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Answer the question based on the following context: To determine the effect of sickle cell disease (SCD) on hospital resource use among patients admitted for priapism. Using the Nationwide Inpatient Sample, a weighted sample of 12,547 patients was selected with a primary diagnosis of priapism from 2002 to 2011. Baseline differences for patient demographics and hospital characteristics were compared between SCD and non-SCD patients. Multivariate analysis was performed to identify the effect of SCD on length of stay, use of penile operations, blood transfusion, and cost. The proportion of SCD patients was 21.5%. SCD patients were younger, more often black, more likely to have Medicaid insurance, and treated more frequently in Southern urban teaching hospitals. SCD was a significant predictor of having a blood transfusion (odds ratio [OR], 16.3; P<.001), and an elongated length of stay (OR, 1.42; P<.001). SCD was associated with less penile operations (OR, 0.40; P<.001). When SCD patients did have an operation, it was performed later in the admission (mean, 0.87 vs 0.47 days; P<.001). SCD was not a significant predictor of increased cost (OR, 1.02; P = .869). | Sickle Cell Disease in Priapism: Disparity in Care? | SCD patients represent a demographically distinct subgroup of priapism patients with different patterns of resource use manifested by longer hospital stays and more blood transfusions. Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events. | Question: Sickle Cell Disease in Priapism: Disparity in Care?
Answer: SCD patients represent a demographically distinct subgroup of priapism patients with different patterns of resource use manifested by longer hospital stays and more blood transfusions. Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events. |
Answer the question based on the following context: The association between olmesartan and an enteropathy histologically indistinguishable from untreated celiac disease has recently been described. However, pathogenetic mechanisms leading to villous atrophy, prevalence, natural history and genetic background of this condition have not yet been defined. We describe here two cases of olmesartan-associated enteropathy and discuss some aspects of the natural history of this condition. In both patients, an infectious episode seems to have triggered the severe malabsorption syndrome which led them to hospitalization. High titer positive antinuclear antibodies with homogeneous pattern were found. | Olmesartan-associated enteropathy: new insights on the natural history? | Our reports add to a growing body of evidence suggesting that olmesartan-associated enteropathy should be considered in the presence of villous atrophy and negative celiac serology and in the diagnostic algorithm of non-responsive celiac disease. | Question: Olmesartan-associated enteropathy: new insights on the natural history?
Answer: Our reports add to a growing body of evidence suggesting that olmesartan-associated enteropathy should be considered in the presence of villous atrophy and negative celiac serology and in the diagnostic algorithm of non-responsive celiac disease. |
Answer the question based on the following context: To compare glaucoma development and intraocular pressure (IOP) in the longer term following phacoemulsification cataract surgery in eyes with and without pseudoexfoliation syndrome (PEX). Fifty-one patients with PEX were compared with 102 age- and gender-matched controls without PEX. Patients were re-examined a mean of 76 (SD 5.4) months after cataract surgery, recording IOP, glaucoma diagnosis, glaucoma treatment and LogMAR. Data from the preoperative visit (baseline) and IOP on the first postoperative day were obtained from medical records. A glaucoma parameter was predefined as patients developing glaucoma or needing increased glaucoma treatment during the postoperative time period. One new glaucoma case in each group was diagnosed postoperatively, yielding glaucoma incidences of 0.47 cases per 100 person-years [95% confidence interval (CI) 0.006-2.61] and 0.17 cases per 100 person-years (CI 0.002-0.95) in the PEX and control groups respectively (p = 0.53). IOP declined by 2.6 (SD 4.0) mmHg in the PEX group (p<0.001) and 1.9 (SD 3.5) mmHg in the control group (p<0.001) from baseline to the re-examination, with a non-significant group difference (p = 0.310). IOP spike (≥6 mmHg increase) was significantly associated with the glaucoma parameter, both within the PEX (p = 0.034) and the control group (p = 0.044). | Does cataract surgery reduce the long-term risk of glaucoma in eyes with pseudoexfoliation syndrome? | The number of newly diagnosed glaucoma cases was lower than expected 6-7 years following cataract extraction, especially in the PEX group, which indicates that PEX eyes benefit particularly from cataract surgery in terms of IOP and glaucoma development. | Question: Does cataract surgery reduce the long-term risk of glaucoma in eyes with pseudoexfoliation syndrome?
Answer: The number of newly diagnosed glaucoma cases was lower than expected 6-7 years following cataract extraction, especially in the PEX group, which indicates that PEX eyes benefit particularly from cataract surgery in terms of IOP and glaucoma development. |
Answer the question based on the following context: The frequency with which CIN was identified at a range of positions on the anterior and posterior lips and left and right lateral aspects of the cervix was assessed in 100 cone biopsy specimens. CIN affected one or other cervical lip in all 100 cases studied and involved the midline positions (12 and 6 o'clock) in 94. The lateral edges of the cervical canal were also involved in 38 cases. | Distribution of cervical intraepithelial neoplasia: are hysterectomy specimens sampled appropriately? | CIN is more likely to be identified on the anterior and posterior lips than on the lateral aspect of the cervical os. The findings support the continuation of the established practice of taking blocks from the midline in these areas. | Question: Distribution of cervical intraepithelial neoplasia: are hysterectomy specimens sampled appropriately?
Answer: CIN is more likely to be identified on the anterior and posterior lips than on the lateral aspect of the cervical os. The findings support the continuation of the established practice of taking blocks from the midline in these areas. |
Answer the question based on the following context: To evaluate the accuracy of imprint cytology of core needle biopsy specimens in the diagnosis of prostate cancer. Between December 24, 2011 and May 9, 2013, patients with an abnormal DRE and/or serum PSA level of>2.5 ng/mL underwent transrectal prostate needle biopsy. Samples with positive imprint cytology but negative initial histologic exam underwent repeat sectioning and histological examination. 1,262 transrectal prostate needle biopsy specimens were evaluated from 100 patients. Malignant imprint cytology was found in 236 specimens (18.7%), 197 (15.6%) of which were confirmed by histologic examination, giving an initial 3.1% (n = 39) rate of discrepant results by imprint cytology. Upon repeat sectioning and histologic examination of these 39 biopsy samples, 14 (1.1% of the original specimens) were then diagnosed as malignant, 3 (0.2%) as atypical small acinar proliferation (ASAP), and 5 (0.4%) as high-grade prostatic intraepithelial neoplasia (HGPIN). Overall, 964 (76.4%) specimens were negative for malignancy by imprint cytology. Seven (0.6%) specimens were benign by cytology but malignant cells were found on histological evaluation. On imprint cytology examination, nonmalignant but abnormal findings were seen in 62 specimens (4.9%). These were all due to benign processes. After reexamination, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate, false-negative rate of imprint preparations were 98.1, 96.9, 98.4, 92.8, 99.3, 1.6, 3.1%, respectively. | Does imprint cytology improve the accuracy of transrectal prostate needle biopsy? | Imprint cytology is valuable tool for evaluating TRUS-guided core needle biopsy specimens from the prostate. Use of imprint cytology in combination with histopathology increases diagnostic accuracy when compared with histopathologic assessment alone. | Question: Does imprint cytology improve the accuracy of transrectal prostate needle biopsy?
Answer: Imprint cytology is valuable tool for evaluating TRUS-guided core needle biopsy specimens from the prostate. Use of imprint cytology in combination with histopathology increases diagnostic accuracy when compared with histopathologic assessment alone. |
Answer the question based on the following context: To assess the clinical value of a modified version, not employing video recording, of Precthl's method on the qualitative assessment of general movements (GMs) in preterm, term and young infants at neurological risk. One-hundred and fifteen infants consecutively enrolled in our follow-up program were selected for the study (103 preterm and 12 term infants). While being video recorded, each infant's spontaneous motor activity was directly observed and documented using a written proforma. An evaluation of the video was later performed by a different assessor blind to the infant's clinical history. The correlation between the two techniques was significant both at writhing age (birth to 6 weeks post-term age) and at fidgety age (9-15 weeks post-term age). Both methods showed a very high sensitivity for the prediction of cerebral palsy, as no false negatives were observed. The direct assessment showed a lower specificity, particularly during the writhing period. | Does the assessment of general movements without video observation reliably predict neurological outcome? | These results support the use of the direct assessment of GMs when the full application of the standard video observation cannot be routinely applied, restraining the use of video recordings to the abnormal or doubtful cases. This may facilitate the wished integration of the assessment of spontaneous motility into more general protocols of neurological examination and into clinical follow-up programs. | Question: Does the assessment of general movements without video observation reliably predict neurological outcome?
Answer: These results support the use of the direct assessment of GMs when the full application of the standard video observation cannot be routinely applied, restraining the use of video recordings to the abnormal or doubtful cases. This may facilitate the wished integration of the assessment of spontaneous motility into more general protocols of neurological examination and into clinical follow-up programs. |
Answer the question based on the following context: We examined potential ethnicity-related differences in progression of chronic kidney disease (CKD) between South Asian and white European diabetic adults with CKD stage 3 over a 5-year period. We analysed data collected from diabetic adults of white European and South Asian ethnicity who had attended diabetes and diabetes-renal outpatient clinics with baseline estimated glomerular filtration rate (eGFR) values ≥30 and<60 ml/min/1.73 m(2) over 5 years (2005-2010); 891 (76%) were white Europeans, 282 (24%) were South Asians. Despite similar baseline eGFR (P=0.103), South Asians were younger [median (interquartile range) 68 (63-73) vs. 70 (64-77) years; P<0.001] and had worse baseline glycated haemoglobin than white Europeans [8.0 (7.0-9.1) vs. 7.6 (6.8-8.7)%; P=0.004]. The 5-year follow-up eGFR and the decline in eGFR did not differ between the two groups. Thirty-five (12.4%) South Asians and 82 (9.2%) white Europeans progressed to stages 4-5 CKD (P=0.112). There was a trend towards higher follow-up glycated haemoglobin levels in South Asians (P=0.064). | Is there a difference in progression of renal disease between South Asian and white European diabetic adults with moderately reduced kidney function? | Despite worse glycaemic control, South Asian diabetic adults with CKD stage 3 did not show any difference in 5-year decline in eGFR compared with white Europeans. These data do not support ethnic differences in progression of CKD between the South Asian and white European patient populations. | Question: Is there a difference in progression of renal disease between South Asian and white European diabetic adults with moderately reduced kidney function?
Answer: Despite worse glycaemic control, South Asian diabetic adults with CKD stage 3 did not show any difference in 5-year decline in eGFR compared with white Europeans. These data do not support ethnic differences in progression of CKD between the South Asian and white European patient populations. |
Answer the question based on the following context: Systemic rheumatoid vasculitis (SRV) is a relatively rare complication of RA. The incidence of SRV appeared to increase during the 1970s and 1980s from 6.0 to 12.5/million. During the 1990s there have been major changes in the treatment of RA, with more aggressive control of inflammation. Our aim was to study the epidemiology of SRV in a stable, well-defined population over a 15-yr period. Since 1988 we have maintained a prospective register of all patients with systemic vasculitis attending the Norfolk and Norwich University Hospital. Patients presenting with new-onset SRV, as defined by the criteria of Scott and Bacon, and registered with general practitioners in the former Norwich Health Authority area between 1988 and 2002 were identified. The population in 2002 was estimated to be 445 000 (215 000 males). Fifty-one patients (24 male) with SRV were identified, with median age 61 yr and disease duration 16.8 yr. The overall annual incidence was 7.9/million (95% CI 5.9-10.4) (males, 7.7/million; females, 8.1/million). During the first quinquennium (1988-92) the incidence was 11.6/million (95% CI 7.4-17.0) and during the third (1998-2002) it was 3.6/million (95% CI 1.6-7.1). A rolling 3-yr average showed that the peak incidence was in 1992-94, at 15.2/million (95% CI 9.1-23.8), and the nadir was in 1998-2000, at 3.0/million (95% CI 0.8-7.8). A similar pattern was seen for males and females. There was no difference in age or disease duration at onset of SRV between the three quinquennia. | Rheumatoid vasculitis: becoming extinct? | The incidence of SRV has declined dramatically since the 1980s. This could be due to better control of inflammatory disease or changes in smoking habits. | Question: Rheumatoid vasculitis: becoming extinct?
Answer: The incidence of SRV has declined dramatically since the 1980s. This could be due to better control of inflammatory disease or changes in smoking habits. |
Answer the question based on the following context: The mothers and teachers completed validated questionnaires addressing school performance and the child's IQ was evaluated by WISC-R, prorated. In addition, socioeconomic status was investigated using different questionnaires. According to maternal reports, twice as many low birthweight children had school problems and three times as many of these children were referred to the School Psychological Service. Mean prorated IQ was 5 points lower in the low birthweight group. No statistically significant difference was found for mean IQ between the groups with birthweights of less than 1500 g vs 1500-2000 g. In a multivariate linear regression analysis, parental factors accounted for 13% of the variance in child IQ compared with only 3% accounted for by child birthweight. | Low birthweight children: coping in school? | Low birthweight significantly increases the risk of school problems. | Question: Low birthweight children: coping in school?
Answer: Low birthweight significantly increases the risk of school problems. |
Answer the question based on the following context: Medical research using human participants must conform to the basic ethical principles found in the Declaration of Helsinki (DoH) of the World Medical Association. The purpose of this review was to assess whether journals in China have improved in regard to the fulfillment of ethical disclosure procedures for clinical trials of anti-dementia drugs. Four medical databases were searched for articles reporting clinical trials of oral anti-dementia drugs published in China in 2003, 2009, and 2014. The frequencies of reporting of informed consent from participants (ICP), approval of a regional ethical committee (REC), reference to DoH, and study registration were estimated respectively. Statistical analyses were conducted with SPSS v21 software. Among those randomized controlled trials published in 2003, 2009, and 2014, disclosure of REC approval was present for 2.67%, 1.15%, and 6.84%; statements of ICP were included in 9.33%, 7.76%, and 17.34%; reference to DoH was found for 4.00%, 1.44%, and 7.45%; and study registration reporting was included in 2.67%, 2.59%, and 9.28%, respectively. Improvements to reporting rates between 2009 and 2014 were seen, with more than twice as many trials reporting REC approval, ICP, reference to DoH, and study registration compared with 2009. | Do Chinese Researchers Conduct Ethical Research and Use Ethics Committee Review in Clinical Trials of Anti-Dementia Drugs? | Compared with 2003 and 2009, reporting rates for REC approval, ICP, reference to DoH, and study registration for clinical trials of anti-dementia drugs were enhanced in 2014 in the major medical journals of China. However, biomedical publications without definite statements of ethical considerations remain common, and this continues to be seen in Chinese journals. It is imperative that measures are taken to reinforce the ethical protection in clinical trials in China. | Question: Do Chinese Researchers Conduct Ethical Research and Use Ethics Committee Review in Clinical Trials of Anti-Dementia Drugs?
Answer: Compared with 2003 and 2009, reporting rates for REC approval, ICP, reference to DoH, and study registration for clinical trials of anti-dementia drugs were enhanced in 2014 in the major medical journals of China. However, biomedical publications without definite statements of ethical considerations remain common, and this continues to be seen in Chinese journals. It is imperative that measures are taken to reinforce the ethical protection in clinical trials in China. |
Answer the question based on the following context: To examine whether depression and apathy are independently associated with longitudinal trajectories of cortical atrophy in the entorhinal cortex compared with frontal subregions previously implicated in late-life mood disturbance. Data from 334 participants classified as having mild cognitive impairment in the Alzheimer's Disease Neuroimaging Initiative (ADNI) were analyzed by using multilevel models for change adjusted for age, global cognitive status, and total intracranial volume at enrollment. Participants in ADNI were recruited from>50 clinical research sites in the United States and Canada. Depression and apathy were identified by informants using the Neuropsychiatric Inventory Questionnaire. Serial magnetic resonance imaging was performed on 1.5-Tesla scanners according to the standardized ADNI-1 protocol on an average of 5 occasions over an average of 30.5 months. Regional cortical thickness values were derived from longitudinal data processing in FreeSurfer version 4.4. Depression was associated with reduced cortical thickness in the entorhinal cortex at baseline and accelerated atrophy in the anterior cingulate cortex. Similar relationships between depression and the orbitofrontal cortex and between apathy and the anterior cingulate cortex were not significant. | Are apathy and depression independently associated with longitudinal trajectories of cortical atrophy in mild cognitive impairment? | In mild cognitive impairment, depression signs are a better marker of longitudinal cortical atrophy than apathy. Results are consistent with hypotheses that depression is an early sign of a more aggressive neurodegenerative process or that depression lowers brain reserve capacity, allowing for more rapid progression of Alzheimer disease neuropathology. | Question: Are apathy and depression independently associated with longitudinal trajectories of cortical atrophy in mild cognitive impairment?
Answer: In mild cognitive impairment, depression signs are a better marker of longitudinal cortical atrophy than apathy. Results are consistent with hypotheses that depression is an early sign of a more aggressive neurodegenerative process or that depression lowers brain reserve capacity, allowing for more rapid progression of Alzheimer disease neuropathology. |
Answer the question based on the following context: The prevention and control of HCV infection is complex and challenging in terms of describing risk factors and modes of transmission. This meta-analysis was conducted to summarize the best available data on HCV risk factors worldwide and in Egypt. Through exhaustive literature searches (1989-2013) of HCV risk factors, 357 original eligible articles were included in this study. The highest detected risk was intravenous drug users (IDUs) (OR = 9.6) followed by HIV infection (OR = 4.9), having an IDU partner (OR = 4.1), HBV infection (OR = 3.5), Caesarean section (CS) (OR = 3.35), blood transfusion (OR = 3.2) and having an HCV+ partner (OR = 3). Organ transplantation, hospital admission, haemodialysis and having a sexually transmitted infection carry 2.96, 2.4, 2.18 and 2 risks of having HCV respectively. Other significant risk factors included poor education, older age, sharing sharp or blunt objects, MSM, tattooing, hijama, body piercing, minor operations and medical procedures. Some risks showed a decrease over the previous decade, including blood transfusion, organ transplantation, IDUs, IDU partner and CS. Others showed rising risks, including having an HCV+ partner, MSM and suffering from STI. In Egypt, male gender, rural residence, acupuncture and receiving parenteral antischistosomal treatment were significant risks, while neither HIV nor HBV were found to carry a risk of HCV infection. | A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt? | Blood transfusion, organ transplantation, CS, IDUs, haemodialysis, minor operations and medical procedures are established risk factors. Attention and urgent intervention should be given to the sexual route of transmission, as well as that through minor operations and medical procedures. | Question: A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt?
Answer: Blood transfusion, organ transplantation, CS, IDUs, haemodialysis, minor operations and medical procedures are established risk factors. Attention and urgent intervention should be given to the sexual route of transmission, as well as that through minor operations and medical procedures. |
Answer the question based on the following context: Currently it is not yet defined if the rapid virologic response (RVR) can predict a sustained virologic response (SVR) in relapsers and nonresponders. To evaluate treatment-RVR as a predictive factor of SVR in genotype 1 hepatitis C treatment naive, relapsers, and nonresponder patients treated with pegylated interferon-alpha (PEG-IFN-alpha2b) and ribavirin. One hundred sixty-seven genotype 1 hepatitis C patients who were treated with PEG-IFN-alpha2b and ribavirin and had SVR assessed were included. Hepatitis C virus RNA analysis at the fourth week of treatment was performed in all patients. The exclusion criteria were hepatitis B virus and/or HIV co-infection. A comparative analysis was performed between the groups with and without RVR and a logistic regression model was applied. One hundred sixty-seven patients were analyzed, 103 (62%) were naives, 22 (13%) relapsers, and 42 (25%) nonresponders. The SVR rates were 44% in naives, 68% in relapsers, and 12% in nonresponders. RVR was attained in 51/167 (31%) patients and in this group the SVR was higher than in those without RVR (75% vs. 23%; P<0.001). This difference was also observed in all subgroups: naives (71% vs. 29%; P=0.001), relapsers (92% vs. 40%; P=0.02), and nonresponders (50% vs. 8%; P=0.06). A stepwise logistic regression model identified RVR and absence of cirrhosis as the factors independently associated to SVR. | Is the rapid virologic response a positive predictive factor of sustained virologic response in all pretreatment status genotype 1 hepatitis c patients treated with peginterferon-alpha2b and ribavirin? | RVR and absence of cirrhosis are the strongest predictive factors of SVR in HCV genotype 1 patients. Assessment of RVR is very useful in all pretreatment status patients in predicting SVR and provides information for individualizing therapy. | Question: Is the rapid virologic response a positive predictive factor of sustained virologic response in all pretreatment status genotype 1 hepatitis c patients treated with peginterferon-alpha2b and ribavirin?
