Miracle-dz/UniFAR-FTUs huggingface dataset:
CARDIOVASCULAR DISEASE AND STROKE ( P PERRONE-FILARDI AND S . AGEWALL , SECTION EDITORS ) Stable Angina Pectoris

The stable coronary artery disease (SCAD) population is a heterogeneous group of patients both for clinical presentations and for different underlying mechanisms. The recent European Society of Cardiology guidelines extensively review SCAD from its definition to patients’ diagnostic and therapeutic management. In this review, we deal with five topics that, in our opinion, represent the most intriguing, novel and/or clinically relevant aspects of this complex coronary condition. Firstly, we deal with a peculiar SCAD population: patients with angina and ‘normal’ coronary arteries. Secondly, we reinforce the clinical importance of a diagnostic approach based on the pretest probability of disease. Thirdly, we review and critically discuss the novel pharmacological therapies for SCAD patients. Finally, we analyse the results of the most recent clinical trials comparing revascularization versus optimal medical therapy in SCAD patients and review the currently recommended use of intracoronary functional evaluation of stenosis.
Multivariate analyses are only informative if sufficient information is provided.

Reporting of multivariate methods is usu-ally insufficient [1]. Thus, readers must trust the authors that they can believe the conclu-sions of an article. Thus, clinicians are ex-pected to assess complex associations with-out sufficient information about the methods the authors used.I read with interest the article by Blaich-man et al. [2], in which the authors perform an ordinal logistic regression analysis. They constructed a model to predict the histologic grade of breast cancer and stated that “the full model differed significantly from the constant-only model, indicating that the fea-tures, as a set, reliably distinguished surgical grades. ” This model is not described in the article, and there is no table with the final model containing the logistic coefficients, standard errors,
Histological assessment of the chondral and connective tissues of the knee by confocal arthroscope

Conventional histological assessment of tissue requires the removal of tissue from its physiological environment for pathological processing. In this study we report on the development and application of a laser scanning confocal arthroscope (LSCA) capable of in situ histological assessment by confocal microscopy. The knee joints of three euthanasied adult Merino sheep were imaged using the LSCA and a combination of fluorescent contrasting agents. LSCA images of various tissues were examined for common histological characteristics. The confocal histology images from the ovine knee acquired during the course of our study illustrated some of the major histological features of chondral and connective tissues. Our study demonstrates the efficacy of the LSCA for the histological assessment of the chondral and connective tissues of the ovine knee. The LSCA provides an easy and rapid method for assessing the in situ structure of cartilage, muscle, tendon, ligament, meniscus and synovium in their native and unaltered physiological environment. By obviating the need for mechanical biopsy, the LSCA provides a method for the non-destructive assessment of the chondral and connective tissues of the knee, and may be of great benefit in the investigation of orthopedic diseases or in the assessment of newly emerging cartilage repair techniques.
Comparison of Swede-O-Universal® Ankle Support and Aircast® Sport-Stirrup orthoses and ankle tape in restricting eversion-inversion before and after exercise

The purpose of this study was to compare the effectiveness of Swede-O-Universal® Ankle Support and Aircast® Sport-Stirrup® orthoses and ankle tape in restricting eversion-inversion before and after exercise. Subjects were eight males and eight females with no history of ankle injury during the six months prior to testing, neurological condition, lower extremity arthritis, lower extremity fracture, cardiac condition, or balance problems. A Biodex dynamometer and computer were used to impose passive moments and to measure eversion and inversion of an ankle support system prior to application, following application, and following 10 minutes of figure-of-eight running and 20 unilateral toe raises. Both ankles of each subject were assessed for each of the three ankle support systems. All support systems significantly reduced eversion and inversion following application and following exercise. Eversion increased significantly following exercise for all support systems, and inversion increased significantly for .
Interrater agreement in the evaluation of discrepant imaging findings with the Radpeer system.

