99951
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Adewole OO, Erhabor GE, Sogaolu MO, Onipede AO, Owiafe PK, Awopeju FO, Ota MOC. Diagnostic utility of QuantiFERON-TB gold in-tube in active pulmonary Tuberculosis in Nigeria. West Afr J Med 2013; 32:180-185. [PMID: 24122682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The high positive responses obtained in active TB indicate that IGRAs may be useful in diagnosing active TB. This study aimed at evaluating the usefulness of Quantifer on-TB Gold-in Tube test (QFT-IT) in the diagnosis of active TB among Nigerians. METHODS This study prospectively enrolled sputum smear positive TB cases and healthy disease free controls. Basic demographic and clinical data were collected using a structured questionnaire. Venous blood was collected into the QTF-IT tubes, incubated for 16-24 hours, serum harvested and stored at -200C till analysed in a batch. Tuberculin skin test (TST) was also done using 5TU and read within 48-72 hours. The performances of QFT-IT and TST among the cases and controls were compared. RESULTS Sixty one TB cases and 41 controls were enrolled. The mean (SD) age of the TB cases was higher than the controls, 35.14+4.3 yrs v 27.8 + 2.1, p<0.001. Forty three (70.5%), 13 (21.3%) and 5 (8.2%) of the cases had a positive, negative and indeterminate QFT-IT results respectively compared with 14 (34.1%), 25 (61%), and 2 (4.9%) of the controls respectively, p values <0.001, 0.005 and 0.05 respectively. Fifty eight(95%) and 29(70.7%) of the TB cases and controls had a positive TST result respectively while 3 (5%) and 12( 29.3%) of the TB cases and controls had a negative TST result respectively, p values 0.003 each .QFT-IT had a sensitivity of 76% (95% CI 61.8 -85.2%) while the sensitivity of TST was 96.6% (95% CI 88.5 -98.3%), p = 0.07. The specificity of QFT-IT was 63.7% (95% CI 46-76%) and 30% (95% CI 20- 56%) for TST, p =0.001. Positive Likelihood ratio was 1.7 (95% CI 1.06-2.85) for QFT-IT and 1.4 (95%CI 1.06-1.8) for TST, p =0.002. Among the cases, both TST and QFT-IT were positive in 43(70.5%) and both negative in 1 (1.6%), and overall test .agreement was 77.7% (Kappa =0.13; p= 0.07). Female sex and higher total lymphocytes count were significantly associated with a positive QFT results. CONCLUSION IGRA has a higher specificity and positive likelihood ratio in TB cases. Our findings indicate that QFT-IT may be a good adjunct tool to diagnose TB disease.
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Affiliation(s)
- O O Adewole
- Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
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99952
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Jirapinyo P, Densupsoontorn N, Kangwanpornsiri C. Anal fissures in infants may be a pathognomonic sign of infants with cow's milk allergy. J Med Assoc Thai 2013; 96:786-789. [PMID: 24319847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To study the association between analfissures and cow's milk allergy (CMA) in infants. METHODS AND METHOD: In a prospective study, 72 confirmed cases of CMA in infants were examined for anal fissure by pediatricians with five years' experience. A positive finding was defined as when an anal fissure was detected by at least two out of three examiners. RESULTS Of infants with CMA with and without gastrointestinal GI symptoms, 79% and 83% had anal fissures, respectively The prevalence of anal fissure in these infants is significantly higher than in normal infants. CONCLUSION Anal fissure may be a pathognomonic sign of cow's milk allergy in infants.
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Affiliation(s)
- Pipop Jirapinyo
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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99953
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Joachin-Hernández P, Alpízar-Aguirre A, Zárate-Kalfópulus B, Rosales-Olivares LM, Sánchez-Bringas G, Reyes-Sánchez AA. [Use of the PEEK cage in cervical spondylosis treatment]. CIR CIR 2013; 81:307-311. [PMID: 25063895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Decompression and fusion with autograft is the gold standard technique in the treatment of cervical canal strait. Using PEEK cages or boxes of non-absorbable polymer with elasticity similar to bone, radiolucent, reduces morbidity and same degree of fusion. METHODS A case series, prospective, longitudinal, deliberate intervention, evaluation panel before and after 2 years follow-up. Discectomy and PEEK housing placement with autologous graft. Arthrodesis were evaluated, cervical lordosis, intervertebral space height, pain evaluated with Visual Analogue Scale, Neck Disability Index, operative time, intraoperative bleeding, hospital stay and complications. Statistical analysis with t Sudent, Wilcoxon and Fisher's exact text. RESULTS Of 17 patients studied, 9 (53%) were female. Average age 62 years. The most affected level was C5-6, C6-7 with 5 patients. Melting was found at 100%. There was no sag or migration of the box, space height was conserved, but segmental lordosis was not retained. Clinical improvement in all patients as well as disability index was seen. Bleeding was on average 187 mL. CONCLUSION With regard to symptom improvement, conservation of interspace height and back, no segmental lordosis conservation and fusion using PEEK box is consistent with the literature. We suggest using anterior plate to maintain cervical lordosis. We found a melt index of 100%. We found clinical improvement of symptoms, pain and disability, and a global loss of cervical lordosis.
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Affiliation(s)
| | - Armando Alpízar-Aguirre
- Servicio de Cirugía de Columna, Instituto Nacional de Rehabilitación. Secretaría de Salud, México, DF, Mexico
| | - Barón Zárate-Kalfópulus
- Servicio de Cirugía de Columna, Instituto Nacional de Rehabilitación. Secretaría de Salud, México, DF, Mexico
| | | | - Guadalupe Sánchez-Bringas
- Servicio de Cirugía de Columna, Instituto Nacional de Rehabilitación. Secretaría de Salud, México, DF, Mexico
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99954
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Win T, Miles KA, Janes SM, Ganeshan B, Shastry M, Endozo R, Meagher M, Shortman RI, Wan S, Kayani I, Ell PJ, Groves AM. Tumor heterogeneity and permeability as measured on the CT component of PET/CT predict survival in patients with non-small cell lung cancer. Clin Cancer Res 2013; 19:3591-9. [PMID: 23659970 DOI: 10.1158/1078-0432.ccr-12-1307] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We prospectively examined the role of tumor textural heterogeneity on positron emission tomography/computed tomography (PET/CT) in predicting survival compared with other clinical and imaging parameters in patients with non-small cell lung cancer (NSCLC). EXPERIMENTAL DESIGN The feasibility study consisted of 56 assessed consecutive patients with NSCLC (32 males, 24 females; mean age 67 ± 9.7 years) who underwent combined fluorodeoxyglucose (FDG) PET/CT. The validation study population consisted of 66 prospectively recruited consecutive consenting patients with NSCLC (37 males, 29 females; mean age, 67.5 ± 7.8 years) who successfully underwent combined FDG PET/CT-dynamic contrast-enhanced (DCE) CT. Images were used to derive tumoral PET/CT textural heterogeneity, DCE CT permeability, and FDG uptake (SUVmax). The mean follow-up periods were 22.6 ± 13.3 months and 28.5± 13.2 months for the feasibility and validation studies, respectively. Optimum threshold was determined for clinical stage and each of the above biomarkers (where available) from the feasibility study population. Kaplan-Meier analysis was used to assess the ability of the biomarkers to predict survival in the validation study. Cox regression determined survival factor independence. RESULTS Univariate analysis revealed that tumor CT-derived heterogeneity (P < 0.001), PET-derived heterogeneity (P = 0.003), CT-derived permeability (P = 0.002), and stage (P < 0.001) were all significant survival predictors. The thresholds used in this study were derived from a previously conducted feasibility study. Tumor SUVmax did not predict survival. Using multivariable analysis, tumor CT textural heterogeneity (P = 0.021), stage (P = 0.001), and permeability (P < 0.001) were independent survival predictors. These predictors were independent of patient treatment. CONCLUSIONS Tumor stage and CT-derived textural heterogeneity were the best predictors of survival in NSCLC. The use of CT-derived textural heterogeneity should assist the management of many patients with NSCLC.
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Affiliation(s)
- Thida Win
- Lister Hospital, Coreys Mills Lane, Stevenage, Hertfordshire, United Kingdom
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99955
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Lee J, Kwon IS, Bae EH, Chung WY. Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 2013; 98:2701-8. [PMID: 23678034 DOI: 10.1210/jc.2013-1583] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Robotic total thyroidectomy (TT) with modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported safe and effective in patients with N1b papillary thyroid carcinoma (PTC), with notable cosmetic benefits when compared with conventional open TT. We have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic TT and MRND and those undergoing conventional open procedures. MATERIALS AND METHODS Between March 2010 and July 2011, 128 patients with PTC and lateral neck node metastases underwent TT with MRND, including 62 who underwent robotic and 66 who underwent open TT. We compared oncologic outcomes and safety as well as functional outcomes such as postoperative subjective voice and swallowing difficulties. We also evaluated neck pain, sensory changes, and cosmetic satisfaction after surgery using various QoL symptom scales. Neck and shoulder disability was assessed using arm abduction tests (AAT) and questions from the neck dissection impairment index (NDII). RESULTS Although the mean operating time was significantly longer in the robotic (mean, 271.8 ± 50.2 min) than in the open group (mean, 208.9 ± 56.3 min) (P < .0001), postoperative complication rates and oncologic outcomes, including the results of radioactive iodine scans and postoperative serum Tg concentrations, did not differ significantly. Subjective voice outcomes and postoperative AAT and neck dissection impairment index were also similar, but postoperative swallowing difficulties (P = .0041) and sensory changes (P < .0001) were significantly more frequent in the open than in the robotic group. In particular, mean cosmetic satisfaction score was significantly higher in the robotic than in the open group (P < .0001). CONCLUSIONS Robotic TT with MRND yielded similar oncologic outcomes and safety as conventional open procedures, with similar recovery of neck and shoulder disability. However, the robot technique resulted in better QoL outcomes, including better cosmetic results and reductions in neck sensory changes and swallowing discomfort.
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Affiliation(s)
- Jandee Lee
- Department of Surgery, Eulji University College of Medicine, 139-872 Seoul, Korea
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99956
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Abstract
PURPOSE The aim of this cross-sectional trial was to identify the bacterial flora and to quantify the level of bacterial presence in healthy adult frontal sinus cavities. MATERIALS AND METHODS Ninety five consecutive patients undergoing craniotomy of the anterior cranial fossa were enrolled. All patients were evaluated preoperatively by a sino-nasal questionnaire, nasal endoscopy and CT scan. Exclusion criteria were patients with sinus tumours, presenting a cold in the past 8 weeks, having signs or symptoms suggestive of sinus disease, history suggestive of allergic rhinitis and/or asthma, having undergone hospitalization or an outpatient clinic visit within the past 12 months, patients with known systemic disease, having previous sinus or nose surgery, history of trauma of the sino-nasal region, or having used systemic antibiotics, steroids, or nasal spray in the past 8 weeks. Lavages were obtained from frontal sinuses before craniotomy through trephination of the anterior wall. The sinus was irrigated with sterile saline followed by aspiration. Specimens were inoculated for aerobic and anaerobic organisms. RESULTS After applying the exclusion criteria, 42 patients (84 sinuses) were finally included in the study. Bacterial organisms were recovered in 12 of 84 (14.28%) sinuses. However, 85.72% of the sinuses were found to be sterile. Bacteria recovered included three different coagulase-negative staphylococci, one Citrobacter diversus and two Micrococcus spp. No anaerobic organism was isolated. CONCLUSIONS This study demonstrated that the majority of frontal sinuses of asymptomatic adults with normal CT and endoscopic appearance are sterile.
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Affiliation(s)
- Silviu Albu
- Second Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Romania.
