bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Assistance, Drug Testing, and the Law: The Limits of Population-Based Legal Analysis
Authors: Player Candice T.
Published: January 2017

InPopulations, Public Health and the Law, legal scholar Wendy Parmet urges courts to embrace population-based legal analysis, a public health inspired approach to legal reasoning. Parmet contends that population-based legal analysis offers a way to analyze legal issues—not unlike law and economics—as well as a set of values from which to critique contemporary legal discourse. Population-based analysis has been warmly embraced by the health law community as a bold new way of analyzing legal issues. Still, population-based analysis is not without its problems. At times, Parmet claims too much territory for the population perspective. Moreover, Parmet urges courts to recognize population health as an important norm in legal reasoning. What should we do when the insights of public health and conventional legal reasoning conflict? Still in its infancy, population-based analysis offers little in the way of answers to these questions. This Article applies population-based legal analysis to the constitutional problems that arise when states condition public assistance benefits on passing a drug test, thereby highlighting the strengths of the population perspective and exposing its weaknesses.
Obamacare's Impact on Labor Markets: Limits on the Predictive Value of Romneycare
Authors: Archambault Josh
Published: January 2017

There has been great debate about the potential labor market impact of the Affordable Care Act (“ACA” or “Obamacare”). Some have pointed to Massachusetts as the harbinger of what is to come nationally, while others have predicted massive dumping of employer-based insurance. An extension of this labor market debate was on full display during the summer of 2012. Critics seized on a McKinsey & Co. survey that found that Obamacare could result in thirty percent of companies dropping employer-sponsored insurance (ESI). Meanwhile, proponents of the ACA quickly and continually referred to the experience of companies in Massachusetts as a way to push back on this narrative.

Surprisingly, there is bipartisan agreement that Massachusetts’s own health reform efforts (“Romneycare”) does in fact serve as an accurate model for what to expect under the federal law: this has complicated a lucid discussion of the ACA’s potential labor market impact.
Assessing the True Impact of the ACA: Revisiting the CBO's Initial Predictions
Authors: Auerbach David
Published: January 2017

In Obamacare’s Impact on Labor Markets: Limits on the Predictive Value of Romneycare, Josh Archambault makes a number of arguments about the ultimate impact of the Affordable Care Act (ACA). A central point is that the overall impact on the US labor market and economy will be worse than the Congressional Budget Office (CBO) projected—to some extent, because the CBO used the experience in Massachusetts as one piece of evidence in guiding its estimates. A recent report by the CBO on potential effects of the ACA on employment has added additional fuel to the debate. In particular, Archambault argues that more people will leave employer-sponsored insurance (ESI), and that the ACA will cost more than the CBO projected.

Archambault makes many good points. The ACA does add new taxes, such as an additional 1% Medicare tax on families earning over $250,000, a 2.3% tax on medical devices, and additional taxes on some health insurers and tanning salons. Altogether, these taxes were expected to raise roughly $400 billion between 2010 and 2019.
Collective action and labour militancy interrupted: Back-to-work legislation and the state of permanent exceptionalism at Air Canada
Authors: Stevens Andrew , Templeton Andrew
Published: January 2017

Using data collected from survey responses and interviews conducted in 2014, this study examines the consequences of back-to-work legislation from the perspective of customer service workers at Air Canada represented by Unifor Local 2002. By examining union attitudes, opinions of strikes, wildcat actions and back-to-work legislation deployed in 2011 and 2012, the study concludes that this type of legislation functioned to protect the interests of the employer in an ongoing process of corporate restructuring. Such ad hoc legislative measures, defined by political economists as ‘permanent exceptionalism’, further undermines the industrial pluralist regime that is the foundation of Canadian labour relations.
Standard Stripping versus Long Saphenous Vein-Saving Surgery for Primary Varicose Veins: A Prospective, Randomized Study with the Patients as Their Own Controls
Authors: Campanello M. , Hammarsten J. , Forsberg C. , Bernland P. , Henrikson O. , Jensen J.
Published: January 2017

Objective:

To compare the postoperative discomfort and long-term outcome following standard stripping and atter long saphenous vein-saving surgery.

Design:

Prospective, randomized case-control study with patients serving as their own controls.

Setting:

Department of Surgery, County Hospital, Varberg, Sweden.

Patients:

Eighteen patients with bilateral primary varicose veins.

Interventions:

The patients were randomized prospectively to stripping or long saphenous vein-saving surgery. The leg causing most discomfort was operated on first. The other leg was operated on using the alternative method.

Main outcome measures:

Postoperative discomfort was assessed after an interview with the patient. Long-term outcome was determined by clinical assessment and Plethysmographic venous return time.

Results:

After 4 years the legs subjected to long saphenous vein-saving surgery yielded equal clinical results and had as great a prolongation of the plethysmographic venous return time as legs operated on using standard stripping. More patients reported greater discomfort following stripping than after vein-saving surgery. The saved long saphenous vein in all legs operated on was patent, compressible, non-sclerotic and free of intraluminal echoes.

