bluuebunny/crossref_metadata_2025 huggingface dataset:
Abū Bakr al-Rāzī (d. 925),
Authors: Adamson Peter
Published: November 2016

This chapter offers an overview and analysis of an important ethical work by the early thinker Abū Bakr Muḥammad ibn Zakariyyāʾ al-Rāzī (251/865–313/925). In keeping with his main occupation as a medical doctor, this work approaches ethics as “spiritual medicine,” echoing the ancient idea of ethical improvement as a kind of regime the soul. The chapter shows how al-Rāzī drew on Galen in developing this idea, and explores the central idea of the treatise (taken ultimately from Plato, by way of Galen), which is that reason must rule the lower parts of the soul. Consideration is also given to whether the teaching of The Spiritual Medicine can be reconciled with another work of al-Rāzī’s, The Philosophical Life, and with his infamous cosmological theory.
Ismāʿīlite Critique of Ibn Sīnā
Authors: Griffel Frank
Published: November 2016

Al-Shahrastānī’s (d. 548/1153) Wrestling Match with the Falāsifa (Muṣāraʿat al-falāsifa) is the second book of refutation of Ibn Sīnā’s (Avicenna, d. 428/1037) philosophy by a Muslim philosopher and theologian. While al-Ghazālī tried to prove the nondemonstrative character of Ibn Sīnā’s teachings, al-Shahrastānī “wrestles” with Ibn Sīnā about what is true to say about God. Heavily influenced by the cosmology of the Ismāʿīlite Shīʿites of his day, al-Shahrastānī claims that God is too transcendent to be included in divisions of what is existent. God is beyond the dichotomy of existence and nonexistence. Equally God is not “simplicity” (wāḥda) the way Ibn Sīnā claims. Rather, words like “existence” and “simplicity” apply to God only in an equivocal way rather than univocal or, as Ibn Sīnā claims, moderated. Most mistakes in philosophical theology are committed, so al-Shahrastānī, because equivocal terms are wrongfully understood to be univocal.
Reconciling Religion and Philosophy: Nāṣir-i Khusraw’s (d. 1088)
Authors: Andani Khalil
Published: November 2016

Nāṣir-i Khusraw (d. 481/1088), the renowned Ismāʿīlī philosopher, poet, travel writer, and missionary (dāʿī), took on the formidable challenge of showing the essential harmony between philosophy and Ismāʿīlī doctrine in his Jāmiʿ al-ḥikmatayn (The Reconciliation of Philosophy and Religion). After introducing his life and works, this chapter explores this text’s central themes and examines the manner in which Nāṣir attempts to achieve this reconciliation. Fundamental to Nāṣir’s method is a form of spiritual hermeneutics, or taʾwīl, through which he demonstrates that the truths of philosophy serve as iconic representations of the spiritual truths contained in the Ismāʿīlī interpretation of Islam, thereby restoring philosophy to its original state of union with revealed, prophetic wisdom.
Ali Sedad Bey’s (d. 1900), ()
Authors: Muhtaroglu Nazif
Published: November 2016

This chapter presents and evaluates Ali Sedāt’s (d. 1900) Principles of Transformation in the Motion of Particles. In this work, Ali Sedad gives a detailed description of the working mechanism of the whole universe, including topics that range from the interaction of atoms to the emergence of animate bodies and the motion of heavenly bodies. In doing this, he introduces thermodynamics and Darwin’s theory of evolution for the first time to the Turkish-speaking community in a detailed way and discusses the laws behind natural phenomena in a philosophical way. Ali Sedāt’s Principles of Transformation is a unique work introducing the basic principles of the natural sciences in nineteenth-century European circles to the Ottoman world and interpreting them from an Ashʿarite perspective. It shows how an Ashʿarite scholar from the late Ottoman era followed modern science thoroughly but interpreted it critically from its own philosophical point of view.
Muḥammad Iqbāl (d. 1938)
Authors: Mir Mustansir
Published: November 2016

Muhammad Iqbal’s The Reconstruction of Religious Thought in Islam belongs in the category of modern Muslim reformist works, which address, issues of a practical nature faced by Muslims in the social, political, and legal spheres. Iqbal’s Reconstruction analyzes these issues at a deeper, philosophical level, seeking to transform minds and outlook before proposing specific solutions to specific problems. The primary aim of the Reconstruction is to rejuvenate Muslim thought in the modern context. To this end, it enters into a critical engagement with the intellectual, religious, spiritual, and scientific thought of the Muslim and Western traditions, inquiring into the prospects of bringing into harmony, from an Islamic standpoint and in an Islamic setting, tradition and modernity, religion and science. The legacy of the Reconstruction is its invitation to Muslims to reassess the entire Islamic tradition, being fully cognizant of modern developments in thought without breaking with their own past.
Relativistic radiative transfer in relativistic spherical flows
Authors: Fukue Jun
Published: November 2016