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99957
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Fox EE, Bulger EM, Dickerson AS, del Junco DJ, Klotz P, Podbielski J, Matijevic N, Brasel KJ, Holcomb JB, Schreiber MA, Cotton BA, Phelan HA, Cohen MJ, Myers JG, Alarcon LH, Muskat P, Wade CE, Rahbar MH. Waiver of consent in noninterventional, observational emergency research: the PROMMTT experience. J Trauma Acute Care Surg 2013; 75:S3-8. [PMID: 23778508 PMCID: PMC3744180 DOI: 10.1097/ta.0b013e31828fa3a0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, waiver of consent was used because previous literature reported low response rates and subsequent bias. The goal of this article was to examine the rationale and tradeoffs of using waiver of consent in PROMMTT. METHODS PROMMTT enrolled trauma patients receiving at least 1 U of red blood cells within 6 hours after admission at 10 US Level 1 trauma centers. Local institutional review boards (IRBs) from all sites approved the study. Site 8 was required by their IRB to attempt consent but was allowed to retain data on patients unable to be consented. RESULTS Of 121 subjects enrolled at Site 8, 55 consents were obtained (46%), and no patient or legally authorized representative refused to give consent. Of the patients, 36 (30%) died, and 6 (5%) were discharged before consent could be attempted. Consent was attempted but not possible among 24 patients (20%). Of the 10 clinical sites, 6 of the local IRBs approved collection of residual blood samples, 1 had previous approval to collect timed blood samples under a separate protocol, and 3 reported that their local IRBs would not approve collection of residual blood under a waiver of consent. CONCLUSION Waiver of consent was used in PROMMTT because of the potential adverse impact of consent refusals; however, there were no refusals. If the IRB for Site 8 had required withdrawal of patients unable to consent and destruction of their data, a serious bias would likely have been introduced. Other tradeoffs included a reduction in sites participating in residual blood collection and a smaller than expected amount of residual blood collected among sites operating under a waiver of consent. Noninterventional emergency research studies should consider these potential tradeoffs carefully before deciding whether waiver of consent would best achieve the goals of a study.
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Affiliation(s)
- Erin E Fox
- Biostatistics/Epidemiology/Research Design Core, Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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99958
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Guglielmi G, Rossini M, Nicolosi MG, Ragno A, Lentini G, de Terlizzi F. Three-year prospective study on fracture risk in postmenopausal women by quantitative ultrasound at the phalanges. J Clin Densitom 2013; 16:341-346. [PMID: 22901551 DOI: 10.1016/j.jocd.2012.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/11/2012] [Accepted: 07/18/2012] [Indexed: 11/22/2022]
Abstract
The purpose of this study was the calculation of fracture risk in a prospective study on postmenopausal women by quantitative ultrasound (QUS) at the phalanges. A total of 2341 postmenopausal women were recruited in 5 centers in Italy during 2006 and 2007 for QUS measurement during a screening program for osteoporosis. Two ultrasound parameters were collected: amplitude-dependent speed of sound (AD-SoS) and ultrasound bone profile index (UBPI). Women were then recontacted in 2010 and were asked about fracture occurrence during the period since previous QUS measurement. Data about new fracture occurred in this period, site and cause of fracture were requested. Two thousand two hundred eleven women were successfully recontacted. Mean age of the recruited women was 60.9 ± 10.0 yr, mean age at menopause was 49.3 ± 4.4 yr, mean body mass index (BMI) was 26.5 ± 4.6 kg/m². A total number of 108 new major osteoporotic fractures occurred during the 3-yr period, of which 23 are hip fractures, 51 are vertebral fractures. Relative risk (RR) per standard deviation (SD) decrease for major fractures was 1.77 (confidence interval [CI]: 1.59-1.97) for AD-SoS and 2.06 (CI: 1.78-2.37) for UBPI. When corrected for age, BMI, age at menopause, the RRs are still significant and equal to 1.44 (CI: 1.26-1.65) for AD-SoS and 1.67 (CI: 1.39-2.00) for UBPI. RR for vertebral fractures was 1.63 (CI: 1.41-1.88) for AD-SoS and 1.73 (CI: 1.44-2.08) for UBPI. RR for hip fractures was 1.92 (CI: 1.55-2.37) for AD-SoS and 2.68 (CI: 1.86-3.86) for UBPI. Ultrasound parameters AD-SoS and UBPI are able to significantly predict future major fractures in a prospective cohort of more than 2000 postmenopausal women.
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Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy.
| | - Maurizio Rossini
- Department of Rheumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mario Guido Nicolosi
- Department of Gynecology and Obstetrics, Divisione Ospedaliera B, S. Anna Hospital, Torino, Italy
| | - Alessandro Ragno
- Department of Internal Medicine, Ospedale "Regina Apostolorum," Albano Laziale, Italy
| | - Giovanni Lentini
- Department of Gynecology and Obstetrics, Buccheri La Ferla FBF Hospital, Palermo, Italy
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99959
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Abstract
BACKGROUND Ultrasound and ultrasound-guided fine-needle aspiration biopsy are considered the most effective approaches for both identifying and classifying thyroid nodules. However, despite continuing improvements in scanner technology and refinements in ultrasound/cytological classification guidelines, indeterminate findings still lead to diagnostic lobectomy under general anesthesia. This study aims to investigate the feasibility of applying a modified noninvasive electrical impedance spectroscopy (EIS) approach to classifying thyroid nodules. METHOD To increase nodule classification sensitivity, we developed a new EIS-based model that introduces an optimized inductance component, which increases the measured signal-to-noise ratio of capacitance variation in and about thyroid nodules. Our model then measures the change of resonance frequency when the positive reactance of the system inductor cancels out the negative reactance of the nodule capacitance in a multi-frequency electrical signal scan. The system is termed "resonance-frequency-based electrical impedance spectroscopy" (REIS). A portable REIS system with multiple probes was assembled and preliminarily tested in our clinical facility. From an ongoing prospective study, an initial data set of 160 REIS examinations including 27 verified cancer cases was used. From the data set, a number of EIS signal features was extracted and analyzed. A multi-feature-based Bayesian Belief Network was built to classify the detected thyroid nodules. A receiver operating characteristic data analysis method was applied to evaluate classification performance. RESULTS The results showed that (i) the median resonance frequency measured by the probe nearest to malignant nodules was in general lower than that measured in benign cases, and (ii) the median descending slope of EIS signal sweep curves computed from cancer cases was larger than that computed from benign cases. The Bayesian Belief Network yielded a classification performance as measured by the area under the receiver operating characteristic curve of 0.794 [with a 95% confidence interval of 0.709-0.863]. CONCLUSIONS The study demonstrates that noninvasive measurement of REIS signal features may potentially provide useful supplementary information to assist in classifying between malignant and benign thyroid nodules. Such an approach may ultimately lead to a reduction in the number of unnecessary thyroid surgeries.
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Affiliation(s)
- Bin Zheng
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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99960
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Vuletic V, Drenjancevic I, Rahelic D, Demarin V. Effect of indomethacin on cerebrovascular reactivity in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2013; 101:81-7. [PMID: 23684449 DOI: 10.1016/j.diabres.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/21/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
AIM Impaired cerebral vasoreactivity to endothelium-dependent stimuli were described in type 2 diabetes mellitus (T2DM), but the mechanisms underlying that impairment are still unclear. The aim of this study was to investigate the role of cyclooxygenases' metabolites in response to acute hypercapnic stimulus in cerebral vessels, in patients with T2DM. METHODS Vascular responses in the breath-holding test (BHT) were assessed in the absence/presence of a non-selective, reversible-inhibitor of cyclooxygenases, indomethacin (INDO), by functional transcranial Doppler sonography of the middle cerebral artery (N of patients=50; 33 men and 17 women). The functional hemodynamic parameter mean flow velocity (MFV) was assessed at rest, before and 90min after 100mg of INDO, and during the BHT. Breath holding index (BHI) [(MFV at the end of BHT minus MFV at rest)/MFV at rest)×100/s of breath-holding] was calculated after BHT performed before and 90min after INDO. RESULTS MFV at rest significantly decreased after INDO administration compared with a control condition before INDO (at rest before INDO from 49.36±15.09 to 36.72±8.45 after INDO, p<0.001) However, overall cerebral vessel vasoreactivity to hypercapnia, evaluated with BHI, was significantly improved after INDO administration compared with the BHI before INDO administration (from 0.68±0.4 to 1.27±0.42, p<0.001). CONCLUSIONS The improvement in cerebral vasoreactivity in response to BHT after INDO administration suggests that the production of a vasoconstrictor metabolite of cyclooxygenase in diabetic patients was reduced by indomethacin consumption.
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Affiliation(s)
- Vladimira Vuletic
- Department of Neurology, Dubrava University Hospital, Zagreb, Croatia.
| | - Ines Drenjancevic
- Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip, Juraj Strossmayer, Osijek, Croatia
| | - Dario Rahelic
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dubrava University Hospital, Zagreb, Croatia
| | - Vida Demarin
- Medical Director, Medical Centre "Aviva", Zagreb, Croatia
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99961
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Prisciandaro JJ, Myrick H, Henderson S, McRae-Clark AL, Brady KT. Prospective associations between brain activation to cocaine and no-go cues and cocaine relapse. Drug Alcohol Depend 2013; 131:44-9. [PMID: 23683790 PMCID: PMC3703628 DOI: 10.1016/j.drugalcdep.2013.04.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The ability to predict potential for relapse to substance use following treatment could be very useful in targeting aftercare strategies. Recently, a number of investigators have focused on using neural activity measured by fMRI to predict relapse propensity. The purpose of the present study was to use fMRI to investigate prospective associations between brain reactivity to cocaine and response inhibition cues and relapse to cocaine use. METHODS Thirty cocaine-dependent participants with clean cocaine urine drug screens (UDS) completed a baseline fMRI scan, including a cocaine-cue reactivity task and a go no-go response inhibition task. After participating in a brief clinical trial of d-cycloserine for the facilitation of cocaine-cue extinction, they returned for a one-week follow-up UDS. Associations between baseline activation to cocaine and inhibition cues and relapse to cocaine use were explored. RESULTS Positive cocaine UDS was significantly associated with cocaine-cue activation in the right putamen and insula, as well as bilateral occipital regions. Associations between positive cocaine UDS and activation to no-go cues were concentrated in the postcentral gyri, a region involved in response execution. CONCLUSIONS Although preliminary, these results suggest that brain imaging may be a useful tool for predicting risk for relapse in cocaine-dependent individuals. Further, larger-scale naturalistic studies are needed to corroborate and extend these findings.
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Affiliation(s)
- James J Prisciandaro
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, 67 President Street, Charleston, SC 29425, USA.
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99962
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Vieira MLC, Oliveira WA, Cordovil A, Rodrigues ACT, Mônaco CG, Afonso T, Lira Filho EB, Perin M, Fischer CH, Morhy SS. 3D Echo pilot study of geometric left ventricular changes after acute myocardial infarction. Arq Bras Cardiol 2013; 101:43-51. [PMID: 23740401 PMCID: PMC3998181 DOI: 10.5935/abc.20130112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 03/25/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Left ventricular remodeling (LVR) after AMI characterizes a factor of poor prognosis. There is little information in the literature on the LVR analyzed with three-dimensional echocardiography (3D ECHO). OBJECTIVE To analyze, with 3D ECHO, the geometric and volumetric modifications of the left ventricle (VE) six months after AMI in patients subjected to percutaneous primary treatment. METHODS Prospective study with 3D ECHO of 21 subjects (16 men, 56 ± 12 years-old), affected by AMI with ST segment elevation. The morphological and functional analysis (LV) with 3D ECHO (volumes, LVEF, 3D sphericity index) was carried out up to seven days and six months after the AMI. The LVR was considered for increase > 15% of the end diastolic volume of the LV (LVEDV) six months after the AMI, compared to the LVEDV up to seven days from the event. RESULTS Eight (38%) patients have presented LVR. Echocardiographic measurements (n = 21 patients): I- up to seven days after the AMI: 1- LVEDV: 92.3 ± 22.3 mL; 2- LVEF: 0.51 ± 0.01; 3- sphericity index: 0.38 ± 0.05; II- after six months: 1- LVEDV: 107.3 ± 26.8 mL; 2- LVEF: 0.59 ± 0.01; 3- sphericity index: 0.31 ± 0.05. Correlation coefficient (r) between the sphericity index up to seven days after the AMI and the LVEDV at six months (n = 8) after the AMI: r: 0.74, p = 0.0007; (r) between the sphericity index six months after the AMI and the LVEDV at six months after the AMI: r: 0.85, p < 0.0001. CONCLUSION In this series, LVR has been observed in 38% of the patients six months after the AMI. The three-dimensional sphericity index has been associated to the occurrence of LVR.
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99963
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Ramzanali SAA, Shah SSH. Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy. J Ayub Med Coll Abbottabad 2013; 25:16-18. [PMID: 25226730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Gold standard treatment for symptomatic gall stones is laparoscopic cholecystectomy (LC). Ultrasonically activated devices have been used for gall bladder dissection in LC. Harmonic scalpel (HS) is the leading ultrasonically cutting coagulation device offering surgeons important benefits. The main aim of our study was to compare the surgical outcomes of LC performed by HS to that performed by conventional mono-polar diathermy (electro-cautery). METHODS This prospective randomized study was conducted in surgical department of Jinnah Postgraduate Medical Centre, Karachi, during May-October 2013. During this period we selected 92 patients with symptomatic gallstones who underwent LC; these patients were randomly recruited into two groups using sealed opaque envelopes. Group A underwent gallbladder dissection from its bed using mono-polar diathermy, while on the other hand in Group B the dissection was carried out using harmonic scalpel. The outcomes like gallbladder perforation with bile spillage, intra-operative bleeding and operative time were assessed. RESULTS The harmonic scalpel (HS) usage in surgery results in shorter operative time, it also leads to less gallbladder injury, bile leakage and stone spillage (due to minimal lateralization of heat energy) not only this it also leads to less intra-operative blood loss. CONCLUSION Harmonic scalpel is a new innovation in gallbladder surgery it has multiple functions like cutting, coagulation, coaptaion and cavitation which have made it safe, handy, effective and reliable instrument.