Conclusion:

The long-term results of long saphenous vein-saving surgery are as good as standard stripping, provided that incompetent perforators are throughly mapped preoperatively and ligated at surgery. Long saphenous vein-saving surgery causes less subjective postoperative discomfort than standard stripping. The saved long saphenous vein can probably be used for future arterial reconstruction.
Depression, Osteoporosis and Osteoarthritis
Authors: Varga Ervin , Kline Nathan S
Published: January 2017

A correlation was found between clinical depression and the presence of either osteoporosis or osteoarthritis. Sex, age and race influenced which disease pattern was expressed. Other research has indicated a relationship between parathyroid disease and depression. The effectiveness of lithium therapy in affective disorders is also of possible relevance.

The nature of the relationship between mineral metabolism and affective disease may well lead to an explanation of the pathogenesis of affective disorders.
Lymecycline and Concurrent Ingestion of Milk
Authors: Ericson S , Gnarpe H
Published: January 2017

It has been suggested in the past that milk causes an impaired absorption of tetracycline and this paper describes a study set up to examine any inhibition of absorption of a tetracycline derivative, lymecycline (Tetralysal) with the concurrent intake of milk. The results of the study show no clinical reason for restricting a moderate intake of milk in conjunction with lymecycline therapy.
Preliminary Results of a Clinical Trial Relative to the Use of Rifamycin SV in the Treatment of Herpes Zoster
Authors: Bruni L , Califano A , Angelis De G , Montagnani A , Pisani M , Pezzarossa G , Pozzo G , Reali D , Rebora A , Zanca A
Published: January 2017

In a controlled clinical trial undertaken in ten Italian centres, rifamycin SV was compared to associations of various drugs such as erythromycin, aureomycin, multivitamin preparations, etc, in the treatment of herpes zoster.

Up to now 144 patients, suffering from herpes zoster at different localizations, were divided into three groups and randomly given either rifamycin SV by intramuscular injection and topically, or rifamycin SV by injection only, or the routine treatment used at the particular centre in question. To evaluate the effectiveness of the treatments, the presence of subjective and objective symptoms was determined before treatment started and daily thereafter.

The duration, in days, of the most important symptoms, such as erythema, vesicles, scabs and pain, was considered for this partial evaluation.

All the above-mentioned symptoms constantly showed a shorter duration in the two groups treated with rifamycin SV compared to the group treated with other therapies, with differences as significant on statistical calculation as they were important on the level of a clinical evaluation of the disease's course.
Comparative Efficacy of Lormetazepam (Noctamid®) and Diazepam (Valium®) in 100 Out-Patients with Insomnia
Authors: Hernández M Sastre y , Hentschel H-D , Fichte K
Published: January 2017

Lormetazepam (Noctamid®) at a dosage of 1 mg was compared with diazepam (Valium®) at a dosage of 5 mg in a 7-day double-blind study. The study involved fifty patients in the lormetazepam group and fifty patients in the diazepam group. All the patients were suffering from sleep disorders as a concomitant symptom of general diseases.

Lormetazepam was significantly better than diazepam in the:

Reduction of the time taken to fall asleep (p < 0.05) Prolongation of the duration of uninterrupted sleep (p < 0.05) Reduction of the frequency of awakening (p < 0.05)

Lormetazepam displayed no hang-over effects or other side-effects and, in this respect too, was significantly superior to diazepam (p < 0.05).
Theophylline Absorption by Effervescent Activated Charcoal (Medicoal®)
Authors: Helliwell M , Berry D
Published: January 2017

Plasma theophylline concentrations were measured in six volunteers given 675 mg of a sustained-release preparation (Phyllocontin®). Significant reductions in both the mean recorded peak theophylline plasma concentrations and the mean 12-hour theophylline bioavailability were observed after the administration of effervescent activated charcoal (Medicoal®) in single and multiple doses. These results indicate the potential use of activated charcoal in the management of theophylline poisoning.
Etizolam in the Treatment of Generalized Anxiety Disorder: A Controlled Clinical Trial
Authors: Bertolino A. , Mastucci E. , Porro V. , Corfiati L. , Palermo M. , Ecari U. , Ceccarelli G.
Published: January 2017

A total of 45 patients with generalized anxiety disorder were treated twice daily for 2 weeks, on a double-blind basis, with 0.5 mg etizolam, 0.5 mg alprazolam or 3 mg bromazepam, and symptoms were assessed using Hamilton's rating scale for anxiety and Hamilton's rating scale for depression. Patients then received the same drug for a further 2 weeks, the drugs being given three times daily if a poor response was observed during the first 2 weeks. All drugs displayed equivalent anxiolytic activity after 2 weeks, but etizolam displayed a progressive increase in anxiolytic activity over 4 weeks of treatment. Etizolam also possessed a more marked antidepressant effect than did alprazolam or bromazepam. There were no differences in the tolerability of the three drugs.
Imedeen® for the Treatment of Degenerated Skin in Females
Authors: Lassus A. , Jeskanen L. , Happonen H.P. , Santalahti J.
Published: January 2017