OBJECTIVE The Radpeer system is central to the quality assurance process in many radiology practices. Previous studies have shown poor agreement between physicians in the evaluation of their peers. The purpose of this study was to assess the reliability of the Radpeer scoring system. MATERIALS AND METHODS A sample of 25 discrepant cases was extracted from our quality assurance database. Images were made anonymous; associated reports and identities of interpreting radiologists were removed. Indications for the studies and descriptions of the discrepancies were provided. Twenty-one subspecialist attending radiologists rated the cases using the Radpeer scoring system. Multirater kappa statistics were used to assess interrater agreement, both with the standard scoring system and with dichotomized scores to reflect the practice of further review for cases rated 3 and 4. Subgroup analyses were conducted to assess subspecialist evaluation of cases. RESULTS Interrater agreement was slight to fair compared with that expected by chance. For the group of 21 raters, the kappa values were 0.11 (95% CI, 0.06-0.16) with the standard scoring system and 0.20 (95% CI, 0.13-0.27) with dichotomized scores. There was disagreement about whether a discrepancy had occurred in 20 cases. Subgroup analyses did not reveal significant differences in the degree of interrater agreement. CONCLUSION The identification of discrepant interpretations is valuable for the education of individual radiologists and for larger-scale quality assurance and quality improvement efforts. Our results show that a ratings-based peer review system is unreliable and subjective for the evaluation of discrepant interpretations. Resources should be devoted to developing more robust and objective assessment procedures, particularly those with clear quality improvement goals.
Characterization of 1-to 2-cm liver nodules detected on hcc surveillance ultrasound according to the criteria of the American Association for the Study of Liver Disease: is quadriphasic CT necessary?

OBJECTIVE The purpose of this study was to identify the essential number of phases from multiphasic CT for 1- to 2-cm hepatocellular carcinoma (HCC) on surveillance ultrasound and to compare the results with the American Association for the Study of Liver Disease (AASLD) standard (arterial phase hypervascularity and portal venous phase [PVP] or delayed phase hypovascularity). MATERIALS AND METHODS The study included 110 newly detected nodules (1-2 cm; 36 HCC, 74 benign) in 96 patients detected in an HCC surveillance program. Three radiologists prospectively evaluated the attenuation of each nodule relative to the liver on each phase of quadriphasic CT. Univariate and multivariate logistic regression analyses were used to identify parameters associated with HCC. Multiple combinations of phases were compared with the AASLD standard. RESULTS Only arterial phase hypervascularity and delayed phase hypovascularity were significantly associated with HCC both on univariate (odds ratio, arterial phase 7.51 [95% CI, 2.79-20.20]; delayed phase, 2.80 [1.14-6.90]) and multivariate analyses (arterial phase, 11.30 [4.30-29.68]; delayed phase, 4.39 [1.20-16.13]). The combination of arterial phase and delayed phase yielded the highest specificity (99%) and sensitivity (57%). There was no significant difference between AASLD standard (sensitivity, 57%; specificity, 98%) versus biphasic (arterial phase hypervascularity and delayed phase hypovascularity: sensitivity, 57%; p = 1 and specificity, 99%; p = 0.32), triphasic (arterial phase hypervascularity and unenhanced or PVP hypovascularity: sensitivity, 53%; p = 0.325 and specificity, 97%; p = 0.32), or quadriphasic combination (arterial phase hypervascularity and unenhanced, PVP or delayed phase hypovascularity: sensitivity, 57%; specificity, 97%), whereas the sensitivity of biphasic arterial phase and PVP was significantly lower (39% vs 57%, p = 0.022). CONCLUSION For diagnosing 1- to 2-cm HCC detected on surveillance ultrasound, arterial phase and delayed phase are two essential phases, providing higher sensitivity than the combination of arterial phase and PVP, and equal performance with triphasic and quadriphasic combinations. The biphasic combination of arterial phase and delayed phase may replace quadriphasic CT recommended by AASLD.
Intraductal papillary mucinous neoplasms with associated invasive carcinoma of the pancreas: imaging findings and diagnostic performance of MDCT for prediction of prognostic factors.

