bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptomatic Disease
Authors: Laureno Robert
Published: August 2017

This chapter on “Asymptomatic Disease” examines the discovery and management of asymptomatic neurologic diseases. Considered are carotid stenosis, berry aneurysm, arteriovenous malformation, and pseudotumor cerebri. Asymptomatic disease can be discovered by routine physical examination or by diagnostic tests that have been ordered for some unrelated reason. Discovery of asymptomatic disease is not always accidental; practitioners sometimes search for asymptomatic brain disease. Such testing can be prompted by the family history, the patient’s personal history, or the clinical situation. After an asymptomatic condition has been found, the practitioner must decide how to use the information. Judgment, in such cases, can be difficult.
Terminology
Authors: Laureno Robert
Published: August 2017

This chapter on “Terminology” examines neurologic terms. Topics considered are eponyms, origins of terms, political aspects of terms, renaming, and success of terms. Terms from classical languages came to medicine in waves. Some originated in ancient times, some developed when Latin was the language of scholars in the Renaissance and during the Scientific Revolution, and some emerged in modern times. The resulting language of medicine is mainly a Latinized Greek. By and large, the vocabulary is Greek and the structure is Latin. The two main roots of our medical terminology have given us some duplicate terms. Arriving at names for neurologicanatomy and disease can be a complicated process.
Causation
Authors: Laureno Robert
Published: August 2017

This chapter on “Causation” examines the determination of the causes of neurologic disease. Considered are Koch-Henle postuates and Bradford Hill criteria. When we talk about “cause,” we make a distinction between necessary and sufficient causes, as well as those causes of disease that are neither necessary nor sufficient, that contribute to the development of a disease but cannot by themselves cause the disease. Probabilistic causes show their effects in combination with other probabilistic causes, known and unknown. In the absence of experimental evidence for cause, we rely on observational information. Observational study may be prospective or retrospective (case-control study). The criteria for medicolegal causation in the courtroom and in the clinic differ, and the neurologist asked to determine cause in a court of law must rely on experience, good judgment, and common sense.
Decussation
Authors: Laureno Robert
Published: August 2017

This chapter on “Decussation” examines the right–left crossing of neurological systems. Covered are the corticospinal tract, optic chiasm, and other subjects. The presence of crossed neurological systems is basic to clinical neurology. Crossing, however, appears to not be essential, and the amount of crossing can vary from individual to individual. We can track across vertebrate species the evolution of complete chiasmal crossing to the diminished crossing seen in the human visual system. This change in crossing of vision is very understandable as a correlate of the evolution of a lateral-eyed animal to a frontal-eyed human. The origin of crossing cannot be determined with certainty; we can only speculate about how many times crossing developed in pre-vertebrate history or what advantages, if any, crossing conferred. Clinicians, however, must be prepared to recognize patients with uncrossed anatomy—a challenge when we expect systems to be crossed as usual.
Key working versus the whole-team approach
Authors: Burns Tom , Firn Mike
Published: August 2017

In ACT, it was originally proposed that every patient should be looked after by the whole team and not have an individual case manager or key worker. Its originator, Len Stein, was convinced that key working fostered pathological dependence, and the idea has gained considerable prominence. We reject this proposal and explore the practical differences between the whole-team approach and more usual forms of multidisciplinary care. There is clearly a range of practice that can be adapted for different teams depending on the specific needs of their group of patients.
Cultural sensitivity
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter concentrates on ethnicity and the complex relationship with both economic disadvantage and mental health access and outcomes when working in culturally diverse communities. The social processes that underlie cultural norms in behaviour and beliefs are discussed with examples of how mental health community services must be alert to unconscious and other forms of discrimination. Understanding each unique individual in the context of their families, communities, shared history, and how they see the world around them is the core task for mental health workers. Implications for practice, team composition, and training are explored, including dealing with racism towards staff as well as from within services and institutions. The legal framework of the Equalities Act in the UK is used as a guide.
Personality problems and disorders
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter deals with the controversial issue of personality disorder, whether these are meaningful diagnoses and, if so, how they affect management. The classification is entirely pragmatic: the definitions and classification in both ICD-10 and DSM-V are outlined along with proposals to abandon categories in favour of a dimensional approach. The issue of treatability is explored, but we conclude that ignoring personality and personality disorders is not a viable alternative for outreach workers. Most of the chapter deals with the management of dissocial personality disorder (usually in men) and borderline personality disorder (usually in women). Specific psychotherapies are not dealt with here; the focus is on how to use team work to manage individuals with severe mental illness and disorders of personality.
Substance misuse/dual diagnosis
Authors: Burns Tom , Firn Mike
Published: August 2017