Imedeen®, a new compound for oral administration consisting of special protein fractions and some glucosaminoglycans extracted from marine fish, has been shown in previous pilot studies to have a repairing effect on sun-damaged skin. In an open study, 10 females with sun-damaged skin, aged 39 – 61 years, were treated with 0.5 g/day Imedeen® for 90 days. At baseline and after 30, 60 and 90 days, the following parameters were clinically evaluated: wrinkles; mottles; dryness of skin; and brittleness of hair and nails. After 90 days' treatment all signs of sun-damage had improved and brittleness of hair and nails was normalized in all cases. These clinical observations were confirmed by changes in skin thickness and elasticity. In a second double-blind study, 30 females in the same age range and with similar signs of sun-damage were treated with 0.5 g/day Imedeen® or placebo for 90 days. The results in the Imedeen®-treated group corresponded to those in the first study whereas no response to treatment was observed in the placebo treatment group.
Morphological Lesions in Red Blood Cells from Herring Gulls and Atlantic Puffins Ingesting Prudhoe Bay Crude Oil
Authors: Leighton F. A.
Published: January 2017

Red blood cells from nestling herring gulls and Atlantic puffins that had ingested 10 ml or more of a Prudhoe Bay crude oil/kg body weight/day for four to five days were examined by light and electron microscopy. In stained smears, red blood cells from oil-dosed birds were characterized by anisocytosis, poikilocytosis, reticulocytosis, and Heinz body formation. In transmission electron micrographs, affected cells had intracytoplasmic and intranuclear Heinz bodies, a variety of abnormal cytoplasmic vesicles, degenerate mitochondria, absence of circumferential microtubules, abnormal shape, and crenulation of the plasma membrane. The latter two cell surface anomalies were evident in scanning electron micrographs. Identical lesions were present in red cells from gulls injected with phenylhydrazine. Reticulocytosis was the only change evident in blood from gulls made anemic by hemorrhage. These observations support the hypothesis that the toxicity of ingested Prudhoe Bay oil to red cells was exerted by oxidant chemical compounds.
Expanding the airwaves
Authors: Hopkinson Amanda
Published: January 2017

Twenty years of dictatorship and a machismo culture keep women silent. No longer. A new radio station is making their voice heard throughout Chile
CD40 Ligand-Dependent Maturation of Human Monocyte-Derived Dendritic Cells by Activated Platelets
Authors: Kaneider N.C. , Kaser A. , Tilg H. , Ricevuti G. , Wiedermann C.J.
Published: January 2017

Atherosclerosis is defined as an inflammatory immunological disease that is triggered by platelet activation, endothelial injury and consequent innate and adaptive immune processes. Dendritic cells are critical for the cell-mediated arm of the immune response as they activate naïve T cells after maturation. Platelets play a crucial role in thrombus formation in the injured vessel walls. We investigated the role of resting and thrombin-activated platelets in dendritic cell maturation in vitro using platelets and monocyte-derived dendritic cells from healthy donors. Resting platelet supernatants did not affect maturation, whereas supernatants from thrombin-activated platelets induced dendritic cell maturation as demonstrated by FACS analysis of HLA-DR expression. This effect was inhibited by anti CD40 ligand antibody, but not by aspirin pretreatment of platelets. Supernatants of platelet-dendritic cell co-cultures induced augmented monocyte migration when platelets were activated by thrombin, again reversible by blocking CD40 ligand. These data show that activated platelets trigger dendritic cell maturation independent of cyclooxygenase-derived arachidonic acid metabolites by mechanisms involving CD40 ligand, which is also involved in monocyte chemotactic mediator release from platelets and dendritic cells. The results of this study suggest a role of CD40 ligand from activated platelets in connecting innate and adaptive immunity.
Expression of Proliferating Cell Nuclear Antigen (PCNA) in Multiple Myeloma: Its Relationship to Bone Marrow Microvessel Density and other Factors of Disease Activity
Authors: Alexandrakis M.G. , Passam F.H. , Pappa C.A. , Dambaki C. , Sfakiotaki G. , Alegakis A.K. , Kyriakou D.S. , Stathopoulos E.
Published: January 2017

The expression of the proliferating cell nuclear antigen (PCNA) was studied in plasma cells in bone marrow biopsies from patients with multiple myeloma (MM) using a double immunostaining method. In the same samples, microvessel density (MVD), after staining with anti-CD34 antibodies, was determined before and after chemotherapy. The correlation of PCNA expression and MVD with other myeloma parameters (clinical stage, bone marrow plasma cell infiltration and serum interleukin –6 (IL-6)) was also investigated.

The study population included 51 newly diagnosed MM patients, 12 patients in plateau phase after treatment and 15 normal controls. Pretreatment mean ± SE values of PCNA, MVD, plasma cell infiltration and serum IL-6 were significantly higher than post treatment values and controls. Pretreatment PCNA expression correlated significantly with bone marrow MVD (p<0.05) plasma cell infiltration (p<0.01) and IL-6 (p<0.01).