Answer: RVR and absence of cirrhosis are the strongest predictive factors of SVR in HCV genotype 1 patients. Assessment of RVR is very useful in all pretreatment status patients in predicting SVR and provides information for individualizing therapy. |
Answer the question based on the following context: In boys with resected posterior urethral valves (PUV) deterioration of renal function is seen during childhood and adolescence, which may partly be caused by bladder dysfunction. We present data on renal and bladder function initially and at followup of boys with PUV in whom the bladder dysfunction has been treated since infancy. The study included 35 boys with PUV. Bladder regimen, including early toilet training from the age of 1.5 years and detrusor relaxant drugs for the treatment of incontinence from ages 4 to 6 years, was introduced to all patients. A total of 19 boys were started on clean intermittent catheterization (CIC) at a median age of 8 months due to pronounced bladder dysfunction with poor emptying, unsafe pressure levels, high grade reflux and renal impairment. No serious complications of CIC have been seen during followup. Of the 19 boys 2 stopped performing CIC due to noncompliance of the parents at 1 and 3 years, respectively. Initial renal function, measured as median glomerular filtration rate (GFR) in percent of expected for age, was 60% in the CIC group and 90% in the nonCIC group. At followup at a median age of 8 years the CIC group (n = 14, 3 transplanted boys excluded) had an increase in median differential GFR (difference between followup and initial GFR) of 7% (p<0.01), which was similar increase to that of the nonCIC group. In the 2 boys who stopped performing CIC renal function deteriorated with a median differential GFR of -24%. In the CIC group detrusor instability decreased. Poor compliance was seen in 6 of the 19 boys initially and only one remained poorly compliant. In 1 of the boys who stopped performing catheterization a low compliant bladder developed. In all of the other cases bladder capacity increased more than expected for age. | Does treatment with clean intermittent catheterization in boys with posterior urethral valves affect bladder and renal function? | The results suggest that treatment of bladder dysfunction in boys with PUV can counteract the deterioration in renal function seen during childhood but the number of patients in our study is limited. | Question: Does treatment with clean intermittent catheterization in boys with posterior urethral valves affect bladder and renal function?
Answer: The results suggest that treatment of bladder dysfunction in boys with PUV can counteract the deterioration in renal function seen during childhood but the number of patients in our study is limited. |
Answer the question based on the following context: The aim of this study was to analyze the effects of short-term resistance training on the body composition profile and muscle function in a group of Anorexia Nervosa restricting type (AN-R) patients. The sample consisted of AN-R female adolescents (12.8 ± 0.6 years) allocated into the control and intervention groups (n = 18 each). Body composition and relative strength were assessed at baseline, after 8 weeks and 4 weeks following the intervention. Body mass index (BMI) increased throughout the study (p = 0.011). Significant skeletal muscle mass (SMM) gains were found in the intervention group (p = 0.045, d = 0.6) that correlated to the change in BMI (r = 0.51, p < 0.031). Meanwhile, fat mass (FM) gains were significant in the control group (p = 0.047, d = 0.6) and correlated (r > 0.60) with change in BMI in both the groups. Significant relative strength increases (p < 0.001) were found in the intervention group and were sustained over time. | Muscle function and body composition profile in adolescents with restrictive anorexia nervosa: does resistance training help? | SMM gain is linked to an increased relative strength when resistance training is prescribed. Although FM, relative body fat (%BF), BMI and body weight (BW) are used to monitor nutritional progress. Based on our results, we suggest to monitor SMM and relative strength ratios for a better estimation of body composition profile and muscle function recovery. Implications for Rehabilitation Anorexia Nervosa Restricting Type (AN-R) AN-R is a psychiatric disorder that has a major impact on muscle mass content and function. However, little or no attention has been paid to muscle recovery. High intensity resistance training is safe for AN-R after hospitalization and enhances the force generating capacity as well as muscle mass gains. Skeletal muscle mass content and muscular function improvements are partially maintained for a short period of time when the exercise program ceases. | Question: Muscle function and body composition profile in adolescents with restrictive anorexia nervosa: does resistance training help?
Answer: SMM gain is linked to an increased relative strength when resistance training is prescribed. Although FM, relative body fat (%BF), BMI and body weight (BW) are used to monitor nutritional progress. Based on our results, we suggest to monitor SMM and relative strength ratios for a better estimation of body composition profile and muscle function recovery. Implications for Rehabilitation Anorexia Nervosa Restricting Type (AN-R) AN-R is a psychiatric disorder that has a major impact on muscle mass content and function. However, little or no attention has been paid to muscle recovery. High intensity resistance training is safe for AN-R after hospitalization and enhances the force generating capacity as well as muscle mass gains. Skeletal muscle mass content and muscular function improvements are partially maintained for a short period of time when the exercise program ceases. |
Answer the question based on the following context: Apart from several subjective criteria, ASCUS and LSIL are defined by nuclear enlargement of 2.5x to 3x and>or = 3x the area of a normal intermediate squamous cell nucleus, respectively. The aim of this study was to assess the ability of observers with various degrees of experience to estimate nuclear area ratios. Forty-five participants (5 anatomic pathologists, 5 cytopathologists, 2 cytopathology fellows, 16 pathology residents, 8 cytotechnologists, 6 medical students, and 3 cytopreparatory staff members) judged the area ratios of pairs of squamous cell nuclei imaged at x100 objective magnification. For Test 1 (T1), participants chose between 5 preset area ratios (1.0x to 1.4x, 1.5x to 1.9x, 2.0x to 2.4x, 2.5x to 2.9x, 3.0x to 3.4x) for 15 pairs of cells with ratios falling in the middle of these intervals. One week after T1, an instructional tutorial was given and T1 was repeated in different order of cell pairs as Test 2 (T2). The kappa values for all participants were 0.30 for T1 and 0.39 for T2. Accurate responses were given in 50.5% in T1 and 53.5% in T2. Both T1 and T2 responses failed to differentiate between area ratios corresponding to ASCUS and LSIL. There were no differences in accuracy according to sex, experience, or expertise in cytopathology. | Visual estimates of nucleus-to-nucleus ratios: can we trust our eyes to use the Bethesda ASCUS and LSIL size criteria? | The overall accuracy of participants in estimating nuclear area ratios was low, especially for ratios in the range of ASCUS versus LSIL, with only minimal improvement after an instructional tutorial. Nuclear area ratio estimation may, therefore, contribute to the well-known substantial variability in ASCUS rates and ASC/squamous intraepithelial lesion ratios. | Question: Visual estimates of nucleus-to-nucleus ratios: can we trust our eyes to use the Bethesda ASCUS and LSIL size criteria?
Answer: The overall accuracy of participants in estimating nuclear area ratios was low, especially for ratios in the range of ASCUS versus LSIL, with only minimal improvement after an instructional tutorial. Nuclear area ratio estimation may, therefore, contribute to the well-known substantial variability in ASCUS rates and ASC/squamous intraepithelial lesion ratios. |
Answer the question based on the following context: Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches.QUESTIONS/ We therefore asked: (1) Is there a difference in surgical time between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches? Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 3×3 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 3×3 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon. Patients who underwent arthroscopic double-row suture anchor fixation had longer surgical times than did patients who underwent ORIF (mean, 95.3 minutes, SD, 10.6 minutes vs mean, 61.5 minutes, SD, 7.2 minutes; mean difference, 33.9 minutes; 95% CI, 27.4-40.3 minutes; p<0.001). All patients achieved bone union within 3 months. Compared with patients who had ORIF, the patients who had arthroscopic double-row suture anchor fixation had greater ranges of forward flexion (mean, 152.7°, SD, 13.3° vs mean, 137.7°, SD, 19.2°; p = 0.017) and abduction (mean, 146.0°, SD, 16.4° vs mean, 132.4°, SD, 20.5°; p = 0.048), and higher ASES score (mean, 91.8 points, SD, 4.1 points vs mean, 87.4 points, SD, 5.8 points; p = 0.021); however, in general, these differences were small and of questionable clinical importance. With the numbers available, there were no differences in the proportion of patients experiencing complications resulting in reoperation; secondary subacromial impingement occurred in two patients in the ORIF group and postoperative stiffness in one from the ORIF group. The two patients experiencing secondary subacromial impingement underwent reoperation to remove the implant. The patient with postoperative stiffness underwent adhesion release while receiving anesthesia, to improve the function of the shoulder. These three patients had the only reoperations. | Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures? | We found that in the hands of surgeons comfortable with both approaches, there were few important differences between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures. Future, larger studies with consistent indications should be performed to compare these treatments; our data can help inform sample-size calculations for such studies. | Question: Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?
Answer: We found that in the hands of surgeons comfortable with both approaches, there were few important differences between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures. Future, larger studies with consistent indications should be performed to compare these treatments; our data can help inform sample-size calculations for such studies. |
Answer the question based on the following context: The therapeutic efficacy of transarterial chemoembolization (TACE) has not been evaluated in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. We investigated the efficacy of TACE with/without systemic chemotherapy (s-chemo) in these patients. We performed a survival analysis of consecutive HCC patients with extrahepatic metastasis, diagnosed at initial presentation according to treatment modality after stratification, using the Child-Pugh classification and intrahepatic HCC T stage, retrospectively. Between 2005 and 2007, 251 patients were newly diagnosed with HCC involving extrahepatic metastasis at our institution. Among those, 226 were classified as Child-Pugh A-B and the other 25, Child-Pugh C. Within the Child-Pugh A-B group, repeated TACE or transarterial chemoinfusion (TACI) was performed with/without s-chemo in 171 patients. Eight of 226 received s-chemo alone, and 47, conservative management (CM) alone. The median survival time of patients treated with TACE/TACI with s-chemo, TACE/TACI alone, and CM was 10, 5, and 2.9 months in patients classified as Child-Pugh A and T3-stage HCC (TACE/TACI with s-chemo vs CM, P=0.0354; TACE/TACI alone vs CM, P=0.0553) and 7.1, 2.6, and 1.6 months in Child-Pugh B and T3-stage patients, respectively (TACE/TACI with s-chemo vs CM, P=0.0097; TACE/TACI alone vs CM, P<0.0001). Individual treatment with TACE/TACI or sorafenib showed independent prognostic significance in the multivariate analysis. | Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: does transarterial chemoembolization improve survival in these patients? | Repeated TACE could show significant survival benefits in metastatic HCC patients with conserved liver function and intrahepatic HCC T3 stage. The survival data of our study could be used as a historical control for TACE monotherapy in future clinical trials evaluating combination treatments containing TACE in these patients. | Question: Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: does transarterial chemoembolization improve survival in these patients?
Answer: Repeated TACE could show significant survival benefits in metastatic HCC patients with conserved liver function and intrahepatic HCC T3 stage. The survival data of our study could be used as a historical control for TACE monotherapy in future clinical trials evaluating combination treatments containing TACE in these patients. |
Answer the question based on the following context: Global health experiences (GHEs) are becoming increasingly prevalent in surgical residency education. Although it may seem intuitive that participation in GHEs develops CanMEDS competencies, this has not been studied in depth in surgery. The purpose of this study is (1) to explore if and how otolaryngology-head and neck surgery (OHNS) resident participation in GHEs facilitates the development of CanMEDS competencies and (2) to develop an OHNS GHE tool to facilitate the integration of CanMEDS into GHE participation and evaluation. An online survey explored the GHEs of current and past OHNS residents in Canada. Based on the data collected and a literature review, a foundational tool was then created to (1) enable OHNS residents to structure their GHEs into CanMEDS-related learning objectives and (2) enable OHNS program directors to more effectively evaluate residents' GHEs with respect to CanMEDS competencies. Participants' GHEs varied widely. These experiences often contributed informally to the development of several CanMEDS competencies. However, few residents had concrete objectives, rarely were CanMEDS roles clearly incorporated, and most residents were not formally evaluated during their experience. Residents felt they achieved greater learning when predeparture objectives and postexperience reflections were integrated into their GHEs. | Distributed learning or medical tourism? | Although GHEs vary widely, they can serve as valuable forums for developing CanMEDS competencies among participating residents. Without clear objectives that adhere to the CanMEDS framework or formal assessment methods however, residents in GHEs risk becoming medical tourists. The use of an objective and evaluation tool may facilitate the creation of predeparture learning objectives, encourage self-reflection on their GHE, and better enable program directors to evaluate residents participating in GHEs. | Question: Distributed learning or medical tourism?
Answer: Although GHEs vary widely, they can serve as valuable forums for developing CanMEDS competencies among participating residents. Without clear objectives that adhere to the CanMEDS framework or formal assessment methods however, residents in GHEs risk becoming medical tourists. The use of an objective and evaluation tool may facilitate the creation of predeparture learning objectives, encourage self-reflection on their GHE, and better enable program directors to evaluate residents participating in GHEs. |
Answer the question based on the following context: Few studies have compared simultaneously different antidepressants in long-term treatment of major depressive disorder (MDD). Long-term prevention of recurrences should be the main goal of MDD treatment. The purpose of this study was to compare antidepressants of different pharmacological classes in terms of retention in treatment (no discontinuation for recurrences, hospitalizations, side effects). One hundred and fifty outpatients with an MDD diagnosis, treated with antidepressants in mono-therapy, were included. Follow-up period was set at 24 months, and information have been obtained from charts, interviews with patients and their relatives, and from the Lombardy regional register. A survival analysis (Kaplan-Meier) was performed, considering recurrences, hospitalizations, or discontinuation due to side effects as 'death' events. In our sample, 48.7% of the patients presented a recurrence within the first 2 years of treatment. Bupropion appears less effective in long-term treatment of MDD than the other compared antidepressants, with exception of fluoxetine (p = 0.09), amitriptyline (p = 0.13), fluvoxamine (p = 0.83), venlafaxine (p = 0.5), and trazodone (p = 0.58). Fluvoxamine appears to be less effective than citalopram (p = 0.036), paroxetine (p = 0.037), clomipramine (p = 0.05), sertraline (p = 0.011), and duloxetine (p = 0.024). | Are antidepressants equally effective in the long-term treatment of major depressive disorder? | Bupropion and fluvoxamine appear less effective in long-term treatment of MDD. These results should be confirmed by randomized placebo-controlled prospective studies with larger samples. | Question: Are antidepressants equally effective in the long-term treatment of major depressive disorder?
Answer: Bupropion and fluvoxamine appear less effective in long-term treatment of MDD. These results should be confirmed by randomized placebo-controlled prospective studies with larger samples. |
Answer the question based on the following context: The "ideal" treatment of acute aortic dissection type A (AADA) with dissected and dilated root is controversial. We compared the outcome of classical Bentall procedure (biological and mechanical) with valve-sparing David procedure. Between January 2002 and July 2011, 119 patients with AADA and aortic root involvement underwent surgery at our center. Thirty-one patients (group 1) received biological conduits, 41 (group 2) received mechanical conduits, and 47 (group 3) underwent David procedures. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times were 151 ± 52, 232 ± 84, and 36 ± 30 minutes (group 1); 148 ± 44, 237 ± 91, and 45 ± 29 minutes (group 2); and 160 ± 46, 231 ± 63, and 35 ± 17 minutes (group 3), respectively. The 30-day mortality rates were 32.3% (group 1), 22% (group 2), and 12.8% (group 3). The 1-year rates for freedom from valve-related reoperation were 100% (group 1), 92.5% (group 2), and 95.2% (group 3) (p = 0.172). The 1-year survival rates were 61% (group 1), 61% (group 2), and 84.1% (group 3) (p = 0.008). | Is Bentall Procedure Still the Gold Standard for Acute Aortic Dissection with Aortic Root Involvement? | Even in AADA patients with root involvement, David procedure has acceptable results. David procedure (if possible) or a Bio-Bentall (for pathological valves) seems to be the optimal technique. | Question: Is Bentall Procedure Still the Gold Standard for Acute Aortic Dissection with Aortic Root Involvement?
Answer: Even in AADA patients with root involvement, David procedure has acceptable results. David procedure (if possible) or a Bio-Bentall (for pathological valves) seems to be the optimal technique. |
Answer the question based on the following context: Data demonstrating the outcome of transcatheter aortic valve replacement (TAVR) in the very elderly patients are limited, as they often represent only a small proportion of the trial populations. The purpose of this study was to compare the outcomes of nonagenarians to younger patients undergoing TAVR in current practice. We analyzed data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. Outcomes at 30 days and 1 year were compared between patients ≥90 years versus<90 years of age using cumulative incidence curves. Quality of life was assessed with the 12-item Kansas City Cardiomyopathy Questionnaire. Between November 2011 and September 2014, 24,025 patients underwent TAVR in 329 participating hospitals, of which 3,773 (15.7%) were age ≥90 years. The 30-day and 1-year mortality rates were significantly higher among nonagenarians (age ≥90 years vs.<90 years: 30-day: 8.8% vs. 5.9%; p<0.001; 1 year: 24.8% vs. 22.0%; p<0.001, absolute risk: 2.8%, relative risk: 12.7%). However, nonagenarians had a higher mean Society of Thoracic Surgeons Predicted Risk of Operative Mortality score (10.9% vs. 8.1%; p<0.001) and, therefore, had similar ratios of observed to expected rates of 30-day death (age ≥90 years vs.<90 years: 0.81, 95% confidence interval: 0.70 to 0.92 vs. 0.72, 95% confidence interval: 0.67 to 0.78). There were no differences in the rates of stroke, aortic valve reintervention, or myocardial infarction at 30 days or 1 year. Nonagenarians had lower (worse) median Kansas City Cardiomyopathy Questionnaire scores at 30 days; however, there was no significant difference at 1 year. | Should Transcatheter Aortic Valve Replacement Be Performed in Nonagenarians? | In current U.S. clinical practice, approximately 16% of patients undergoing TAVR are ≥90 years of age. Although 30-day and 1-year mortality rates were statistically higher compared with younger patients undergoing TAVR, the absolute and relative differences were clinically modest. TAVR also improves quality of life to the same degree in nonagenarians as in younger patients. These data support safety and efficacy of TAVR in select very elderly patients. | Question: Should Transcatheter Aortic Valve Replacement Be Performed in Nonagenarians?
Answer: In current U.S. clinical practice, approximately 16% of patients undergoing TAVR are ≥90 years of age. Although 30-day and 1-year mortality rates were statistically higher compared with younger patients undergoing TAVR, the absolute and relative differences were clinically modest. TAVR also improves quality of life to the same degree in nonagenarians as in younger patients. These data support safety and efficacy of TAVR in select very elderly patients. |
Answer the question based on the following context: Insulin sensitivity is impaired in patients with type II diabetes and is exacerbated by high mean blood glucose (BG). Potentially, large postprandial swings in BG could result in further decrements of insulin sensitivity. Because alpha-glucosidase inhibitors cause a marked reduction in the amplitude of BG changes, the aim of this study was to determine if such a BG-smoothing effect improves insulin sensitivity in well-controlled type II diabetic subjects treated with diet alone. Patients received either miglitol (BAY m 1099) (50 mg three times daily) or placebo for 8 weeks in a randomized double-blind parallel study. The miglitol (9 men, 2 women) and placebo (7 men, 3 women) groups were well matched (mean +/- SD) for age, weight, and blood glucose control (fasting BG, 6.4 +/- 1.0 vs. 6.9 +/- 1.6 mmol/l; HbA1, 7.7 +/- 1.0 vs. 7.9 +/- 0.4%; fructosamine, 0.99 +/- 0.08 vs. 1.07 +/- 0.17 mmol/l). The glucose metabolic clearance rate was calculated during the last 30 min of a 150 min glucose/insulin sensitivity test (glucose, 6 mg . kg-1 . min-1; insulin, 0.5 U . kg-1 . min-1). There was no significant improvement in metabolic clearance rate (0.21 +/- 0.27 vs. 0.16 +/- 0.35 l . kg-1 . min-1) for the miglitol- and placebo-treated groups, respectively. There were no statistically significant differences between miglitol and placebo for changes from baseline in BG (0.1 +/- 0.1 vs. -0.1 +/- 0.2 mmol/l), HbA1 (0.1 +/- 0.1 vs. 0.3 +/- 0.1%), and fructosamine (-0.06 +/- 0.02 vs. -0.03 +/- 0.02 mmol/l). | Does suppression of postprandial blood glucose excursions by the alpha-glucosidase inhibitor miglitol improve insulin sensitivity in diet-treated type II diabetic patients? | Alpha-glucosidase-induced improvement in postprandial hyperglycemia does not result in increased insulin sensitivity. | Question: Does suppression of postprandial blood glucose excursions by the alpha-glucosidase inhibitor miglitol improve insulin sensitivity in diet-treated type II diabetic patients?