Dual diagnosis is used to refer to people with a psychotic illness plus harmful or hazardous substance misuse, which includes alcohol and any legal or illegal drugs. These coexisting morbidities present challenges for the delivery of services which have traditionally specialized in one or the other in the form of different approaches in addictions and community outreach services. The chapter provides data on the high incidence, poorer outcomes, associated risks, and high service use of these dual diagnosis patients. Best practice in service responses and clinical assessment and interventions are presented alongside a case study and care planning documentation.
Daily living skills
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter covers interventions with people who need encouragement with cooking or shopping due to motivational, cognitive, and information-processing difficulties associated with severe mental illness. Community outreach allows an in vivo approach to supporting these tasks that enable people to survive outside of hospital and which contribute to their quality of life. Functional assessment, activity analysis, and collaborative goal setting are discussed, together with ways of measuring progress. The evidence base for interventions such as social skills training is critiqued. A case study and summary care plan illustrate typical approaches with patients in the community.
Operational and team management
Authors: Burns Tom , Firn Mike
Published: August 2017

Outreach in community mental health is a complex and labour-intensive activity that relies on coordination, communication, and clear procedures. This chapter looks at team systems and processes in a typical week that help ensure a safe, efficient, patient-centred, equitable, and timely service that has effective outcomes. Leadership, accountability, and responsibility frameworks are explored, and strategies for the effective recruitment, selection, and supervision of staff discussed. Role functions within the multidisciplinary team—such as team leader, psychiatrist, and case manager—are explained, and a typical weekly schedule for a team presented. Effective communication and coordination strategies are discussed, including the format and functions of the handover and review meetings.
Service planning
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter aims to guide practitioners and managers in setting up and reviewing community outreach services for people with severe mental illness from a non-technical service planning perspective. Examples of different service configurations within a comprehensive local system are given, with some observations on their relative merits and drawbacks from evaluations. Service models and structures are important for providing a framework for delivering quality care, yet from the perspective of the service user, many of these service details—integrated care, specialization, caseload size, staffing mix, ownership of beds, and degree of shared caseload—are invisible. For people with severe mental health problems, patients and carers value the principles of good community-based care, such as access, responsiveness, consistency, and continuity.
Hepatobiliary pathology
Authors: Carton James
Published: August 2017

This chapter discusses hepatobiliary pathology and covers acute viral hepatitis, chronic viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), Wilson’s disease, hereditary haemochromatosis, cirrhosis, benign liver lesions, hepatocellular carcinoma (liver cell cancer), intrahepatic cholangiocarcinoma, cholecystitis, and extrahepatic bile duct carcinoma.
Endocrine pathology
Authors: Carton James
Published: August 2017

This chapter discusses endocrine pathology and includes diabetes mellitus, Hashimoto’s thyroiditis, Graves’ disease, nodular goitre, follicular adenoma, thyroid carcinomas, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), parathyroid hyperplasia, parathyroid adenoma, parathyroid carcinoma, Addison’s disease, adrenal cortical adenoma, adrenal cortical carcinoma, phaeochromocytoma, neuroblastoma, pituitary adenoma, and multiple endocrine neoplasia (MEN) syndromes.
Ventilator System Composition
Authors: Lei Yuan
Published: August 2017

‘Ventilator System Composition’ describes in depth, each of the six essential parts: the electrical supply, compressed gas supply, ventilator, breathing circuit, artificial airway, and the patient’s lungs. The chapter discusses the internal design of the ventilator, particularly the inspiratory channel and expiratory channel, and the use of a proportional valve. It describes the structure of the various breathing circuits or patient circuits that are used, and their relationship to the humidifier in use. Next, the author addresses the artificial airway or non-invasive patient interface, and finally the additional components that are added to the airway, components that add dead space and resistance to the circuit.
Radiological and Nuclear Incidents
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 10 covers information on definitions and types of radiological incident, radiation units, classification of radiation and nuclear incidents, basic radiation physics, stochastic and deterministic effects of radiation, types of device, acute effects of a nuclear explosion (detonation), managing an incident, radiological triage, radiation and the body, management of acute radiation syndrome, chronic effects, planning the response to a nuclear or radiation incident, planning at civilian sites, principles of radiation protection, civil nuclear constabulary, emergency exposures, the police response, RADSAFE, the site operator, fire and rescue services response, role of local authorities and Public Health England, national arrangements, radiation monitoring units, the Government Decontamination Service, central government response, dealing with the media, recovery, nuclear incidents overseas, and RIMNET.
Ethical issues in cardiac arrest and acute cardiac care: a European perspective
Authors: Vincent Jean-Louis
Published: August 2017