These findings show that the proliferative activity of plasma cells is related to the angiogenic activity in the bone marrow of multiple myeloma patients. Both PCNA and MVD correlate with markers of disease activity thus may provide additional information when included in the initial evaluation of myeloma bone marrow biopsies.
Occupational Asthma Due to Low Molecular Weight Agents
Authors: Di Stefano F. , Verna N. , Di Giampaolo L. , Schiavone C. , Di Gioacchino G. , Balatsinou L. , Burge P. S. , Boscolo P. , Di Gioacchino M.
Published: January 2017

Occupational asthma is defined as variable airflow obstruction and airways hyperresponsiveness caused by exposure to agents present in the workplace. Low molecular weight agents such as isocyanates, aldehydes, anhydrides, colophony, dyes, persulphate, amines, acrylates and metals are steadily increasing as causative agents of occupational asthma. Isocyanates, aldehydes and anhydrides may cause sensitisation through an IgE mediated response in some workers. These agents act as haptens which combine with a carrier protein to form a complete antigen. Assays for the detection of specific IgE are standardized for very few agents and have a good specificity, but poor sensitivity. The diagnosis of occupational asthma relies not only on a suggestive hystory showing that asthma is caused or exacerbated specifically by work exposure, but in most cases needs to be confirmed by objective means. Combined monitoring of lung function parameters, such as peak expiratory flow rate at the work site and non specific bronchial hyperresponsiveness during and away from exposure, is necessary. The “gold standard” for confirming a diagnosis in an individual worker still remains the specific bronchoprovocation test, which has now reached a high degree of sensitivity, specificity and reproducibility for agents such as isocyanates. In occupational asthma due to low molecular weight agents, there are no individual risk factors which could predict the susceptibility to develop the disease. The primary prevention is based on appropriate interventions in the workplace. The strict medical surveillance of workers may allow the early diagnosis and removal from further exposure in order to prevent morbidity and disability.
Cellular Infiltrate and Related Cytokines, Chemokines, Chemokine Receptors and Adhesion Molecules in Chronic Autoimmune Urticaria: Comparison between Spontaneous and Autologous Serum Skin Test Induced Wheal
Authors: Caproni M. , Giomi B. , Melani L. , Volpi W. , Antiga E. , Torchia D. , Fabbri P.
Published: January 2017

In recent years, the demonstration of circulating functional autoantibodies against the high affinity IgE receptor or against IgE themselves in about one-third of patients with chronic idiopathic urticaria has suggested that an autoimmune mechanism might be involved in the pathogenesis of the disease [the so-called chronic autoimmune urticaria (CAIU)]. In this study we compare findings from serum-induced and spontaneous wheals with regard to immunohistochemical markers of disease activity and discuss whether autologous serum skin test (ASST) may be regarded as an in vivo experimental model of the physiological stimulus causing urticaria skin condition, or if it does not reproduce the whole of the mechanisms operating in the development of spontaneous wheals. By means of immunohistochemical technique, we analyzed specimens from just-developed spontaneous wheals and from serum-evoked wheals of six CAIU patients, to glean information on cellular infiltrate and related cytokines, chemokines, chemokine receptors and adhesion molecules. According to the results of our study, spontaneous urticaria lesions seem to be sustained by a characteristic inflammation pattern where neutrophils, adhesion molecules, IL-8 and chemokine receptors play a main role in flogosis triggering and, consequently, disease development. On the contrary, ASST-induced wheals seem to imply different activities mainly represented by basophil granulocytes and related molecules, i.e. IL-4. Although it represents an efficacious diagnostic instrument to screen CAIU patients, ASST is not an exhaustive model of the many immunopathogenic pathways operating in the development of urticaria lesions, especially with regard to systemic activation networks.
Doctors' and Patients' Educational Levels Affect Immunotherapy Prescription
Authors: Ciprandi G. , Larosa M. , Tesi C.F. , Cadario G. , Fiocchi A. , Romano A. , Frati F.
Published: January 2017

Cultural level appears to be a critical factor in the decision process of allergen-specific immunotherapy (SIT) both for doctors and patients. Thus, appropriate educational programs should be carried out to increase the number of allergic patients to be treated with SIT.
Antioxidative Role of Interleukin-6 in Septic Lung Injury in Mice
Authors: Inoue K. , Takano H. , Yanagisawa R. , Sakurai M. , Shimada A. , Satoh M. , Yoshino S. , Yamaki K. , Yoshikawa T.
Published: January 2017

We have previously demonstrated the protective role of interleukin (IL)-6 against septic lung injury induced by lipopolysaccharide (LPS) using IL-6 knock-out (−/−) mice. This protection is mediated, at least partly, through the inhibition of the enhanced local expression of proinflammatory cytokines. In the present study, we addressed whether IL-6 regulates oxidative stress in the lung generated by LPS exposure using IL-6 (−/−) and corresponding wild type (WT) mice. Intraperitoneal LPS (1 mg/kg) challenge induced transcriptional expressions of inducible nitric oxide synthase and heme oxygenase −1 in the lung of mice with both genotypes. In the presence of LPS, these expressions were significantly greater in IL-6 (−/−) than in WT mice. Immunohistochemistry also showed that LPS induced a significant increase in 8-hydroxy-2′-deoxyguanosine formation in the lung as compared to vehicle. Furthermore, the formation was more intense in IL-6 (−/−) than in WT mice in the presence of LPS challenge. In the presence of LPS, lipid peroxidation in the lung was significantly greater in IL-6 (−/−) than in WT mice. These data suggest that the possible mechanisms in which endogenous IL-6 protects against septic lung injury induced by LPS involve, at least in part, its antioxidative properties.
Influence and Variation of the Body Mass Index in Patients Treated with Etanercept for Plaque-Type Psoriasis
Authors: Esposito M. , Mazzotta A. , Saraceno R. , Schipani C. , Chimenti S.
Published: January 2017