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99964
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Sbarbati MM, Mattei A, Scacciafratte P, Marci S, Troiano MG, Battisti E, Patacchiola A, Angelone AM, Baldi G. [Survey on the prevalence, duration and exclusivity of breastfeeding in the province of Rieti, Italy]. Ann Ig 2013; 25:317-327. [PMID: 23703306 DOI: 10.7416/ai.2013.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The aim of the survey was to estimate the prevalence, duration and exclusivity of breastfeeding (AS) in the province of Rieti, using standardized indicators, for further assessment. METHODS this is an observational prospective study, through questionnaires self-administered to parents of children receiving the first two vaccinations mandatores. The survey was conducted in the outpatient paediatric vaccine clinics and attended by parents of 198 children born in 2010, who carried out the vaccinations required by law in the first six months of life. The main outcome measures were the prevalence of exclusive breastfeeding (AE), predominant breastfeeding (AP), partial breastfeeding (AC) and with formula feeding only (not AS) after three and six months in postpartum. Have been also studied a number of factors that may affect the ability of the mothers to breastfeed and its continuation. RESULTS At 3 months of age, the proportion of infants who were being breastfed was 65.5%, (AE 39.7%, AP 11.7%, 14.1% AC), while, after 5 months in postpartum the proportion of any AS was 51.7% ( AE 18.5%, AP 15.6% and 17.9% AC). Based on the regression model, significant associations were observed between AS complete at the 3rd and 5th month, and natural delivery (OR 2.6, respectively, and OR 1.9); having breastfed her son during the first 48 hours of birth was associated with increased prevalence of AS at 3rd month (OR 3.5), but it was not significant associated at the 5th month. Pre-term birth reduces significantly the probability of BF (OR 0.3) at the first vaccination. The use of pacifiers has been associated with reduced prevalence and early discontinuation of BF (respectively, OR 0.2 at 3rd month and OR 0.3 at 5th month). CONCLUSION The survey confirms the need to assist the new mothers in the postpartum to promote the practice of exclusive breastfeeding and its continuation. The identification of specific risk groups, such as women who have caesarean delivery or who started late lactation, allows health professionals to act with greater awareness and achieve greater efficiency in interventions.
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Affiliation(s)
- M M Sbarbati
- Unita' Operativa Complessa Materno Infantile, ASL di Rieti, Italy.
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99965
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Zooker C, Pandarinath R, Kraeutler MJ, Ciccotti MG, Cohen SB, DeLuca PF. Clinical measurement of patellar tendon: accuracy and relationship to surgical tendon dimensions. Am J Orthop (Belle Mead NJ) 2013; 42:317-320. [PMID: 24078943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patellar tendon width and length are commonly used for preoperative planning for anterior cruciate ligament reconstruction (ACLR). In the study reported here, we assessed the accuracy of preoperative measurements made by palpation through the skin, and correlated these measurements with the actual dimensions of the tendons at surgery. Before making incisions in 53 patients undergoing ACLR with patellar tendon autograft, we measured patellar tendon length with the knee in full extension and in 90° of flexion, and tendon width with the knee in 90° of flexion. The tendon was then exposed, and its width was measured with the knee in 90° of flexion. The length of the central third of the tendon was measured after the graft was prepared. Mean patellar tendon length and width with the knee in 90° of flexion were 39 mm and 32 mm, respectively. No clinical difference was found between the estimated pre-incision and surgical widths. However, the estimated pre-incision length with the knee in full extension and in 90° of flexion was significantly shorter than the surgical length. Skin measurements can be used to accurately determine patellar tendon width before surgery, but measurements of length are not as reliable.
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Affiliation(s)
- Chad Zooker
- Sports Medicine Orthopaedic Surgery Fellow, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
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99966
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Sidorenko EV, Preobrazhenskiĭ VI, Vnukov DV, Preobrazhenskaia MV. [Peculiarities of early rehabilitation of mountain ski athletes after plastic reconstruction of anterior cruciate ligament]. Vopr Kurortol Fizioter Lech Fiz Kult 2013:35-38. [PMID: 24137934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The primary objective of the present study was to estimate the effectiveness of the new methods of physical rehabilitation for mountain ski athletes designed to optimize and accelerate restoration of their professional capabilities after arthroscopic plastic reconstruction of anterior cruciate ligament (ACL). This open controlled prospective study involved 26 alpine skiers aged from 18 to 25 who were recruited into the regular follow up program based at our Centre during the last 3 years. The athletes proved able to start balance training on the Biodex platform 4 weeks earlier than with the use of the conventional approach. These exercises were supplemented by the training of speed endurance on the Speed Courte tensor platform and Sky Teck ski simulators. Control studies were carried out on the 16th and 24th weeks of the rehabilitation period. Their results were compared with the results shown by the same athletes before injury. It was found that the early introduction of exercises designed to normalize proprioception into the rehabilitative treatment allowed the injured mountain ski athletes to restore the strength of femoral muscles and specific professional skills by the 4th month of the rehabilitation period. It is concluded that the combination of classical rehabilitative techniques with balance training, Speed Court training, and training on the alpine ski simulator makes it possible to begin special of alpine ski training on the snow 2 months earlier than with the use of conventkional methods.
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99967
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Majluf-Cruz A, Moreno-Hernández M, Alvarado-Moreno JA, Isordia-Salas I, Guardado-Mendoza R, Majluf-Cruz K, Coria-Ramírez E, Hernández-Juárez J. Safety of the oral methionine load test: effects on the clinical performance and laboratory tests. Rev Invest Clin 2013; 65:323-330. [PMID: 24304733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Hyperhomocysteinemia is a prothrombotic risk factor. Homocysteine is evaluated during fasting and after an oral methionine load (OML). AIM To determine the safety of the OML test according to the general performance status and clinical laboratory tests. We studied healthy nonsmoking volunteers and patients with several thrombotic conditions. Before and after receiving an OML, blood samples were obtained to perform several laboratory tests. We also evaluated acute and subacute adverse effects and 30-day associated morbidity and mortality. Of 353 individuals, three were eliminated because they did not tolerate the OML. We studied 175 healthy individuals and 175 patients without age differences. After OML, mild to moderate clinical abnormalities were recorded in 78 subjects (22.1%): nausea (n = 69; 88.5%), dizziness (n = 13; 16.7%) and decreased or increased blood pressure (n = 8; 10.2%). Nausea always disappeared after breakfast in affected individuals. Prevalence of complications was similar in patients and controls. No patient required hospitalization and there was no mortality during the 30-day study period. In conclusion, OML test had no significant undesirable effects on the clinical status or the general laboratory tests of patients and healthy controls. Some mild and moderate symptoms associated with OML tests were observed, and OML test did not negatively affect general laboratory tests. OML test is a safe diagnostic procedure in patients with previous thrombotic events (and with the consequent associated risk factors such as diabetes mellitus or dyslipidemia) and in healthy subjects.
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Affiliation(s)
- Abraham Majluf-Cruz
- Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social
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Wang PL, Zhao XQ, Wang YL, Yang ZH, Wang AX, Wang YJ. [The impact of in-hospital pneumonia on the risk of in-hospital and long-term mortality in patients with acute ischemic stroke]. Zhonghua Nei Ke Za Zhi 2013; 52:554-557. [PMID: 24266994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To observe the short-term and long-term impacts of in-hospital pneumonia on outcomes of patients hospitalized with acute ischemic stroke. METHODS All consecutive patients older than 18 years with acute ischemic stroke were prospectively recruited to this study, including 132 clinical centers in 32 provinces and 4 municipalities (including Hong Kong region) in China from September 2007 to August 2008. Case report form was designed. Data of pneumonia and survival outcomes at baseline; discharge; 3, 6 and 12 months after admission were recorded. Multivariable logistic regression was used for statistical correlation analysis. RESULTS A total of 1373 (11.88%) patients from 11 560 acute ischemic stroke patients were notified with in-hospital pneumonia. The case fatality rate was 14.4% (1664 patients) within 12 months after stroke onset. The fatality rate in patients with pneumonia was higher than that of patients without pneumonia.In-hospital pneumonia was an independent risk factor for death at discharge (adjusted OR = 5.916; 95%CI 4.470-7.831), at 3 months (adjusted OR = 3.641; 95%CI 3.035-4.367), 6 months (adjusted OR = 3.445; 95%CI 2.905-4.086), and 12 months (adjusted OR = 3.543; 95%CI 3.016-4.161) after onset. CONCLUSION In-hospital pneumonia is an adverse factor for the short-term and long-term survival of acute ischemic patients in China.
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Affiliation(s)
- Peng-lian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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Nie RQ, Liu JR, Deng BQ, Xie SL, Wang JF. [Impact of insulin resistance on prognosis in non-diabetic patients with acute coronary syndromes]. Zhonghua Xin Xue Guan Bing Za Zhi 2013; 41:559-562. [PMID: 24284181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the impact of insulin resistance (IR) on prognosis in non-diabetic acute coronary syndrome patients. METHODS In this prospective study, we enrolled 332 non-diabetic patients suffering from acute coronary syndrome. The patients were divided into three groups by HOMA-IR which calculated by formula: low HOMA-IR group (HOMA-IR < 2), 44 cases; moderate HOMA-IR group (2 ≤ HOMA2-IR < 6), 99 cases; high HOMA-IR group (HOMA ≥ 6) with HOMA index, 179 cases. The in-hospital medical records of patients were compared, and all patients were followed up for one year after discharge. RESULTS Incidence of hypertension (P = 0.013), dyslipidemia (P < 0.001), faster resting heart rate (P < 0.001) and number of triple vessel coronary artery disease (P = 0.017) in high HOMA-IR group were significantly higher than in low and moderate HOMA-IR group. During follow-up, the major end-point events increased in proportion to IR grade: 64.3% (26/44) in the high HOMA-IR group, 54.7% (52/99) in moderate HOMA-IR group and 41.3% (74/199) in low HOMA-IR group (P = 0.034). Multivariable logistic regression analysis showed that high sensitivity C reactive protein (OR = 1.012, 95%CI:1.002-1.022, P = 0.022), HOMA-IR (OR = 1.250, 95%CI:1.043-1.497, P = 0.015) , triple vessel coronary artery disease (OR = 5.914, 95%CI:2.947-11.868, P < 0.001) , ischemic changes on ECG (OR = 5.495, 95%CI:2.925-10.324, P < 0.001) and low left ventricular ejection fraction (LVEF ≤ 40%) (OR = 13.205, 95%CI:5.000-34.661, P < 0.001) were independent risk factor for major end-point events during follow-up. CONCLUSIONS Increased insulin resistance is linked with poor prognosis of non-diabetic patients with acute coronary syndrome.
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Affiliation(s)
- Ru-qiong Nie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China.
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99970
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Mosgaard BJ, Skovlund VR, Hendel HW. Promising results using sentinel node biopsy as a substitute for radical lymphadenectomy in endometrial cancer staging. Dan Med J 2013; 60:A4665. [PMID: 23809974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the efficacy of the sentinel node (SN) procedure in endometrial cancer patients. MATERIAL AND METHODS This was a prospective follow-up study including patients referred to Herlev Hospital, Denmark, to be treated for endometrial cancer in the period from October 2005 to December 2008. Hysteroscopy was performed with a 4.5 mm hysteroscope. Injections of 100-150 MBq (99m)Tc-traced colloid were administered subendometrially, and a dynamic scintigram was made. SN(s) identified with a gammaprobe were resected at the operation, and frozen sections were performed, followed by radical pelvic and para-aortic lymphadenectomy. RESULTS A total of 32 patients were included. Among patients without clinical macro-metastases (n = 27), the SNs were detected by gamma probe in 23 (85.2%), and in most patients (n = 17, 74.0%) one (n = 12) or two (n = 5) SNs were found. The consistency between the scintigram and peroperative findings increased from 50.0% to 78.9% when the dose of (99m)Tc was increased to 150 MBq, mostly because the detection failure rate was lower at the higher dose: 4.8% versus 18.2%. By frozen section all macro-metastases were confirmed, but only one micro-metastasis was diagnosed. All subsequent lymph node metastases found in the final histology were found in SNs, i.e. no false negative SNs were found. CONCLUSION The SN procedure can be used for endometrial cancer and it has a high detection rate and no false negative SNs were detected. The sensitivity of the SN procedure may be increased by the use of single-photon emission computed tomography (SPECT)/computed tomography (CT) and peroperative cytokeratin (CK) staining of the SN(s). FUNDING External funding was received from the following University Foundation, Copenhagen County Research, Manufacturer Einar Willumsen's Memorial Foundation, Toyota Foundation Denmark, Lilly Benthine Lund Foundation. TRIAL REGISTRATION The study was registered with the Danish Data Protection Agency.