Answer: Alpha-glucosidase-induced improvement in postprandial hyperglycemia does not result in increased insulin sensitivity. |
Answer the question based on the following context: Epidural pressures have been reported as being systematically higher than ventricular fluid pressures. These discrepancies have been attributed both to the characteristics of the sensor and to the particular anatomy of the epidural space. To determine which of these two possible causes better explains higher epidural readings, the authors compared pressure values obtained during simultaneous epidural and lumbar pressure monitoring in 53 patients and during simultaneous subdural and lumbar pressure monitoring in 22 patients. The same nonfluid coupled sensor device was used in all compartments. All 75 patients had normal craniospinal communication. Simultaneous intracranial and lumbar readings were performed every 30 seconds. The epidural-lumbar and subdural-lumbar pressure values were compared using correlation analysis and the Bland-Altman method. The median differences in initial epidural-lumbar and subdural-lumbar pressure values were 11 mm Hg (interquartile range 2-24 mm Hg) and 0 mm Hg (interquartile range -2 to 1 mm Hg), respectively. The correlation coefficients of the mean epidural-lumbar and subdural-lumbar intracranial pressure (ICP) values were p = 0.48 (p<0.001) and p = 0.88 (p<0.001), respectively. Using the Bland-Altman analysis, epidural-lumbar methods showed a mean difference of -20.93 mm Hg; epidural pressure values were systematically higher than lumbar values, and these discrepancies were greater with higher ICP values. Subdural-lumbar methods showed a mean difference of 0.35 mm Hg and both were equally valid with all mean ICP values. | Is intracranial pressure monitoring in the epidural space reliable? | Epidural ICP monitoring produces artifactually high values. These values are not related to the type of sensor used but to the specific characteristics of the epidural intracranial space. | Question: Is intracranial pressure monitoring in the epidural space reliable?
Answer: Epidural ICP monitoring produces artifactually high values. These values are not related to the type of sensor used but to the specific characteristics of the epidural intracranial space. |
Answer the question based on the following context: Previous studies have documented higher health risks for lesbian, gay, and bisexual youth compared to heterosexual youth. However, none has reported whether the sexual orientation-based gaps have widened, narrowed, or remained unchanged over time. The purpose of this study was to develop a way to test differences in trends between sexual minority and heterosexual youth cohorts in population-based studies, with cigarette smoking as an exemplar. We analysed the Minnesota Student Survey of 1998-2010, a repeated, cross-sectional census of adolescent health in grades 9 and 12. Our sample was students with recent sexual experience (Ns = 17,376-19,617). Sexual orientation was measured by gender of sexual partners in the past 12 months: students with only opposite-gender partner(s) (OPPOS), students with both male and female partners (BOTH), students with only same-gender partner(s) (SAME). We used logistic regressions to examine trends in prevalence of past-month cigarette smoking from 1998 to 2010, separately for each orientation group. We then applied novel interaction analyses to test whether disparities in smoking prevalence between OPPOS and SAME/BOTH changed over time. Recent smoking rates decreased over time among all orientation groups. BOTH adolescents were more likely than OPPOS adolescents to report past 30-day smoking, but there were no significant differences between SAME adolescents and OPPOS adolescents. Year-by-orientation interactions indicated the gap between BOTH adolescents and OPPOS adolescents widened from 1998 to 2004, then persisted between 2004 and 2010. No significant interaction effects were observed between SAME adolescents and OPPOS adolescents. | Is it getting better? | All orientation groups had decreasing trends in recent cigarette smoking; however, disparities in smoking rates remain between heterosexual adolescents and bisexual adolescents. These results provide a new method of not just documenting trends within minority groups, but examining whether health equity is improving for them compared to dominant groups. | Question: Is it getting better?
Answer: All orientation groups had decreasing trends in recent cigarette smoking; however, disparities in smoking rates remain between heterosexual adolescents and bisexual adolescents. These results provide a new method of not just documenting trends within minority groups, but examining whether health equity is improving for them compared to dominant groups. |
Answer the question based on the following context: Liver resection for hepatocellular carcinoma (HCC) in Child-Pugh class C cirrhotic patients is considered to be high risk and even contraindicated. This study examined our results of hepatectomy for HCC in such cirrhotic patients. A retrospective review of the clinicopathological features, as well as early and late resection results of Child-Pugh class A (n = 181) and class C patients (n = 13) were compared. The extent of hepatectomy was based on the pre-operative liver function test and indocyanine-green (ICG) clearance rate. The tumor size in class C patients was smaller than that in class A patients. There were no significant differences with regard to operative blood loss, amount of blood transfusion, operative morbidity or mortality. The surgical margins of class C patients were narrower (p = 0.003). The tumors of class C patients had higher incidences of well-formed capsules and absence of satellite nodules. The 5-year disease-free and actuarial survival rates of class A and C patients were 35.4% and 40.7% (p = 0.28), and 48% and 50% (p = 0.13), respectively. | Is hepatic resection absolutely contraindicated for hepatocellular carcinoma in Child-Pugh class C cirrhotic patients? | Not all HCCs in Child-Pugh class C cirrhotic patients are contraindicated for liver resection. In the absence of uncontrollable ascites, marked jaundice and encephalopathy, surgical resection is still justified in some selected cases, in spite of a narrow surgical margin. | Question: Is hepatic resection absolutely contraindicated for hepatocellular carcinoma in Child-Pugh class C cirrhotic patients?
Answer: Not all HCCs in Child-Pugh class C cirrhotic patients are contraindicated for liver resection. In the absence of uncontrollable ascites, marked jaundice and encephalopathy, surgical resection is still justified in some selected cases, in spite of a narrow surgical margin. |
Answer the question based on the following context: We assessed the HIV-positive yield of offering provider-initiated HIV testing and counselling (PITC) for TB and the costs, in Madagascar, which has a low HIV prevalence and a high TB burden. A cross-sectional study of routinely collected records from January 2010 to June 2011. A total of 37 596 TB patients were registered in 205 TB centres. HIV testing was available in 95 (46%) of centres where 7524 (40%) of those offered testing accepted it. Only 35 (0.5%) individuals were found HIV positive. Initial costs were about US$1.4 million and annual recurrent costs about US$0.1 million. | Provider-initiated HIV testing and counselling for TB in low HIV prevalence settings: is it worthwhile? | There are concerns of cost investment for countrywide introduction of PITC in a low HIV prevalence setting. | Question: Provider-initiated HIV testing and counselling for TB in low HIV prevalence settings: is it worthwhile?
Answer: There are concerns of cost investment for countrywide introduction of PITC in a low HIV prevalence setting. |
Answer the question based on the following context: Most theories of health-behavior change focus exclusively on individual self-regulation without taking social factors, such as social support, into account. This study's first aim was to systematically test the added value of received instrumental and emotional social support within the Health Action Process Approach (HAPA) in the context of dietary change. In the social support literature, gender effects emerge with regard to the effectiveness of social support. Thus, a second aim was the examination of gender differences in the association of social support with dietary behavior. Participants were 252 overweight and obese individuals. At baseline and 12 months later, participants completed questionnaires on HAPA variables; diet-specific received social support and low-fat diet. For the prediction of intentions 12 months later, instrumental support was more beneficial for men than for women over and above individual self-regulation. In terms of dietary behavior at T2, a moderate main effect of instrumental support emerged. Moreover, received emotional social support was beneficial for men, but not for women in terms of a low-fat diet 12 months later. | Does social support really help to eat a low-fat diet? | Effects of received instrumental social support found in this study provide new evidence for the added value of integrating social support into the HAPA. | Question: Does social support really help to eat a low-fat diet?
Answer: Effects of received instrumental social support found in this study provide new evidence for the added value of integrating social support into the HAPA. |
Answer the question based on the following context: We purpose to verify if paraoxonase 1 (PON1) activity may be a marker of cardiovascular risk in a young Tunisian population with type 1 diabetes (T1D). PON1 activity was measured by a kinetic method using paraoxon as substrate. The other parameters were determined by automated methods. One hundred and nine children and adolescents with T1D and 97 healthy subjects were involved in this study. PON1 activity and PON1/HDL-cholesterol ratio were significantly decreased in diabetics (303 ± 174 vs. 372 ± 180 U/L and 221 ± 139 vs. 298 ± 20 1U/mmol, P=0.006, P=0.002, respectively) compared to controls. A significant increase in total cholesterol, LDL-c and microalbuminuria was observed in diabetics compared to controls. PON1 activity was decreased by 9.5% in patients with diabetes duration ≥ 6 years, by 28.4% for those with fasting glycemia ≥ 7 mmol/L (P<0.001), by 14% in those with HbA1c ≥ 8% and by 12.3% for diabetics with dyslipidemia. PON1 activity is reduced when the number of cardiovascular risk factors increases (P<0.001). | Is paraoxonase 1 a marker of cardiovascular risk in youth with type 1 diabetes? | PON1 seems to be associated to cardiovascular risk markers in T1D. This result remains to be seen. Nevertheless, improving PON1 activity could be a significant target for reducing cardiovascular risk. | Question: Is paraoxonase 1 a marker of cardiovascular risk in youth with type 1 diabetes?
Answer: PON1 seems to be associated to cardiovascular risk markers in T1D. This result remains to be seen. Nevertheless, improving PON1 activity could be a significant target for reducing cardiovascular risk. |
Answer the question based on the following context: Pancreatitis is the most severe complication of ERCP. The aim of this study was to assess whether the use of potentially pancreatotoxic drugs is a risk factor for post-ERCP pancreatitis. Risk factors for post-ERCP pancreatitis and all drugs taken during the month before ERCP were recorded retrospectively in a database. Patients with other causes of acute pancreatitis or chronic pancreatitis were excluded from the analysis. Post-ERCP pancreatitis was defined as abdominal pain and/or vomiting associated with amylase/lipase plasma levels equal to or greater than twice the upper normal value. A total of 173 patients (95 men, 78 women; mean age, 68 [16] years) were included. Post-ERCP pancreatitis occurred in 31 patients (18%). Several risk factors were identified in a multivariate analysis: difficulty in cannulation (p<0.001), endoscopic sphincterotomy (p<0.005), and female gender (p=0.02). Having taken potent pancreatotoxic drugs increased the occurrence of post-ERCP pancreatitis: odds ratio 3.7: 95% confidence intervals [1.1,12.4], p=0.04. | Are drugs a risk factor of post-ERCP pancreatitis? | Use of pancreatotoxic drugs before or during ERCP significantly increased the risk of post-ERCP pancreatitis. Thus, discontinuation of the use of such drugs before ERCP seems justified whenever possible. | Question: Are drugs a risk factor of post-ERCP pancreatitis?
Answer: Use of pancreatotoxic drugs before or during ERCP significantly increased the risk of post-ERCP pancreatitis. Thus, discontinuation of the use of such drugs before ERCP seems justified whenever possible. |
Answer the question based on the following context: On 1 October 2008, in an effort to stimulate efforts to prevent catheter-associated urinary tract infection (CAUTI), the Centers for Medicare&Medicaid Services (CMS) implemented a policy of not reimbursing hospitals for hospital-acquired CAUTI. Since any urinary tract infection present on admission would not fall under this initiative, concerns have been raised that the policy may encourage more testing for and treatment of asymptomatic bacteriuria. We conducted a retrospective multicenter cohort study with time series analysis of all adults admitted to the hospital 16 months before and 16 months after policy implementation among participating Society for Healthcare Epidemiology of America Research Network hospitals. Our outcomes were frequency of urine culture on admission and antimicrobial use. A total of 39 hospitals from 22 states submitted data on 2 362 742 admissions. In 35 hospitals affected by the CMS policy, the median frequency of urine culture performance did not change after CMS policy implementation (19.2% during the prepolicy period vs 19.3% during the postpolicy period). The rate of change in urine culture performance increased minimally during the prepolicy period (0.5% per month) and decreased slightly during the postpolicy period (-0.25% per month; P<.001). In the subset of 10 hospitals providing antimicrobial use data, the median frequency of fluoroquinolone antimicrobial use did not change substantially (14.6% during the prepolicy period vs 14.0% during the postpolicy period). The rate of change in fluoroquinolone use increased during the prepolicy period (1.26% per month) and decreased during the postpolicy period (-0.60% per month; P<.001). | Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? | We found no evidence that CMS nonpayment policy resulted in overtesting to screen for and document a diagnosis of urinary tract infection as present on admission. | Question: Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing?
Answer: We found no evidence that CMS nonpayment policy resulted in overtesting to screen for and document a diagnosis of urinary tract infection as present on admission. |
Answer the question based on the following context: Self-rated health (SRH) is widely used to compare population health across countries, but comparability is often hampered by the use of different versions of this item. This study compares the WHO recommended version (ranging from 'very good' to 'very bad') with the US version (ranging from 'excellent' to 'poor') in European countries. Data came from the Survey of Health, Ageing and Retirement in Europe (SHARE). Both the WHO and US versions of SRH were measured in representative samples of Europeans aged 50+ (n = 11,643) in five countries. Concordance between the two SRH versions and differences in their associations with demographics, chronic diseases, functioning and depression were assessed using ordered probit regression. The US version has a more symmetric distribution and larger variance than the WHO version. Although the WHO version discriminates better at the positive end, the US version shows better discrimination at the positive end of the scale. Sixty-nine percent of respondents provided literally concordant answers, while only about one-third provided relatively concordant answers. Overall, however, less than 10% of respondents were discordant in either sense. The two versions were strongly correlated (polychoric correlation = 0.88), had similar associations with demographics and health indicators, and showed a similar pattern of international variation. | Are different measures of self-rated health comparable? | Health levels based on different measurements of SRH are not directly comparable and require rescaling of items. However, both versions represent parallel assessments of the same latent health variable. We did not find evidence that the WHO version is preferable to the US version as standard measure of SRH in European countries. | Question: Are different measures of self-rated health comparable?
Answer: Health levels based on different measurements of SRH are not directly comparable and require rescaling of items. However, both versions represent parallel assessments of the same latent health variable. We did not find evidence that the WHO version is preferable to the US version as standard measure of SRH in European countries. |
Answer the question based on the following context: To assess whether the presence of neuroendocrine (NE) cells is of value as an independent indicator of poor prognosis in patients with prostate carcinoma. A series of 160 consecutive patients with prostate carcinoma was studied retrospectively. In 120 there was sufficient tissue for review and to perform immunoperoxidase stains for neuron specific enolase (NSE) and chromogranin A (CGA). All patients had a potential follow-up of at least 5 years. Five-year survival was poorer for patients with a high tumour grade and stage at presentation compared to those with a lower grade and stage. NE cells were more common in higher grade and stage disease, but 5-year survival did not differ significantly between patients with NE cell positive and negative tumours. | Are neuroendocrine cells of practical value as an independent prognostic parameter in prostate cancer? | NE cells are of no practical value as an independent prognostic indicator in patients with prostatic adenocarcinoma. | Question: Are neuroendocrine cells of practical value as an independent prognostic parameter in prostate cancer?
Answer: NE cells are of no practical value as an independent prognostic indicator in patients with prostatic adenocarcinoma. |
Answer the question based on the following context: Human neutrophiles play a crucial role in inmate immunity. Inmate and aquired immune response depend on their functional condition at the first stage of an inflammation process. Reactive forms of oxygen (RFO) produced by neutrophiles play a significant role in the eradication of pathogens as well as in the regulation of immune response. The aim of this study is question, does the hearing loss affect the inmate immunity? The RFO production was directly examined in four systems - without stimulation, after stimulation with fMLP, opsonized zymosan or PMA. Direct RFO measurement was performed chemiluminescency evaluation using the whole blood, which indirectly depend on RFO production. In the group of children with hearing loss was observed disturbances in RFO productions. | Does the hearing loss affect the child's innate immunity? | This observation is very original and important for general practice. | Question: Does the hearing loss affect the child's innate immunity?
Answer: This observation is very original and important for general practice. |
Answer the question based on the following context: We studied patients with coronary artery disease (CAD) and complete atrioventricular (AV) block of acute onset that were treated with coronary artery bypass grafting (CABG) to see whether revascularization can restore the sinus rhythm. CABG was performed on eight patients with newly developed complete AV block and severe CAD. The distribution of coronary artery lesions showed a type IV pattern in six patients and a type II pattern in two patients. Complete revascularization was performed in six patients. Left anterior descending artery was revascularized in all eight patients. The patients were followed-up after operation for approximately 10 days before the implantation of a permanent pacemaker to see if they recover from AV block. The mean interval from development of complete AV block to operation was 3.63 +/- 1.3 days. There was no operative and/or early mortality. None of the patients recovered from complete AV block after coronary revascularization. Early morbidity was not detected. The mean hospital stay (12.75 +/- 1.49 days) and intensive care unit stay (30.25 +/- 19.39 hours) were relatively long because of the delay in permanent pacemaker implantation. All patients were asymptomatic at the end of their follow-up period (23.38 +/- 18.41 months). | Can revascularization restore sinus rhythm in patients with acute onset atrioventricular block? | Preoperatively developed complete AV block did not adversely affect the operative and early postoperative outcome of CABG operations. Recovery from complete AV block cannot be achieved by coronary revascularization performed 3.63 +/- 1.3 days after the onset of complete AV block. | Question: Can revascularization restore sinus rhythm in patients with acute onset atrioventricular block?
Answer: Preoperatively developed complete AV block did not adversely affect the operative and early postoperative outcome of CABG operations. Recovery from complete AV block cannot be achieved by coronary revascularization performed 3.63 +/- 1.3 days after the onset of complete AV block. |
Answer the question based on the following context: Since 2011, all acute general surgical admissions have been managed by the consultant-led emergency general surgery service (EGS) at our institution. We aim to compare EGS management of acute biliary disease to its preceding model. Retrospective review of prospectively collated databases was performed to capture consecutive emergency admissions with biliary disease from 1st February 2009 to 31st January 2013. Patient demographics, surgical intervention, use of diagnostic radiology, histological diagnosis, complications and hospital length of stay (LOS) were retrieved. A total of 566 patients were included (pre-EGS 254 vs. EGS 312). In the EGS period, the number of patients having surgery on index admission increased from 43.7 to 58.7 % (p<0.001) as did use of intra-operative cholangiography from 75.7 to 89.6 % (p = 0.003). The conversion to open cholecystectomy rate also was reduced from 14.4 to 3.3 % (p<0.001). Overall, a 14 % reduction in use of multiple (>1) imaging modalities for diagnosis was noted (p = 0.003). There was a positive trend in reduction of bile leaks but no significant difference in the overall morbidity and mortality. Time to theatre was reduced by 1 day [pre-EGS 2.7 (IQR 1.5-5.0) vs. EGS 1.7 (IQR 1.2-2.6) p<0.001]. The overall hospital LOS was reduced by 1.5 days [pre-EGS 5.0 (IQR 3-7) vs. EGS 3.5 (IQR 2-5) p<0.001]. | Emergency Management of Gallbladder Disease: Are Acute Surgical Units the New Gold Standard? | Since the advent of EGS, more judicious use of diagnostic radiology, reduced complications, reduced LOS, reduced time to theatre and an increased rate of definitive management during the index admission were demonstrated. | Question: Emergency Management of Gallbladder Disease: Are Acute Surgical Units the New Gold Standard?
Answer: Since the advent of EGS, more judicious use of diagnostic radiology, reduced complications, reduced LOS, reduced time to theatre and an increased rate of definitive management during the index admission were demonstrated. |
Answer the question based on the following context: Patient dissatisfaction has been previously associated with motor block in shoulder surgery patients receiving brachial plexus block. For elective minor wrist and hand surgery, we tested whether a regional block accelerating the early return of upper extremity motor function would improve patient satisfaction compared with a long-acting proximal brachial plexus block. A total of 177 patients having elective 'minor' wrist and hand surgery under awake regional block randomly received adrenalized infraclavicular lidocaine 2% 10 ml+ropivacaine 0.75% 20 ml ('long acting', n=90), or adrenalized infraclavicular lidocaine 1.5% 30 ml+long-acting distal median, radial, and ulnar nerve blocks selected according to the anticipated area of postoperative pain ('short acting', n=87). A blinded observer questioned patients on day 1 for numerically rated (0-10) subjective outcomes. With 95% power, there was no evidence for a 1-point satisfaction shift in the short acting group: satisfaction was similarly high for both groups [median (inter-quartile range)=10 (8-10) vs 10 (8-10), P=0.71], and also demonstrated strong evidence for equivalence [mean difference (95% confidence interval)=-0.18 (-0.70 to 0.35)]. There was no difference between the groups for weakness- or numbness-related dissatisfaction (low for both groups), or for numerically rated or time to first pain. Surgical anaesthesia success was similar between the groups (short acting, 97% vs 93%, P=0.50), although more patients in the short acting group had surgery initiated in ≤25 min (P=0.03). | Does motor block related to long-acting brachial plexus block cause patient dissatisfaction after minor wrist and hand surgery? | Patient satisfaction is not improved after elective minor wrist and hand surgery with a regional block accelerating the early return of motor function. For this surgery, motor block related to a long-acting brachial plexus block does not appear to cause patient dissatisfaction. Clinical Trial Registration number. ACTRN12610000749000, https://www.anzctr.org.au/registry/trial_review.aspx?ID=335931. | Question: Does motor block related to long-acting brachial plexus block cause patient dissatisfaction after minor wrist and hand surgery?