A relationship between psoriasis, pro-inflammatory cytokines and obesity has been demonstrated. Tumour necrosis factor-alpha (TNF-α), that is involved in the pathogenesis of psoriasis, is commonly over-expressed in obese subjects, and seems to be derived from inflammatory cells and adipocytes. The primary aim of this study is to investigate whether the Body Mass Index (BMI) of patients influences the clinical response to etanercept, a competitive inhibitor of TNF-α approved for the treatment of moderate-to-severe plaque-type psoriasis. The secondary aim is to evaluate whether the TNF-α inhibition influences the weight and BMI profile of patients. One hundred patients received 50 mg etanercept twice weekly for 12 weeks, followed by 25 mg. At weeks-12 and 24, treatment efficacy and tolerability were evaluated, as well as body weight and BMI. BMI values did not correlate with etanercept efficacy. Mean PASI score variation did not show significant differences among the BMI groups. A statistically significant weight gain and BMI variation were observed in a consistent rate of patients. Patient BMI does not influence psoriasis efficacy parameters. Although the role of and TNF-α molecules on weight regulation need to be confirmed, our study shows that etanercept treatment may induce weight gain and a BMI increase.
Direct Visualization of Oral-Cavity Tissue Fluorescence as Novel Aid for Early Oral Cancer Diagnosis and Potentially Malignant Disorders Monitoring
Authors: Paderni C. , Compilato D. , Carinci F. , Nardi G. , Rodolico V. , Lo Muzio L. , Spinelli G. , Mazzotta M. , Campisi G.
Published: January 2017

Direct visualization of the oral tissue autofluorescence has been recently reviewed in several studies as a possible adjunctive tool for early recognition and diagnosis of potentially malignant and malignant oral disorders. The aims of this study were to assess: a) the value of a simple handheld device for tissue auto-fluorescence visualization of potentially malignant oral lesions; and b) the sensitivity, specificity and diagnostic accuracy of tested device, using histological examination as the gold standard. 175 consecutive patients, with at least one clinical oral lesion, were enrolled in the study. Clinical conventional inspections were performed for each patient by two blind operators. Then, oral biopsy and histological examination were performed. Pathologist was blind with respect to the autofluorescence results. The 175 histological assessments revealed no dysplasia, mild dysplasia, moderate/severe dysplasia and OSCC, in the 67.4%, 8.6%, 8%, 16% of cases, respectively. Oral lesions diagnosed as OSCC were found as positive under fluorescent light in the 96.4% of cases. Statistically significant correlation was observed between oral dysplastic lesions and the loss of tissue fluorescence (p-value=0.001). Low sensitivity values (60% and 71%) were recorded about the ability of the device in differentiating mild dysplasia vs. lack of dysplasia and moderate/severe dysplasia vs absence of dysplasia, respectively. The device tested in our study was found to not replace the histopathology procedure. However, we assessed its usefulness for oral tissue examination, especially within an oral medicine secondary care facility, before performing a biopsy and in monitoring oral lesions.
The Effect of Autologous Conditioned Plasma on the Treatment of Focal Chondral Defects of the Knee. An Experimental Study
Authors: Milano G. , Deriu L. , Passino E. Sanna , Masala G. , Saccomanno MF , Postacchini R. , Fabbriciani C.
Published: January 2017

The purpose of the present study was to evaluate the effect of local application of Autologous Conditioned Plasma (ACP) on the treatment of full-thickness cartilage injuries of the knee. The hypothesis of the study was that ACP can enhance healing response of injured cartilage. A full-thickness chondral lesion on the weight-bearing area of the medial femoral condyle was performed in 30 sheep. Animals were divided into 2 groups, according to postoperative treatment: in group 1, weekly injections of ACP for five times were performed; in group 2, lesions were left untreated. Animals were sacrificed at 3, 6 and 12 months after treatment. A histological evaluation was performed according to a modified O'Driscoll histological score. Comparison between groups for each time interval was performed with the Student's t-test. Significance was set at P <0.05. A post-hoc power analysis was performed according to the hypothesis of the study. Histological evaluation at 3 and 6 months showed that group 1 had significantly greater total score than group 2. At 12 months, no significant difference was observed between groups. In conclusion, local injections of ACP for treatment of full-thickness cartilage injuries did not produce hyaline cartilage. However, it promoted reparative response of the cartilage defect until 6 months after treatment.
Toll-like Receptor Kinetics in Septic Shock Patients: A Preliminary Study
Authors: Piazza O. , Pulcrano G. , Fiori P.L. , Tufano R. , Lonardo M. , Rossano F. , Catania M.R.
Published: January 2017