Acute cardiac syndromes are common and responsible for considerable mortality and morbidity. Decision making in such patients can be difficult clinically but can also be complex and challenging from an ethical perspective. This chapter reviews some of the ethical problems, including organ donation and withholding/withdrawing, that can occur in the acutely ill adult cardiac patient, starting with a brief look at the ethical principles that should guide our decision making: beneficence, non-maleficence, autonomy, and distributive justice. The role of advance directives and considerations related to family presence during cardiopulmonary resuscitation will also be discussed. With the increasing incidence and prevalence of coronary artery disease worldwide, the number of patients with cardiac arrest and requiring acute cardiac care is going to increase, and doctors will increasingly be faced with difficult ethical decisions associated with these patients. Open discussion and debate about these issues and good communication among patients, family members, and members of the health care team are essential to ensure that all patients receive the best possible end-of-life care.
Clinical assessment and monitoring of chest radiographs
Authors: Parkhomenko Alexander , Gurjeva Olga S , Yalynska Tetyana
Published: August 2017

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.
Physiotherapy in critically ill patients
Authors: Gosselink R , Roeseler J
Published: August 2017

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment of critically ill patients is less driven by medical diagnosis; instead, there is a strong focus on deficiencies at a pathophysiological and functional level. An accurate and valid assessment of respiratory conditions (retained airway secretions, atelectasis, and respiratory muscle weakness), physical deconditioning, and related problems (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity, and emotional function) allows the identifying of targets for physiotherapy. Evidence-based targets for physiotherapy are deconditioning, impaired airway clearance, atelectasis, (re-)intubation avoidance, and weaning failure. Early physical activity and mobility are key in the prevention, attenuation, or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence-based and are implemented, depending on the stage of critical illness, comorbid conditions, and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and make recommendations for their progression, jointly with medical and nursing staff.
Atherosclerosis and thrombosis
Authors: Badimon Lina , Vilahur Gemma
Published: August 2017

Atherosclerosis is the main underlying cause of heart disease. The continuous exposure to cardiovascular risk factors induces endothelial activation/dysfunction which enhances the permeability of the endothelial layer and the expression of cytokines/chemokines and adhesion molecules. This results in the accumulation of lipids (low-density lipoprotein particles) in the intimal layer and the triggering of an inflammatory response. Accumulated low-density lipoprotein particles attached to the extracellular matrix suffer modifications and become pro-atherogenic, enhancing leucocyte recruitment and further transmigration across the endothelium into the intima. Infiltrated pro-atherogenic monocytes (mainly Mon2) differentiate into macrophages which acquire a specialized phenotypic polarization (protective/M1 or harmful/M2), depending on the stage of the atherosclerosis progression. Once differentiated, macrophages upregulate pattern recognition receptors capable of engulfing modified low-density lipoprotein, leading to foam cell formation. Foam cells release growth factors and cytokines that promote vascular smooth muscle cell migration into the intima, which then internalize low-density lipoproteins via low-density lipoprotein receptor-related protein-1 receptors becoming foam cells. As the plaque evolves, the number of vascular smooth muscle cells decline, whereas the presence of fragile/haemorrhagic neovessels and calcium deposits increases, promoting plaque destabilization. Disruption of this atherosclerotic lesion exposes thrombogenic surfaces rich in tissue factor that initiate platelet adhesion, activation, and aggregation, as well as thrombin generation. Platelets also participate in leucocyte and progenitor cell recruitment are likely to mediate atherosclerosis progression. Recent data attribute to microparticles a modulatory effect in the overall atherothrombotic process and evidence their potential use as systemic biomarkers of thrombus growth. This chapter reviews our current understanding of the pathophysiological mechanisms involved in atherogenesis, highlights platelet contribution to thrombosis and atherosclerosis progression, and provides new insights into how atherothrombosis may be prevented and modulated.
Cardiogenic shock in patients with acute coronary syndromes
Authors: Thiele Holger , Zeymer Uwe
Published: August 2017

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
Acute valve disease and endocarditis
Authors: Ducrocq Gregory , Thuny Franck , Iung Bernard , Vahanian Alec
Published: August 2017

The management of patients with acute valve disease is now a rare, but challenging, event, as valvular patients are often elderly with severe comorbidities. Furthermore, a proportion of previously operated patients present with acute valve dysfunction. The aim, in this situation, is to establish a rapid diagnosis, based on clinical examination and echocardiography, followed by early intervention. The primary treatment remains surgical valve replacement. However, a more conservative surgical approach is under development, and, more recently, percutaneous interventional techniques have been introduced. In the future, every effort should be made to avoid performing interventions in an acute situation, as it is always at high risk.
Acute kidney injury
Authors: Gevaert Sofie A , Hoste Eric , Kellum John A
Published: August 2017