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99971
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Lua PL, Talib NS. Auricular acupuncture for drug dependence: an open-label randomized investigation on clinical outcomes, health-related quality of life, and patient acceptability. Altern Ther Health Med 2013; 19:28-42. [PMID: 23981370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CONTEXT Substance abuse has been prevalent in Malaysia for many years and currently represents one of the main concerns to its society. The limitations of conventional therapies have resulted in efforts to explore the potentia of complementary therapies in the management of drug addiction. The evidence for auricular acupuncture (AA) as a potential complementary therapy for drug addiction is still limited and inconclusive. OBJECTIVE The study intended (1) to compare the clinical outcomes of methadone maintenance treatment (MMT) alone and MMT plus AA (MMT+AA) with regard to the daily methadone dose, number of cigarettes smoked/wk, relapse rates, and withdrawal symptoms; (2) to evaluate health-related quality of life (HR QoL) pre- and postintervention; and (3) to determine participants' acceptance of AA therapy. DESIGN The research team designed this study to be prospective, longitudinal, open-labeled, and randomized, with one intervention group (AA group) and one control group. SETTING The settings were three MMT centers in Terengganu, Malaysia: (1) the Methadone Maintenance Treatment (MMT) Center, Hospital Sultanah Nur Zahirah; (2) the MMT Center, Marang Health Clinic; and (3) the MMT Center, Seberang Takir Health Clinic. PARTICIPANTS Participants were individuals who were enrolled in the three MMT programs. INTERVENTION After randomization, the intervention group received MMT+AA while the control group received MMT only. Participants in the AA group underwent concurrent AA sessions for 8 wk. OUTCOME MEASURES All outcomes were evaluated using questionnaires that the research team developed and WHOQOL-BREF. Data were analysed employing descriptive and nonparametric statistics (SPSS v16). RESULTS A total of 97, eligible, male patients consented to participation (MMT = 42; MMT+AA = 55; median age = 36.0 y; Malay ethnicity = 97.9%). After screening for dropouts, the data from only 69 participants were considered for postintervention analysis (MMT = 40; MMT+AA = 29). At preintervention, participants differed significantly by HR QoL profile and the frequency of withdrawal symptoms (better for MMT participants). Postintervention, all groups reported significantly reduced numbers of cigarettes smoked and a reduced methadone dose (P < .05), whereas no significant difference was detected for other parameters. No difference for relapse rate was detected between the groups. On separate group analysis, only the number of cigarettes was significantly lower for MMT+AA participants, whereas apart from methadone dose, all other parameters had significantly improved over time in the MMT+AA cohort. The additional AA therapy also demonstrated favorable acceptance and tolerable side effects. CONCLUSION Findings implied that AA could be beneficial as an adjunct to MMT in managing addiction, but the effectiveness of AA still requires further extensive investigation.
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Affiliation(s)
- Pei Lin Lua
- Center for Clinical and Quality of Life Studies, Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidini, Kota Campus, Kuala Terengganu, Malaysia.
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Zheng J, Xia E, Li TC, Sun X. Comparison of combined transcervical resection of the endometrium and levonorgestrel-containing intrauterine system treatment versus levonorgestrel-containing intrauterine system treatment alone in women with adenomyosis: a prospective clinical trial. J Reprod Med 2013; 58:285-290. [PMID: 23947077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the effect of transcervical resection of the endometrium (TCRE) combined with levonorgestrel-containing intrauterine system (LNG-IUS) versus LNG-IUS alone in the treatment of adenomyosis. STUDY DESIGN A total of 43 patients with adenomyosis, suffering from dysmenorrhea and menorrhagia, were recruited. Twenty patients underwent TCRE first followed by insertion of the LNG-IUS (group 1), while 23 patients were managed with the LNG-IUS alone (group 2). Both groups were followed up at 3, 6 and 12 months with regard to menstrual characteristics. Visual analogue scores, transvaginal ultrasound scans and routine gynecological examinations were performed on all patients during the follow-up visits. RESULTS There was a significant reduction in menstrual flow and pain in both groups following treatment. The reduction in menstrual flow in group 1 was significantly (p < 0.001) greater than that of group 2 at 3, 6 and 12 months posttreatment. On the other hand, there was no significant difference (p = 0.061) in the reduction of pain between the two groups. CONCLUSION TCRE combined with LNG-IUS for the treatment ofadenomyosis is more effective in reducing menstrual flow compared with the LNG-IUS alone. However, there was no demonstrable difference in the amount of pain reduction between the two treatment strategies.
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Affiliation(s)
- Jie Zheng
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, #20 Fuxingmen Wai Street, Xicheng District, Beijing 100038, China.
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Sampaio-Barros PD, Pereira IA, Hernández-Cuevas C, Berman A, Burgos-Vargas R, Gutierrez MA, Barcelos A, Chávez-Corrales JE, Moreno M, Palleiro DR, Saénz-Castro R, Stekman I, Azevedo VF, Braga-da-Silva JA, Citera G, Flores-Alvarado D, Gonçalves CR, Graf C, Nitsche A, Saavedra J, Ximenes AC, Vázquez-Mellado J, Collantes-Estevez E. An analysis of 372 patients with anterior uveitis in a large Ibero-American cohort of spondyloarthritis: the RESPONDIA Group. Clin Exp Rheumatol 2013; 31:484-489. [PMID: 23899968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/05/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This study analysed the frequency of anterior uveitis (AU) and its correlations in a large cohort of patients with spondyloarthritis (SpA). METHODS A common protocol of investigation was prospectively applied to 2012 SpA patients in 85 centres from 10 Ibero-American countries. Clinical and demographic variables and disease indexes were investigated. Categorical variables were compared by χ2 and Fisher's exact test, and continuous variables were compared by ANOVA or Kruskal-Wallis test. A value of p<0.05 was considered significant. RESULTS AU was referred by 372 SpA patients (18.5%). AU was statistically associated with inflammatory low back pain (p<0.001), radiographic sacroiliitis (p<0.001), enthesopathies (p=0.004), urethritis/acute diarrhoea (p<0.001), balanitis (p=0.002), hip involvement (p=0.002), HLA-B27 (p=0.003), and higher C-reactive protein (p=0.001), whilst it was negatively associated with the number of painful (p=0.03) and swollen (p=0.005) peripheral joints, psoriatic arthritis (p<0.001), psoriasis (p<0.001), nail involvement (p<0.001), and dactilitis (p=0.062; trend). No association with gender, race, and indices (disease activity, functionality and quality of life) was observed. Logistic regression showed that ankylosing spondylitis (p=0.001) and HLA-B27 (p=0.083; trend) was significantly associated with AU, while extra-articular manifestations (predominantly psoriasis) were negatively associated (p=0.016). CONCLUSIONS Anterior uveitis is a frequent extra-articular manifestation in SpA patients, positively associated with axial involvement and HLA-B27 and negatively associated with peripheral involvement and psoriatic arthritis.
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99974
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Ülker Efteli E, Yapucu Günes Ü. A prospective, descriptive study of risk factors related to pressure ulcer development among patients in intensive care units. Ostomy Wound Manage 2013; 59:22-27. [PMID: 23846003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Many risk factors for the development of pressure ulcers (PUs) in the general hospital population have been identified, but consensus is lacking on specific PU risk factors for critical care patients. A prospective, descriptive study was conducted to determine the incidence of and risk factors for PU development among high-risk patients (Braden risk scale score <12) admitted to an intensive care unit (ICU) of a university hospital in Turkey. Demographic variables, APACHE II scores, serum albumin, hemoglobin, and glucose levels were obtained, and patients' skin was assessed daily until discharge. Data were analyzed using percentage distributions, Student's t-test, chi-square, and logistic regression analysis. Seventy (70) patients (22 women, 48 men), average age 56.2 (SD 19.2) years, mean albumin level 2.86 (median: 2.86, SD 2.73), and mean APACHE II score 17.2 (SD 6.48), completed the study. During an average length of stay of 17.2 days (SD 4.2), PU incidence was 28.6%. Of the 23 ulcers that developed, 12 (52.1%) were Stage I, eight (8, 34.8%) were Stage II, and three (3, 13.1%) were Stage III; no patient developed a Stage IV ulcer. Multivariate logistic regression analysis showed that being female (OR = 0.15, [95% CI:0.03- 0.71] P <0.05) and having a lower serum albumin level (OR=11.6, [95% CI:1.92- 70.4] P <0.01) were independent risk factors for PU development. Patient gender and serum albumin levels should be considered as risk factors for PU development in ICU patients. Larger prospective studies examining these risk factors in ICU patients are warranted.
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Affiliation(s)
- Elçin Ülker Efteli
- Department of Fundamentals of Nursing, Ege University Faculty of Nursing, Izmir, Turkey
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Cardoso T, Ribeiro O, Aragão I, Costa-Pereira A, Sarmento A. Differences in microbiological profile between community-acquired, healthcare-associated and hospital-acquired infections. ACTA MEDICA PORT 2013; 26:377-384. [PMID: 24016647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Microbiological profiles were analysed and compared for intra-abdominal, urinary, respiratory and bloodstream infections according to place of acquisition: community-acquired, with a separate analysis of healthcare-associated, and hospital-acquired. MATERIAL AND METHODS Prospective cohort study performed at a university tertiary care hospital over 1 year. Inclusion criteria were meeting the Centers for Disease Control definition of intra-abdominal, urinary, respiratory and bloodstream infections. RESULTS A total of 1035 patients were included in the study. More than 25% of intra-abdominal infections were polymicrobial; multi-drug resistant gram-negatives were 38% in community-acquired, 50% in healthcare-associated and 57% in hospital-acquired. E. coli was the most prevalent among urinary infections: 69% in community-acquired, 56% in healthcare-associated and 26% in hospital-acquired; ESBL producers' pathogens were 10% in healthcare-associated and 3% in community-acquired and hospital-acquired. In respiratory infections Streptococcus pneumoniae was the most prevalent in community-acquired (54%) and MRSA in healthcare-associated (24%) and hospital-acquired (24%). A significant association was found between MRSA respiratory infection and hospitalization in the previous year (adjusted OR = 6.3), previous instrumentation (adjusted OR = 4.3) and previous antibiotic therapy (adjusted OR = 5.7); no cases were documented among patients without risk factors. Hospital mortality rate was 10% in community-acquired, 14% in healthcare-associated and 19% in hospital-acquired infection. DISCUSSION AND CONCLUSION This study shows that healthcare-associated has a different microbiologic profile than those from community or hospital acquired for the four main focus of infection. Knowledge of this fact is important because the existing guidelines for community-acquired are not entirely applicable for this group of patients.
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Affiliation(s)
- Teresa Cardoso
- Unidade de Cuidados Intensivos Polivalente. Hospital de Santo António. Centro Hospitalar do Porto. Universidade do Porto. Porto. Portugal..
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Kalava A, Darji SJ, Kalstein A, Yarmush JM, SchianodiCola J, Weinberg J. Efficacy of ginger on intraoperative and postoperative nausea and vomiting in elective cesarean section patients. Eur J Obstet Gynecol Reprod Biol 2013; 169:184-8. [PMID: 23510951 DOI: 10.1016/j.ejogrb.2013.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/30/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of dry powdered ginger, given orally, on nausea and vomiting during and after an elective cesarean section performed under combined spinal epidural anesthesia. STUDY DESIGN 239 women, ginger (n=116) and placebo (n=123), who underwent elective cesarean section at term under combined spinal-epidural anesthesia were provided with standard preoperative antiemetic treatment in addition to a randomized study drug. They were given two capsules (1g each) of either dry powdered ginger or placebo, one capsule a half-hour before induction of anesthesia and the second 2h after surgery. The study was double-blinded and the incidences of nausea and vomiting were assessed both intraoperatively and postoperatively. Levels of pain and pruritus were also assessed postoperatively. RESULTS The intraoperative incidence of nausea was 52% and 61%, ginger versus placebo (p=0.149). The number of episodes of intraoperative nausea was less in the ginger group compared to placebo (mean difference was -0.396, 95% CI -0.738, -0.054) and the result was statistically significant (p=0.023). The incidence of intraoperative vomiting was 27.35% in the ginger group and 36.59% in the placebo group, and the difference was not statistically significant (p=0.126). The number of episodes of vomiting during surgery was less in the ginger group compared to placebo: (mean difference -0.158, 95% CI -0.626, 0.311) although statistically insignificant (p=0.505). Furthermore, postoperatively, there was no statistical difference in the incidence of nausea and vomiting assessed at 0, 2, 2 ½ and 24h after surgery. There were also no differences in postoperative pain or pruritus. CONCLUSION Ginger given in dry powdered form reduced the number of episodes of intraoperative nausea compared to a placebo, but it had no effect on incidence of nausea, vomiting, or pain during and after an elective cesarean section performed under combined spinal epidural anesthesia.