OBJECTIVE The purpose of this study was to assess the diagnostic accuracy of MDCT for determining the prognostic factors, including the T category, lymph node metastasis, tumor size, and perineural invasion, in surgically proven intraductal papillary mucinous neoplasms (IPMNs) with an associated invasive carcinoma (IPMC) and to investigate the imaging findings. MATERIALS AND METHODS Our study group consisted of 38 patients with surgically proven IPMC who underwent preoperative dynamic CT. Two radiologists retrospectively assessed the morphologic type of IPMN, size of the cyst, size of the main pancreatic duct, and presence or absence of mural nodules. The radiologists also assessed the T category, lymph node metastasis, and perineural invasion. They graded the perineural invasion using a 3-point scale as follows: 1, normal; 2, streaky and strandlike structure in fat tissue as well as a fine, reticular pattern; and 3, irregular masses adjacent to the lesions. Statistical analyses were performed using receiver operating characteristic analysis, the McNemar test, and Fisher exact test. Kappa statistics were used to determine interobserver agreement. RESULTS The morphologic types of IPMC included the main-duct type (n=11, 29%), combined type (n=18, 47%), and branch-duct type (n=9, 24%). The diagnostic accuracy for the T category was 73.7% (n=28) and 68.4% (n=26) and for the lymph node metastasis was 68.4% (n=26) and 76.3% (n=29), respectively, for the two readers, with moderate interobserver agreement (κ=0.636 and 0.708). The areas under the receiver operating characteristic curve for perineural invasion were 0.868 and 0.821. The sensitivity, specificity, and positive predictive value were 100%, 71.4%, 55.5%, and 90%, 71.4%, 52.9%, respectively. Interobserver agreement was moderate (κ=0.659). The tumor size seen on CT was not statistically different from the tumor size determined on pathology (3.9±[SD] 2.7 cm vs 3.8±2.1 cm, p=0.582). The main duct size was 11.5+6.2 mm. Mural nodules were detected in 74% (n=28) of our study patients. CONCLUSION CT might be useful for preoperatively evaluating the T category, lymph node metastasis, tumor size, and perineural invasion of IPMC. Main pancreatic duct dilatation and the presence of mural nodules are common findings of IPMC.
When Ending the Relationship Does Not End the Violence

Much of the existing research on intimate male violence against women has focused on the prevalence of and response to abuse that occurs within an ongoing intimate relationship. Little attention has been paid to the abuse that occurs after women have ended abusive relationships. In the current study, women leaving a shelter for women with abusive partners were interviewed across 2 years. More than one third of the women were assaulted by a former partner during the time of the study. Several factors under the control of the batterer were found to be related to ex-partner assaults, including his prior violence, threats, and sexual suspicion. Several factors under partial control of the survivor were also explored and were found to be less strongly related to violence by an ex-partner. Implications for improving the community response to women with abusive partners and ex-partners are discussed.
Imaging features of carcinoid tumors of the gastrointestinal tract.

OBJECTIVE Recent studies have provided a better understanding of the biologic behavior of gastrointestinal carcinoid tumors. This article focusing on imaging of gastrointestinal carcinoids will emphasize epidemiology, molecular biology, taxonomy, histopathology, and management. CONCLUSION Gastrointestinal carcinoids are a biologically heterogeneous group of tumors, with variable clinical presentation and biologic behavior. Imaging can play an important role in multidisciplinary identification and management of this disease.
Fatores associados à preferência por cesareana

OBJETIVO: Estudar os fatores relacionados a preferencia por cesariana, em gestantes sem intercorrencias. METODOS: Estudo transversal com 156 gestantes, de clinica privada na cidade de Osasco, Estado de Sao Paulo, no periodo de outubro de 2000 a dezembro de 2001. As gestantes estavam em idade gestacional de 28 semanas ou mais, sem contra-indicacao formal para parto vaginal, no momento da entrevista. Foi aplicado questionario sobre informacoes sociodemograficas, historia obstetrica passada e atual. Perguntou-se a gestante questao especifica sobre preferencia para o parto. Realizou-se teste do qui-quadrado de Pearson e regressao logistica para analise multivariada, com nivel de significância de 5%. RESULTADOS: Sessenta e sete (42,9%) gestantes se diziam pouco motivadas para parto vaginal. Na analise multivariada foram estatisticamente significativas as seguintes variaveis: parto vaginal previo (p<0,001; ORaj=0,04; IC 95%=0,01-0,12); a renda do marido superior a 750 Reais mensais (p=0,006; ORaj=3,44; IC 95%=1,38-8,33). As mulheres com parto vaginal previo apresentaram chance 25 vezes menor de optarem por cesariana. O fato de a gestante nao ter considerado satisfatoria a experiencia do parto previo esteve marginalmente associado ao desfecho (p=0,06; ORaj=0,42; IC 95%=0,16-1,05). CONCLUSOES: A motivacao para parto cesariano esta associada a influencias como tipo e grau de satisfacao com o parto previo e renda.
Journal Club: Structured radiology reports are more complete and more effective than unstructured reports.