Acute kidney injury is a serious condition, occurring in up to two-thirds of intensive care unit patients, and 8.8-55% of patients with acute cardiac conditions. Renal replacement therapy is used in about 5-10% of intensive care unit patients. The term cardiorenal syndrome refers to combined heart and kidney failure; three types of acute cardiorenal syndrome have been described: acute cardiorenal syndrome or cardiorenal syndrome type 1, acute renocardiac syndrome or cardiorenal syndrome type 3, and acute cardiorenal syndrome type 5 (cardiac and renal injury secondary to a third entity such as sepsis). Acute kidney injury replaced the previously used term ‘acute renal failure’ and comprises the entire spectrum of the disease, from small changes in function to the requirement of renal replacement therapy. Not only failure, but also minor and less severe decreases, in kidney function are of clinical significance both in the short and long-term. The most recent definition for acute kidney injury is proposed by the Kidney Disease: Improving Global Outcomes clinical practice guidelines workgroup. This definition is a modification of the RIFLE and AKIN definitions and staging criteria, and it stages patients according to changes in the urine output and serum creatinine (see Tables 68.1 and 68.2). Acute kidney injury is a heterogeneous syndrome with different and multiple aetiologies, often with several insults occurring in the same individual. The underlying processes include nephrotoxicity, and neurohormonal, haemodynamic, autoimmune, and inflammatory abnormalities. The most frequent cause for acute kidney injury in intensive cardiac care patients are low cardiac output with an impaired kidney perfusion (cardiogenic shock) and/or a marked increase in venous pressure (acute decompensated heart failure). Predictors for acute kidney injury in these patients include: baseline renal dysfunction, diabetes, anaemia, and hypertension, as well as the administration of high doses of diuretics. In the intensive cardiac care unit, attention must be paid to the prevention of acute kidney injury: monitoring of high-risk patients, prompt resuscitation, maintenance of an adequate mean arterial pressure, cardiac output, and intravascular volume (avoidance of both fluid overload and hypovolaemia), as well as the avoidance or protection against nephrotoxic agents. The treatment of acute kidney injury focuses on the treatment of the underlying aetiology, supportive care, and avoiding further injury from nephrotoxic agents. More specific therapies have not yet demonstrated efficacy. Renal replacement therapy is indicated in life-threatening changes in fluid, electrolyte, and acid-base balance, but there are also arguments for more early initiation.
Factors Influencing Physicians' Selection of Continuous Professional Development Activities: A Cross-Specialty National Survey
Authors: Cook David A. , Price David W. , Wittich Christopher M. , West Colin P. , Blachman Morris J.
Published: August 2017

Introduction:

We sought to understand what influences physicians' decisions about participation in continuous professional development (CPD) activities, and how often physicians engage in specific CPD activities.

Methods:

From September 2015 to April 2016, we administered a survey to 4648 randomly sampled licensed US physicians. Survey items addressed perceived barriers to CPD, factors that might influence participation in four prototypical CPD activities (reading an article, or completing a local activity, online course, or far-away course), and frequency of CPD engagement.

Results:

Nine hundred eighty-eight (21.6%) physicians responded. The most important barriers were time (mean [SD] 3.5 [1.3], 1 = not important, 5 = extremely important) and cost (2.9 [1.3]). In prioritizing factors influencing participation in four prototypical CPD activities, topical relevance consistently had the highest average rank. Quality of content and time to complete the activity were also frequently selected. Over the past 3 years, most physicians reported having participated in patient-focused learning and self-directed learning on a weekly basis; quality improvement and local continuing medical education (CME) activities several times per year; online learning, on-site courses, and national board-related activities a few times per year; and interprofessional learning less than once per year. Physicians believed that they ought to engage more often in all of these activities except board-related activities. They would like CME credit for these activities much more often than currently obtained.

Discussion:

The reasons physicians select a given CPD activity vary by activity, but invariably include topic and quality of content. Physicians want CME credit for the CPD activities they are already doing.
Advanced Age is Not a Contraindication for Treatment With Curative Intent in Esophageal Cancer
Authors: Voncken Francine E.M. , van der Kaaij Rosa T. , Sikorska Karolina , van Werkhoven Erik , van Dieren Jolanda M. , Grootscholten Cecile , Snaebjornsson Petur , van Sandick Johanna W. , Aleman Berthe M.P.
Published: August 2017

Objectives:

The objective of this study is to compare long-term outcomes between younger and older (70 y and above) esophageal cancer patients treated with curative intent.

Materials and Methods:

Overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free interval were compared between older (70 y and above) and younger (below 70 y) esophageal cancer patients treated between 1998 and 2013. Treatment consisted of neoadjuvant chemoradiotherapy with surgery or definitive chemoradiotherapy: 36 to 50.4 Gy in 18 to 28 fractions combined with 5-fluorouracil/cisplatin or carboplatin/paclitaxel.