Relativistic radiative transfer in relativistic spherical flows is numerically examined under the fully special relativistic treatment. We first derive relativistic formal solutions for the relativistic radiative transfer equation in relativistic spherical flows. We then iteratively solve the relativistic radiative transfer equation, using an impact parameter method/tangent ray method, and obtain specific intensities in the inertial and comoving frames, as well as moment quantities, and the Eddington factor. We consider several cases; a scattering wind with a luminous central core, an isothermal wind without a core, a scattering accretion on to a luminous core, and an adiabatic accretion on to a dark core. In the typical wind case with a luminous core, the emergent intensity is enhanced at the center due to the Doppler boost, while it reduces at the outskirts due to the transverse Doppler effect. In contrast to the plane-parallel case, the behavior of the Eddington factor is rather complicated in each case, since the Eddington factor depends on the optical depth, the flow velocity, and other parameters.
Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012
Authors: Metz Torri D. , Rovner Polina , Hoffman M. Camille , Allshouse Amanda A. , Beckwith Krista M. , Binswanger Ingrid A.
Published: November 2016

OBJECTIVE:

To ascertain demographic and clinical characteristics of maternal deaths from self-harm (accidental overdose or suicide) to identify opportunities for prevention.

METHODS:

We report a case series of pregnancy-associated deaths resulting from self-harm in the state of Colorado between 2004 and 2012. Self-harm deaths were identified from several sources, including death certificates. Birth and death certificates along with coroner, prenatal care, and delivery hospitalization records were abstracted. Descriptive analyses were performed. For context, we describe demographic characteristics of women with a maternal death from self-harm and all women with live births in Colorado.

RESULTS:

Among the 211 total maternal deaths in Colorado over the study interval, 30% (n=63) resulted from self-harm. The pregnancy-associated death ratio from overdose was 5.0 (95% confidence interval [CI] 3.4–7.2) per 100,000 live births and from suicide 4.6 (95% CI 3.0–6.6) per 100,000 live births. Detailed records were obtained for 94% (n=59) of women with deaths from self-harm. Deaths were equally distributed throughout the first postpartum year (mean 6.21±3.3 months postpartum) with only six maternal deaths during pregnancy. Seventeen percent (n=10) had a known substance use disorder. Prior psychiatric diagnoses were documented in 54% (n=32) and prior suicide attempts in 10% (n=6). Although half (n=27) of the women with deaths from self-harm were noted to be taking psychopharmacotherapy at conception, 48% of them discontinued the medications during pregnancy. Fifty women had toxicology testing available; pharmaceutical opioids were the most common drug identified (n=21).

CONCLUSION:

Self-harm was the most common cause of pregnancy-associated mortality, with most deaths occurring in the postpartum period. A four-pronged educational and program building effort to include women, health care providers, health care systems, and both governments and organizations at the community and national levels may allow for a reduction in maternal deaths.
Risk of Peripartum Hysterectomy and Center Hysterectomy and Delivery Volume
Authors: Govindappagari Shravya , Wright Jason D. , Ananth Cande V. , Huang Yongmei , D'Alton Mary E. , Friedman Alexander M.
Published: November 2016

OBJECTIVE:

To characterize where women at risk for and undergoing peripartum hysterectomy delivered in terms of obstetric volume and procedural experience.

METHODS:

We used data from the Perspective database to retrospectively evaluate trends in peripartum hysterectomy and deliveries at high risk of peripartum hysterectomy based on placenta previa and prior cesarean delivery delivered from 2006 through 2014. Hospitals were categorized two separate ways for the analysis: 1) into five roughly equal quintiles based on annualized delivery volume and 2) by the mean number of hysterectomies performed annually over the study period.

RESULTS:

Four thousand eight hundred eleven hysterectomies occurred among 5,388,486 deliveries in 500 hospitals over the study period. The peripartum hysterectomy rate increased from 81.4 per 100,000 deliveries in 2006 to 98.4 in 2014. The prevalence rate of placenta previa in the setting of previous cesarean delivery also increased over the study period. Between 2006–2008 and 2012–2014, peripartum hysterectomy decreased in the lowest delivery volume quintile and increased in the highest delivery volume quintile (–14.9/100,000 deliveries, 95% confidence interval [CI] −25.6 to −4.2 and +35.4/100,000 deliveries, 95% CI 20.3–50.5, respectively). Similarly, hospitals performing high rates of hysterectomies saw the largest increase over the study period.

CONCLUSION:

With peripartum hysterectomy rates increasing in the population, hospitals with high delivery volumes and high rates of hysterectomies saw the largest increases in peripartum hysterectomy rates. These trends support that improved referral practices and uptake of evidence-based recommendations may be occurring.
State Insurance Mandates and Multiple Birth Rates After In Vitro Fertilization
Authors: Provost Meredith P. , Thomas Samantha M. , Yeh Jason S. , Hurd William W. , Eaton Jennifer L.
Published: November 2016

OBJECTIVE:

To examine the association between state-mandated insurance coverage for in vitro fertilization (IVF) and the incidence of multiple birth while controlling for differences in baseline patient characteristics.

METHODS:

We conducted a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System from 2007 to 2011 to examine the association between state-mandated insurance coverage for IVF and the incidence of multiple birth while controlling for differences in baseline patient characteristics. Analyses were stratified according to patient age and day of embryo transfer (3 or 5).