Answer: Patient satisfaction is not improved after elective minor wrist and hand surgery with a regional block accelerating the early return of motor function. For this surgery, motor block related to a long-acting brachial plexus block does not appear to cause patient dissatisfaction. Clinical Trial Registration number. ACTRN12610000749000, https://www.anzctr.org.au/registry/trial_review.aspx?ID=335931. |
Answer the question based on the following context: The study was designed to test whether neuroticism moderated the effect of extroversion and mediated the impact of menopause status on depressive symptoms among women in Taiwan during their menopausal transition. A sample of 197 women, aged 40 to 60 years, were recruited from the community. We used Ko's Depression Inventory, the Five-Factor Inventory-Chinese version, the Menopausal Symptoms Scale, and the Chinese version of the Modified Schedule of Affective Disorders and Schizophrenia-Lifetime to gather data. Moreover, each woman underwent a semistructured diagnostic interview in person to obtain her lifetime psychiatric history. The hierarchy regression analyses showed that the interaction between neuroticism and extroversion was statistically significant. Further analyses indicated that in the high neuroticism group, extroversion was negatively associated with depressive symptoms; however, in the low neuroticism group, extroversion was not correlated with depressive symptoms. Menopause status was correlated with depressive symptoms, but after adding neuroticism and extroversion, the main effect of menopause status became insignificant. Results of the Sobel test showed that depressive symptoms of women during the menopause transition largely represented neuroticism. | The impact of extroversion or menopause status on depressive symptoms among climacteric women in Taiwan: neuroticism as moderator or mediator? | The present study revealed that the lower levels of extroversion are associated with depression among all stages of menopausal women with high levels of neuroticism; moreover, all stages of menopausal women who have high levels of neuroticism are more vulnerable to depression. The results support that personality may play an important role in women's depression during the transition of menopausal status. | Question: The impact of extroversion or menopause status on depressive symptoms among climacteric women in Taiwan: neuroticism as moderator or mediator?
Answer: The present study revealed that the lower levels of extroversion are associated with depression among all stages of menopausal women with high levels of neuroticism; moreover, all stages of menopausal women who have high levels of neuroticism are more vulnerable to depression. The results support that personality may play an important role in women's depression during the transition of menopausal status. |
Answer the question based on the following context: To find a parameter that would discriminate between the patients with idiopathic interstitial pneumonia who survived to undergo transplantation and those who died while waiting to undergo transplantation. A retrospective review was performed of all lung transplant referrals for idiopathic interstitial pneumonia that were listed with United Network for Organ Sharing at the University of California San Diego from January 1990 to February 1999. Of the 331 patients who were listed, 48 met the eligibility criteria. Patient demographics, radiographic studies, pathology reports, and the results of resting and exercise cardiopulmonary function tests were recorded from each patient's chart. Patients were divided into the following two groups: those patients who survived until transplantation and those still waiting were classified as "alive"; and those patients who died before undergoing transplantation were classified as "deceased." Forty-three of 48 patients had a pathologic diagnosis. The cohort included 25 patients with usual interstitial pneumonitis, 3 patients with nonspecific interstitial pneumonitis, 1 patient with desquamative interstitial pneumonitis, and 14 patients with interstitial lung disease of unknown etiology. The only significant difference between the two groups was resting PaO(2) (p = 0.035). A stepwise multivariate analysis demonstrated that PaO(2) and FEV(1)/FVC ratio were significantly associated with survival (hazards ratio, 1.06; confidence interval, 0.99 to 1.13; p = 0.019). | Predicting survival of lung transplantation candidates with idiopathic interstitial pneumonia: does PaO(2) predict survival? | A survival analysis using PaO(2) and FEV(1)/FVC ratio values proved to be statistically significant, but a prospective trial is needed to determine the clinical relevance of these parameters for predicting survival in patients with idiopathic interstitial pneumonia. | Question: Predicting survival of lung transplantation candidates with idiopathic interstitial pneumonia: does PaO(2) predict survival?
Answer: A survival analysis using PaO(2) and FEV(1)/FVC ratio values proved to be statistically significant, but a prospective trial is needed to determine the clinical relevance of these parameters for predicting survival in patients with idiopathic interstitial pneumonia. |
Answer the question based on the following context: To investigate the frequency of Alzheimer-related dementia in patients with pseudoexfoliation syndrome (PEX). Sixty-seven patients with PEX and 67 age-, gender-, and educational-background-matched control subjects were compared for the presence of Alzheimer-related dementia according to DSM- IV-TR. The effects of cataract, glaucoma, additional ocular and systemic disease on the dementia incidence were also evaluated in patients with PEX and the control group. The frequency of Alzheimer-related dementia was higher in patients with PEX (p = 0.0001). The frequency of dementia in patients who had cataract was higher than in patients without cataract (p = 0.003). There was also an association between additional ocular disease and dementia (p < 0.05). However, there was no association between systemic disease and dementia (p > 0.05). Furthermore, there was no difference for the frequency of dementia between patients who had glaucoma or not among patients with PEX (p = 0.953). | Is there any relation between pseudoexfoliation syndrome and Alzheimer's type dementia? | The increased frequency of Alzheimer-related dementia in patients with PEX is important and a possible association between PEX and Alzheimer's disease could be present. | Question: Is there any relation between pseudoexfoliation syndrome and Alzheimer's type dementia?
Answer: The increased frequency of Alzheimer-related dementia in patients with PEX is important and a possible association between PEX and Alzheimer's disease could be present. |
Answer the question based on the following context: Although delayed union or pseudoarthrosis after lumbar arthrodesis has been recognized as a major radiographic complication, little has been known about the effect of fusion status on the patient's quality-of-life (QOL) outcome. The purpose of this study was to investigate the effects of fusion status after posterior lumbar interbody fusion (PLIF) on QOL outcomes by using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Among 100 patients who underwent single level PLIF for spinal canal stenosis, 29 who had not achieved fusion (incomplete fusion group) and 29 age- and sex ratio-matched patients who had achieved fusion (fusion group) 6 months after surgery were enrolled. Overall clinical evaluation was performed before and 6 months after surgery: the physician determined the Japanese Orthopaedic Association Score for Low Back Pain (JOA score); the JOABPEQ and visual analogue scale (VAS) values were collected. The recovery rate of the JOA score, changes in all JOABPEQ subdomain scores and in the VAS values were calculated. All variables were compared between the groups. The preoperative JOA scores, JOABPEQ scores of all subdomains, and VAS values of all categories did not differ between the groups. The recovery rate was higher in the fusion group than the incomplete fusion group (p = 0.0185). The changes in the JOABPEQ scores for walking ability and social life function were significantly greater in the fusion group than the incomplete fusion group (walking ability, p = 0.0172; social life function, p = 0.0191). The postoperative VAS values and changes in the VAS values for all categories did not differ between the groups. | Does fusion status after posterior lumbar interbody fusion affect patient-based QOL outcomes? | Incomplete fusion after PLIF correlated with poor improvement in walking ability and social life function. Therefore, the achievement of fusion after PLIF is essential to obtain better patient QOL outcomes. | Question: Does fusion status after posterior lumbar interbody fusion affect patient-based QOL outcomes?
Answer: Incomplete fusion after PLIF correlated with poor improvement in walking ability and social life function. Therefore, the achievement of fusion after PLIF is essential to obtain better patient QOL outcomes. |
Answer the question based on the following context: To study the effect and mechanism of action of nonylphenol (NP), an environmental oestrogen, on uterine leiomyoma (UL) cells. Primary culture and subculture of human UL cells, identified as smooth muscle cells by immunocytochemical staining with a monoclonal anti-α-smooth muscle actin antibody, were performed. The viability of cells treated with various concentrations of NP for 24, 48 and 72h was determined by CCK-8 assay. mRNA expression of oestrogen receptor α (ERα), insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF) was detected using real-time quantitative polymerase chain reaction, and protein expression was detected using Western blot analysis for all groups. NP promoted the growth of UL cells and expression of ERα, IGF-1 and VEGF; this was positively correlated with the concentration and duration of NP treatment. | Does nonylphenol promote the growth of uterine fibroids? | NP promotes the growth of UL cells. The mechanism of action appears to be over-expression of IGF-1 and VEGF, up-regulated by ERα, resulting in the growth of UL cells. | Question: Does nonylphenol promote the growth of uterine fibroids?
Answer: NP promotes the growth of UL cells. The mechanism of action appears to be over-expression of IGF-1 and VEGF, up-regulated by ERα, resulting in the growth of UL cells. |
Answer the question based on the following context: The impact of diaphragmatic invasion in patients with colorectal liver metastases (CRLMs) remains poorly evaluated. We aimed to evaluate feasibility and safety of laparoscopic right hepatectomy (LRH) with or without diaphragmatic resection for CRLM. From 2002 to 2012, 52 patients underwent LRH for CRLM. Of them, 7 patients had combined laparoscopic partial diaphragmatic resection ("diaphragm" group). Data were retrospectively collected and short and long-term outcomes analyzed. Operative time was lower in the control group (272 vs 345 min, P = .06). Six patients required conversion to open surgery. Blood loss and transfusion rate were similar. Portal triad clamping was used more frequently in the "diaphragm" group (42.8% vs 6.6%, P = .02). Maximum tumor size was greater in the "diaphragm" group (74.5 vs 37.1 mm, P = .002). Resection margin was negative in all cases. Mortality was nil and general morbidity similar in the 2 groups. Specific liver-related complications occurred in 2 patients in the "diaphragm" group and 17 in the control group (P = .69). Mean hospital stay was similar (P = 56). Twenty-two (42.3%) patients experienced recurrence. One-, 3-, and 5-year overall survival after surgery in "diaphragm" and control groups were 69%, 34%, 34%, and 97%, 83%, 59%, respectively (P = .103). One- and 3-year disease-free survival after surgery in "diaphragm" and control groups were 57%, 47% and 75%, 54%, respectively (P = .310). | Laparoscopic right hepatectomy combined with partial diaphragmatic resection for colorectal liver metastases: Is it feasible and reasonable? | LRH with en-bloc diaphragmatic resection could be reasonably performed for selected patients in expert centers. Technical difficulties related to diaphragmatic invasion must be circumvented. Further experience must be gained to confirm our results. | Question: Laparoscopic right hepatectomy combined with partial diaphragmatic resection for colorectal liver metastases: Is it feasible and reasonable?
Answer: LRH with en-bloc diaphragmatic resection could be reasonably performed for selected patients in expert centers. Technical difficulties related to diaphragmatic invasion must be circumvented. Further experience must be gained to confirm our results. |
Answer the question based on the following context: To determine the frequency of avoidable neonatal neurological damage. We carried out a retrospective study from January 1st to December 31st 2003, including all children transferred from a level I or II maternity unit for suspected neurological damage (SND). Only cases confirmed by a persistent abnormality on clinical examination, EEG, transfontanelle ultrasound scan, CT scan or cerebral MRI were retained. Each case was studied in detail by an expert committee and classified as "avoidable", "unavoidable" or "of indeterminate avoidability." The management of "avoidable" cases was analysed to identify potentially avoidable factors (PAFs): not taking into account a major risk factor (PAF1), diagnostic errors (PAF2), suboptimal decision to delivery interval (PAF3) and mechanical complications (PAF4). In total, 77 children were transferred for SND; two cases were excluded (inaccessible medical files). Forty of the 75 cases of SND included were confirmed: 29 were "avoidable", 8 were "unavoidable" and 3 were "of indeterminate avoidability". Analysis of the 29 avoidable cases identified 39 PAFs: 18 PAF1, 5 PAF2, 10 PAF3 and 6 PAF4. Five had no classifiable PAF (0 death), 11 children had one type of PAF (one death), 11 children had two types of PAF (3 deaths), 2 had three types of PAF (2 deaths). | Is neonatal neurological damage in the delivery room avoidable? | Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors. | Question: Is neonatal neurological damage in the delivery room avoidable?
Answer: Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors. |
Answer the question based on the following context: The differentiation of a pituitary non-functioning macroadenoma from a macroprolactinoma is important for planning appropriate therapy. Serum PRL levels have been suggested as a useful diagnostic indicator. However, values between 2500 and 8000 mU/l are a grey area and are currently associated with diagnostic uncertainty. We wished therefore, to investigate the serum PRL values in a large series of patients presenting with apparently non-functioning pituitary macroadenomas. All patients presenting to the Department of Endocrinology in Oxford with clinically non-functioning pituitary macroadenomas (later histologically verified) between 1990 and 2005 were studied. Information documented in the notes on the medications and on the presence of conditions capable of affecting the serum PRL levels at the time of blood sampling was also collected. Two hundred and twenty-six patients were identified (median age at diagnosis 55 years, range 18-88 years; 146 males/80 females; 143 gonadotroph, 46 null cell, 25 plurihormonal and 12 silent ACTH adenomas). All tumours had suprasellar extension. At the time of blood sampling 41 subjects were taking medications capable of increasing serum PRL. Hyperprolactinaemia was found in 38.5% (87/226) of the patients. The median serum PRL values in the total group were 386 mU/l (range 16-3257) (males: median 299 mU/l, range 16-1560; females: median 572 mU/l, range 20-3257) and in those not taking drugs capable of increasing serum PRL 363 mU/l (range 16-2565) (males: median 299 mU/l, range 16-1560; females: median 572 mU/l, range 20-2565). Serum PRL<2000 mU/l was found in 98.7% (223/226) of the total group and in 99.5% (184/185) of those not taking drugs. Among the three subjects with serum PRL>2000 mU/l, two were taking oestrogen preparations. | Do the limits of serum prolactin in disconnection hyperprolactinaemia need re-definition? | Based on a large series of histologically confirmed cases, serum PRL>2000 mU/l is almost never encountered in nonfunctioning pituitary macroadenomas. Values above this limit in the presence of a macroadenoma should not be surrounded by diagnostic uncertainty (after acromegaly or Cushing's disease have been excluded); a prolactinoma is the most likely diagnosis and a dopamine agonist should be considered as the treatment of choice. | Question: Do the limits of serum prolactin in disconnection hyperprolactinaemia need re-definition?
Answer: Based on a large series of histologically confirmed cases, serum PRL>2000 mU/l is almost never encountered in nonfunctioning pituitary macroadenomas. Values above this limit in the presence of a macroadenoma should not be surrounded by diagnostic uncertainty (after acromegaly or Cushing's disease have been excluded); a prolactinoma is the most likely diagnosis and a dopamine agonist should be considered as the treatment of choice. |
Answer the question based on the following context: Coronal malalignment of the lower extremity is closely related to the onset and progression of osteoarthritis. Restoring satisfactory alignment after tibial osteotomy improves the long-term success of this conservative surgery. The purpose of our study was to determine (1) if there is a difference between two-dimensional (2D) and 3D measurements of the hip-knee-ankle (HKA) angle between the mechanical axes of the femur and the tibia, (2) which parameter most affects 2D-3D HKA measurement, and (3) the percentage of patients who are at risk of error in HKA measurement. We reviewed imaging studies of the consecutive patients referred to us for hip or knee pain between June and October 2013. Patients with previous pelvis or lower extremity surgery were excluded. In 51 % (95/186) of lower extremities examined, the 3D method showed more valgus than the 2D method, and in 49 % (91/186), the 3D method showed more varus. In 12 % of extremities (23/186), the knee varus or valgus alignment was completely opposite in 3D images compared to 2D images. Having more than 7° of flexum/recurvatum alignment increased error in 2D HKA measurement by 5.7°. This was calculated to be 0.15° per 1° increase in femoral torsion and 0.05° per 1° increase in tibial torsion. Approximately 20 % of patients might be at risk of error in HKA angle measurement in 2D imaging studies. | Are advanced three-dimensional imaging studies always needed to measure the coronal knee alignment of the lower extremity? | Orthopaedic surgeons should assess lower extremity alignment in standing position, with enough exposure of the extremity to find severe alignment or rotational deformities, and consider advanced 3D images of those patients who have them. Otherwise, HKA angle can be measured with good accuracy with 2D techniques. | Question: Are advanced three-dimensional imaging studies always needed to measure the coronal knee alignment of the lower extremity?
Answer: Orthopaedic surgeons should assess lower extremity alignment in standing position, with enough exposure of the extremity to find severe alignment or rotational deformities, and consider advanced 3D images of those patients who have them. Otherwise, HKA angle can be measured with good accuracy with 2D techniques. |
Answer the question based on the following context: Rotating instruments in dentistry are radiating an unpleasant high-frequency noise, which was supposed to produce hearing loss by its loudness. Therefore frequently notifications and recognizing procedures were initiated because of the suspicion of occupational noise-induced hearing loss (German listing for occupational diseases as given by decree: Number 2301). In recent years dentists, dental technicians and dental assistants repeatedly had to be tested because of a suspicion for noise-induced inner ear damage. Noise measurements were performed in 3 working places of dentists and 7 dental laboratories. In regard to dentists and dental assistants it was found that the aspirator, not the rotating instruments, was the most intense source for noise in the office. The averaged daily noise level was measured between 70 and 77 db(A) and was therefore obviously below the inner ear damaging limit of 85 dB(A). For dental technicians the on-site related averaged daily noise level was about 68 dB(A) and the person related averaged daily noise level was about 76 dB(A). In some particular cases 80 dB(A) were exceeded, but relevant levels for an occupational noise trauma were not reached. It has to be taken into consideration that the rotating instruments got a considerable noise reduction in the last decade. Additionally it has to be taken into account for the calculation that the averaged running time of rotating instruments is 30 minutes per day in the office. Therefore, a notification or a recognizing procedure can regularly stand aside. | Are professional dental health care workers (dentists, dental technicians, assistants) in danger of noise induced hearing loss? | An endangering by noise as given by the German occupational disease decree (more than 85 db(A)) cannot usually be expected for the dentist, the dental assistant and the dental technician. | Question: Are professional dental health care workers (dentists, dental technicians, assistants) in danger of noise induced hearing loss?
Answer: An endangering by noise as given by the German occupational disease decree (more than 85 db(A)) cannot usually be expected for the dentist, the dental assistant and the dental technician. |
Answer the question based on the following context: Falls have become increasingly focussed in the current discussion about patient safety and quality indicators because falls are one of the most frequently documented problems during geriatric treatment in hospital. We compared 811 "fallers" (total number of falls: 1177) and 5229 "non-fallers" in a geriatric hospital. The research question was: Are falls associated with an outcome of lower mobility (Barthel Index) at discharge? A significant difference between the two groups was found in the following items: female (fallers 63.4% vs. non-fallers 69.8%), hospital stay (fallers 27.1 days vs. non-fallers 19.3 days), Barthel Index at admission (fallers 39.3 pts vs. non-fallers 48.3 pts). No linear relationship was found between the rate of falls and the mobility (Barthel Index at discharge). The lowest fall rates were found in the BI groups 80-100 pts (6.4%) and 0-20 pts (13.1%). A higher rate of falls was associated with a better outcome in two of the three mobility-related items of the Barthel Index (transfer, walk/wheelchair). 44% of the falls resulted in injuries or pain. | In-hospital falls: a quality indicator? | The comparison of fall rates requires risk adjustment. Falls are not a suitable quality indicator. | Question: In-hospital falls: a quality indicator?
Answer: The comparison of fall rates requires risk adjustment. Falls are not a suitable quality indicator. |
Answer the question based on the following context: This study investigated the relationship between B(12) (cobalamin) levels and incontinence in older outpatients using secondary data analysis. Between 1991 and 1999, there were 929 patients (258 men and 671 women) for whom urinary incontinence (UI), fecal incontinence (FI), and B(12) were prospectively recorded. Covariates included race, gender, age, medications, Mini-Mental State Examination, modified illness rating, and instrumental activities of daily living (IADLs). Some form of incontinence (UI or FI or both) was found in 41% of subjects, isolated UI in 34%, double incontinence (DI) in 12%, and isolated FI in 4%. Having UI increased the risk of also having FI (p<.0001). Serum B(12) levels of 300 pg/ml or less were not predictive of isolated UI or isolated FI. However, in logistic regression, DI was predicted by B(12) (odds ratio [OR] = 2.113, p =.0094), IADLs (OR = 0.810, p<.0001), cathartics/laxative use (OR = 1.902, p =.126), and diuretic use (OR = 2.226, p =.006). Considering isolated UI in women, higher IADLs reduced risk of UI (OR = 0.956, p =.002), while diuretics (OR = 1.481, p =.041) and antihistamines (OR = 1.909, p =.046) both increased risk of UI. In men, only use of anticonvulsant medications (OR = 4.529, p =.023) increased risk of isolated UI. Greater physical illness in both genders increased risk of isolated FI (OR = 1.204, p =.006). | Vitamin B(12) deficiency and incontinence: is there an association? | These findings suggest that serum B(12) at levels of 300 pg/ml or less are not associated with isolated UI or isolated FI but may play a role in DI. A possible association of low B(12) levels with DI is intriguing because of the implications for treatment and prevention. More immediately, medication side effects should be considered when evaluating this problem. | Question: Vitamin B(12) deficiency and incontinence: is there an association?