The aim of this study is to evaluate some inflammatory parameter changes in septic shock patients and their possible correlation with clinical outcome, in particular when continuous veno-venous hemofiltration (CVVH) treatment is required. Considering the objective difficulty in enrolling this kind of patient, a preliminary study was initiated on seventeen septic shock patients admitted to a medical and surgical ICU. The mRNA expression of Toll-like receptor (TLR)-1, TLR-2, TLR-4, TLR-5, TLR-9, TNFα, IL-8 and IL-1β was assessed, the plasmatic concentrations of IL-18, IL-2, IL-10 and TNFα were measured on the day of sepsis diagnosis and after 72 h. In those patients who developed acute renal failure unresponsive to medical treatment and who underwent CVVH treatment the same parameters were measured every 24 h during CVVH and after completion of the treatment. On sepsis diagnosis, gene expression of TLRs was up-regulated compared to the housekeeping gene in all the patients. After 72 h, in 35% of the patients a down-regulation of these genes was found compared to day 1, but it was not associated with a reduction of cytokine serum levels or improved clinical signs, better outcome or reduced mortality. After high volume hemofiltration treatment, cytokine serum levels and TLR expression were not significantly modified. In conclusion, considering the not numerous number of cases, from our preliminary study, we cannot certainly correlate TLR over-expression in septic shock patients with severity or outcome scores.
Second European Multi-Disciplinary Conference of National Strategies for Chlamydia Trachomatis and Human Papillomavirus (NSCP Conference) in Berlin, 2013 — Enhanced Detection, Management and Surveillance of Sexually Transmitted Infections in Europe are Essential!
Authors: Ozolins D. , D'Elios M.M. , Ripa T. , Bailey R. , Timms P. , Spiteri G. , Haar K. , Unemo M.
Published: January 2017

There is a need for updated guidance on detection, management and surveillance of sexually transmitted infections (STIs). Chlamydia, gonorrhoea and syphilis reporting needs to be mandatory in more European countries to aid collection of data. More widespread Chlamydia screening is needed in many countries as this is the only way to reduce complications. The role of Human Papillomavirus (HPV) screening in a situation where the prevalence of HPV infection has dropped significantly was also discussed in the context of the high cost of screening, the need for a relatively complex infrastructure, particularly in developing countries, and falling vaccination costs. An integrated HPV vaccination and screening policy could be the most appropriate with vaccination at 9–13 years as recommended by WHO and a single HPV screen at 35–39 years, possibly repeated thereafter every 10 years. Female and male HPV vaccination programmes could lead to near elimination of genital warts in both females and males. Surveillance of STIs should be intensified where needed; additional or better quality data should be collected including reasons for testing, denominator data to estimate positivity rates, diagnostic methods, concurrent STIs, sexual orientation and country of acquisition; more analytical rather than descriptive epidemiology is needed.
Tridimensional Personality of Adolescents with Internet Addiction and Substance Use Experience
Authors: Ko Chih-Hung , Yen Ju-Yu , Chen Cheng-Chung , Chen Sue-Huei , Wu Kuanyi , Yen Cheng-Fang
Published: January 2017

Objective:

This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group).

Method:

In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use.

Results:

Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores.

Conclusion:

Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.
Monitoring and Management of Metabolic Risk Factors in Outpatients Taking Antipsychotic Drugs: A Controlled Study
Authors: Jennex Amber , Gardner David M
Published: January 2017

Objective:

To evaluate the screening, monitoring, and management of metabolic risk factors and diseases in long-term antipsychotic users in relation to current practice guidelines and current standards of care as represented by a control group from an HIV clinic.

Methods:

We undertook a retrospective chart review of mental health clinic outpatients taking antipsychotic drugs long-term (cases) and HIV outpatients prescribed highly active antiretroviral therapy (control subjects).

Results:

We included 99 mental health clinic patients and 98 HIV patients in the analysis. According to information available in the outpatient clinic chart, the 10-year coronary artery disease risk was computable for 28% of the mental health clinic patients (mean risk 11.9%) and for 90% of the HIV patients (mean risk 9.5%) (χ2 = 77.0, P < 0.001). Metabolic risk factors were less frequently documented in mental health clinic charts. All HIV clinic patients were screened for hypertension and diabetes, and 90% were screened for dyslipidemia, whereas this information was missing for 30%, 39%, and 60% of mental health clinic patients, respectively ( P < 0.001 for all). Disease monitoring was also more comprehensive in HIV clinic charts (for example, 100% of HIV patients were monitored for lipids, compared with 71% of mental health clinic patients; P = 0.001).

Conclusions:

Improved efforts are needed in the somatic care of patients with bipolar disorder and schizophrenia who are taking antipsychotics, given that they typically have moderate-to-high risk for metabolic diseases.
Permissible Errors in Managing Property: An Approach to the Threshold of Capacity
Authors: Silberfeld Michel , Corber Wendy
Published: January 2017

Objective:

To demonstrate a practical approach to describing the threshold of mental capacity.

Method:

A retrospective analysis of 62 cases of assessments for capacity to manage property was carried out to record the type and frequency of errors.

Results:

For items on the Mini-Mental State Examination (MMSE), there was no clear demarcation of items associated with a judgement of capable. On the clinical criteria, several items almost completely distinguished capable from incapable subjects.