OBJECTIVE The radiology report serves as the primary method of communication about imaging findings. Traditional free-text (i.e., unstructured) radiology reporting entails dictating in a stream-of-consciousness manner. Structured reporting aims to standardize the format and lexicon used in reports. This standardization may improve the communication of findings, allowing ease of reading and comprehension. A structured reporting template may also be used as a checklist while reviewing a case, which may facilitate focused attention and analysis. The goal of this study was to compare unstructured and structured reports in terms of their completeness and effectiveness. MATERIALS AND METHODS Radiology trainees were given an educational lecture on the background of reporting and were provided with a structured reporting template for dictating chest radiographs. Twelve trainees completed the study. Sixty reports from before and 60 reports from after the intervention were each independently scored by four blinded physician raters for completeness and effectiveness. RESULTS Structured reports were found to be statistically significantly more complete and more effective than unstructured reports (mean completeness score, 4.42 vs 3.99, p<0.001; mean effectiveness score, 4.11 vs 3.85, p<0.001). A combined score was calculated for each report and was higher for the structured reports (mean combined score, 8.54 vs 7.83, p<0.001). CONCLUSION Structured chest radiograph reports were more complete and more effective than unstructured chest radiograph reports. Although additional studies are needed for validation, this study suggests that structured reporting may represent an improved reporting method for radiologists.
Lung nodule detection by microdose CT versus chest radiography (standard and dual-energy subtracted).

OBJECTIVE The purpose of this study was to investigate the feasibility of microdose CT using a comparable dose as for conventional chest radiographs in two planes including dual-energy subtraction for lung nodule assessment. MATERIALS AND METHODS We investigated 65 chest phantoms with 141 lung nodules, using an anthropomorphic chest phantom with artificial lung nodules. Microdose CT parameters were 80 kV and 6 mAs, with pitch of 2.2. Iterative reconstruction algorithms and an integrated circuit detector system (Stellar, Siemens Healthcare) were applied for maximum dose reduction. Maximum intensity projections (MIPs) were reconstructed. Chest radiographs were acquired in two projections with bone suppression. Four blinded radiologists interpreted the images in random order. RESULTS A soft-tissue CT kernel (I30f) delivered better sensitivities in a pilot study than a hard kernel (I70f), with respective mean (SD) sensitivities of 91.1%±2.2% versus 85.6%±5.6% (p=0.041). Nodule size was measured accurately for all kernels. Mean clustered nodule sensitivity with chest radiography was 45.7%±8.1% (with bone suppression, 46.1%±8%; p=0.94); for microdose CT, nodule sensitivity was 83.6%±9% without MIP (with additional MIP, 92.5%±6%; p<10(-3)). Individual sensitivities of microdose CT for readers 1, 2, 3, and 4 were 84.3%, 90.7%, 68.6%, and 45.0%, respectively. Sensitivities with chest radiography for readers 1, 2, 3, and 4 were 42.9%, 58.6%, 36.4%, and 90.7%, respectively. In the per-phantom analysis, respective sensitivities of microdose CT versus chest radiography were 96.2% and 75% (p<10(-6)). The effective dose for chest radiography including dual-energy subtraction was 0.242 mSv; for microdose CT, the applied dose was 0.1323 mSv. CONCLUSION Microdose CT is better than the combination of chest radiography and dual-energy subtraction for the detection of solid nodules between 5 and 12 mm at a lower dose level of 0.13 mSv. Soft-tissue kernels allow better sensitivities. These preliminary results indicate that microdose CT has the potential to replace conventional chest radiography for lung nodule detection.
The Effect of Dietary Calcium Intake on Plasma Renin Activity and Parathormon in Deoxycorticosteron Salt Hypertension