Answer: These findings suggest that serum B(12) at levels of 300 pg/ml or less are not associated with isolated UI or isolated FI but may play a role in DI. A possible association of low B(12) levels with DI is intriguing because of the implications for treatment and prevention. More immediately, medication side effects should be considered when evaluating this problem. |
Answer the question based on the following context: The purposes of this study were to describe the imaging features and metastatic pattern of non-inferior vena cava (IVC) retroperitoneal leiomyosarcomas (non-IVC LMS) and to compare them with those of IVC leiomyosarcomas (IVC LMS) to assess any differences between the 2 groups. In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, all 56 patients with pathologically confirmed primary retroperitoneal leiomyosarcoma (34 non-IVC LMS and 22 IVC LMS) seen at our tertiary cancer center during a 10-year period were included. All available imaging of primary tumor (18 non-IVC LMS and 19 IVC LMS) and follow-up imaging studies (on all 56 patients) were reviewed in consensus by 2 fellowship-trained oncoradiologists. Imaging features and metastatic spread of non-IVC LMS were described and compared with those of IVC LMS. Continuous variables were compared using the Student t test, binary variables with the Fisher exact test, and survival using the log-rank test. Non-inferior vena cava retroperitoneal leiomyosarcomas had a mean size of 11.3 cm (range, 3.7-27 cm) and most commonly occurred in the perirenal space (16/18). Primary tumors were hyperattenuating to muscle (11/18) and showed heterogeneous enhancement (17/18). Lungs (22/34), peritoneum (18/34), and liver (18/34) were the most common metastatic sites. There was no significant difference between the imaging features and metastatic pattern of non-IVC and IVC LMS. Although non-IVC LMS presented at a more advanced stage (P<0.002), there was statistically non-significant trend toward better median survival of non-IVC LMS (P = 0.07). | Imaging features and metastatic pattern of non-IVC retroperitoneal leiomyosarcomas: are they different from IVC leiomyosarcomas? | Non-inferior vena cava retroperitoneal leiomyosarcomas are large heterogeneous tumors arising in the perirenal space and frequently metastasize to lungs, peritoneum, and liver. From a radiologist's perspective, non-IVC LMS behave similar to IVC-LMS. | Question: Imaging features and metastatic pattern of non-IVC retroperitoneal leiomyosarcomas: are they different from IVC leiomyosarcomas?
Answer: Non-inferior vena cava retroperitoneal leiomyosarcomas are large heterogeneous tumors arising in the perirenal space and frequently metastasize to lungs, peritoneum, and liver. From a radiologist's perspective, non-IVC LMS behave similar to IVC-LMS. |
Answer the question based on the following context: Small, autogamous flowers have evolved repeatedly in the plant kingdom. While much attention has focused on the mechanisms that promote the shift to autogamy, there is still a paucity of information on the factors that underlie the reduction of flower size so prevalent in selfing lineages. In this study of Crepis tectorum, I examine the role of inbreeding, acting alone or together with selection, in promoting evolutionary reduction of flower size. Experimental crosses were performed to produce progeny populations that differed in inbreeding and (or) selection history. Progenies were grown in two different environments and scored for flower size and other characters. Inbreeding depressed flower and fruit size, but also caused changes in flowering time and the number of heads produced. Despite some inconsistencies in the results for the last progeny generation, the decline in flower size was persistent over generations, consistent across environments, and similar in magnitude to the effects of selection for small flower size and the floral reduction inferred to have taken place during the shift toward autogamy within the study species. The floral size reduction was largely independent of changes in overall vigor, and there was considerable adaptive potential in flower size (measured by sib analyses and parent-offspring comparisons) after inbreeding. | Does inbreeding promote evolutionary reduction of flower size? | The results of this study indicate that inbreeding can promote evolutionary reduction of flower size and highlight the close, persistent association between flower and fruit size in the study species. | Question: Does inbreeding promote evolutionary reduction of flower size?
Answer: The results of this study indicate that inbreeding can promote evolutionary reduction of flower size and highlight the close, persistent association between flower and fruit size in the study species. |
Answer the question based on the following context: Puerperal psychosis (PP) is a psychiatric disorder that occurs in 1 out of 1000 pregnancies. Well known since antiquity, its symptoms have often been described in mothers, but few studies have successfully investigated a related disorder in fathers. The characteristic of this pathology is more related to its appearance than to its semiological description which is why its nosographic place is always discussed. The objective here is to focus on the definition of PP and to suggest an entity for both genders. Our case report focused on the clinical description of an eighteen-year-old man suffering from an acute psychosis episode that occurred around the birth of his first child. Delusion followed a sudden decline in mood that lasted for a short period of time during the course of the third trimester of his wife's pregnancy. The delirium was rich with auditory and cenesthesic hallucinations, pregnancy and birth denial, feeling movements and hearing voices in his stomach. The symptoms disappeared after one month of treatment via an antipsychotic drug, risperidone. | Can men be included in the population subjected to puerperal psychosis? | We can confirm that the symptomatic description of the disorder in this patient fits the classical descriptions of PP. Two elements make the PP different from other acute psychoses: the context of pregnancy and delirium focused on the child which can lead to a child murder. The absence of a framework precisely defining the PP does not improve its prevention and can lead to legal attitudes rather than medical care. Men suffering from acute psychosis in a context of pregnancy are submitted to the same risks as women. It is necessary to emphasize descriptions of PP in men to redefine the disease and consider that this entity involves both men and women. | Question: Can men be included in the population subjected to puerperal psychosis?
Answer: We can confirm that the symptomatic description of the disorder in this patient fits the classical descriptions of PP. Two elements make the PP different from other acute psychoses: the context of pregnancy and delirium focused on the child which can lead to a child murder. The absence of a framework precisely defining the PP does not improve its prevention and can lead to legal attitudes rather than medical care. Men suffering from acute psychosis in a context of pregnancy are submitted to the same risks as women. It is necessary to emphasize descriptions of PP in men to redefine the disease and consider that this entity involves both men and women. |
Answer the question based on the following context: To determine the experience, attitudes, and opinions of program directors regarding the reintroduction of residents in recovery from substance abuse into the clinical practice of anesthesiology. Survey instrument. Anesthesia residency training programs in the United States. After obtaining institutional review board approval, a list of current academic anesthesia residency programs in the United States was compiled. A survey was mailed to 131 program directors along with a self-addressed stamped return envelope to ensure anonymity. Returned surveys were reviewed and data compiled by hand, with categorical variables described as frequency and percentages. A total of 91 (69%) surveys were returned, representing experience with 11,293 residents over the ten-year period from July of 1997 through June of 2007. Fifty-six (62%) program directors reported experience with at least one resident requiring treatment for substance abuse. For residents allowed to continue with anesthesia residency training after treatment, the relapse rate was 29%. For those residents, death was the initial presentation of relapse in 10% of the reported cases. 43% of the program directors surveyed believe residents in recovery from addiction should be allowed to attempt re-entry while 30% believe that residents in recovery from addiction should not. | Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? | The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed. | Question: Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia?
Answer: The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed. |
Answer the question based on the following context: Direct dorsal rootlet stimulation with intraoperative electrophysiological monitoring is an adjunct to clinical evaluation during selective posterior rhizotomy. The purpose of this study was to evaluate the impact of ketamine on intraoperative electrophysiological monitoring during selective posterior rhizotomy. Specifically, we sought to determine if low dose ketamine given as part of the anesthesia was associated with changes in intraoperative electrophysiological monitoring in patients who underwent selective posterior rhizotomy. A retrospective cohort study was conducted using anesthetic records and electrophysiological records of 32 children who had intraoperative electrophysiological monitoring during selective posterior rhizotomy under general anesthesia. Administration and dosage of ketamine preceding the stimulation of dorsal roots was determined from the anesthetic record. A pediatric neurologist, blinded to patient, and to ketamine exposure, evaluated different electrophysiological criteria. Eight children received ketamine and 24 did not receive it. The mean average dose of ketamine was 0.18 mg x kg(-1) (sd: 0.04). We did not find any statistically significant difference in intraoperative electrophysiological response between the ketamine and the control groups. However, we noted some trends: Administration of ketamine preceding the stimulation of dorsal roots was associated with a lower maximal threshold (2.7 mA vs 3.5 mA, P = 0.663) and root thresholds compared with children who did not receive ketamine. In addition, the train response following delivery of the suprastimulation tended to last longer with the presence of ketamine. | Does ketamine affect intraoperative electrophysiological monitoring in children undergoing selective posterior rhizotomy? | Administration of low dose ketamine preceding the stimulation of dorsal roots during selective posterior rhizotomy might be associated with lower maximal thresholds and a more sustained train response following stimulation. Physicians should be aware of this finding in order to avoid misinterpreting intraoperative electrophysiological monitoring. | Question: Does ketamine affect intraoperative electrophysiological monitoring in children undergoing selective posterior rhizotomy?
Answer: Administration of low dose ketamine preceding the stimulation of dorsal roots during selective posterior rhizotomy might be associated with lower maximal thresholds and a more sustained train response following stimulation. Physicians should be aware of this finding in order to avoid misinterpreting intraoperative electrophysiological monitoring. |
Answer the question based on the following context: To examine physician and patient characteristics related to the ordering of imaging studies in a general medicine practice and to determine whether physician gender influences ordering patterns. Retrospective cohort study. Hospital-based academic general medicine practice of 29 attending physicians. All 8,203 visits by 5,011 patients during a 6-month period. For each visit the following variables were abstracted from the electronic patient record: patient age, patient gender, visit urgency, visit type, and physician seen. All diagnostic imaging studies performed within 30 days of each outpatient visit were identified from the hospital's Radiology Information System. Screening mammography was not included in the analysis. Physician variables included gender and years since medical school graduation. Logistic regression analysis was used to evaluate the effect of various patient, physician, and visit characteristics on the probability of a diagnostic imaging study being ordered. Patient age, urgent visits, visit frequency, and the gender of the physician were all significantly related to the ordering of an imaging study. Correcting for all other factors, the ordering of an imaging study during an outpatient medical visit was 40% more likely if the physician was female (odds ratio = 1.40; 95% confidence interval [CI] 1.01, 1.95). Female physicians were 62% more likely (95% CI 0.99, 2.64) than male physicians to order an imaging study for a male patient and 21% more likely (95% CI 0.87, 1.69) to order an imaging study for a female patient. | Utilization of outpatient diagnostic imaging. Does the physician's gender play a role? | Physician gender is a predictor of whether an outpatient medical visit generates an imaging study. Reasons for this observation are unclear, but may be the result of different practice styles of male and female physicians or unmeasured patient characteristics. | Question: Utilization of outpatient diagnostic imaging. Does the physician's gender play a role?
Answer: Physician gender is a predictor of whether an outpatient medical visit generates an imaging study. Reasons for this observation are unclear, but may be the result of different practice styles of male and female physicians or unmeasured patient characteristics. |
Answer the question based on the following context: Administrative data are widely used to study health systems and make important health policy decisions. Yet little is known about the influence of coder characteristics on administrative data validity in these studies. Our goal was to describe the relationship between several measures of validity in coded hospital discharge data and 1) coders' volume of coding (>or = 13,000 vs.<13,000 records), 2) coders' employment status (full- vs. part-time), and 3) hospital type. This descriptive study examined 6 indicators of face validity in ICD-10 coded discharge records from 4 hospitals in Calgary, Canada between April 2002 and March 2007. Specifically, mean number of coded diagnoses, procedures, complications, Z-codes, and codes ending in 8 or 9 were compared by coding volume and employment status, as well as hospital type. The mean number of diagnoses was also compared across coder characteristics for 6 major conditions of varying complexity. Next, kappa statistics were computed to assess agreement between discharge data and linked chart data reabstracted by nursing chart reviewers. Kappas were compared across coder characteristics. 422,618 discharge records were coded by 59 coders during the study period. The mean number of diagnoses per record decreased from 5.2 in 2002/2003 to 3.9 in 2006/2007, while the number of records coded annually increased from 69,613 to 102,842. Coders at the tertiary hospital coded the most diagnoses (5.0 compared with 3.9 and 3.8 at other sites). There was no variation by coder or site characteristics for any other face validity indicator. The mean number of diagnoses increased from 1.5 to 7.9 with increasing complexity of the major diagnosis, but did not vary with coder characteristics. Agreement (kappa) between coded data and chart review did not show any consistent pattern with respect to coder characteristics. | Do coder characteristics influence validity of ICD-10 hospital discharge data? | This large study suggests that coder characteristics do not influence the validity of hospital discharge data. Other jurisdictions might benefit from implementing similar employment programs to ours, e.g.: a requirement for a 2-year college training program, a single management structure across sites, and rotation of coders between sites. Limitations include few coder characteristics available for study due to privacy concerns. | Question: Do coder characteristics influence validity of ICD-10 hospital discharge data?
Answer: This large study suggests that coder characteristics do not influence the validity of hospital discharge data. Other jurisdictions might benefit from implementing similar employment programs to ours, e.g.: a requirement for a 2-year college training program, a single management structure across sites, and rotation of coders between sites. Limitations include few coder characteristics available for study due to privacy concerns. |
Answer the question based on the following context: Upper limb robot-assisted rehabilitation is a highly intensive therapy, mainly recommended after stroke. Whether robotic therapy is suitable for subacute patients with severe impairments including cognitive disorders is unknown. This retrospective study explored factors impacting on motor performance achieved in a 16-session robotic training combined with standard rehabilitation. Seventeen subacute inpatients (age 53 ± 18; 49 ± 26 days post-stroke) were assessed at baseline using upper extremity motor impairments scales, Functional Independence Measure, aphasia and neglect scores. Number of movements and robotic assistance were compared between Session 2 (S2), 8 (8) and 16 (S16), Motricity Index between pre and post-treatment. Correlation analyses explored predictors of motor performance. Overall, number of movements and Motricity Index increased significantly while robot-assistance decreased. The mean number of movements per session correlated positively with baseline motor capacities but not with age, aphasia and neglect. However, the increase in Motricity index correlated negatively with baseline Motricity index and the increase in the number of movements correlated negatively with the number of movements at S2. | Do all sub acute stroke patients benefit from robot-assisted therapy? | High intensity robot-assisted training may be associated with motor improvement in subacute hemiparesis. More severely impaired patients may derive greater benefit from robot-assisted training; age, aphasia and neglect do not represent exclusion criteria. | Question: Do all sub acute stroke patients benefit from robot-assisted therapy?
Answer: High intensity robot-assisted training may be associated with motor improvement in subacute hemiparesis. More severely impaired patients may derive greater benefit from robot-assisted training; age, aphasia and neglect do not represent exclusion criteria. |
Answer the question based on the following context: To apply human error theory to explain non-adherence and examine how well it fits. Patients who were taking chronic medication were telephoned and asked whether they had been adhering to their medicine, and if not the reasons were explored and analysed according to a human error theory. Of 105 patients, 87 were contacted by telephone and they took part in the study. Forty-two recalled being non-adherent, 17 of them in the last 7 days; 11 of the 42 were intentionally non-adherent. The errors could be described by human error theory, and it explained unintentional non-adherence well, however, the application of 'rules' was difficult when considering mistakes. The consideration of error producing conditions and latent failures also revealed useful contributing factors. | Can human error theory explain non-adherence? | Human error theory offers a new and valuable way of understanding non-adherence, and could inform interventions. However, the theory needs further development to explain intentional non-adherence. | Question: Can human error theory explain non-adherence?
Answer: Human error theory offers a new and valuable way of understanding non-adherence, and could inform interventions. However, the theory needs further development to explain intentional non-adherence. |
Answer the question based on the following context: To investigate whether intermittent catheterisation is a valuable alternative to an indwelling catheter in patients older than 70 years with post-void residuals more than 50% of the bladder capacity. We retrospectively reviewed the medical records of 21 patients (14 women, 7 men) older than 70 years in whom intermittent catheterisation was initiated because of voiding dysfunction with post-void residuals more than 50% of the bladder capacity resistant to other treatment. Twelve patients mastered the technique of intermittent self-catheterisation, seven were catheterised by their partners and two by nurses. The mean age of patients was 76.5 years (range 71-83 years) and the mean observation period with regard to intermittent catheterisation was 27.9 months (range 5-129 months). For those relying on intermittent catheterisation, the urinary tract infection rate was 0.84 per year and patient (range 0-3), and urinary continence was restored in all of the six previously incontinent patients. Eighteen of the 21 patients reported a significantly improved quality of life owing to the restoration of urinary continence, decreasing of daytime frequency, nocturia and urge, and the lowering of the urinary tract infection rate. | Intermittent catheterisation in older people: a valuable alternative to an indwelling catheter? | Intermittent (self-) catheterisation is a safe and valuable technique in older people with significant post-void residuals owing to detrusor underactivity. Urinary continence is restored, urge, daytime frequency and nocturia are decreased, and the urinary tract infection rate is diminished, resulting in improved quality of life. Therefore, intermittent (self-) catheterisation is strongly recommended in older people. | Question: Intermittent catheterisation in older people: a valuable alternative to an indwelling catheter?
Answer: Intermittent (self-) catheterisation is a safe and valuable technique in older people with significant post-void residuals owing to detrusor underactivity. Urinary continence is restored, urge, daytime frequency and nocturia are decreased, and the urinary tract infection rate is diminished, resulting in improved quality of life. Therefore, intermittent (self-) catheterisation is strongly recommended in older people. |
Answer the question based on the following context: Selected patients who failed to be weaned off temporary veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support may be considered for long-term left ventricular assist devices (LVADs). Activation of the systemic inflammatory response due to the cardiopulmonary bypass (CPB) machine and its associated deleterious effects on the coagulation system have been well documented. The aim of the study was to compare the outcome of patients receiving VAD on VA-ECMO with patients who were converted to CPB at the time of VAD implantation. Data of patients undergoing LVAD implantation between January 2010 and September 2015 were retrospectively reviewed. Inclusion criteria were patients with prior VA-ECMO. Perioperative characteristics and postoperative outcome of patients who received LVAD after VA-ECMO with (CPB group) or without CPB (no-CPB group) were compared. A total of 110 permanent VADs were implanted during this time frame. Forty patients had VA-ECMO prior to VAD implantation and met the inclusion criteria. The CPB was used in 23 patients and 17 patients received VAD on VA-ECMO without using CPB. The preoperative characteristics of the patients were comparable except for lower body mass index, higher international normalized ratio (INR) and higher rate of preoperative intra-aortic balloon pump usage in the CPB group (P = 0.035, 0.008 and 0.003, respectively). The incidence of postoperative right VAD implantation and survival rate was comparable between both groups. However, the chest tube blood loss and amount of blood product usage was higher in the CPB group. The total blood loss in the first 24 h after surgery (2469 ± 2067 vs 1080 ± 941 ml, P= 0.05) and number of units of intraoperative fresh frozen plasma administered (4 ± 3 vs 1 ± 2, P= 0.02) remained higher in the CPB group even after adjustment for differences in preoperative INR value by propensity score matching. | Implanting permanent left ventricular assist devices in patients on veno-arterial extracorporeal membrane oxygenation support: do we really need a cardiopulmonary bypass machine? | This study demonstrates that the CPB machine can be safely omitted when a long-term VAD is implanted on VA-ECMO support. Blood loss in the first 24 h after surgery was less and a significantly lower number of blood products were necessary in these patients compared with patients in whom the CPB machine was used. However, similar survival rates between these two groups were observed. | Question: Implanting permanent left ventricular assist devices in patients on veno-arterial extracorporeal membrane oxygenation support: do we really need a cardiopulmonary bypass machine?
Answer: This study demonstrates that the CPB machine can be safely omitted when a long-term VAD is implanted on VA-ECMO support. Blood loss in the first 24 h after surgery was less and a significantly lower number of blood products were necessary in these patients compared with patients in whom the CPB machine was used. However, similar survival rates between these two groups were observed. |
Answer the question based on the following context: The formin family of proteins has been implicated in signaling pathways of cellular morphogenesis in both animals and fungi; in the latter case, at least, they participate in communication between the actin cytoskeleton and the cell surface. Nevertheless, they appear to be cytoplasmic or nuclear proteins, and it is not clear whether they communicate with the plasma membrane, and if so, how. Because nothing is known about formin function in plants, I performed a systematic search for putative Arabidopsis thaliana formin homologs. I found eight putative formin-coding genes in the publicly available part of the Arabidopsis genome sequence and analyzed their predicted protein sequences. Surprisingly, some of them lack parts of the conserved formin-homology 2 (FH2) domain and the majority of them seem to have signal sequences and putative transmembrane segments that are not found in yeast or animals formins. | Are plant formins integral membrane proteins? | Plant formins define a distinct subfamily. The presence in most Arabidopsis formins of sequence motifs typical or transmembrane proteins suggests a mechanism of membrane attachment that may be specific to plant formins, and indicates an unexpected evolutionary flexibility of the conserved formin domain. | Question: Are plant formins integral membrane proteins?
Answer: Plant formins define a distinct subfamily. The presence in most Arabidopsis formins of sequence motifs typical or transmembrane proteins suggests a mechanism of membrane attachment that may be specific to plant formins, and indicates an unexpected evolutionary flexibility of the conserved formin domain. |
Answer the question based on the following context: The Systolic pressure variation (SPV) is known to be a sensitive indicator of hypovolemia. However, the SPV may be elevated due to other reasons, such as changes in lung compliance or tidal volumes. Using the SPV to monitor the hemodynamic status of patients in the prone position may, therefore, be problematic due to possible effects of increased abdominal pressure on both venous return and lung compliance. The purpose of this study is to examine whether or not the SPV changes significantly when placing the patient in the prone position. The arterial pressure waveform was recorded and SPV measured in 25 patients undergoing spine surgery. Patients that were elderly (age>65 years), obese (BMI>30), or had history of lung disease (COPD, Asthma), were excluded. Measurements were taken in the supine and prone position and the results were compared using the Paired Student's t-test. A P<0.05 was considered significant. Values expressed are for mean+/-standard deviation. The SPV was 6.9+/-1.9 and 7.0+/-1.8 mmHg in the supine and prone position respectively. These two results were not statistically significant. | Does the systolic pressure variation change in the prone position? | This study is important because it shows for the first time that the SPV does not change significantly in the prone position, and may therefore continue to be used as an indicator of the volume status. It also would appear to indicate that our methods for protecting the chest and abdomen in the prone position are effective. | Question: Does the systolic pressure variation change in the prone position?