Conclusions:

The permissible error approach makes the threshold of capacity explicit. It is well suited to the emphasis put on functional performance in the evaluation of mental capacity.
Strategic Positioning of Home Health Care Services in a Regional Integrated Delivery System
Authors: Tapper Gina M.
Published: January 2017

With the rapid growth of managed care, health care providers are consolidating to form regional, fully integrated delivery systems to achieve operational efficiencies and to meet contracting requirements. Increasingly home health care is becoming a core business, with critical links to system-affiliated physicians and facilities and the communities served. As a result, most large integrated delivery systems (IDSs) have expanded the strategic positioning and capabilities of home care within their provider networks. This article explores (1) industry trends impacting the need for a regional home care strategy; (2) some recommended action steps for effectively integrating or linking home care into a regional health care delivery system; and (3) a decision-making process by which a regional IDS can define the optimal strategic positioning for home care services.
The Adequacy of Measurement of Short and Long-Term Consequences of False-Positive Screening Mammography
Authors: Brodersen John , Thorsen Hanne , Cockburn Jill
Published: January 2017

Objectives:

The aim of this study is to review quantitative studies on women's experiences of consequences of false-positive screening mammography to assess the adequacy of the most frequently used instruments for measuring short-term and long-term psychological consequences.

Methods:

Relevant papers reporting quantitative studies on consequences of false-positive screening mammography were identified using MEDLlNE, CINAHL, EMBASE and PsycInfo databases. Articles citing development and psychometric properties of the most frequently used measures were also retrieved. Finally, the review focused on studies that had used at least one of the most frequently used measures.

Results:

Twenty-three relevant studies were identified. The most commonly used measures were the General Health Questionnaire (GHQ), the Hospital Anxiety and Depression Scale (HADS), the Psychological Consequences Questionnaire (PCQ) and the State-Trait Anxiety Inventory (STAI). One or more of these was used in 17 of the 23 studies.

Conclusions:

The GHQ, the HADS and the STAI have problems with language, content relevance, and content coverage in studies of false-positive screening mammography. These instruments should not be used to measure psychological consequences of any kind of cancer screening. The PCQ is an adequate questionnaire for measuring short-term consequences, and the PCQ is preferable to other measures because of its higher sensitivity. However, there is little evidence that the PCQ is able to adequately detect all long-term consequences of screening mammography. Given the inadequacy of the measurement instruments used, any current conclusions about the long-term consequences of false-positive results of screening mammography must remain tentative.
Clinical and Ethical Perspectives on Rationing of High-Cost Drugs
Authors: Poirier Therese I. , Giannetti Vincent J.
Published: January 2017

Objective:

To analyze the use of high-cost drugs from a clinical decision-making approach and ethical perspectives on rationing.

Case:

The case of a 26-year-old intravenous drug user with AIDS raises issues of how to ration high-cost drugs such as foscarnet, monoclonal antibodies (MAbs) for septic shock, and granuclocyte colony-stimulating factor.

Assessment:

Should a patient with a terminal illness receive high-cost drugs given limited healthcare resources? Necessary clinical information including treatment algorithms, risk to benefit ratios, and cost-effectiveness data are evaluated. Rationing, especially bedside rationing, by the clinician is rejected because it is contrary to the clinician's ethical obligation of beneficence and nonmaleficence. Patient autonomy and desires may also conflict with society's interest in equitably distributing resources. Treatment could be denied if costs exceed benefits for the outcomes and thus deny resources to others who have more basic healthcare needs. There is no obligation to offer medically futile care or for the patient to accept extraordinary medical care.

Conclusions:

An ethical argument for rationing cannot be made because of the lack of a clear clinical and societal consensus on specific criteria for rationing of healthcare dollars. The decision to use high-cost drugs in the case presented is made using a clinical decision-making approach based on available treatment guidelines. This assumes that the patient continues to consent to therapy and that there is continued benefit.
Failure of Hallux MP Preservation Surgery for Rheumatoid Arthritis
Authors: Thordarson David B. , Aval Soheil , Krieger Lauren
Published: January 2017

Eight patients underwent surgery on 15 feet for rheumatoid forefoot problems. Thirteen of the 15 feet that were operated upon had an attempt to preserve the hallux metatarsophalangeal joint while resectional arthroplasty was performed on the lesser MP joints. All of the 13 feet that had the MP joint preserved had a well-preserved joint space preoperatively and no active signs of inflammation at the time of this procedure. Eight feet underwent a distal Chevron osteotomy to realign the great toe, two feet underwent an IP fusion as only the IP joint had evidence of erosive changes, and one foot underwent a combination of a Chevron osteotomy and a proximal phalangeal osteotomy (Akin procedure). Two patients had no surgery on their first ray as it was well aligned with no evidence of erosive changes.