Results:

The study comprised 253 patients, of whom 76 were 70 years and older. Median age was 64 years (range, 41 to 83). Most patients had stage II-IIIA disease (83%). Planned treatment was neoadjuvant chemoradiotherapy with surgery for 169 patients (41 patients aged 70 y and older) and definitive chemoradiotherapy for 84 patients (31 patients aged 70 y and older). The compliance to radiotherapy was 92%, with no difference between older and younger patients. In 33 patients (13 patients aged 70 y and older) planned surgery was not performed. Median follow-up was 4.9 years. Three-year OS was 42%. The multivariable analysis showed no statistical difference in OS or in DFS comparing older and younger patients: OS (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.61-1.28), DFS (HR, 0.87; 95% CI, 0.60-1.25). Elderly showed a longer locoregional recurrence-free interval; HR, 0.53 (95% CI, 0.30-0.92; P=0.02) and a higher pathologic complete response rate (50% vs. 25%; P=0.02).

Conclusions:

Long-term outcomes of older esophageal cancer patients (70 y and above) selected for treatment with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy were comparable with the outcomes of their younger counterparts. Advanced age alone should not be a contraindication for potentially curative chemoradiotherapy-based treatment in esophageal cancer patients.
Surgical Intervention in Gastric Carcinoid is Associated With Improved Survival in Local and Regional Disease
Authors: Callahan Ann F. , White Michael , Ituarte Philip , Gagandeep Singh , Woo Yanghee , Fong Yuman , Melstrom Laleh
Published: August 2017

Introduction:

Gastric carcinoid is a rare entity with complex management options. This study aims to determine if surgical intervention in patients with local, regional, and metastatic gastric carcinoid is associated with prolonged survival.

Materials and Methods:

The California Cancer Registry merged with the California Office of Statewide Health Planning and Development was queried for patients with a diagnosis of gastric carcinoid (2000 to 2011). Clinicopathologic characteristics, management, and outcomes were evaluated.

Results:

There were 1012 patients with a diagnosis of gastric carcinoid identified. The median age was 63 (range, 18 to 99) and the majority of patients were women (615, 60.7%). Most patients had localized disease (644, 64%), whereas 9.4% (95) had regional and 13.4% (133) had distant metastases at diagnosis. The majority of patients underwent gastric surgery (56.7%, n=574 vs. 43.2%, n=438). Prolonged survival was associated with gastric surgery in patients with both local (median survival not reached; P<0.0001) and regional disease (27 mo with surgery vs. 5 mo with no surgery; P=0.0007). In patients who underwent gastrectomy and resection of hepatic metastasis, the survival approached those patients who had surgery for only regional disease (26 vs. 27 mo, P=0.8721).

Conclusions:

Although the biology of the disease is the most significant predictor of overall outcome, when technically feasible and where comorbidities allow, aggressive endoscopic or surgical intervention should be offered for local and locoregional diseases, respectively.
A Phase I Clinical Trial of the Phosphatidylserine-targeting Antibody Bavituximab in Combination With Radiation Therapy and Capecitabine in the Preoperative Treatment of Rectal Adenocarcinoma
Authors: Meyer Jeffrey , Arriaga Yull , Anandam Joselin , Karri Sirisha , Syed Samira , Verma Udit , Abdelnaby Abier , Raja Grace , Dong Ying , Beg Muhammad Shaalan , Balch Glen
Published: August 2017

Objectives:

There is interest in improving the tumoricidal effects of preoperative radiotherapy for rectal carcinoma by studying new radiosensitizers. The safety and toxicity profile of these combination regimens needs rigorous clinical evaluation. The primary objective of this study was to evaluate the toxicity of combining bavituximab, an antibody that targets exposed phosphatidylserine, with capecitabine and radiation therapy.

Materials and Methods:

Patients with stage II or III rectal adenocarcinoma were enrolled on a phase I study combining radiation therapy, capecitabine, and bavituximab. A standard 3+3 trial designed was used.

Results:

In general, bavituximab was safe and well tolerated in combination with radiation therapy and capecitabine in the treatment of rectal adenocarcinoma. One patient at the highest dose level experienced a grade III infusion reaction related to the bavituximab. One tumor demonstrated a complete pathologic response to the combination treatment.

Conclusions:

Bavituximab is safe in combination with capecitabine and radiation therapy at the doses selected for the study. Further clinical investigation would be necessary to better define the efficacy of this combination.
Application of the 21-item Vulvovaginal Symptoms Questionnaire in postmenopausal Spanish women
Authors: Fernández-Alonso Ana M. , Alcaide-Torres Javier , Fernández-Alonso Isabel M. , Chedraui Peter , Pérez-López Faustino R.
Published: August 2017

Objective:

To assess vulvovaginal symptoms and urinary incontinence in postmenopausal women. Secondarily to evaluate factors related to the severity of vulvovaginal symptoms and the internal consistency of the used tools.

