with children whose mothers were stably employed. The effects of unemployment benefits, welfare and number of hours worked were also explored. A multiple regression analysis was used to analyse changes in BMI over a 4-year period using the National Longitudinal Survey of Youth. In all, 4890 US children, aged 2-16 at baseline, were included in the analysis. As compared with children of mothers who were employed full-time and did not receive welfare, children of mothers who experienced unemployment and received unemployment benefits were not more likely to have significantly different changes in BMI. Yet children of mothers who experienced unemployment and did not receive unemployment benefits were significantly more likely to have greater increases in BMI. These results were also shown in models which controlled for height. This supports the conclusion that adiposity changes, and not simply growth-rate differences, account for the different BMI changes between groups. | Aspects of maternal employment other than number of work hours are associated with child BMI, including unemployment events and what type of support a mother receives during the time of unemployment. This has implications for policies that relate to benefits for mothers who lose their jobs. | closed_qa |
Is aspirin effective in women undergoing in vitro fertilization (IVF)? | Aspirin is believed to improve the outcome of IVF, but previous conventional meta-analyses on the subject are conflicting. Therefore, we performed a meta-analysis with individual patient data (IPD MA) of randomized clinical trials (RCTs) on the subject. A systematic literature search was conducted to identify RCTs assessing the effectiveness of aspirin in IVF. Authors were asked to share their original data. In a one step meta-analytic approach, the treatment effect of aspirin was estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression, based on the intention to treat principle. Ten studies fulfilled the inclusion criteria. Authors of six studies provided IPD, including 1119 patients (562 placebo and 557 aspirin). There were 160 clinical pregnancies in the aspirin (28.8%) and 179 (31.9%) in the placebo group [OR 0.86, 95% CI (0.69-1.1)]. There were 129 ongoing pregnancies in the aspirin (23.6%) and 147 in the placebo group (26.7%) [OR 0.85, 95% CI (0.65-1.1)]. Whereas the conventional meta-analysis limited to studies that could provide IPD showed an OR of 0.89 (95% CI 0.69-1.2), the conventional meta-analysis limited to the eight studies of which method of randomization could be confirmed showed an OR of 0.94 (95% CI 0.76-1.17) and the conventional meta-analysis including all 10 eligible RCTs identified with our search changed the OR to 1.07 (95% CI 0.81-1.41). This difference in direction of effect, derived from the studies not able to share IPD of which quality of randomization could not be confirmed. | Aspirin does not improve pregnancy rates after IVF. | closed_qa |
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