Of the 13 feet that did not have a fusion performed, 11 had development of a valgus deformity or inflammatory erosions. The average time to failure was 24 months (range, six to 36 months). The Chevron/Akin procedure remained successful at 18 months and one of the IP fusions was successful at six years after surgery. Although patients with rheumatoid forefoot disease may on occasion have a well-preserved hallux MP joint with minimal or no deformity and no active inflammation, with severe lesser toe involvement, most of these patients will fail a surgical procedure which does not involve fusion of the hallux MP joint.
Neurilemmoma in the Foot as a Cause of Heel Pain: A Report of Two Cases
Authors: Marui Takashi , Yamamoto Tetsuji , Akisue Toshihiro , Hitora Toshiaki , Kawamoto Teruya , Nagira Keiko , Yoshiya Shinichi , Kurosaka Masahiro
Published: January 2017

Two cases of deep-seated neurilemmoma that arose from plantar branches of the posterior tibial nerve and caused chronic heel pain are described. At the initial examination, one case was misdiagnosed as tarsal tunnel syndrome and the other was overlooked as plantar fasciitis; both cases were treated for long periods prior to operation. Deep-seated neurilemmomas in the foot can easily be overlooked and misdiagnosed as tarsal tunnel syndrome or plantar fasciitis because of the rarity, absence of palpable mass, and similarity of symptoms to those of other frequently encountered foot disorders. Magnetic resonance imaging provides the best modality for differential diagnosis. In the present cases, surgical excision of the tumors resulted in immediate and complete relief of chronic heel pain. Surgeons should consider neurilemmoma as a cause of persistent chronic heel pain despite the rarity of the disease.
Isokinetic Strength and Endurance After Percutaneous and Open Surgical Repair of Achilles Tendon Ruptures
Authors: Goren David , Ayalon Moshe , Nyska Meir
Published: January 2017

Background: Reports on complete spontaneous Achilles tendon ruptures and associated treatment have become more frequent in the literature in the past two decades, as has the request for treatments that enable the finest possible functional recovery. The best available treatment is a matter of considerable controversy in the literature. The purpose of this study was to compare the isokinetic strength and endurance of the plantarflexor muscle-tendon unit in subjects who sustained rupture of the Achilles tendon and underwent either open surgery or closed percutaneous repair of the Achilles tendon. Methods: Twenty patients (18 males, 2 females) with spontaneous ruptures of the Achilles tendon were included in this study. Ten patients were treated by open surgery, and 10 patients were treated percutaneously. All patients had ruptured their Achilles tendon more than 6 months before the study, and all of the ruptures occurred 3.5 years or less before the day of the testing. All patients underwent an oriented physical examination. An isokinetic Biodex dynamometer (Biodex Medical System, Shirley, NY) was used to measure ankle joint angle, and in plantarflexion to calculate the torque at the ankle joint (Newton/meter), and the average work (jouls) for both maximal power and endurance. Each measurement was compared to the normal ankle. Results: Biodex dynamometer evaluations at 90 deg/sec demonstrated a significant difference of maximal voluntary plantarflexor torque, endurance performance and range of motion at the ankle joint between the involved and uninvolved sides in patients treated by either mode of treatment. Yet, no statistically significant differences were revealed for the parameters mentioned above between the subjects that were treated either percutaneously or by an open surgery. Conclusions: In functional terms, the biomechanical outcomes of open surgery and percutaneous repair for acute ruptures of the Achilles tendon are both effective.
Mitchell and Wilson Metatarsal Osteotomies for the Treatment of Hallux Valgus: Comparison of Outcomes Two Decades after the Surgery
Authors: Madjarevic Mladen , Kolundzic Robert , Matek Danijel , Smigovec Igor , Crnkovic Tomislav , Trkujla Vladimir
Published: January 2017

Background:

At short-term followup, the Mitchell osteotomy appears to provide more symptomatic improvement than the Wilson osteotomy. We compared the outcomes of the two procedures two decades after the surgeries.

Methods:

In a two-center retrospective study, 30 patients (35 feet) who had Mitchell osteotomies and 28 patients (35 feet) who had Wilson osteotomies were evaluated 20 to 22 years after surgery for correction of the hallux valgus angle (HVA) and intermetatarsal (IMA) angle, changes in the shortening of the first metatarsal and improvement in the overall status (a composite radiographic and clinical outcome according to Bonney and McNab).

Results:

With adjustment for the preoperative values and surgical center (analysis of covariance), the HVA (degrees) had a higher correction in the Mitchell group ( p = 0.075), while IMA was comparably corrected by the two methods. Shortening of the first metatarsal was greater in the Wilson group ( Mitchell- Wilson = −1.93, 95% CI −2.69 to −1.17, p < 0.001). Before the surgery, overall status was graded “poor” or “good” in all feet (28/7 Mitchell, 29/6 Wilson). After the surgery, the status was graded “excellent,” or “good” (29/6) in the Mitchell group, and “excellent,” “good” or “poor” (25/7/3) in the Wilson group. The status was improved by at least one grade-level in all 35 feet in the Mitchell group and in 31 of 35 feet in the Wilson group. With stratification for the preoperative status, the proportion of “improvements” was higher in the Mitchell group ( Mitchell-Wilson = 11.1%, 95% CI 0.7 to 21.5%, p = 0.036). In an alternative analysis (logistic regression), with adjustment for the preoperative status, center, and IMA values, the Mitchell method also appeared superior in this outcome (likelihood ratio test p = 0.021).

Conclusions:

As assessed 20 to 22 years after the surgery, the Mitchell osteotomy resulted in less shortening of the first metatarsal in a somewhat greater proportion of feet with an improved overall status than the Wilson method.