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Affiliation(s)
- Arun Kalava
- Department of Anesthesiology, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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99977
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Yu F. A novel technique for reconstruction of the posterior wall of the external auditory canal and tympanum using pedicled temporalis myofascia. Acta Otolaryngol 2013; 133:699-707. [PMID: 23441810 DOI: 10.3109/00016489.2013.767987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The procedure cleared the lesion completely and preserved the physiological function of the external auditory canal. OBJECTIVE To develop a novel surgical procedure to treat chronic suppurative otitis media (CSOM). To explore the merit of using pedicled temporalis myofascia (PTM) and reconstruction of the posterior wall of the external auditory canal with pedicled postauricular periosteal flap and intact skin of the external auditory canal. METHODS Forty-seven patients with CSOM were chosen. Open radical mastoidectomy was used to complete clean-up lesions; the fascia of PTM was used to repair the tympanic membrane. The PTM, pedicled postauricular periosteal flap, and intact skin of the external auditory canal were used in the reconstruction of the posterior wall of the external auditory canal. All subjects were followed up for over 2 years. Hearing thresholds, including air conduction (AC), bone conduction (BC), and air-bone gap (ABG) before and after surgery, and after follow-up, were compared. RESULTS The healing rate of postoperated tympanic membrane was 95.74% and the 2-year healing rate of tympanic membrane perforation was 95.65%. The 46 ears included in the 2-year follow-up showed significant improvement between preoperative and postoperative AC and ABG values.
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Affiliation(s)
- Feng Yu
- Department of Otorhinolaryngology, Guangzhou Ear Nose Throat Neck Surgery Hospital, Guangzhou, China.
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99978
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Bacaksiz A, Vatankulu MA, Kayrak M, Telli HH, Ayhan SS, Sonmez O, Alp A, Buyukbas S. Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction. Clinics (Sao Paulo) 2013; 68:997-1003. [PMID: 23917666 PMCID: PMC3714741 DOI: 10.6061/clinics/2013(07)18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/30/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements. METHODS A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated. RESULTS Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90±3.75 vs. 1.35±0.72 nmol/L, p<0.001). Although the left atrial diameter was comparable in patients and controls, the left atrial volume index was increased in patients with acute myocardial infarction (26.5±7.1 vs. 21.3±4.9 mL/m2, p<0.01). Multivariate regression analysis showed a strong independent correlation between the left atrial volume index and the plasma atrial natriuretic peptide level (β=0.23, p=0.03). CONCLUSIONS The left atrial volume index and plasma atrial natriuretic peptide level were correlated in patients with acute myocardial infarction.
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Affiliation(s)
- Ahmet Bacaksiz
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey.
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99979
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Wu QJ, Xie L, Zheng W, Vogtmann E, Li HL, Yang G, Ji BT, Gao YT, Shu XO, Xiang YB. Cruciferous vegetables consumption and the risk of female lung cancer: a prospective study and a meta-analysis. Ann Oncol 2013; 24:1918-1924. [PMID: 23553059 PMCID: PMC3690909 DOI: 10.1093/annonc/mdt119] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/09/2013] [Accepted: 02/11/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Epidemiological studies evaluating the association between cruciferous vegetables (CVs) intake and female lung cancer risk have produced inconsistent results. PATIENTS AND METHODS This study followed 74 914 Chinese women aged 40-70 years who participated in the Shanghai Women's Health Study. CV intake was assessed through a validated food-frequency questionnaire (FFQ) at baseline and reassessed during follow-up. Hazard ratios (HRs) and 95% confidence interval (CIs) were estimated by using Cox proportional hazards models. Furthermore, we carried out a meta-analysis of all observational studies until December 2011. RESULTS After excluding the first 2 years of follow-up, 417 women developed lung cancer over a mean of 11.1 years of follow-up. An inverse association of borderline statistical significance was observed between CV consumption and female lung cancer risk, with HR for the highest compared with the lowest quartiles of 0.73 (95% CI 0.54-1.00, P trend = 0.1607). The association was strengthened in analyses restricting to never smokers, with the corresponding HR of 0.59 (95% CI 0.40-0.87, P trend = 0.0510). The finding of an inverse association between CV intake and lung cancer risk in women was supported by our meta-analysis of 10 included studies. CONCLUSIONS Our study suggests that CV consumption may reduce the risk of lung cancer in women, particularly among never smokers.
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Affiliation(s)
- Q J Wu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai; State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Shanghai; Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - L Xie
- State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Shanghai; Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - W Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville
| | - E Vogtmann
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - H L Li
- State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Shanghai; Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - G Yang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville
| | - B T Ji
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Y T Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - X O Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville
| | - Y B Xiang
- State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Shanghai; Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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99980
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Hubbard A, Munoz ID, Decker A, Holcomb JB, Schreiber MA, Bulger EM, Brasel KJ, Fox EE, del Junco DJ, Wade CE, Rahbar MH, Cotton BA, Phelan HA, Myers JG, Alarcon LH, Muskat P, Cohen MJ. Time-dependent prediction and evaluation of variable importance using superlearning in high-dimensional clinical data. J Trauma Acute Care Surg 2013; 75:S53-60. [PMID: 23778512 PMCID: PMC3744063 DOI: 10.1097/ta.0b013e3182914553] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prediction of outcome after injury is fraught with uncertainty and statistically beset by misspecified models. Single-time point regression only gives prediction and inference at one time, of dubious value for continuous prediction of ongoing bleeding. New statistical machine learning techniques such as SuperLearner (SL) exist to make superior prediction at iterative time points while evaluating the changing relative importance of each measured variable on an outcome. This then can provide continuously changing prediction of outcome and evaluation of which clinical variables likely drive a particular outcome. METHODS PROMMTT data were evaluated using both naive (standard stepwise logistic regression) and SL techniques to develop a time-dependent prediction of future mortality within discrete time intervals. We avoided both underfitting and overfitting using cross validation to select an optimal combination of predictors among candidate predictors/machine learning algorithms. SL was also used to produce interval-specific robust measures of variable importance measures (VIM resulting in an ordered list of variables, by time point) that have the strongest impact on future mortality. RESULTS Nine hundred eighty patients had complete clinical and outcome data and were included in the analysis. The prediction of ongoing transfusion with SL was superior to the naive approach for all time intervals (correlations of cross-validated predictions with the outcome were 0.819, 0.789, 0.792 for time intervals 30-90, 90-180, 180-360, >360 minutes). The estimated VIM of mortality also changed significantly at each time point. CONCLUSION The SL technique for prediction of outcome from a complex dynamic multivariate data set is superior at each time interval to standard models. In addition, the SL VIM at each time point provides insight into the time-specific drivers of future outcome, patient trajectory, and targets for clinical intervention. Thus, this automated approach mimics clinical practice, changing form and content through time to optimize the accuracy of the prognosis based on the evolving trajectory of the patient.
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Affiliation(s)
- Alan Hubbard
- School of Public Health, University of California Berkeley
| | | | - Anna Decker
- School of Public Health, University of California Berkeley
| | - John B Holcomb
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Martin A Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health & Science University
| | - Eileen M Bulger
- Division of Trauma and Critical Care, Department of Surgery, School of Medicine, University of Washington
| | - Karen J Brasel
- Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin
| | - Erin E Fox
- Biostatistics/Epidemiology/Research Design Core, Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston
| | - Deborah J del Junco
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Charles E Wade
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Mohammad H Rahbar
- Biostatistics/Epidemiology/Research Design Core, Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston
- Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston
| | - Bryan A Cotton
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Herb A Phelan
- Division of Burn/Trauma/Critical Care, Department of Surgery, Medical School, University of Texas Southwestern Medical Center at Dallas
| | - John G Myers
- Division of Trauma, Department of Surgery, School of Medicine, University of Texas Health Science Center at San Antonio
| | - Louis H Alarcon
- Division of Trauma and General Surgery, Department of Surgery, School of Medicine, University of Pittsburgh
| | - Peter Muskat
- Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati
| | - Mitchell J Cohen
- Division of General Surgery, Department of Surgery, School of Medicine, University of California San Francisco
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99981
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Powell R, Davidson D, Divers J, Manichaikul A, Carr JJ, Detrano R, Hoffman EA, Jiang R, Kronmal RA, Liu K, Punjabi NM, Shahar E, Watson KE, Rotter JI, Taylor KD, Rich SS, Barr RG. Genetic ancestry and the relationship of cigarette smoking to lung function and per cent emphysema in four race/ethnic groups: a cross-sectional study. Thorax 2013; 68:634-642. [PMID: 23585509 PMCID: PMC4020409 DOI: 10.1136/thoraxjnl-2012-202116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cigarette smoking is the major cause of chronic obstructive pulmonary disease and emphysema. Recent studies suggest that susceptibility to cigarette smoke may vary by race/ethnicity; however, they were generally small and relied on self-reported race/ethnicity. OBJECTIVE To test the hypothesis that relationships of smoking to lung function and per cent emphysema differ by genetic ancestry and self-reported race/ethnicity among Caucasians, African-Americans, Hispanics and Chinese-Americans. DESIGN Cross-sectional population-based study of adults age 45-84 years in the USA. MEASUREMENTS Principal components of genetic ancestry and continental ancestry estimated from one million genome-wide single nucleotide polymorphisms; pack-years of smoking; spirometry measured for 3344 participants; and per cent emphysema on computed tomography for 8224 participants. RESULTS The prevalence of ever-smoking was: Caucasians, 57.6%; African-Americans, 56.4%; Hispanics, 46.7%; and Chinese-Americans, 26.8%. Every 10 pack-years was associated with -0.73% (95% CI -0.90% to -0.56%) decrement in the forced expiratory volume in 1 s to forced vital capacity (FEV1 to FVC) and a 0.23% (95% CI 0.08% to 0.38%) increase in per cent emphysema. There was no evidence that relationships of pack-years to the FEV1 to FVC, airflow obstruction and per cent emphysema varied by genetic ancestry (all p>0.10), self-reported race/ethnicity (all p>0.10) or, among African-Americans, African ancestry. There were small differences in relationships of pack-years to the FEV1 among male Chinese-Americans and to the FEV1 to FVC ratio with African and Native American ancestry among male Hispanics only. CONCLUSIONS In this large cohort, there was little to no evidence that the associations of smoking to lung function and per cent emphysema differed by genetic ancestry or self-reported race/ethnicity.
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Affiliation(s)
- Rhea Powell
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Duncan Davidson
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jasmin Divers
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Ani Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - J. Jeffrey Carr
- Department of Radiology, Division of Radiological Sciences, Wake-Forest University, Winston-Salem, NC
| | - Robert Detrano
- Department of Radiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Rui Jiang
- Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Kiang Liu
- Department of Preventative Medicine, Northwestern University Medical School, Chicago, IL
| | | | - Eyal Shahar
- Division of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ
| | - Karol E. Watson
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Jerome I. Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kent D. Taylor
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - R. Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, NY
- Department of Epidemiology, Columbia University Medical Center, New York, NY
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99982
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Morris DH, Khunti K, Achana F, Srinivasan B, Gray LJ, Davies MJ, Webb D. Progression rates from HbA1c 6.0-6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia 2013; 56:1489-93. [PMID: 23584433 DOI: 10.1007/s00125-013-2902-4] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/15/2013] [Indexed: 12/30/2022]
Abstract
AIMS/HYPOTHESIS Precise estimates of progression rates from 'prediabetes' to type 2 diabetes are needed to optimise prevention strategies for high-risk individuals. There is acceptance of prediabetes defined by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), but there is some controversy surrounding HbA1c-defined prediabetes ranges, with some favouring 6.0-6.4% (42-46 mmol/mol). Comparing progression rates between groups might aid this issue, thus we aimed to accurately estimate progression rates to diabetes from different prediabetes categories. METHODS Meta-analysis of prospective observational studies in which participants had prediabetes at baseline (ADA-defined IFG [5.6-6.9 mmol/l], WHO-defined IFG [6.1-6.9 mmol/l], IGT (7.8-11.0 mmol/l) or raised HbA1c [6.0-6.4%/42-46 mmol/mol]) and were followed up for incident diabetes. Incidence rates were combined using Bayesian random effects models. RESULTS Overall, 70 studies met the inclusion criteria. In the six studies that used raised HbA1c, the pooled incidence rate (95% credible interval) of diabetes was 35.6 (15.1, 83.0) per 1,000 person-years. This rate was most similar to that for ADA-defined IFG (11 studies; 35.5 [26.6, 48.0]) and was non-significantly lower than WHO-defined IFG (34 studies; 47.4 [37.4, 59.8]), IGT (46 studies, 45.5 [37.8, 54.5]) and IFG plus IGT (15 studies, 70.4 [53.8, 89.7]). Similar results were seen when the data were analysed by the criteria used to diagnose diabetes. CONCLUSIONS/INTERPRETATION This study provides evidence that progression rates differ by prediabetes definition, which has implications for the planning and implementation of diabetes prevention programmes. HbA1c 6.0-6.4% might identify people at a lower diabetes risk than other prediabetes definitions, but further research is needed.