Answer: This study is important because it shows for the first time that the SPV does not change significantly in the prone position, and may therefore continue to be used as an indicator of the volume status. It also would appear to indicate that our methods for protecting the chest and abdomen in the prone position are effective. |
Answer the question based on the following context: The use of social networking sites (SNS) has become a central aspect of youth culture allowing individuals to explore and assert their identities. A commonly portrayed online identity is an "alcohol identity," and past research suggests such identities may contribute to one's risk of using alcohol. The present study builds on past research by examining the relationship between alcohol, marijuana, and synthetic cannabinoid use (e.g., Spice, K2) and time spent on SNS in a sample of college students. Six hundred ninety nine undergraduates (62.4% female; Mage=21.0, SD=8.56) were recruited from a university on the U.S./Mexico border for an online study. Participants completed measures assessing demographics, substance use history, and amount of time spent on SNS. Participants reported spending 46h per month on SNS. Seventy-one percent, 14%, and 3% of the sample reported past month use of alcohol, marijuana, and synthetic cannabinoids, respectively. Regression analyses revealed that hours spent on SNS in the past month were significantly associated with frequency of alcohol (p<0.001) and synthetic cannabinoid use (p<0.001). In addition, being male was associated with frequency of alcohol and marijuana use in the past month (p<0.001 and p<0.001, respectively). | The use of social networking sites: A risk factor for using alcohol, marijuana, and synthetic cannabinoids? | These findings suggest that assessment of time spent on SNS is warranted in studies investigating drug use among college students. | Question: The use of social networking sites: A risk factor for using alcohol, marijuana, and synthetic cannabinoids?
Answer: These findings suggest that assessment of time spent on SNS is warranted in studies investigating drug use among college students. |
Answer the question based on the following context: Robot-assisted radical prostatectomy has become an acceptable option for the treatment of clinically localized prostate cancer. The role of cystography in robot-assisted radical prostatectomy was evaluated prospectively. A total of 80 consecutive patients who underwent robot-assisted radical prostatectomy with an intraperitoneal approach were evaluated. There were 40 patients (group 1/surgeon A) who received a routine postoperative cystogram before Foley catheter removal. An additional 40 patients (group 2/surgeon B) had their catheters removed without radiographic imaging. Patient demographics, intraoperative data, postoperative data, and complications were recorded prospectively. The 2 groups were similar in age, Gleason score, and history of previous urethral/bladder neck surgery. Univariate analysis showed no statistical difference among case duration, estimated blood loss, need for bladder neck reconstruction, presence of visible anastomotic leak, or use of pelvic drains. Anastomosis time was the only variable that reached statistical significance. Mean catheter duration (11 days) was similar between the 2 groups. There were 3 patients from group 1 who had an anastomotic leak identified on a cystogram. In group 2, 1 patient had a persistent mild leak based on a cystogram obtained for urinary symptoms. No patient in either group had urinary retention, urinary tract infection, renal failure, or bladder neck contracture develop. The degree of postoperative urinary incontinence was similar between groups. | Is a cystogram necessary after robot-assisted radical prostatectomy? | Foley catheter removal on postoperative days 8-10 after robot-assisted radical prostatectomy without routine cystography appears safe. | Question: Is a cystogram necessary after robot-assisted radical prostatectomy?
Answer: Foley catheter removal on postoperative days 8-10 after robot-assisted radical prostatectomy without routine cystography appears safe. |
Answer the question based on the following context: We compared the predictive abilities of the Abbott Real Time hepatitis C virus (HCV) assay (ART) with those of standard serum HCV ribonucleic acid (RNA) detection methods in patients undergoing triple therapy, which involves treatment with a protease inhibitor combined with pegylated interferon and ribavirin. In this study, 28 patients underwent triple therapy. The hepatitis C virus ribonucleic acid (HCV RNA) level of each patient was measured at weeks 0, 4, 8, and 12 after the initiation of therapy using the Roche COBAS AmpliPrep/COBAS TaqMan HCV assay version 1.0 (CAP/CTM v1.0) and ART. At week 8 after the initiation of therapy, the sustained virological response (SVR) rate among patients who tested negative and positive for HCV RNA using CAP/CTM v1.0, was 80.0% (20/25) and 33.3% (1/3), and using ART, it was 91.3% (21/23) and 0.0% (0/5), respectively. Although at week 8, the predictive capability of CAP/CTM v1.0 was 78.5%, ART was found to be a more accurate predictor of future SVR status with a rate of 92.9%. | Can the Abbott RealTime hepatitis C virus assay be used to predict therapeutic outcomes in hepatitis C virus-infected patients undergoing triple therapy? | These results indicate that the presence or absence of serum HCV RNA, evaluated using ART at week 8 after the initiation of therapy, may be useful for predicting therapeutic outcomes in patients receiving triple therapy. | Question: Can the Abbott RealTime hepatitis C virus assay be used to predict therapeutic outcomes in hepatitis C virus-infected patients undergoing triple therapy?
Answer: These results indicate that the presence or absence of serum HCV RNA, evaluated using ART at week 8 after the initiation of therapy, may be useful for predicting therapeutic outcomes in patients receiving triple therapy. |
Answer the question based on the following context: To assess the feasibility and effectiveness of sex education conducted through the Internet. Two high schools and four colleges of a university in Shanghai were selected as the research sites. Half of these were assigned to the intervention group and the other half to the control group. The interventions consisted of offering sexual and reproductive health knowledge, service information, counseling and discussion to all grade one students in the intervention group. The intervention phase lasted for 10 months and was implemented through a special website, with web pages, online videos, Bulletin Board System (BBS) and expert mailbox. In total, 624 students from the intervention, and 713 from the control schools and colleges participated in the baseline survey, and about 97% of them were followed up in postintervention survey to assess changes that can be attributed to the sex education interventions provided through the Internet. The median scores of the overall knowledge and of each specific aspect of reproductive health such as reproduction, contraception, condom, sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) were significantly higher in the intervention group as compared with those in the control group at postintervention (p<.0001), although no significant differences were found between these two groups in the baseline survey (p>.05). Group by time interaction effects in ordinal logistic regression analysis were found on knowledge score (p<.0001) and in attitude of high school students toward sex-related issues (p<.05), suggesting that interventions increased subjects' knowledge significantly and changed high school students' attitudes to being less liberal toward sex. The intervention also had positive influence on students' attitudes toward providing contraceptive service for unmarried people. | Can the Internet be used effectively to provide sex education to young people in China? | Providing sex education to students in Shanghai through the Internet was found feasible and effective. The Internet-based sex education program increased students' reproductive health knowledge effectively and changed their attitudes toward sex-related issues in terms of being less liberal toward sex and more favorable to providing services to unmarried young people. The Internet thus offers an important and hitherto untapped potential for providing sex education to students and young people in China. | Question: Can the Internet be used effectively to provide sex education to young people in China?
Answer: Providing sex education to students in Shanghai through the Internet was found feasible and effective. The Internet-based sex education program increased students' reproductive health knowledge effectively and changed their attitudes toward sex-related issues in terms of being less liberal toward sex and more favorable to providing services to unmarried young people. The Internet thus offers an important and hitherto untapped potential for providing sex education to students and young people in China. |
Answer the question based on the following context: Due to organ shortage in renal transplantation, many transplant centers attempt to increase the donor pool. Non-heart-beating donors seem to be a promising alternative. We performed 14 renal transplantations from 8 non-heart-beating donors. 2, 1, 3 and 2 donors were from groups 1, 2, 3 and 4, respectively, according to Maastricht classification. In 6 of the patients' warm ischemia time was over 30 minutes. Three of them had primary non-function. In 6 patients delayed graft function was seen. The remaining 5 kidneys functioned immediately. Two patients whose kidney functioned returned to hemodialysis in the I I and 13th months after their transplantations. One of the patients with primary non-function died. 9 kidneys function well in their follow-up period between 5-111 months. 1 and 5-year graft survival rates were 69.8 and 61.1 percent, respectively. The mean graft survival time is 69.9 +/- 14.5 months. | Non-heart-beating donors: is it worthwhile? | Despite the high primary non-function rate, we think that non-heart-beating donors especially in Maastricht classification 3 and 4 should be used due to dramatic shortage of organs. | Question: Non-heart-beating donors: is it worthwhile?
Answer: Despite the high primary non-function rate, we think that non-heart-beating donors especially in Maastricht classification 3 and 4 should be used due to dramatic shortage of organs. |
Answer the question based on the following context: To evaluate the outcomes of bilateral vasectomy reversal procedure in relation to the macroscopic technique, surgical time and duration of obstructive interval. We performed a retrospective study over a twelve-year period using a macroscopic technique. All cases of vasectomy reversal were consecutive and performed by the same surgeon. The procedure was performed using a single layer, spatulate end to end anastomosis technique using 6 x 6-0 prolene. No loupe magnification was used. The median age of the men was 42 years (range 30-56). The median obstructive interval in years was 8.5 years (range 2-23). The procedure was a day case and the median surgical time under general anaesthetic was 75 minutes (range 45-90). None of the patients required hospital admission following discharge. 63 of the 70 patients had positive patency test postoperatively (90%). The sperm count was more than twenty million/ml. The pregnancy rate was 54% and the miscarriage rate was 7.1%. | Vasectomy reversal: is the microscope really essential? | The outcomes of macroscopic vasectomy reversal performed by an experienced surgeon can have a high success rate using the macroscopic single layer spatulate end to end anastomosis technique. This technique is easy to learn compared to the learning curve involved in microsurgery and is an effective means of "re- establishing" fertility in vasectomised men. | Question: Vasectomy reversal: is the microscope really essential?
Answer: The outcomes of macroscopic vasectomy reversal performed by an experienced surgeon can have a high success rate using the macroscopic single layer spatulate end to end anastomosis technique. This technique is easy to learn compared to the learning curve involved in microsurgery and is an effective means of "re- establishing" fertility in vasectomised men. |
Answer the question based on the following context: Fiberoptic bronchoscopy (FOB) is frequently used to diagnose and stage bronchogenic carcinoma (BC). However, the value of FOB in diagnosis/staging BC presenting as a pulmonary nodule or mass (PNM) is controversial. Since chest CT is usually obtained in these patients, it may be used in patient selection for preoperative FOB. Evaluation of the role of chest CT in determining the predictive value of FOB in diagnosing/staging a PNM, by comparing the results of CT and bronchoscopy. Retrospective review of chest CTs and medical records. Consecutive patients with BC between 1992 and 1994 who had diagnostic FOB and CT in our institution, but without radiographic evidence of (1) pulmonary atelectasis, (2) endobronchial tumor or narrowing of the central airways, and (3) the PNM abutting the central airways. Sixty-four patients met the selection criteria. The size of the PNM ranged from 1.5 to 10 cm; the size was<or = 4 cm in 62 patients. FOB provided a diagnosis in 22 patients. Bronchoscopy detected endobronchial lesions in 11 patients (17%); 3 had lesions in more than one lobe. In three patients, the PNM was<3 cm. The radiographically undetected endobronchial tumor increased the tumor stage in only two patients. The "CT bronchus" sign had a positive and negative predictive value of 75% and 68%, respectively. | Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma? | (1) In this study, CT failed to detect endobronchial tumor in 11 of 64 patients (17%). Because of the implications of a new staging system, more studies are necessary before abandoning staging FOB. (2) The CT bronchus sign has a very high positive and negative predictive value in the use of diagnostic FOB and should be used to guide the method of biopsy of a PNM. | Question: Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma?
Answer: (1) In this study, CT failed to detect endobronchial tumor in 11 of 64 patients (17%). Because of the implications of a new staging system, more studies are necessary before abandoning staging FOB. (2) The CT bronchus sign has a very high positive and negative predictive value in the use of diagnostic FOB and should be used to guide the method of biopsy of a PNM. |
Answer the question based on the following context: Previous studies showed conflicting and inconsistent results regarding the effect of anatomic location of the melanoma on sentinel lymph node (SLN) positivity and/or survival. This study was conducted to evaluate and compare the effect of the anatomic locations of primary melanoma on long-term clinical outcomes. All consecutive cutaneous melanoma patients (n=2,079) who underwent selective SLN dissection (SLND) from 1993 to 2009 in a single academic tertiary-care medical center were included. SLN positive rate, disease-free survival (DFS), and overall survival (OS) were determined. Kaplan-Meier survival, univariate, and multivariate analyses were performed to determine predictive factors for SLN status, DFS, and OS. Head and neck melanoma (HNM) had the lowest SLN-positive rate at 10.8% (16.8% for extremity and 19.3% for trunk; P=0.002) but had the worst 5-year DFS (P<0.0001) and 5-year OS (P<0.0001) compared with other sites. Tumor thickness (P<0.001), ulceration (P<0.001), HNM location (P=0.001), mitotic rate (P<0.001), and decreasing age (P<0.001) were independent predictive factors for SLN-positivity. HNM with T3 or T4 thickness had significantly lower SLN positive rate compared with other locations (P≤0.05). Also, on multivariate analysis, HNM location versus other anatomic sites was independently predictive of decreased DFS and OS (P<0.001). By Kaplan-Meier analysis, HNM was associated significantly with the worst DFS and OS. | Is head and neck melanoma different from trunk and extremity melanomas with respect to sentinel lymph node status and clinical outcome? | Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites. | Question: Is head and neck melanoma different from trunk and extremity melanomas with respect to sentinel lymph node status and clinical outcome?
Answer: Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites. |
Answer the question based on the following context: Women with a mid-trimester short cervical length (CL) are at increased risk for preterm delivery. Consequently, CL measurement is a potential screening tool to identify women at risk for preterm birth. Our objective was to assess possible associations between CL and maternal characteristics. A nationwide screening study was performed in which CL was measured during the standard anomaly scan among low risk women with a singleton pregnancy. Data on maternal height, pre-pregnancy weight, ethnicity, parity and gestational age at the time of the CL measurement were collected from January 2010 to December 2012. Univariable and multivariable linear regression analyses were performed to assess the relationship between CL and maternal characteristics. We included 5092 women. The mean CL was 44.3mm. No association was found between CL and maternal height or gestational age of the measurement. Maternal weight was associated with CL (p=0.007, adjusted R(2) 0.03). Separate analysis for BMI did not change these results. Ethnicity, known in 2702 out of 5092 women, was associated with CL (mean CL in Caucasian women 45.0mm, Asian 43.9mm, Mediterranean 43.1mm, and African 41.8mm, p=0.003), as well as parity (mean CL multiparous 45.3mm, nulliparous 43.5mm, p<0.0001). | Is cervical length associated with maternal characteristics? | Shorter mid-trimester cervical length is associated with higher maternal weight, younger maternal age, nulliparity and non-Caucasian ethnicity, but not with maternal height. | Question: Is cervical length associated with maternal characteristics?
Answer: Shorter mid-trimester cervical length is associated with higher maternal weight, younger maternal age, nulliparity and non-Caucasian ethnicity, but not with maternal height. |
Answer the question based on the following context: Many adolescents are having sex and adolescents with life-limiting illnesses are no exception. It is therefore important for health care professionals to take a sexual history and provide advice about sexually transmitted diseases, unintended pregnancies, and ways of reducing high-risk sexual behaviors. Consultations should provide a forum for discussion and education. A literature review revealed no previous studies on this topic. Our aim was to review medical consultations between adolescents with life-limiting illnesses and pediatricians to establish whether sex was discussed. The clinical medical notes of 25 adolescents aged 12 to 18 years, under the care of a community team specializing in patients with nonmalignant life-limiting conditions at a District General Hospital in the United Kingdom (UK) were selected at random. Researchers retrospectively reviewed handwritten notes and typed letters in the medical records with a view to establishing whether a sexual history was taken on any occasion. None of the health care professionals took a sexual history from any of the adolescents on any occasion despite multiple clinic attendances. | Sexual history taking: a dying skill? | Sexual health is described by the World Health Organization as a basic human right. Clinicians may struggle to accept that adolescents with life-limiting illnesses may want to talk about sex, and this study has highlighted it as a topic that is generally ignored. Health professionals should include sexual health in routine palliative assessments. Adolescents with life-limiting illnesses should not be denied the right to holistic health care. | Question: Sexual history taking: a dying skill?
Answer: Sexual health is described by the World Health Organization as a basic human right. Clinicians may struggle to accept that adolescents with life-limiting illnesses may want to talk about sex, and this study has highlighted it as a topic that is generally ignored. Health professionals should include sexual health in routine palliative assessments. Adolescents with life-limiting illnesses should not be denied the right to holistic health care. |
Answer the question based on the following context: Due to complex multimodal treatments and a lengthy natural history of disease, the impact of radiation therapy for well-differentiated thyroid cancer (WDTC) is challenging to evaluate. We analysed the effect of dose escalation, as enabled by intensity-modulated radiation therapy (IMRT), on preventing local-regional failure (LRF) of microscopic and macroscopic WDTC. We performed a retrospective review of WDTC patients treated with IMRT from 1998-2011. Diagnostic imaging demonstrating first LRF was registered to the simulation CT containing the treated radiation isodose volumes. Areas of disease progression were contoured and the relationships of LRFs with isodose volumes were recorded. Thirty patients had a median follow-up of 56 months (range = 1-139). Seventeen (57%) had gross residual, five (17%) had microscopic residual and eight (27%) had clear margins at the time of IMRT. Nine patients (30%) developed LRF, at a median time of 44 months (range = 0-116). Of these, six (67%) had been radiated to gross disease and one (11%) had microscopic residual. In the seven analysable cases, only one (14%) LRF occurred within the 70 Gy isodose volume. Marginal LRFs were: four (57%) outside 70 Gy, one (14%) outside 60 Gy and one (14%) outside 50 Gy. All but one recurrence (86%) occurred in the perioesophageal region. | Does radiation dose matter in thyroid cancer? | Local-regional failure was seen most in patients who had gross disease at the time of IMRT, almost always occurred outside of the 70 Gy volume and was frequently in the area of oesophageal sparing. Meticulous surgical dissection, especially in the perioesophageal region, should be prioritised to prevent long-term LRF. | Question: Does radiation dose matter in thyroid cancer?
Answer: Local-regional failure was seen most in patients who had gross disease at the time of IMRT, almost always occurred outside of the 70 Gy volume and was frequently in the area of oesophageal sparing. Meticulous surgical dissection, especially in the perioesophageal region, should be prioritised to prevent long-term LRF. |
Answer the question based on the following context: To investigate the role of CD40 ligand and P-selectin in the mechanism of decreased incidence of cardiovascular disease in Gilbert's syndrome (GS). The soluble forms of CD40 ligand (sCD40L) and P-selectin (sP-selectin), and high sensitive C reactive protein (hs-CRP) levels were investigated in subjects with GS (n=25) and compared to healthy controls (n=53). sCD40L and hs-CRP levels were significantly lower in GS compared to the controls (0.33+/-0.27 vs 0.71+/-0.37 ng/mL, p<0.001 and 0.51+/-0.45 vs 1.16+/-1.31 mg/L, p=0.046, respectively). Both sCD40L and hs-CRP were negatively correlated with total bilirubin (r=-0.5, p<0.001 and r=-0.34, p=0.002, respectively). sP-selectin levels were lower in GS when compared to the controls but the difference did not reach statistical significance (p=0.052). No correlation was found between the plasma levels of sCD40L, sP-selectin and hs-CRP. | Soluble CD40 ligand and soluble P-selectin levels in Gilbert's syndrome: a link to protection against atherosclerosis? | These novel findings suggest that reduced sCD40L and hs-CRP concentrations may have a role in the mechanism of protection against atherosclerosis in GS. | Question: Soluble CD40 ligand and soluble P-selectin levels in Gilbert's syndrome: a link to protection against atherosclerosis?