Methods:

In this cross-sectional study, the Spanish language version of the 21-item Vulvovaginal Symptoms Questionnaire (VSQ) and the 3-item International Consultation on Incontinence Questionnaire (ICIQ-SF) were applied to 122 postmenopausal Spanish women aged 45 to 75 years.

Results:

Mean age of the whole sample was 59.5 ± 4.9 years; 89.3% had natural menopause, 77.9% reported vulvovaginal symptoms, 54.9% had urinary incontinence, 54.1% were sexually active, and 77.0% currently had a partner. Calculated Cronbach's alpha coefficients were 0.87 and 0.88 for the VSQ and the ICIQ-SF, respectively. Multiple linear regression analysis determined that total VSQ scores (more severe vulvovaginal symptoms) were positively correlated with female age, parity, surgical menopause, being sexually active, economic problems, phytoestrogen use, and more severe urinary incontinence. An inverse correlation was found with urban residency and time since menopause onset.

Conclusions:

Internal consistency of the VSQ and the ICIQ-SF was good in this postmenopausal sample in which age, sexual activity, urinary incontinence, drug use, and other personal aspects were important covariates determining the severity of vulvovaginal symptoms.
Relative contribution of obesity and menopause to the association between serum adiponectin and incident metabolic syndrome
Authors: Ahn Song Vogue , Jung Dong-Hyuk , Yadav Dhananjay , Kim Jang-Young , Koh Sang-Baek
Published: August 2017

Objective:

Metabolic syndrome is closely linked to obesity. Menopause may play a critical role in understanding the pathophysiology of metabolic syndrome in women. We investigated the relative contribution of obesity and menopause to the association between serum adiponectin levels and the development of metabolic syndrome.

Methods:

A prospective cohort study was conducted in which a total of 1,219 women without metabolic syndrome were examined at baseline (2005-2008) and followed up (2008-2011). Women were divided according to tertiles of serum adiponectin levels and menopause status, and then stratified into four groups: the nonobese with high adiponectin; the nonobese with low adiponectin; the obese with high adiponectin; and the obese with low adiponectin.

Results:

During an average 2.5-year follow-up, 44 premenopausal women (9.8%) and 161 postmenopausal women (20.9%) developed metabolic syndrome. The obese group with low serum adiponectin demonstrated an increased risk for developing metabolic syndrome in both premenopausal (odds ratio [OR] 5.92, 95% confidence interval [CI] 2.24-15.66) and postmenopausal women (OR 4.22, 95% CI 2.41-7.36). However, the inverse association between serum adiponectin levels and incidence of metabolic syndrome was observed in premenopausal women with obesity (OR 0.16, 95% CI 0.03-0.81), but not in postmenopausal women with obesity (OR 0.55, 95% CI 0.27-1.14).

Conclusions:

High serum adiponectin levels showed no inverse association with metabolic syndrome in postmenopausal women with obesity. These findings may suggest a need for closer management of metabolic risk in postmenopausal women.
Optic Nerve Head Drusen: Imaging Using Optical Coherence Tomography Angiography
Authors: Flores-Reyes Elsa , Hoskens Kirsten , Mansouri Kaweh
Published: August 2017

Purpose:

To describe findings and utility of optical coherence tomography angiography (OCTA) in optic nerve head drusen (ONHD).

Observations:

A 57-year-old white man presented with a decrease in contrast sensitivity of the inferior visual field in both eyes. Clinical examination, visual fields, optical coherence tomography, fundus autofluorescence and OCTA revealed ONHD bilaterally. A focal decrease in vessel density within the localization of ONHD in both eyes was demonstrated suggesting a connection between those findings.

Conclusions and Importance:

This is the first report in which peripapillary vessel density is analyzed using OCTA technology for this entity. OCTA could confirm the diagnosis and has the potential to assist with the diagnosis and evaluation of progression of ONHD.
Cytomegalovirus Infection in Pediatric Severe Ulcerative Colitis—A Multicenter Study from the Pediatric Inflammatory Bowel Disease Porto Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition
Authors: Cohen Shlomi , Martinez-Vinson Christine , Aloi Marina , Turner Dan , Assa Amit , de Ridder Lissy , Wolters Victorien M. , de Meij Tim , Alvisi Patrizia , Bronsky Jiri , Kopylov Uri
Published: August 2017

Background:

Data on the clinical course and outcomes of pediatric patients with cytomegalovirus (CMV) infection complicating acute severe ulcerative colitis (ASC) are very limited. The aim of our study was to compare outcomes of children with ASC who were CMV positive or CMV negative.

Methods:

This was a multicenter retrospective case-controlled study, from centers affiliated with the Pediatric Inflammatory Bowel Disease Porto Group of European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. We included CMV-positive children hospitalized for ASC and compared their colectomy rate during hospitalization and up to 1 year thereafter, matched with CMV-negative controls.