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Affiliation(s)
- D H Morris
- Diabetes Research Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
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99983
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Pickwell KM, Siersma VD, Kars M, Holstein PE, Schaper NC. Diabetic foot disease: impact of ulcer location on ulcer healing. Diabetes Metab Res Rev 2013; 29:377-83. [PMID: 23390115 DOI: 10.1002/dmrr.2400] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 01/03/2013] [Accepted: 01/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing. METHODS The influence of ulcer location on time to healing of diabetic foot ulcers was analysed by multivariate Cox regression analysis for 1000 patients included in the Eurodiale study, a prospective cohort study of patients with diabetic foot disease. RESULTS Median time to healing was 147 days for toe ulcers [(95% confidence interval (CI) 135-159 days)], 188 days for midfoot ulcers (95% CI 158-218 days) and 237 days for heel ulcers (95% CI 205-269 days) (p < 0.01). The median time to healing for plantar ulcers was 172 days (95% CI 157-187 days) and 155 days (95% CI 138-172 days) for nonplantar ulcers (p = 0.71). In multivariate Cox regression analysis, the hazard ratio for ulcer healing for midfoot and heel ulcers compared with toe ulcers was 0.77 (95% CI 0.64-0.92) and 0.62 (95% CI 0.47-0.83), respectively; the hazard ratio for ulcer healing for plantar versus nonplantar ulcers was 1 (95% CI 0.84-1.19). Other factors significantly influencing time to healing were the duration of diabetes, ulcer duration, the presence of heart failure and the presence of peripheral arterial disease. CONCLUSIONS Time to ulcer healing increased progressively from toe to midfoot to heel, but did not differ between plantar and nonplantar ulcers. Our data also indicate that risk factors for longer time to healing differ from factors that affect the ultimate number of ulcers that heal (healing rate).
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Affiliation(s)
- Kristy M Pickwell
- Department of Internal Medicine, Subdivision of Endocrinology, Maastricht University Medical Centre, P. Debeyelaan 25, Maastricht, the Netherlands.
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99984
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Corso G, Bottacchi E, Giardini G, Di Giovanni M, Meloni T, Pesenti Campagnoni M, Veronese Morosini M. Epidemiology of stroke in northern Italy: the Cerebrovascular Aosta Registry, 2004-2008. Neurol Sci 2013; 34:1071-81. [PMID: 23007380 PMCID: PMC3719005 DOI: 10.1007/s10072-012-1185-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/29/2012] [Indexed: 02/03/2023]
Abstract
Our aim was to prospectively ascertain the incidence of first-ever stroke and ischaemic stroke subtypes, mortality, functional outcome and recurrence in northern Italy. We identified all possible cases of stroke (1st January 2004 and 31st December 2008). Multiple overlapping sources were used. Standard definitions for incident cases, pathological types and infarction subtypes were used. Patient characteristics were identified and analysed, case-fatality was ascertained from administrative databases, and outcome was assessed in all surviving patients by modified Rankin Scale. We identified 1,326 incident strokes. The pathological diagnosis was confirmed in 94% of cases. The incidence of first-ever stroke was 80.2 per 100,000 (95% CI 73-87) when adjusted to world population. The incidence of embolic stroke was significantly greater in women than in men (p < 0.001) whereas the incidence of atherothrombotic stroke was significantly greater in men than in women (p < 0.001). The case-fatality of incident strokes was 9.5% at 7 day, 16.1% at 28 day, and 29.9% at 1 year. Case-fatality of ischaemic stroke was lower than that of other pathological types (p < 0.0001). Hypertension was the most important risk factor, and atrial fibrillation was the most common in embolic stroke. Increasing age, female gender and embolic stroke subtypes were associated with an adverse outcome. Data on stroke incidence and case-fatality were similar to those of other high-income countries. However, differences were found in the distribution of risk factors and prognosis across the stroke types and ischaemic stroke subtypes. Gender differences in long-term functional outcomes were significant.
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Affiliation(s)
- Giovanni Corso
- Stroke Unit, Department of Neurology, Ospedale Regionale, Viale Ginevra n 3, 11100 Aosta, Italy.
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99985
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Morandi A, Vasilevskis E, Pandharipande PP, Girard TD, Solberg LM, Neal EB, Koestner T, Torres RE, Thompson JL, Shintani AK, Han JH, Schnelle JF, Fick DM, Ely EW, Kripalani S. Inappropriate medication prescriptions in elderly adults surviving an intensive care unit hospitalization. J Am Geriatr Soc 2013; 61:1128-34. [PMID: 23855843 PMCID: PMC3713508 DOI: 10.1111/jgs.12329] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine types of potentially (PIMs) and actually inappropriate medications (AIMs), which PIMs are most likely to be considered AIMs, and risk factors for PIMs and AIMs at hospital discharge in elderly intensive care unit (ICU) survivors. DESIGN Prospective cohort study. SETTING Tertiary care, academic medical center. PARTICIPANTS One hundred twenty individuals aged 60 and older who survived an ICU hospitalization. MEASUREMENTS Potentially inappropriate medications were defined according to published criteria; a multidisciplinary panel adjudicated AIMs. Medications from before admission, ward admission, ICU admission, ICU discharge, and hospital discharge were abstracted. Poisson regression was used to examine independent risk factors for hospital discharge PIMs and AIMs. RESULTS Of 250 PIMs prescribed at discharge, the most common were opioids (28%), anticholinergics (24%), antidepressants (12%), and drugs causing orthostasis (8%). The three most common AIMs were anticholinergics (37%), nonbenzodiazepine hypnotics (14%), and opioids (12%). Overall, 36% of discharge PIMs were classified as AIMs, but the percentage varied according to drug type. Whereas only 16% of opioids, 23% of antidepressants, and 10% of drugs causing orthostasis were classified as AIMs, 55% of anticholinergics, 71% of atypical antipyschotics, 67% of nonbenzodiazepine hypnotics and benzodiazepines, and 100% of muscle relaxants were deemed AIMs. The majority of PIMs and AIMs were first prescribed in the ICU. Preadmission PIMs, discharge to somewhere other than home, and discharge from a surgical service predicted number of discharge PIMs, but none of the factors predicted AIMs at discharge. CONCLUSION Certain types of PIMs, which are commonly initiated in the ICU, are more frequently considered inappropriate upon clinical review. Efforts to reduce AIMs in elderly ICU survivors should target these specific classes of medications.
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99986
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Chopra V, Marotta F, Kumari A, Bishier MP, He F, Zerbinati N, Agarwal C, Naito Y, Tomella C, Sharma A, Solimene U. Prophylactic strategies in recurrent vulvovaginal candidiasis: a 2-year study testing a phytonutrient vs itraconazole. J BIOL REG HOMEOS AG 2013; 27:875-82. [PMID: 24152852 DOI: pmid/24152852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the present study was to assess the clinical efficacy of a one week/month treatment with a phytocompound with antimycotic properties (K-712, with following 100 mg composition: 10 mg of oleoresin from Pseudowintera colorata at 30 percent concentration in Polygodial together with trace amounts of Olea europea) in recurrent vulvo-vaginal candidiasis (RVVC), as compared to once a week treatment with an azole drug for 24 months follow up. This prospective randomized study involving 122 women (19 to 63 years old) with a history of proven episodes of RVVC in the prior 12 months. Patients were allocated in two treatment groups of 61 patients each and given A) Itraconazole 200 mg orally once a week or B) 1 tab twice a day of K-712 for one week/month. Each treatment schedule was well tolerated with 19 patients in the azole group complaining of transient mild symptoms (nausea, abdominal discomfort, unpleasant taste), while only 3 patients on K-712 reported slight dyspepsia. The number of relapses was significantly lower in the K-712-treated group as compared to the itraconazole-group (22 vs 39, p less than 0.05). Moreover, the former group showed a significantly decreased number of cases resistant or dose-dependent susceptible as compared to group A (p less than 0.05 vs itraconazole) and the same occurred for the occurrence of non-albicans species (group A 64.1 percent vs group B 31.8 percent, p less than 0.05). The overall mycological cure at the end of the 2-year study showed a comparable benefit between the two groups. From these data it appears that the present antifungal phytonutrient is equally effective as itraconazole in the overall treatment of RVVC over a 2-year follow-up, but yielding a significantly better prophylactic effect and also maintenance benefit with lower relapse rate, antifungal susceptibility and growth of azole-resistant species.
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Affiliation(s)
- V Chopra
- ReGenera Research Group for Intervention in Aging, Milano, Italy
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99987
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Abstract
BACKGROUND Medications that may increase risk of birth defects if used during pregnancy or immediately preconception are dispensed to approximately half of female Veterans who fill prescriptions at a VA pharmacy. OBJECTIVE To assess receipt of counseling about risk of medication-induced birth defects among female Veterans of reproductive age and to examine Veterans' confidence that their healthcare provider would counsel them about teratogenic risks. DESIGN AND PARTICIPANTS Cross-sectional analysis of data provided by 286 female Veterans of Operation Iraqi Freedom and/or Operation Enduring Freedom who completed a mailed survey between July 2008 and October 2010. MAIN MEASURES We examined associations between demographic, reproductive, and health service utilization variables and female Veterans' receipt of counseling and confidence that they would receive such counseling. KEY RESULTS The response rate was 11 %; the large majority (89 %) of responding female Veterans reported use of a prescription medication in the last 12 months. Most (90 %) of the 286 female Veterans who reported medication use were confident that they would be told by their healthcare provider if a medication might cause a birth defect. However, only 24 % of women who received prescription medications reported they had been warned of teratogenic risks. Female Veterans who used medications that are known to be teratogenic were not more likely than women using other medications to report having been warned about risks of medication-induced birth defects, and fewer were confident that their health care providers would provide teratogenic risk counseling when needed. CONCLUSIONS Female Veterans may not receive appropriate counseling when medications that can cause birth defects are prescribed.
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Affiliation(s)
- Eleanor Bimla Schwarz
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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99988
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Sardhara J, Behari S, Jaiswal AK, Srivastava A, Sahu RN, Mehrotra A, Phadke S, Singh U. Syndromic versus nonsyndromic atlantoaxial dislocation: do clinico-radiological differences have a bearing on management? Acta Neurochir (Wien) 2013; 155:1157-67. [PMID: 23645321 DOI: 10.1007/s00701-013-1717-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/04/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND This prospective study attempts to study the clinico-radiological differences between patients with syndromic AAD (SAAD), non-syndromic AAD (NSAAD), and AAD with Klippel-Feil anomaly (AADKFA) that may impact management. METHODS In 46 patients with AAD [SAAD (including Morquio, Down, Larson and Marshall syndrome and achondroplasia; n = 6); NSAAD(n = 20); and, AADKFS (n = 20)], myelopathy was graded as mild (n = 17, 37 %), moderate (15, 32.5 %) or severe (14, 30.5 %) based on Japanese Orthopaedic Association Score modified for Indian patients (mJOAS). Basilar invagination (BI), basal angle, odontoid hypoplasia, facet-joint angle, effective canal diameter, Ishihara curvature index, and angle of retroversion of odontoid and vertebral artery (VA) variations were also studied. STATISTICS Clinico-radiological differences were assessed by Fisher's exact test, and mean craniometric values by Kruskal-Wallis test (p value ≤ 0.05 significant) RESULTS Incidence of irreducible AAD in SAAD (n = 0), NSA AD (11.55 %) and AADKFS (n = 18.90 %) showed significant difference (p = 0.01). High incidence of kyphoscoliosis (83 %) and odontoid hypoplasia (83 %) in SAAD, and assimilated atlas and BI in NSAAD and AADKFA groups were found. In AADKFA, effective canal diameter was significantly reduced(p = 0.017) with increased Ishihara index and increased angle of odontoid retroversion; 61 % patients had VA variations. Thirty-five patients underwent single-stage transoral decompression with posterior fusion (for irreducible AAD) or direct posterior stabilization (for reducible AAD). Postoperative mJOAS evaluation often revealed persistent residual myelopathy despite clinical improvement. CONCLUSIONS Myelopathy is induced by recurrent cord trauma due to reducible AAD in SAAD, and compromised cervicomedullary canal diameter in NSAAD and AADKFA. SAAD in children may be missed due to incomplete odontoid ossification or coexisting angular deformities. In AADKFA, decisions regarding vertebral levels to be included in posterior stabilization should take into consideration intact intervening motion segments and compensatory cervical hyperlordosis. Following VA injury, endovascular primary vessel occlusion/stenting across pseudoaneurysm preempts delayed rehemorrhage.