Answer: These novel findings suggest that reduced sCD40L and hs-CRP concentrations may have a role in the mechanism of protection against atherosclerosis in GS. |
Answer the question based on the following context: Thyroid hormones play an important role in the regulation of lipid and carbohydrate metabolism, both of which are affected in patients with non-alcoholic steatohepatitis (NASH). Anecdotally, we have observed that a number of patients with NASH carried a diagnosis of hypothyroidism. However, it is unknown if thyroid dysfunction plays any role in the pathogenesis of NASH. To further investigate this observation, we conducted a case-control study to determine the association between hypothyroidism and NASH. Cases were defined as patients with well-documented NASH attending hepatology clinics at Indiana University Hospital from January 1, 1995 to December 31, 2000. Age, gender, race, and body-weight matched individuals seen during the same period in the general medical clinics served as controls. Patients with a previous diagnosis of hypothyroidism who are currently on synthetic T4 replacement were considered to be "hypothyroid". The strength of association was assessed by logistic regression analysis after controlling for the frequency of diabetes mellitus, hyperlipidemia, and hypertension. One hundred seventy-four patients with NASH (cases) and 442 controls were included. The mean age of cohort was 49 +/- 13 years, 59% were female, and 98% were white. The prevalence of hypothyroidism in patients with NASH was 15% was significantly higher than in the controls (7.2%, P<0.001). By multivariate analysis, the prevalence of hypothyroidism in the NASH group was significantly higher than in control group (OR: 2.3, 95% CI: 1.2-4.2, P = 0.008). | Is hypothyroidism a risk factor for non-alcoholic steatohepatitis? | These data suggest that hypothyroidism is associated with human NASH. Further research is needed to confirm this finding and to understand its implications. | Question: Is hypothyroidism a risk factor for non-alcoholic steatohepatitis?
Answer: These data suggest that hypothyroidism is associated with human NASH. Further research is needed to confirm this finding and to understand its implications. |
Answer the question based on the following context: Although 'integrated' public health policies are assumed to be the ideal way to optimize public health, it remains hard to determine how far removed we are from this ideal, since clear operational criteria and defining characteristics are lacking. A literature review identified gaps in previous operationalizations of integrated public health policies. We searched for an approach that could fill these gaps. We propose the following defining characteristics of an integrated policy: (1) the combination of policies includes an appropriate mix of interventions that optimizes the functioning of the behavioral system, thus ensuring that motivation, capability and opportunity interact in such a way that they promote the preferred (health-promoting) behavior of the target population, and (2) the policies are implemented by the relevant policy sectors from different policy domains. | 'Are we there yet? | Our criteria should offer added value since they describe pathways in the process towards formulating integrated policy. The aim of introducing our operationalization is to assist policy makers and researchers in identifying truly integrated cases. The Behavior Change Wheel proved to be a useful framework to develop operational criteria to assess the current state of integrated public health policies in practice. | Question: 'Are we there yet?
Answer: Our criteria should offer added value since they describe pathways in the process towards formulating integrated policy. The aim of introducing our operationalization is to assist policy makers and researchers in identifying truly integrated cases. The Behavior Change Wheel proved to be a useful framework to develop operational criteria to assess the current state of integrated public health policies in practice. |
Answer the question based on the following context: In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers' knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan. This cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers' ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each. All prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers. | Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria? | Overall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers. | Question: Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria?
Answer: Overall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers. |
Answer the question based on the following context: Anemia is iron responsive in 30 to 50% of nondialysis patients with chronic kidney disease (CKD), but the utility of bone marrow iron stores and peripheral iron indices to predict the erythropoietic response is not settled. We investigated the accuracy of peripheral and central iron indices to predict the response to intravenous iron in nondialysis patients with CKD and anemia.DESIGN, SETTING, PARTICIPANTS, & A diagnostic study was conducted on 100 nondialysis patients who had CKD and anemia and were erythropoiesis-stimulating agent and iron naive. Bone marrow iron stores were evaluated by aspiration. Hemoglobin, transferrin saturation index (TSAT), and ferritin were measured at baseline and 1 month after 1000 mg of intravenous iron sucrose. Posttest predictive values for the erythropoietic response (>or =1-g/dl increase in hemoglobin) of peripheral and central iron indices were calculated. The erythropoietic response was noted in a higher proportion in bone marrow iron-deplete than in iron-replete patients (63 versus 30%). Peripheral iron indices had a moderate accuracy in predicting response. The positive (PPV) and negative predictive values (NPV) were 76 and 72% for a TSAT of 15% and 74 and 70% for a ferritin of 75 ng/ml, respectively. In the final logistic regression model, including TSAT and ferritin, the chances of a positive response increased by 7% for each 1% decrease in TSAT. | Can the response to iron therapy be predicted in anemic nondialysis patients with chronic kidney disease? | Because an erythropoietic response is seen in half of patients and even one third of those with iron-replete stores responded whereas peripheral indices had only a moderate utility in predicting response, the therapeutic trial to intravenous iron seems to be a useful tool in the management of anemia in nondialysis patients with CKD. | Question: Can the response to iron therapy be predicted in anemic nondialysis patients with chronic kidney disease?
Answer: Because an erythropoietic response is seen in half of patients and even one third of those with iron-replete stores responded whereas peripheral indices had only a moderate utility in predicting response, the therapeutic trial to intravenous iron seems to be a useful tool in the management of anemia in nondialysis patients with CKD. |
Answer the question based on the following context: Our purpose was to determine whether intrapartum obstetric interventions are associated with umbilical cord prolapse. A computer search identified patients who had intrapartum umbilical cord prolapse. Thirty-seven cases were identified between 1990 and 1994 (incidence of 1.85 per 1000). These women were randomly matched to control patients with intact membranes. Patients with umbilical cord prolapse were delivered earlier (34.8 vs 37.1 weeks, p = 0.05). Otherwise, there were no differences between groups regarding the use of cervical ripening, incidence of labor induction, or the use of amnioinfusion and amniotomy. Although cervical dilatation and station were similar between groups at the time of admission, women with umbilical cord prolapse did not have as much descent of the presenting part associated with cervical dilatation and progressive labor compared with control patients. | Are obstetric interventions such as cervical ripening, induction of labor, amnioinfusion, or amniotomy associated with umbilical cord prolapse? | By themselves, obstetric interventions of cervical ripening, labor induction, amnioinfusion, and amniotomy do not increase the likelihood that a patient will have umbilical cord prolapse. | Question: Are obstetric interventions such as cervical ripening, induction of labor, amnioinfusion, or amniotomy associated with umbilical cord prolapse?
Answer: By themselves, obstetric interventions of cervical ripening, labor induction, amnioinfusion, and amniotomy do not increase the likelihood that a patient will have umbilical cord prolapse. |
Answer the question based on the following context: It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. We analysed data from 567,049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal. Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal. | Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? | This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access. | Question: Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services?
Answer: This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access. |
Answer the question based on the following context: The objective of this study was to evaluate gynecologic oncology provider (GOP) practices regarding weight loss (WL) counseling, and to assess their willingness to initiate weight loss interventions, specifically bariatric surgery (WLS). Members of the Society of Gynecologic Oncology were invited to complete an online survey of 49 items assessing knowledge, attitudes, and behaviors related to WL counseling. A total of 454 participants initiated the survey, yielding a response rate of 30%. The majority of respondents (85%) were practicing GOP or fellows. A majority of responders reported that>50% of their patient population is clinically obese (BMI ≥ 30). Only 10% reported having any formal training in WL counseling, most often in medical school or residency. Providers who feel adequate about WL counseling were more likely to offer multiple WL options to their patients (p<.05). Over 90% of responders believe that WLS is an effective WL option and is more effective than self-directed diet and medical management of obesity. Providers who were more comfortable with WL counseling were significantly more likely to recommend WLS (p<.01). Approximately 75% of respondents expressed interest in clinical trials evaluating WLS in obese cancer survivors. | Is bariatric surgery an option for women with gynecologic cancer? | The present study suggests that GOP appreciate the importance of WL counseling, but often fail to provide it. Our results demonstrate the paucity of formal obesity training in oncology. Providers seem willing to recommend WLS as an option to their patients but also in clinical trials examining gynecologic cancer outcomes in women treated with BS. | Question: Is bariatric surgery an option for women with gynecologic cancer?
Answer: The present study suggests that GOP appreciate the importance of WL counseling, but often fail to provide it. Our results demonstrate the paucity of formal obesity training in oncology. Providers seem willing to recommend WLS as an option to their patients but also in clinical trials examining gynecologic cancer outcomes in women treated with BS. |
Answer the question based on the following context: The autonomic nervous system exerts important effects upon atrial fibrillation (AF) initiation. The strategy of anesthesia used during AF ablation may impact the provocation of AF triggers. We hypothesized that the use of general anesthesia (GA) would reduce the incidence of provokable AF triggers in patients undergoing AF ablation compared to patients studied while receiving only conscious sedation (CS). We performed a prospective, case control study comparing the incidence of provokable AF triggers in a consecutive series of patients undergoing AF ablation under GA using a standard trigger induction protocol. We compared the frequency and distribution of AF triggers to a second cohort of historical controls (matched for age, gender, left atrial dimension, and AF phenotype) who underwent ablation while receiving CS. We calculated that 44 total subjects (22 patients in each group) were required to detect a 50% reduction in the incidence of AF triggers in the GA cohort. There was no difference between the 2 groups in the rate of AF trigger inducibility (77% vs. 68%, P = 0.26) or the number of triggers provoked per patient (1.2 ± 0.8 vs. 1.3 ± 0.8, P = 0.38). Patients ablated under GA required higher doses of phenylephrine during the trigger induction protocol (408.3 mg [52-600] vs. 158.3 mg [0-75]; P = 0.003), and tended to require higher doses of isoproterenol to initiate triggers (92.8 mg [20-111] vs. 63.6 mg [6-103]; P = 0.25). | Provocation of atrial fibrillation triggers during ablation: does the use of general anesthesia affect inducibility? | AF trigger induction during GA is both safe and efficacious. | Question: Provocation of atrial fibrillation triggers during ablation: does the use of general anesthesia affect inducibility?
Answer: AF trigger induction during GA is both safe and efficacious. |
Answer the question based on the following context: Systemic vascular resistance falls in exercise as a consequence of metabolically-linked vasodilatation in active skeletal muscles. This exercise-induced vasodilatation is closely linked with reduced muscle tissue oxygen tension in and is characterised by reduced response to adrenergic vasoconstrictor mechanisms which is often referred to as functional sympatholysis. Systemic arterial blood pressure in exercise is maintained at normal or, more commonly, at elevated levels by increase in cardiac output and increased sympathetic vasomotor tone. Recovery of normal resting skeletal muscle tissue oxygen tension and skeletal muscle vascular tone after exercise depends on the post-exercise recovery process. This process requires ongoing elevated skeletal muscle perfusion and can therefore be predicted to be impaired in shock and cardiopulmonary resuscitation scenarios. Comprehensive consideration of this exercise physiology and its extrapolation into shock, cardiac arrest and resuscitation scenarios supports the proposal that exercise-induced sympatholytic vasodilatation in skeletal muscle may be of considerable unrecognised significance for resuscitation medicine. Reduced systemic vascular resistance due to pre-existing exercise-induced sympatholytic vasodilatation in skeletal muscle can significantly exacerbate systemic arterial hypotension in acute shock states and resuscitation scenarios. SUB- 1. Onset of syncope, clinical shock states and pulseless electrical activity can occur at significantly higher cardiac output levels in subjects who were engaged in immediate pre-morbid exercise as compared to resting subjects. 2. The efficacy of external chest compression in generating coronary and cerebral perfusion in cardiopulmonary resuscitation can be significantly impaired when cardiac arrest has occurred during exercise. 3. The efficacy of adrenergic vasopressor agents in resuscitation scenarios can be significantly impaired in subjects who were engaged in immediate pre-morbid exercise. The limited available evidence is compatible with the hypothesis being true but does not provide direct confirmation. There is no evidence available directly supporting or refuting the hypothesis. Significant potential clinical implications are outlined relating to the management of cardiopulmonary and trauma resuscitation for patients who were involved in immediate pre-morbid exercise, particularly, but not exclusively, at higher exercise intensities. There are also significant potential prognostic implications. | Exercise-induced reduction in systemic vascular resistance: a covert killer and an unrecognised resuscitation challenge? | Reduction in systemic vascular resistance due to exercise-induced sympatholytic vasodilatation in skeletal muscle may largely explain the reported poor success rate for cardiopulmonary resuscitation with prompt defibrillation for sudden cardiac arrest in young previously healthy athletes. Investigation of this unexplored area of pathophysiology poses major difficulties but could lead to significant improvements in the outcomes of resuscitation for patients who were involved in immediate pre-morbid exercise. | Question: Exercise-induced reduction in systemic vascular resistance: a covert killer and an unrecognised resuscitation challenge?
Answer: Reduction in systemic vascular resistance due to exercise-induced sympatholytic vasodilatation in skeletal muscle may largely explain the reported poor success rate for cardiopulmonary resuscitation with prompt defibrillation for sudden cardiac arrest in young previously healthy athletes. Investigation of this unexplored area of pathophysiology poses major difficulties but could lead to significant improvements in the outcomes of resuscitation for patients who were involved in immediate pre-morbid exercise. |
Answer the question based on the following context: Few data exist about the incidence of drug-induced pancreatitis in the general population. Drugs are related to the etiology of pancreatitis in about 1.4-2% of cases. While statins are generally well tolerated they have been known to be associated with pancreatitis. Acute pancreatitis has been reported in a few cases treated with atorvastatin, fluvastatin, lovastatin, simvastatin and pravastatin. We report the case of a 77-year-old patient who developed acute pancreatitis after treatment with rosuvastatin, which resolved on withdrawal of the medication. She had a similar episode of pancreatitis a year ago precipitated by atorvastatin, which resolved on withdrawal. Extensive workup on both occasions failed to reveal any other etiology for the pancreatitis. | Recurrent acute pancreatitis possibly induced by atorvastatin and rosuvastatin. Is statin induced pancreatitis a class effect? | To our knowledge this is the first report of rosuvastatin-induced pancreatitis. The occurrence of pancreatitis with two different statins in our patient argues that statins induced pancreatitis may be a class-effect of statins. With statin prescriptions on the rise clinicians need to be aware of this complication of statin treatment and remember that the newest statin, rosuvastatin is not dissimilar to the other statins in causing pancreatitis. | Question: Recurrent acute pancreatitis possibly induced by atorvastatin and rosuvastatin. Is statin induced pancreatitis a class effect?
Answer: To our knowledge this is the first report of rosuvastatin-induced pancreatitis. The occurrence of pancreatitis with two different statins in our patient argues that statins induced pancreatitis may be a class-effect of statins. With statin prescriptions on the rise clinicians need to be aware of this complication of statin treatment and remember that the newest statin, rosuvastatin is not dissimilar to the other statins in causing pancreatitis. |
Answer the question based on the following context: Our purpose was to examine maternal and neonatal outcomes in a cohort of women who underwent delivery with the sequential use of instruments. This retrospective case-control study included deliveries from May 1996 through March 1998. Charts of women who underwent delivery with the sequential use of instruments (vacuum first, then forceps, or vice versa) were identified. Two control groups (1 forceps group, 1 vacuum group) were randomly selected and matched for each case. Maternal and neonatal outcomes were abstracted and compared. There were 34 patients in each group. There were no significant demographic differences. The vacuum group had lower rates of episiotomy (P =.01) and deep perineal lacerations (P =.014), whereas these outcomes were similar in the sequential and forceps groups. All other maternal outcomes were equivalent. There were no differences in any neonatal parameter except for superficial scalp trauma, which was more common in the vacuum group (P =.002). | Sequential use of instruments at operative vaginal delivery: is it safe? | We conclude that the prudent use of sequential instruments at operative vaginal delivery did not engender higher rates of maternal or neonatal morbidity. | Question: Sequential use of instruments at operative vaginal delivery: is it safe?
Answer: We conclude that the prudent use of sequential instruments at operative vaginal delivery did not engender higher rates of maternal or neonatal morbidity. |
Answer the question based on the following context: To investigate whether the protective efficacy of bacille Calmette-Guérin (BCG) against tuberculosis decreases with time since vaccination. A quantitative review of all 10 randomized trials of BCG against tuberculosis in purified protein derivative (PPD)-negative individuals, that presented data for discrete periods. For each trial, we derived log rate ratios for the annual change in the efficacy of BCG. We also compared efficacy in the first two years, and the first 10 years, to that in the rest of the trial. There was considerable heterogeneity between trials in the annual change in the efficacy of BCG. In seven efficacy decreased overtime, while in three it increased. Average annual change in efficacy was not related to overall efficacy. Efficacy also varied between trials in the first two years after vaccination, at more than two years after vaccination and in the first ten years after vaccination. However the variation in efficacy between trials more than 10 years after vaccination was not statistically significant (P = 0.26). We therefore calculated that the average efficacy more than 10 years after vaccination was 14% (95% confidence interval -9% to 32%). | Does the efficacy of BCG decline with time since vaccination? | BCG protection can wane with time since vaccination. There is no good evidence that BCG provides protection more than 10 years after vaccination. | Question: Does the efficacy of BCG decline with time since vaccination?
Answer: BCG protection can wane with time since vaccination. There is no good evidence that BCG provides protection more than 10 years after vaccination. |
Answer the question based on the following context: The objectives of this study were to evaluate if a strategy based on routine endotracheal aspirate (ETA) cultures is better than using the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines to prescribe antimicrobials in ventilator-associated pneumonia (VAP). This was a prospective, observational, cohort study conducted in a 15-bed ICU and comprising 283 patients who were mechanically ventilated for ≥48 h. Interventions included twice-weekly ETA; BAL culture was done if VAP was suspected. BAL (collected at the time of VAP) plus ETA cultures (collected≤7 days before VAP) (n=146 different pairs) were defined. We compared two models of 10 days of empirical antimicrobials (ETA-based vs ATS/IDSA guidelines-based strategies), analyzing their impact on appropriateness of therapy and total antimicrobial-days, using the BAL result as the standard for comparison. Complete ETA and BAL culture concordance (identical pathogens or negative result) occurred in 52 pairs; discordance (false positive or false negative) in 67, and partial concordance in two. ETA predicted the etiology in 62.4% of all pairs, in 74.0% of pairs if ETA was performed≤2 days before BAL, and in 46.2% of pairs if ETA was performed 3 to 7 days before BAL (P=.016). Strategies based on the ATS/IDSA guidelines and on ETA results led to appropriate therapy in 97.9% and 77.4% of pairs, respectively (P<.001). The numbers of antimicrobial-days were 1,942 and 1,557 for therapies based on ATS/IDSA guidelines and ETA results, respectively (P<.001). | Is a strategy based on routine endotracheal cultures the best way to prescribe antibiotics in ventilator-associated pneumonia? | The ATS/IDSA guidelines-based approach was more accurate than the ETA-based strategy for prescribing appropriate, initial, empirical antibiotics in VAP, unless a sample was available≤2 days of the onset of VAP. The ETA-based strategy led to fewer days on prescribed antimicrobials. | Question: Is a strategy based on routine endotracheal cultures the best way to prescribe antibiotics in ventilator-associated pneumonia?
Answer: The ATS/IDSA guidelines-based approach was more accurate than the ETA-based strategy for prescribing appropriate, initial, empirical antibiotics in VAP, unless a sample was available≤2 days of the onset of VAP. The ETA-based strategy led to fewer days on prescribed antimicrobials. |
Answer the question based on the following context: In a previous study, we found that new mothers could and would express concerns about their parenting, including concerns about maltreatment and poor care. In this study, we examine the utility of early maternal concerns for predicting parenting stress in the first year. Parenting stress is important because it has been shown to be related to maltreatment and poor parent-child relationships. A sample of 246 mothers were interviewed shortly after delivery in a publicly funded hospital about their parenting concerns, and 93% were reinterviewed in their homes about their parenting when the infants were 6 to 12 months old. Standardized measures with demonstrated psychometric properties were employed, including a measure of parenting stress due to the demands of the parenting role, characteristics of the child that make him or her difficult to care for, and stress due to difficult interactions. Multiple regression results indicate that both mothers concerns at delivery and sociodemographic variables are significant predictors of all three types of parenting stress in infancy. Maternal concerns were more powerful than sociodemographics in predicting stress related to the demands of parenting, while sociodemographics were more powerful for the prediction of stress related to difficult child characteristics and difficult mother-infant interaction. | Do maternal concerns at delivery predict parenting stress during infancy? | These findings suggest that knowledge of new mothers' parenting concerns might be useful for predicting parenting problems, as well as for engaging mothers' in and enhancing the effectiveness of parenting services. | Question: Do maternal concerns at delivery predict parenting stress during infancy?
Answer: These findings suggest that knowledge of new mothers' parenting concerns might be useful for predicting parenting problems, as well as for engaging mothers' in and enhancing the effectiveness of parenting services. |
Answer the question based on the following context: To examine the prevalence of refractive errors in children aged 3-6 years in China. Children were recruited for a trial of a home-based amblyopia screening kit in Guangzhou preschools, during which cycloplegic refractions were measured in both eyes of 2480 children. Cycloplegic refraction (from 3 to 4 drops of 1% cyclopentolate to ensure abolition of the light reflex) was measured by both autorefraction and retinoscopy. Refractive errors were defined as followed: myopia (at least -0.50 D in the worse eye), hyperopia (at least +2.00 D in the worse eye) and astigmatism (at least 1.50 D in the worse eye). Different definitions, as specified in the text, were also used to facilitate comparison with other studies. The mean spherical equivalent refractive error was at least +1.22 D for all ages and both genders. The prevalence of myopia for any definition at any age was at most 2.5%, and lower in most cases. In contrast, the prevalence of hyperopia was generally over 20%, and declined slightly with age. The prevalence of astigmatism was between 6% and 11%. There was very little change in refractive error with age over this age range. | Refractive errors in 3-6 year-old Chinese children: a very low prevalence of myopia? | Previous reports of less hyperopic mean spherical equivalent refractive error, and more myopia and less hyperopia in children of this age may be due to problems with achieving adequate cycloplegia in children with dark irises. Using up to 4 drops of 1% cyclopentolate may be necessary to accurately measure refractive error in paediatric studies of such children. Our results suggest that children from all ethnic groups may follow a similar pattern of early refractive development, with little myopia and a hyperopic mean spherical equivalent over +1.00 D up to the age of 5-6 years in most conditions. | Question: Refractive errors in 3-6 year-old Chinese children: a very low prevalence of myopia?