Results:

A total of 56 children were included; 15 CMV positive and 41 CMV negative. More CMV-positive patients were resistant to intravenous corticosteroids as compared with CMV negative (93% and 56% respectively, P = 0.009). Fourteen of the CMV-positive children (93%) were treated with ganciclovir [5/14 (36%) with 5 mg/kg and 9/14 (64%) with 10 mg/kg]. During hospitalization, 3 (20%) CMV-positive and 3 (7.8%) CMV-negative patients required colectomy (P = 0.17). By 12 months, 5 (33%) and 5 (13%) CMV-positive and CMV-negative patients required colectomy, respectively (P = 0.049); the significance was not retained on multivariate analysis.

Conclusions:

A higher prevalence of CMVpositivity was found in pediatric ulcerative colitis patients who required colectomy within 12 months of hospitalization for ASC. Further studies are needed to clarify the impact of CMV infection on the outcome of acute severe colitis in pediatric patients.
Congenital Cytomegalovirus Infection After a Multiple Birth Pregnancy
Authors: Shmueli Einat , Hadar Eran , Pardo Joseph , Attias Joseph , Amir Jacob , Bilavsky Efraim
Published: August 2017

Background:

Congenital cytomegalovirus (cCMV) infection is an important cause of hearing loss and neurodevelopment delay. While data on vertical transmission and neonatal outcome after singleton pregnancy with cCMV are well established, only scarce reports have addressed cCMV in multiple birth pregnancies. Furthermore, no studies have yet compared the outcome after birth and long-term follow-up of children with cCMV born after a singleton versus multiple pregnancies.

Methods:

Infant outcome after birth of symptomatic versus asymptomatic infection was compared for infants born with cCMV after multiple (study group) and singleton (control group) pregnancies in a 1:2 ratio.

Results:

Of 508 infants diagnosed with cCMV, 25 (4.9%) were born after a multiple pregnancy. Children in the study and control groups did not differ in terms of specific prenatal CMV investigations including amniocentesis and brain magnetic resonance imaging studies. However, prematurity rates were significantly higher in the study compared with control group (52% vs. 4%, P < 0.001). There was a higher rate of symptomatic cCMV infection in the study group than in the controls (48% vs. 14%, P < 0.001). Hearing impairment at birth was also more frequent in the study group (32% vs. 8%, P = 0.016). A long-term follow-up demonstrated that children in the study group had higher rates of neurologic sequelae (hearing impairment or neurodevelopmental delay) compared with children in the control group (20% vs. 4%, P = 0.016).

Conclusions:

Infants with cCMV born after multiple birth pregnancies are born earlier and have a higher risk of symptomatic disease at birth and worse long-term neurologic outcome than those born after a singleton pregnancy. This important group of children warrants meticulous prenatal and postnatal care.
Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis
Authors: Lerman Sheera F. , Finan Patrick H. , Smith Michael T. , Haythornthwaite Jennifer A.
Published: August 2017

Pain catastrophizing is a significant risk factor for patients with knee osteoarthritis (KOA) and thus is a target for many psychological interventions for pain. This study examined if interventions targeting sleep found to be effective in improving sleep in KOA also reduce pain catastrophizing measured as a trait through the pain catastrophizing scale and measured as a daytime and nocturnal state through daily diaries. Secondary analyses were conducted on data collected as part of a randomized controlled trial assessing the effectiveness of cognitive behavioral therapy for insomnia in patients with KOA at 5 different time points: pretreatment, midtreatment and posttreatment and at 3- and 6-month follow-up. One hundred patients diagnosed with KOA and insomnia were randomized to receive either 8 sessions of cognitive behavioral therapy for insomnia or a placebo intervention of behavioral desensitization. Multilevel modeling revealed that both intervention groups showed a significant reduction pretreatment to posttreatment in all 3 measures of pain catastrophizing and maintained stable levels through the 6-month follow-up. Increased sleep continuity early in treatment (pretreatment to midtreatment), but not reductions in pain, was associated with a reduction in trait and nocturnal catastrophizing later in treatment (midtreatment to posttreatment). These results suggest that short interventions focusing on sleep can significantly reduce pain catastrophizing even in a clinical population with low baseline levels of catastrophizing, possibly through improving sleep continuity.
Marijuana and Its Effects on Athletic Performance: A Systematic Review
Authors: Trinh Kien V. , Diep Dion , Robson Hannah
Published: August 2017

Objective:

To determine the effects of marijuana on athletic performance.

Design:

We searched MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, and SPORTDiscus from their beginning to September 2016. Study quality was assessed using the Cochrane collaboration tool for assessing risk of bias and the Cochrane GRADE scale. No meta-analyses were performed for this review.

Setting:

Subjects in a track, gym, or recreational ward.