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Affiliation(s)
- Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India
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99989
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Kim DW, Kim WH, Kim MH, Kim SS, Mo EH, Lee CH, Kim CG. Effect of ¹⁸F-FDG administration on measurements of bone mineral density and body composition by dual-energy X-ray absorptiometry. J Clin Densitom 2013; 16:283-286. [PMID: 23562363 DOI: 10.1016/j.jocd.2013.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 02/27/2013] [Accepted: 03/01/2013] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine whether antecedent administration of ¹⁸F-fluorodeoxyglucose (FDG) used in positron emission tomography (PET) scanning results in corruption of bone mineral density (BMD) and body composition measured by dual-energy X-ray absorptiometry (DXA) system. DXA measurements of BMD and body composition had been performed twice, before and after ¹⁸F-FDG PET scan in 30 patients. The comparison of pre-values and post-values of all BMD values showed a decrease after the injection. However, only the decrease of whole-body BMD (WB-BMD) was statistically significant (p < 0.05). Whole-body fat mass had increased and whole-body lean body mass had decreased after the injection of ¹⁸F-FDG, and these were statistically significant (p < 0.05). There is statistically significant correlation between the injected ¹⁸F-FDG dose and a decrease of WB-BMD (r = -0.405; p < 0.05). The findings of this study suggest that when both ¹⁸F-FDG PET and DXA measurements for whole-body composition are performed in close-time proximity, ¹⁸F-FDG PET scans should follow the DXA measurement. Otherwise, BMD measurements of total femur or lumbar spine could be followed by ¹⁸F-FDG PET in close-time proximity.
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Affiliation(s)
- Dae-Weung Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea; Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea
| | - Woo Hyoung Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea
| | - Myoung Hyoun Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea
| | - Seong Su Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea
| | - Eun Hee Mo
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea
| | - Chun Ho Lee
- Department of Nuclear Medicine, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea
| | - Chang Guhn Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea; Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Republic of Korea.
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99990
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Kreissl MC, Schirbel A, Fassnacht M, Haenscheid H, Verburg FA, Bock S, Saeger W, Knoedler P, Reiners C, Buck AK, Allolio B, Hahner S. [¹²³I]Iodometomidate imaging in adrenocortical carcinoma. J Clin Endocrinol Metab 2013; 98:2755-64. [PMID: 23609836 DOI: 10.1210/jc.2012-3261] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Imaging with [¹²³I]iodometomidate ([¹²³I]IMTO) has been shown to diagnose adrenocortical lesions with high sensitivity and specificity. OBJECTIVE Our objective was to evaluate the clinical utility of [¹²³I]IMTO imaging in adrenocortical carcinoma (ACC). DESIGN We conducted a prospective monocentric diagnostic study and a prospective case series at a single tertiary referral center. PATIENTS AND INTERVENTIONS Fifty-eight patients with histologically confirmed ACC, all European Network for the Study of Adrenal Tumors stage IV (with distant metastases), received 185 MBq [¹²³I]IMTO. Sequential planar whole-body scans until 24 hours post injection and single photon emission computed tomography/computed tomography (SPECT/CT) hybrid imaging 4 to 6 hours post injection were performed. MAIN OUTCOME MEASURES Outcome measures included uptake of [¹²³I]IMTO in ACC lesions, sensitivity and specificity of [¹²³I]IMTO imaging compared with conventional imaging, and number of patients eligible for [¹³¹I]IMTO therapy. RESULTS Of 430 lesions detected by conventional imaging, 30% showed strong, 8% moderate, and 62% no tracer accumulation. [¹²³I]IMTO detected both primary and metastatic lesions of ACC. However, a substantial percentage of lesions failed to show [¹²³I]IMTO uptake. The overall sensitivity and specificity values were 38% and 100%, respectively. Thirty-four patients (59%) had at least 1 [¹²³I]IMTO-positive lesion. Cortisol and aldosterone secretion by ACC was positively correlated to [¹²³I]IMTO uptake (P = .01); cytotoxic chemotherapy and mitotane treatment presumably did not influence tracer uptake. Twenty-one patients (36.2%) had radiotracer uptake in all lesions ≥ 2 cm and therefore were potential candidates for targeted systemic radiotherapy with [¹³¹I]IMTO. CONCLUSION About one-third of patients with ACC show specific retention of [¹²³I]IMTO in metastatic lesions. This study provides support for the conduct of a prospective trial to determine whether the first molecular informed therapy using [¹³¹I]IMTO will be of value to patients with metastatic ACC.
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Affiliation(s)
- Michael C Kreissl
- Department of Nuclear Medicine, University Hospital of Wuerzburg, University of Wuerzburg, D-97080 Wuerzburg, Germany.
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99991
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Zonča P, Guňková P, Martínek L, Foltys A, Bužga M, Jacobi CA. [The staple line in sleeve gastrectomy]. Rozhl Chir 2013; 92:373-378. [PMID: 24003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Postoperative leak and bleeding from the staple line are potentially serious early complications following laparoscopic sleeve gastrectomy. AIM This study aims to assess the significance of oversewing the staple line after laparoscopic sleeve gastrectomy in preventing leak and bleeding in our group of patients. MATERIAL AND METHODS Patients after laparoscopic sleeve gastrectomy were included in the trial. Two different principles of oversewing the staple line (selective vs. mandatory) were analyzed. The design of the trial was retrospective-prospective, non-randomized. Postoperative complications were recorded. RESULTS Between October 2006 and December 2011, 638 laparoscopic sleeve gastrectomies were carried out using standard laparoscopic technique. 297 of the patients belonged to the group with selective oversewing of the staple line. The remaining 341 patients belonged to the group in which the staple line was oversewn in all cases. Both groups of patients were comparable in the basic parameters. Early postoperative leak affected one patient in both groups, 0.30% versus 0.29% (p = 0.9203), respectively. The rates of postoperative bleeding were 2.7% (selective oversewing) versus 0% (mandatory oversewing) (p = 0.0023), respectively. CONCLUSION Our study did not demonstrate the impact of oversewing the staple line on the occurrence of postoperative leak. The rates of postoperative bleeding from the resection site were statistically significantly lower in the group with the mandatory oversewing of the staple line.
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Affiliation(s)
- P Zonča
- Zentrun für Viszeral und Minimal Invasive Chirugie, Wesseling, Německo.
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99992
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Pavoni C, Franchi L, Laganà G, Baccetti T, Cozza P. Management of impacted incisors following surgery to remove obstacles to eruption: a prospective clinical trial. Pediatr Dent 2013; 35:364-368. [PMID: 23930638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of rapid maxillary expansion (RME) vs simply monitoring the eruption of permanent maxillary incisors following the surgical removal of obstacles to their eruption (supernumerary teeth, odontomas). METHODS Following surgical removal of the obstacles to incisor eruption (T1), 62 patients were randomly assigned to either the group to undergo RME (34 subjects; mean age 8 years, 11 months ± 11 months) or the group that was monitored without further treatment (28 subjects; mean age=9 years, 1 month ± 1 year). At T2 (1 year after T1), the prevalence rate of erupted incisors was recorded. Also, the time of eruption of the incisors and the amount of space loss were analyzed. RESULTS At T2, eruption of impacted incisors occurred in approximately 82 percent of the RME group cases vs approximately 39 percent of the monitored group cases (chi-square=10.43, P<.001). Time of eruption was significantly faster in the RME group, and anterior space loss significantly smaller. CONCLUSIONS Rapid maxillary expansion treatment following surgical removal of the obstacles to the eruption of permanent maxillary incisors appears to be an efficient interceptive approach leading to eruption of the incisors in four out of five cases within seven months.
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Affiliation(s)
- Chiara Pavoni
- Department of Orthodontics, The University of Florence, Florence, Italy; Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, Mich., USA
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99993
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Helwich E, Wójkowska-Mach J, Borszewska-Kornacka M, Gadzinowski J, Gulczyńska E, Kordek A, Pawlik D, Szczapa J, Domańska J, Klamka J, Heczko PB. [Epidemiology of infections in very low birth weight infants. Polish Neonatology Network research]. Med Wieku Rozwoj 2013; 17:224-231. [PMID: 24296446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM OF STUDY 1. prospective record of infections; 2. prevention of nosocomial infections by providing current data about infections, which are significant for making therapeutic decisions. MATERIAL AND METHODS Recorded infections: early-onset sepsis (congenital), late-onset sepsis (acquired in hospital), necrotising enterocolitis (NEC), pneumonia. Infections were diagnosed and qualified on the basis of definitions of infections based on the National Nosocomial Infections Surveillance (NNIS) criteria, developed by CDC, USA, including modifications of German Neo-KISS programme. Infection control was realised as a part of common research project of "Polish Neonatology Network", appointed by the decision of the Minister of Science and Higher Education no. 669/E-215/BWSN- 0180/2008 dated 20.05.2008 r. The study was conducted by 6 Polish neonatology units, Microbiology Chair of Jagiellonian University Collegium Medicum and Institute of Theoretical and Applied Computer Science. Infants with birth weight lower than 1500 g were qualified for the study. RESULTS Between 1.01.2009 and 31.12.2009, 910 patients were registered, i.e. 19.1% of VLBW infants born in that period. The conducted analysis showed significant differences between centres in gestational age, birth weight, hospitalisation, use of invasive procedures, antibiotics and parenteral feeding. Cumulative morbidity rate was 68.5% total. Blood infection (sepsis) was the most commonly observed type of infection: 268 cases - 43.1% of all recorded forms of infection. Pneumonia was diagnosed in 242 cases, 38.8% total. NEC constituted 12.7% studied infections (79 cases). Apart from NEC, the risk of other forms of infection differed between centres. Dominant etiologic factor of all infections were Gram-positive cocci, which constituted 565 isolated microorganisms. Among them coagulase-negative staphylococci (CNS) were the most common (41.7%), while Staphylococcus aureus was fourth most frequent etiologic factor of infections (6.3% total). CONCLUSIONS 1. Introduction of unified definition and criteria for diagnosing infections and the use of morbidity rates enables comparative analysis of epidemiology of infections in neonatal intensive care units. 2. Due to significant differences observed between prophylactic and therapeutic procedures in various units, it is essential to propose Polish recommendations regarding control over etiology of infections and use of invasive procedures, such as intravenous catheters and ventilation. 3. It is essential to undertake action leading to fully rational antibiotic therapy, because overuse of antibiotics leads to bacterial resistance and increases incidence of infections.
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Affiliation(s)
- Ewa Helwich
- Klinika Neonatologii i Intensywnej Terapii, Kasprzaka 17a, 01-211 Warszawa,
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99994
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Lamy S, De Gaudemaris R, Sobaszek A, Caroly S, Descatha A, Lang T. [Improvement of hospital working conditions: ORSOSA, from research to preventive actions]. Sante Publique 2013; 25:389-397. [PMID: 24404721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The health of hospital workers, nurses and nurse-aids constitutes a public health challenge for three reasons: maintenance of personnel at work in a context in which many express their desire to quit their jobs, protection of their health, and maintenance of quality of care. ORSOSA (ORganisation des SOins et SAnté des soignants) is a multidisciplinary interventional population health research programme designed to improve quality of life in the workplace of healthcare workers. This programme is designed to develop a tool to diagnose psychosocial and organisational work factors (POWFs) and mechanical constraints (MC), and then to implement this method in primary prevention interventions. ORSOSA consists of two steps: research (ORSOSA 1) and intervention (ORSOSA 2). In ORSOSA 1, a prospective cohort of healthcare workers was developed to construct and validate the diagnostic tool of work-related constraints at the work unit level. ORSOSA 2 consists of using the tool to implement both a collective and consensual dynamic based on collective restitution of the strengths and weaknesses of the work unit in order to propose recommendations for better quality of life at work. ORSOSA is now deployed in 4 teaching hospitals (Lille, Bordeaux, Grenoble and Strasbourg), each with 5 peripheral hospitals. Evaluation and follow-up of the programme is ongoing.