Answer: Previous reports of less hyperopic mean spherical equivalent refractive error, and more myopia and less hyperopia in children of this age may be due to problems with achieving adequate cycloplegia in children with dark irises. Using up to 4 drops of 1% cyclopentolate may be necessary to accurately measure refractive error in paediatric studies of such children. Our results suggest that children from all ethnic groups may follow a similar pattern of early refractive development, with little myopia and a hyperopic mean spherical equivalent over +1.00 D up to the age of 5-6 years in most conditions. |
Answer the question based on the following context: To ascertain the extent to which neonatal analgesia for invasive procedures has changed in the last 5 years since the publication of Italian guidelines. We compared survey data for the years 2004 and 2010 on analgesia policy and practices for common invasive procedures at Italian Neonatal Intensive Care Units (NICUs); 75 NICUs answered questionnaires for both years and formed the object of this analysis. By 2010, analgesia practices for procedural pain had improved significantly for almost all invasive procedures (p<0.05), with both non-pharmacological and pharmacological methods being adopted by the majority of NICUs (unlike the situation in 2004). The routine use of medication for major invasive procedures was still limited, however (35% of lumbar punctures, 40% of tracheal intubations, 46% during mechanical ventilation). Postoperative pain treatment was still inadequate, and 41% of facilities caring for patients after surgery did not treat pain routinely. Pain monitoring had definitely improved since 2004 (p<0.05), but not enough: only 21 and 17% of NICUs routinely assess pain during mechanical ventilation and after surgery, respectively. | Pain management during invasive procedures at Italian NICUs: has anything changed in the last 5 years? | There have been improvements in neonatal analgesia practices in Italy since national guidelines were published, but pain is still undertreated and underscored, especially during major invasive procedures. It is mandatory to address the gap between the recommendations in the guidelines and clinical practice must be addressed through with effective quality improvement initiatives. | Question: Pain management during invasive procedures at Italian NICUs: has anything changed in the last 5 years?
Answer: There have been improvements in neonatal analgesia practices in Italy since national guidelines were published, but pain is still undertreated and underscored, especially during major invasive procedures. It is mandatory to address the gap between the recommendations in the guidelines and clinical practice must be addressed through with effective quality improvement initiatives. |
Answer the question based on the following context: The standard triple therapy for the eradication of Helicobacter pylori consists of a combination of a proton pump inhibitor at a standard dose together with two antibiotics (amoxicillin 1000 mg plus either clarithromycin 500 mg or metronidazole 400 mg) all given twice daily for a period of 7-14 days. Recent reports have shown a dramatic decline in the rate of H. pylori eradication utilizing standard triple therapy from 95% down to 70-80%. Our study was designed to evaluate the effect of adding a probiotic as an adjuvant to common regimens used for H. pylori eradication. An open label randomized observational clinical study was designed to test three different regimens of H. pylori eradication treatment: Standard triple therapy with a concomitant probiotic added at the same time (n = 100), starting the probiotic for 2 weeks before initiating standard triple therapy along with the probiotic (n = 95), and the third regimen consists of the probiotic given concomitantly to sequential treatment (n = 76). The three arms were compared to a control group of patients treated with the traditional standard triple therapy (n = 106). The eradication rate for the traditional standard therapy was 68.9%, and adding the probiotic "Bifidus infantis" to triple therapy, led to a successful rate of eradication of 83% (P<0.001). Pre-treatment with 2 weeks of B. infantis before adding it to standard triple therapy increased the success rate of eradication to 90.5%. Similar improvement in eradication rate was noted when B. infantis was added as an adjuvant to the sequential therapy leading to an eradication rate of 90.8%. | Do probiotics improve eradication response to Helicobacter pylori on standard triple or sequential therapy? | Adding B. infantis as an adjuvant to several therapeutic regimens commonly used for the eradication of H. pylori infection significantly improves the cure rates. | Question: Do probiotics improve eradication response to Helicobacter pylori on standard triple or sequential therapy?
Answer: Adding B. infantis as an adjuvant to several therapeutic regimens commonly used for the eradication of H. pylori infection significantly improves the cure rates. |
Answer the question based on the following context: The aim of the present study was to investigate the relationship between reduced serum vitamin D levels and psychiatric illness. This study was an audit of serum 25-hydroxyvitamin D (25-OHD) levels measured routinely in a sample of 53 inpatients in a private psychiatric clinic. These levels were compared with those of controls without psychiatric illness. The median levels of serum 25-OHD were 43.0 nmol L(-1) (range 20-102 nmol L(-1)) in the patient population, 46.0 nmol L(-1) (range 20-102 nmol L(-1)) in female patients (n =33) and 41.5 nmol L(-1) (range 22-97 nmol L(-1)) in male patients (n =20). The proportion of vitamin D insufficiency (serum 25-OHD<or =50 nmol L(-1)) in this patient population was 58%. Furthermore, 11% had moderate deficiency (serum 25-OHD<or =25 nmol L(-1)). There was a 29% difference between mean levels in the patient population and control sample (geometric mean age- and season-adjusted levels: 46.4 nmol L(-1) (95% confidence interval (CI) =38.6-54.9 nmol L(-1)) vs 65.3 nmol L(-1) (95%CI =63.2-67.4 nmol L(-1)), p<0.001). | Is this D vitamin to worry about? | Low levels of serum 25-OHD were found in this patient population. These data add to the literature suggesting an association between vitamin D insufficiency and psychiatric illness, and suggest that routine monitoring of vitamin D levels may be of benefit given the high yield of clinically relevant findings. | Question: Is this D vitamin to worry about?
Answer: Low levels of serum 25-OHD were found in this patient population. These data add to the literature suggesting an association between vitamin D insufficiency and psychiatric illness, and suggest that routine monitoring of vitamin D levels may be of benefit given the high yield of clinically relevant findings. |
Answer the question based on the following context: Current practice guidelines for performance of percutaneous coronary intervention (PCI) in the United States mandate availability of on-site surgical backup. With the decreasing frequency of urgent coronary bypass surgery (UCABG) with newer technologies, it is unclear whether such backup continues to be necessary. A database of 5655 consecutive patients undergoing PCI at a single center between August 1, 1992, and December 31, 1997, was analyzed. Outcomes were determined as well as clinical, lesion, and procedural characteristics of patients during 4 time periods preceding and during use of coronary stenting. Frequency of UCABG for failed PCI decreased from 2.2% to 0.6% in the most recent time period (P<.01) with no change in incidence of in-hospital death or myocardial infarction. Incidence of stenting progressively increased to 72% in the latest period. Patients requiring UCABG had a higher prevalence of acute coronary syndromes (95%) and type B lesions (79%), but these characteristics were also common in patients who did not undergo UCABG. Although coronary stents were available during the last 3 periods studied, only 30% of UCABG patients had lesions or complications amenable to stenting, and stenting attempts in these patients were all unsuccessful. Despite stenting and use of perfusion balloons and intra-aortic balloon pumps, only 40% of patients having UCABG were stable and pain free on transfer to the operating room. | Urgent coronary bypass surgery for failed percutaneous coronary intervention in the stent era: Is backup still necessary? | Although use of UCABG for a failed PCI is currently very low, there are no satisfactory predictors, patients requiring UCABG are frequently clinically unstable, and availability of stenting does not reliably eliminate the need for UCABG or result in a decrease in mortality. This small group of patients continues to require readily available surgical standby. | Question: Urgent coronary bypass surgery for failed percutaneous coronary intervention in the stent era: Is backup still necessary?
Answer: Although use of UCABG for a failed PCI is currently very low, there are no satisfactory predictors, patients requiring UCABG are frequently clinically unstable, and availability of stenting does not reliably eliminate the need for UCABG or result in a decrease in mortality. This small group of patients continues to require readily available surgical standby. |
Answer the question based on the following context: The aim of this study was to assess whether changes in Cystatin C (CyC) after 48 h post contrast media exposure was a reliable indicator of acute kidney injury and the validity of a risk scoring tool for contrast-induced acute kidney injury (CI-AKI). We enrolled 121 patients for whom diagnostic coronary angiography were planned. The risk score for CI-AKI was calculated and serum creatinine (sCr) and CyC were measured before and 48 h post coronary angiography. CyC and sCr based AKI was calculated as a 25% increase from baseline within 48 h from contrast media exposure. Mean serum CyC and creatinine concentrations were 0.88 ± 0.27 mg/dL and 0.79 ± 0.22 mg/dL, respectively before the procedure and 1.07 ± 0.47 mg/dL and 0.89 ± 0.36 mg/dL, respectively 48 h after contrast media exposure (P<0.001). CyC based AKI occurred in 45 patients (37.19 %) and sCr based AKI occurred in 20 patients (16.52%) after the procedure. Mean risk score was found to be 4.00 ± 3.478 and 3.60 ± 4.122 for CyC based AKI and sCr based AKI, respectively and was significantly increased in CyC based AKI group (P<0.001). | Is cystatin-C superior to creatinine in the early diagnosis of contrast-induced nephropathy? | CyC measured 48 h after contrast media exposure may be a more sensitive indicator of CI-AKI relative to creatinine and Mehran risk scoring is in good correlation with CyC increase. | Question: Is cystatin-C superior to creatinine in the early diagnosis of contrast-induced nephropathy?
Answer: CyC measured 48 h after contrast media exposure may be a more sensitive indicator of CI-AKI relative to creatinine and Mehran risk scoring is in good correlation with CyC increase. |
Answer the question based on the following context: Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events, particularly in the context of stable heart disease treated by percutaneous coronary intervention. To stratify medium-term prognosis of an acute coronary syndrome (ACS) population by platelet aggregation. We performed a prospective longitudinal study of 70 patients admitted for an ACS between May and August 2009. Platelet function was assessed by ADP-induced platelet aggregation using a commercially available kit (Multiplate(®) analyzer) at discharge. The primary endpoint was a combined outcome of mortality, non-fatal myocardial infarction, or unstable angina, with a median follow-up of 136.0 (79.0-188.0) days. The median value of platelet aggregation was 16.0U (11.0-22.5U) with a maximum of 41.0U and a minimum of 4.0U (normal value according to the manufacturer: 53-122U). After ROC curve analysis with respect to the combined endpoint (AUC 0.72), we concluded that a value of 18.5U conferred a sensitivity of 75.0% and a specificity of 68% to that result. We therefore created two groups based on that level: group A - platelet aggregation<18.5U, n=44; and group B - platelet aggregation ≥18.5U, n=26. The groups were similar with respect to demographic data (age 60.5 [49.0-65.0] vs. 62.0 [49.0-65.0]years, p=0.21), previous cardiovascular history, and admission diagnosis. There were no associations between left ventricular ejection fraction, GRACE risk score, or length of hospital stay and platelet aggregation. The groups were also similar with respect to antiplatelet, anticoagulant, proton pump inhibitor (63.6 vs. 46.2%, p=0.15) and statin therapy. The variability in platelets and hemoglobin was also similar between groups. Combined event-free survival was higher in group A (96.0 vs. 76.7%, log-rank p<0.01). Platelet aggregation higher than 18.5U was an independent predictor of the combined event (HR 6.75, 95% CI 1.38-32.90, p=0.02). | Platelet aggregation at discharge: a useful tool in acute coronary syndromes? | In our ACS population platelet aggregation at discharge was a predictor of medium-term prognosis. | Question: Platelet aggregation at discharge: a useful tool in acute coronary syndromes?
Answer: In our ACS population platelet aggregation at discharge was a predictor of medium-term prognosis. |
Answer the question based on the following context: Infections are the most frequent complication after colorectal surgery. It has been suggested that adipose tissue metabolism could be related to the risk of post-operative infection, but this could be partially related to the body-mass index. The aim of this study was to look for a relation between adipocytokine levels and the risk of post-operative infection and its type. This prospective cohort study was conducted between March 2013 and March 2014 in two French teaching hospitals. Pre-operative plasma levels of adiponectin and leptin were measured in consecutive patients undergoing elective colorectal surgery. All infections in the 30 d following surgery were recorded. Among the 142 patients included, 29 (20.4%) presented a post-operative infection: 26 surgical site infections and three extra-abdominal infections. Adiponectin and leptin levels correlated weakly but substantially with the body mass index (rspearman=-0.26 and +0.31, respectively). While there was no substantial difference between patients with and those without post-operative infection for adiponectin, median pre-operative leptin was substantially greater in patients with post-operative infection (8.67 vs. 4.37 ng/mL, p=0.003). A substantial interaction was found between leptin and cancer. In patients operated on for cancer, the area under the receiver-operating characteristic (ROC) curve was lower than in patients with benign diseases (0.597 vs. 0.858, p=0.011). Similar results were observed for intra-abdominal infection and surgical site infection. | Are Adiponectin and Leptin Good Predictors of Surgical Infection after Colorectal Surgery? | Patients with greater levels of leptin before colorectal surgery have an increased risk of post-operative surgical infection. This effect is stronger in patients without cancer. Adiponectin levels are not related to the risk of infection in Western patients. | Question: Are Adiponectin and Leptin Good Predictors of Surgical Infection after Colorectal Surgery?
Answer: Patients with greater levels of leptin before colorectal surgery have an increased risk of post-operative surgical infection. This effect is stronger in patients without cancer. Adiponectin levels are not related to the risk of infection in Western patients. |
Answer the question based on the following context: A randomized controlled trial of problem-solving treatment, antidepressant medication and the combination of the two treatments found no difference in treatment efficacy for major depressive disorders in primary care. In addition to treatment outcome, the trial sought to determine possible mechanisms of action of the problem-solving intervention. Two potential mechanisms of action of problem-solving treatment were evaluated by comparison with drug treatment. First, did problem-solving treatment work by achieving problem resolution and secondly, did problem-solving treatment work by increasing the patients' sense of mastery and self-control? Problem-solving treatment did not achieve a greater resolution in the patients' perception of their problem severity by comparison with drug treatment, neither did problem-solving treatment result in a greater sense of mastery or self-control. | Does problem-solving treatment work through resolving problems? | The results from this study did not support the hypotheses that for patients with major depression, by comparison with antidepressant medication: problem-solving treatment would result in better problem resolution; or that problem-solving treatment would increase the patients' sense of mastery and self-control. | Question: Does problem-solving treatment work through resolving problems?
Answer: The results from this study did not support the hypotheses that for patients with major depression, by comparison with antidepressant medication: problem-solving treatment would result in better problem resolution; or that problem-solving treatment would increase the patients' sense of mastery and self-control. |
Answer the question based on the following context: We report 227 patients undergoing surgery for benign thyroid disease. After obtaining patient's informed consent, we collected and analyzed prospectively the following data: calcium serum levels pre and postoperative in the first 24 hours after surgery according to sex, age, duration of surgery, number of parathyroids identified by the surgeon, surgical technique (open and minimally invasive video-assisted thyroidectomy, i.e., MIVAT). We have considered cases treated consecutively from the same two experienced endocrine surgeons. Hypocalcaemia is assumed when the value of serum calcium is below 7.5 mg/dL. Pre-and post-operative mean serum calcium, with confidence intervals at 99% divided by sex, revealed a statistically significant difference in the ANOVA test (p<0.01) in terms of incidence. Female sex has higher incidence of hypocalcemia. The evaluation of the mean serum calcium in pre-and post-operative period, with confidence intervals at 95%, depending on the number of identified parathyroid glands by surgeon, showed that the result is not correlated with values of postoperative serum calcium. Age and pre-and postoperative serum calcium values with confidence intervals at 99% based on sex of patients, didn't show statistically significant differences. We haven't highlighted a significant difference in postoperative hypocalcemia in patients treated with conventional thyroidectomy versus MIVAT. | Is it possible to identify a risk factor condition of hypocalcemia in patients candidates to thyroidectomy for benign disease? | A difference in pre- and postoperative mean serum calcium occurs in all patients surgically treated. The only statistical meaningful risk factor for hypocalcemia has been the female sex. | Question: Is it possible to identify a risk factor condition of hypocalcemia in patients candidates to thyroidectomy for benign disease?
Answer: A difference in pre- and postoperative mean serum calcium occurs in all patients surgically treated. The only statistical meaningful risk factor for hypocalcemia has been the female sex. |
Answer the question based on the following context: Standard treatment for metastatic gastrointestinal stromal tumors (GISTs) is systemic therapy with imatinib. Surgery is performed to remove metastatic lesions to induce long-term remission or even curation. In other patients, surgery is performed to remove (focal) progressive or symptomatic lesions. The impact and long-term results of surgery after systemic therapy have not been clearly defined. Between September 2001 and May 2010, all patients with metastatic GIST who underwent surgery for metastatic GIST after systemic therapy (that is, imatinib and sunitinib) at four Dutch specialized institutions were included. Primary end-points were progression-free survival (PFS) and overall survival (OS). All 55 patients underwent surgery after treatment with systemic therapy. At the last follow-up, tumor recurrence or progression was noted after surgery in 48% of the patients who responded on systemic therapy, and in 85% of the patients who were treated while having progressive disease. Median PFS and OS were not reached in the group of responders. In the non-responders group PFS and OS were median 4 and 25 months, respectively. Response on systemic therapy and a surgical complete resection were significantly correlated to PFS and OS. | Surgery after treatment with imatinib and/or sunitinib in patients with metastasized gastrointestinal stromal tumors: is it worthwhile? | Surgery may play a role in responding patients. In patients with progressive disease, the role of surgery is more difficult to distinguish in this retrospective analysis since PFS is short. Which patients benefit and whether this improves long-term outcome should be established in a multicentric randomized trial. | Question: Surgery after treatment with imatinib and/or sunitinib in patients with metastasized gastrointestinal stromal tumors: is it worthwhile?
Answer: Surgery may play a role in responding patients. In patients with progressive disease, the role of surgery is more difficult to distinguish in this retrospective analysis since PFS is short. Which patients benefit and whether this improves long-term outcome should be established in a multicentric randomized trial. |
Answer the question based on the following context: The purpose of this study was to review the 91 failing polytetrafluoroethylene (PTFE) grafts that were treated at our institution over the past 12 years to better understand their cause and improve the diagnosis and treatment of these grafts. Eighty-five patients with 91 failing grafts were retrospectively reviewed. The 144 graft-threatening lesions associated with these grafts were characterized by location (inflow artery, outflow artery, anastomosis, or graft body) and treatment method used (surgery, balloon angioplasty, or thrombolysis). Progression of atherosclerotic disease was the predominant cause of failing PTFE grafts with 43 inflow lesions and 83 outflow lesions, accounting for 87% of all lesions identified. Ten lesions (7%) were noted within the prosthetic grafts, whereas only eight (6%) lesions were noted at the anastomoses. Forty stenotic lesions 2 cm in length or less were treated with percutaneous transluminal balloon angioplasty, whereas 100 lesions were treated by patch angioplasty or graft extensions. The remaining four lesions, present within the prosthetic grafts, were treated with thrombolytic therapy. The 5-year cumulative patency rate for all failing PTFE grafts was 71%, whereas that of failing femoropopliteal PTFE grafts was 64%. The 5-year limb salvage rate for all failing PTFE grafts was 73%. | Is surveillance to detect failing polytetrafluoroethylene bypasses worthwhile? | The progression of inflow and outflow disease is the predominant cause of failing PTFE grafts, which suggests that this process is a more important cause of PTFE graft thrombosis than is generally recognized. Frequent PTFE graft surveillance may permit detection of some threatening lesions before graft thrombosis occurs and may help maintain and prolong graft patency. The enhanced 5-year patency and limb salvage rates for treated failing PTFE grafts compared with the known poor outcome after reinterventions for PTFE graft failure support the conclusion that surveillance of PTFE grafts is worthwhile. | Question: Is surveillance to detect failing polytetrafluoroethylene bypasses worthwhile?
Answer: The progression of inflow and outflow disease is the predominant cause of failing PTFE grafts, which suggests that this process is a more important cause of PTFE graft thrombosis than is generally recognized. Frequent PTFE graft surveillance may permit detection of some threatening lesions before graft thrombosis occurs and may help maintain and prolong graft patency. The enhanced 5-year patency and limb salvage rates for treated failing PTFE grafts compared with the known poor outcome after reinterventions for PTFE graft failure support the conclusion that surveillance of PTFE grafts is worthwhile. |
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