Participants:

Any primary study which included male and female adults of any athletic background between ages 18 and 65, with no other comorbid conditions.

Interventions:

Any primary study which used marijuana cigarettes and included a control group.

Main Outcome Measures:

Vital signs, pulmonary measures, physical work capacity, grip strength, and exercise duration were determined to be relevant outcomes.

Results:

Three trials examined marijuana and its effects on athletic performance. Two trials had a high risk of bias and 1 trial had an unclear risk of bias. The effect of marijuana on outcomes including heart rate, blood pressure, and exercise duration remains unclear. Low quality evidence suggests that treatment, sham, and inactive control groups do not have a significant difference for grip strength. Low quality evidence suggests that there is an ergogenic effect of treatment demonstrated by increased bronchodilation and FEV1 compared with inactive control and that there is an ergolytic effect of treatment demonstrated by decreased physical work capacity compared with sham and inactive control groups.

Conclusion:

Because the number and quality of studies was low, the effects of marijuana on athletic performance remain unclear.
Rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis: a systematic review and meta-analysis
Authors: Kamal Faisal , Khan Muhammad Ali , Khan Zubair , Cholankeril George , Hammad Tariq A. , Lee Wade M. , Ahmed Aijaz , Waters Bradford , Howden Colin W. , Nair Satheesh , Satapathy Sanjaya K.
Published: August 2017

Prophylactic antibiotics have been recommended in patients with a previous history of spontaneous bacterial peritonitis (SBP). Recently, there has been interest in the use of rifaximin for the prevention of SBP and hepatorenal syndrome (HRS). We conducted a meta-analysis to evaluate this association of rifaximin. We searched several databases from inception through 24 January 2017, to identify comparative studies evaluating the effect of rifaximin on the occurrence of SBP and HRS. We performed predetermined subgroup analyses based on the type of control group, design of the study, and type of prophylaxis. Pooled odds ratios (ORs) were calculated using a random effects model. We included 13 studies with 1703 patients in the meta-analysis of SBP prevention. Pooled OR [95% confidence interval (CI)] was 0.40 (95% CI: 0.22–0.73) (I
2=58%). On sensitivity analysis, adjusted OR was 0.29 (95% CI: 0.20–0.44) (I
2=0%). The results of the subgroup analysis based on type of control was as follows: in the quinolone group, pooled OR was 0.42 (95% CI: 0.14–1.25) (I
2=55%), and in the no antibiotic group, pooled OR was 0.40 (95% CI: 0.18–0.86) (I
2=64%). However, with sensitivity analysis, benefit of rifaximin was demonstrable; pooled ORs were 0.32 (95% CI: 0.17–0.63) (I
2=0%) and 0.28 (95% CI: 0.17–0.45) (I
2=0%) for the comparison with quinolones and no antibiotics, respectively. Pooled OR based on randomized controlled trials was 0.41 (95% CI: 0.22–0.75) (I
2=13%). For the prevention of HRS, the pooled OR was 0.25 (95% CI: 0.13–0.50) (I
2=0%). Rifaximin has a protective effect against the development of SBP in cirrhosis. However, the quality of the evidence as per the GRADE framework was very low. Rifaximin appeared effective for the prevention of HRS.
What’s in a Name? Perceptions of the Terms Sexually Transmitted Disease and Sexually Transmitted Infection Among Late Adolescents
Authors: Lederer Alyssa M. , Laing Elizabeth E.
Published: August 2017

Background

There has been a shift from using the term sexually transmitted disease (STD) to sexually transmitted infection (STI), primarily based on conjecture that STI is less stigmatizing. However, there is a dearth of evidence regarding how the public actually perceives these terms.

Methods

Students at a Midwestern university participated in an online survey and were randomized to the open-ended question “What comes to mind when you think of the term sexually transmitted disease (STD)?” (n = 205) or “What comes to mind when you think of the term sexually transmitted infection (STI)?” (n = 208). Conventional content analysis was conducted to identify response themes. Cross tabulations with the χ2 statistic determined the number of participants that endorsed each theme and any differences between the STD and STI responses.

Results

Almost all themes occurred in similar numbers across the STD and STI responses. Overarching themes for both terms were contracted through sex; specific STDs/STIs; severe; negative emotional affect; types of people who get STDs/STIs; physical symptoms; preventable; common; and treatable/curable. However, participants were more likely to mention that STDs were common (P = 0.030) and reported less negative emotional affect for STIs (P = 0.024). Two themes emerged only in the STI group: STDs (P = 0.001) and site of infection (P = 0.003).

Conclusions

With some exceptions, late adolescents have overlapping conceptualizations of the terms STD and STI. The most commonly reported themes revealed likely areas of misinformation. Although language is an important aspect of health communication, more than a terminology change is needed to reduce the stigma associated with STDs/STIs.