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Affiliation(s)
| | - Régis De Gaudemaris
- CNRS, UMR 5525, Laboratoire TIMC-IMAG, Equipe Environnement et Prediction de la Santé des Populations, F-38706 Grenoble, France
| | - Annie Sobaszek
- CHRU Lille, Clinique de Santé Publique, Médecine du Travail et Pathologies Professionnelles, F-59037 Lille, France
| | - Sandrine Caroly
- CNRS, UMR 5194, Laboratoire PACTE (Politiques Publiques, Action Publique, Territoires), F-38040 Grenoble, France
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99995
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Vidal-Rodríguez FA, Rosas-Sánchez GA. [Anteromedialization in the treatment of high-riding and lateralized patella in adults]. Acta Ortop Mex 2013; 27:240-245. [PMID: 24707613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A study conducted at our hospital showed that patellofemoral instability associated with a high-riding and lateralized patella occurred in 34 out of 4,954 admitted patients (6.86% rate). In order to treat these alterations we studied a series of patients in whom an anteromedialization technique was used. MATERIAL AND METHODS This is a prospective, cross-sectional, descriptive cohort study, with probabilistic sampling, conducted between March 1st, 2009 and September 1st, 2011. Twenty patients who met the inclusion criteria were selected. The same technique was used in all patients, performed by the same surgeon, with the same postoperative and rehabilitation protocol. The modified Lyshom scale was applied and the results were assessed by two blinded observers whose concordance was assessed with the Kappa index. RESULTS Twenty patients were treated, 12 females and 8 males; mean age was 20 years. In 14 patients the dislocating event occurred in one of the knees and in 6 patients it was bilateral; the right side predominated. Dislocation was recurrent in 7 patients and relapsing in 13; 12 of the latter had undergone soft tissue realignment and lateral retinaculum release, and one patellar advancement. The mean clinical Q angle was 18 degrees preoperatively and 7 degrees postoperatively. The preoperative and postoperative radio- graphic assessment was equivalent to a Kappa of 88%. Mean healing time of the osteotomy was 8 weeks; 2 hemarthroses occurred in the immediate postoperative period, which were resolved with puncture; no fractures and no graft collapses were reported. The mean Lysholm scale was 90.9 at 6 months (interobserver kappa of 90%). All patients had quadriceps atrophy of 1-2 cm, one patient had residual pain and by the end of the study none of the patients had had relapsing dislocation. CONCLUSIONS This technique corrects the dislocation resulting from a high-riding and lateralized patella by modifying the Q angle. It involves minimal complications, uses a small 5 cm approach and does not require special guides. This study remains open to long-term follow-up to detect the presence or absence of patellofemoral arthrosis.
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99996
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Anselmetti GC, Manca A, Tutton S, Chiara G, Kelekis A, Facchini FR, Russo F, Regge D, Montemurro F. Percutaneous vertebral augmentation assisted by PEEK implant in painful osteolytic vertebral metastasis involving the vertebral wall: experience on 40 patients. Pain Physician 2013; 16:E397-E404. [PMID: 23877463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this cancer population due to a poor risk-benefit profile, particularly if life expectancy is short. Vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have a higher risk of serious complications, notably cement extravasation. STUDY DESIGN We prospectively evaluated clinical results of polyetheretherketone (PEEK) implant (Kiva) assisted vertebroplasty performed in malignant painful osteolytic lesions at risk for cement extravasation due to vertebral wall involvement. SETTING Department of Interventional Radiology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy METHODS Forty patients (22 women; mean age 66.8 ± 12.4), suffering from a painful spine malignancy with vertebral wall involvement not responding to conventional therapies and without surgical indications, underwent vertebral augmentation with Kiva intravertebral implant for pain palliation. The procedure was performed with moderate sedation and local anesthesia under combined digital fluoroscopy and computed tomography guidance. After the coil-shaped PEEK implant was deployed within the vertebral lesion, bone cement was injected under continuous digital fluoroscopic control. Patients were discharged from the hospital the next procedural day. The Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), analgesic requirement, and use of external brace support were evaluated to determine efficacy. The primary end-point was safety and efficacy at one month after the procedure. However, all the patients were scheduled to be followed-up at month 3, 6, and every 6 months thereafter. Follow-up was prospectively evaluated in all patients after Kiva with clinical interviews. The Institution's Internal Review Board approved this study. RESULTS Median pre-treatment VAS of 10 (range 6 - 10) significantly (P < 0.001) dropped to one (range 0 - 3), with all patients achieving a clinically relevant benefit on pain at one month. Differences in pre- and post-treatment analgesic therapy were significant (P < 0.001). All patients no longer use an external brace after Kiva. In 7 out of 43 (16.3%) treated vertebrae a bone cement leakage was detected. LIMITATIONS This is a not randomized study. Participants were limited to 40 patients. CONCLUSION The Kiva System potentially represents a novel and effective minimally invasive treatment option for patients suffering from severe pain due to osteolytic vertebral metastases.
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99997
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Maloney J, Rogers GS, Kapadia M. Surgical corner: a prospective randomized evaluation of cyanoacrylate glue devices in the closure of surgical wounds. J Drugs Dermatol 2013; 12:810-814. [PMID: 23884497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The use of medical adhesives for topical wound closure is gaining in popularity over conventional wound closure materials such as sutures and staples. Adhesives provide advantages in both wound closure and patient management with good cosmetic outcome and surgeon and patient satisfaction reported. OBJECTIVE To compare the use of two currently marketed medical adhesives; LiquiBand® Flow Control and High Viscosity Dermabond ™ for the topical closure of surgical incisions. METHODS In a prospective blinded manner, subjects were randomly assigned LiquiBand® or DermabondTM for topical closure of a surgical incision. Variables compared included ease of use, time taken to close wound, subject and surgeon satisfaction with device and wound closure, cosmetic outcome at 90 days, and complication rates. RESULTS Use of both devices resulted in effective wound closure with similar high levels of cosmesis subject and surgeon satisfaction, with only minor complications reported. There was no statistically significant difference between the devices for all the parameters studied, with the exception that the Liquiband device was found to significantly reduce the amount of time required for closure. CONCLUSION As the two devices appear substantially equivalent in terms of key surgeon and patient variables, product cost should be the primary determinant in selection of the tissue glue device.
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99998
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Abstract
AIMS In recent years, there has been an effort to understand possible roles of 25(OH)D, including its role in the immune system particularly on T cell medicated immunity, pancreatic insulin secretion and insulin action. 25(OH)D stimulates the cell differentiation and reduces cell proliferation, which is essential for cell growth and wound healing. However, data on the association between low level of plasma 25(OH)D and diabetic foot syndrome are scarce. MATERIALS AND METHODS Circulating plasma levels of 25(OH)D were measured in diabetic patients with ulcer (n=162) and without ulcer (n=162) in a prospective cohort hospital based study. RESULTS Of these patients, 85.1% had type 2 diabetes. Subjects with diabetic foot ulcer showed lower median plasma level of 25(OH)D [6.3(4.2-11.1) vs 28.0(21.4-37.0)] ng/ml after adjusting the age and BMI. Regardless of the low levels of 25(OH)D in cases and controls, it was associated with neuropathy, sex (female), duration of ulcer healing, and smoking status and independent of confounding factors, including BMI (kg/m²), A1c (%), hypertension, nephropathy, foot ulcer, retinopathy, CAD, PAD, HDL-C (mg/dl) and LDL-C (mg/dl). The factors which predict the risk of developing ulcer independent of 25(OH)D status were A1c (>6.9%) [OR 4.37; RR 1.77], HDL-C (<40mg/dl) [OR 1.16; RR 1.07], LDL-C (>100mg/dl) [OR 1.07; RR 1.03], triglycerides (>200mg/dl) [OR 1.40; RR 1.19], neuropathy [OR 6.88; RR 3.12], retinopathy [OR 3.34; RR 1.91], hypertension [OR 1.64; RR 1.28], nephropathy [OR 3.12; RR 1.87] and smoking [OR 4.53; RR 2.99] using odds and risk ratios. CONCLUSION It is not clear whether the suppression of delayed wound healing seen during 25(OH)D deficiency is due to the secondary effect or is a direct action of vitamin D on certain components of the immune system. Long-term randomized trials are needed to see the impact of vitamin D supplementation on the outcome of diabetic foot patients.
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Affiliation(s)
- Mohammad Zubair
- Department of Microbiology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India.
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99999
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Dănulescu RM, Ciobică A, Stanciu C, Trifan A. The influence of antibiotic treatment on the dynamics of oxidative stress in spontaneous bacterial peritonitis. Rev Med Chir Soc Med Nat Iasi 2013; 117:598-604. [PMID: 24502022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Bacterial infections play an important role in liver cirrhosis complications, being together with variceal bleeding and hepatic encephalopathy an important cause of morbidity and mortality in cirrhotic patients. Spontaneous bacterial peritonitis (SBP) is a major complication of liver cirrhosis, with a significant mortality. Recent studies have demonstrated the involvement of oxygen free radicals in the pathogenesis of liver cirrhosis, but the role of oxidative stress in the development of SBP is not very clear yet. PURPOSE This study aims to evaluate the role of oxidative stress in the pathogenesis of spontaneous bacterial peritonitis and its changes after therapy. MATERIAL AND METHODS The study is a prospective case-control, which included 33 patients divided into 3 groups: group I- 10 patients with decompensated cirrhosis and SBP, group II - 17 patients diagnosed with decompensated liver cirrhosis with ascites, and group Ill - 6 patients with compensated liver cirrhosis. The control group consisted of 19 healthy subjects recruited from hospital staff, adapted to patients by age and sex. Malonildyaldehida (MDA), a product of lipid peroxidation, was dosed in the blood and ascitic fluid of patients by assay thiobarbituric acid reactive substances (TBARS). RESULTS Serum MDA significantly increased in the group with decompensated cirrhosis and SBP compared with the control group. MDA levels in ascitic fluid showed a statistically significant increase in the SBP group compared with patients without SBP. There was a decrease of MDA after 6 months of antibiotic treatment compared with the initial stage, while MDA values increased in the absence of treatment. CONCLUSIONS The study demonstrates the increased oxidative stress markers in the blood and ascitic fluid of cirrhotic patients with SBP, which can be considered a predictor of SBP and also a marker of treatment response. KEYWORDS SPON-
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Affiliation(s)
| | - A Ciobică
- Department of Biology, University of Medicine and Pharmacy Grigore T. Popa, Iaşi
| | | | - Anca Trifan
- Discipline of Gastroenterology and Hepatology University Alexandru loan Cuza, Iaşi
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100000
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Gornals JB, Moreno R, Castellote J, Loras C, Barranco R, Catala I, Xiol X, Fabregat J, Corbella X. Single-session endosonography and endoscopic retrograde cholangiopancreatography for biliopancreatic diseases is feasible, effective and cost beneficial. Dig Liver Dis 2013; 45:578-83. [PMID: 23465682 DOI: 10.1016/j.dld.2013.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/14/2013] [Accepted: 01/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) are often required in patients with pancreaticobiliary disorders. AIMS To assess the clinical impact and costs savings of a single session EUS-ERCP. METHODS Patient and intervention data from April 2009 to March 2012 were prospectively recruited and retrospectively analyzed from a database at a tertiary hospital. Indications, diagnostic yield, procedure details, complications and costs were evaluated. RESULTS Fifty-five scheduled combined procedures were done in 53 patients. The accuracy of EUS-fine needle aspiration for malignancy was 90%. The main clinical indication was a malignant obstructing lesion (66%). The ERCP cannulation was successful in 67%, and in 11/15 failed ERCP (73%), drainage was completed thanks to an EUS-guided biliary drainage: 6 transmurals, 5 rendezvous. Eight patients (14%) had related complications: bacteremia (n = 3), pancreatitis (n = 2), bleeding (n = 2) and perforation (n = 1). The mean duration was 65 ± 22.2 min. The mean estimated cost for a single session was €3437, and €4095 for two separate sessions. The estimated cost savings using a single-session strategy was €658 per patient, representing a total savings of €36,189. CONCLUSION Combined EUS and ERCP is safe, technically feasible and cost beneficial. Furthermore, in failed ERCP cases, the endoscopic biliary drainage can be completed with EUS-guided biliary access in the same procedure.
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Affiliation(s)
- Joan B Gornals
- Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
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