The effects of diets containing 2% and 4% calcium (Ca) on deoxycorticosteron (DOC) salt hypertension were studied in 29 male rats weighting 210-260 g. Rats were categorized into four groups: Group I: control rats (6), group II: DOC hypertensive group (n=8), group III: DOC-low Ca diet (2% CaCl2) (8) and group IV: DOC-high Ca diet (4% CaCl2) (n=7). During the six weeks follow up period, indirect systolic blood pressure (SBP) was highest in group II while it was found to be less increased in group III and IV. Weight increase was lowest in group IV (P<0.005 versus 3 other groups). There was no relationship between blood pressure (BP) and plasma renin activity (PRA), parathormon (PTH), angiotensin II (AII), serum Ca, serum phosphorus, urine Ca and final body weight. Serum Ca level was lower in group II as compared to group III (P<0.006). PTH was lower in group III and IV than other groups but the differences were statistically nonsignificant. PRA was found supressed in group IV and group II compared to control and group III (Control vs group II p=0.014, control vs group IV p=0.006, group III vs group IV p=0.01). However, the decrease in PRA was more important in group IV than group III. Left heart weight was greater in group IV than group II (p = 0.033) while right heart weight was not different among the groups. Kidney weight showed an increase in group II and group III, when compared with controls (p=0.009, p=0.045 respectively). As a result, at uninephrectomized DOC-salt treated hypertension model in rats, the increase in BP was less prominent in Ca supplemented diet and this effect continued during the study period. In this hypertension model with suppressed PRA, we can state that a decrease in PTH which suggests the suppression of parathyroid gland, may affect BP.
Dynamic contrast-enhanced MRI for the detection of prostate cancer: meta-analysis.

OBJECTIVE The purpose of this study was to systematically review and meta-analyze dynamic contrast-enhanced MRI (DCE-MRI) for the detection of prostate cancer in comparison with standard evaluation with T2-weighted imaging. MATERIALS AND METHODS A PubMed electronic database search for the terms "dynamic contrast-enhanced," "prostate," and "MRI" was completed for articles up to September 17, 2013. All included studies had histopathologic correlation. Two by two contingency data were constructed for each study. A binormal bayesian ROC model was used to estimate and compare sensitivity, specificity, and AUC among eligible modalities. RESULTS Both DCE-MRI (0.82-0.86) and diffusion-weighted MRI (DWI) (0.84-0.88) yielded significantly better AUC than T2-weighted imaging (0.68-0.77). Moreover, partial AUC for the combination of DCE-MRI, DWI, and T2-weighted imaging was improved significantly (0.111; 0.103-0.119) when compared with DCE-MRI alone (0.079; 0.072-0.085) and T2-weighted imaging alone (0.079; 0.074-0.084) but not DWI alone (0.099; 0.091-0.108). Sensitivity and specificity were similar among the four modalities. CONCLUSION DCE-MRI improves AUC of tumor detection overall compared with T2-weighted imaging alone. Methods for DCE-MRI analysis require standardization, but visual analysis performs similar to semiquantitative methods. A two-parameter approach using DCE-MRI and T2-weighted imaging or DWI and T2-weighted imaging may be sufficient, and the latter may be more favorable for most routine prostate cancer imaging.
Advancing the Integration of Mental and Physical Health Care: Overcoming Barriers, Demonstrating Outcomes with Vulnerable Populations, and Understanding Implementation

The purpose of this case study was to examine how an integrated health care model of service delivery for the treatment of depression works with a low income, uninsured adult population in a primary care setting. Through intensive interviews, I examined a single, multidisciplinary team of providers: the care manager, the primary care physician, the consulting psychiatrist, and the director of social services. In addition to the interviews, other units of analysis included quantitative data of patients’ clinical outcomes, reports and other documents describe the demographics of the population served, services offered, staff, and other operational descriptions. Qualitative data analysis methods were used and multiple themes emerged: details which shed light on how one primary care practice has successfully operationalized the model, the tools which they are using in novel ways, the role of team members, and perceived barriers to sustainability. Targeted journal: Qualitative Health Research