RESULTS:

Of the 173,968 cycles included in the analysis, 45,011 (25.9%) were performed in mandated states and 128,957 (74.1%) in nonmandated states. The multiple birth rate was significantly lower in mandated states (29.0% compared with 32.8%, adjusted odds ratio [OR] 0.87, 99.95% confidence interval [CI] 0.80–0.94). After stratification, this association remained statistically significant only in women younger than 35 years old who underwent transfer on day 5 (33.1% compared with 38.6%, adjusted OR 0.81, 99.95% CI 0.71–0.92). Among women younger than 35 years with day 5 transfer, the elective single embryo transfer rate was significantly higher in mandated states (21.8% compared with 13.1%, adjusted OR 2.36, 99.95% CI 2.09–2.67).

CONCLUSION:

State-mandated insurance coverage for IVF is associated with decreased odds of multiple birth. This relationship is driven by increased use of elective single embryo transfer among young women undergoing day 5 transfer.
Operationalizing 17α-Hydroxyprogesterone Caproate to Prevent Recurrent Preterm Birth
Authors: Stringer Elizabeth M. , Vladutiu Catherine J. , Batra Priya , Stringer Jeffrey S. A. , Menard M. Kathryn
Published: November 2016

Each year in the United States, more than 500,000 neonates are born before 37 weeks of gestation. Women who have experienced a previous preterm birth are at high risk of recurrence. A weekly prenatal injection of 17α-hydroxyprogesterone caproate decreases the risk of recurrent preterm birth and is recommended from as early as 16 weeks of gestation in women carrying singleton pregnancies who have a history of spontaneous singleton preterm birth. A commonly used metric for public health program effectiveness is population coverage of an intervention. In the case of 17α-hydroxyprogesterone caproate, population coverage can be defined as the proportion of women who are eligible for 17α-hydroxyprogesterone caproate (ie, previous pregnancy complicated by spontaneous singleton preterm birth) who actually receive the intervention. To receive a full course of 17α-hydroxyprogesterone caproate, women must negotiate a complex series of steps that includes presenting early for prenatal care, being identified as eligible for 17α-hydroxyprogesterone caproate, being offered 17α-hydroxyprogesterone caproate, accepting 17α-hydroxyprogesterone caproate, and adhering to the weekly 17α-hydroxyprogesterone caproate dose schedule. We describe this series of steps as well potential solutions to increase 17α-hydroxyprogesterone caproate coverage.
Naproxen Sodium for Pain Control With Intrauterine Device Insertion
Authors: Ngo Lynn L. , Braaten Kari P. , Eichen Eva , Fortin Jennifer , Maurer Rie , Goldberg Alisa B.
Published: November 2016

OBJECTIVE:

To evaluate whether 550 mg oral naproxen sodium given 1 hour before intrauterine device (IUD) insertion is effective for pain relief as compared with placebo.

METHODS:

This was a randomized, double-blind, placebo-controlled trial. The primary outcome was pain with IUD insertion measured on a 100-mm visual analog scale (VAS). Our sample size was calculated to detect a 15-mm difference in VAS scores with 80% power (α=0.05). Secondary outcomes included pain with tenaculum placement, uterine sounding, and 5 and 15 minutes postinsertion.

RESULTS:

A total of 118 women were enrolled and analyzed (58 in the naproxen sodium arm, 60 in the placebo arm, 97% nulliparous) between May 11, 2015, and March 25, 2016. There were no differences in baseline demographics or reproductive characteristics between arms. There were no differences in median VAS pain scores for the primary outcome of pain with IUD insertion between the naproxen sodium arm compared with the placebo arm (69 compared with 66 mm, P=.89). There were no differences in the secondary outcomes of median VAS pain scores with tenaculum placement (37 compared with 32 mm, P=.97) or uterine sounding (60 compared with 58 mm, P=.66). However, median pain scores postprocedure were lower in the naproxen arm as compared with the placebo arm: 17 compared with 26 mm (P=.01) at 5 minutes and 13 compared with 24 mm (P=.01) at 15 minutes postinsertion.

CONCLUSION:

Oral naproxen sodium does not reduce pain with IUD insertion but does reduce pain after insertion and should be considered as a premedication.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02388191.
Managing Recurring Obstetric Cholestasis With Metformin
Authors: Elfituri Abdullatif , Ali Amanda , Shehata Hassan
Published: November 2016

BACKGROUND:

Obstetric cholestasis is a pregnancy-related disorder associated with an adverse pregnancy outcome. It is characterized by generalized pruritus, elevated bile acids, and abnormal liver enzymes. Recent publications show that obstetric cholestasis is associated with, and likely to potentiate, the risk of developing gestational diabetes mellitus.

CASE:

This case describes an unusual pattern of the disease, in which obstetric cholestasis occurred in five consecutive pregnancies with a different course of the disease in the fifth pregnancy.

CONCLUSION:

A patient with recurrent cholestasis of pregnancy had worsening disease in her first four pregnancies. In her fifth pregnancy, treatment for gestational diabetes mellitus with metformin was associated with a lowering effect on bile acids and liver enzymes, indicating a possible role for metformin in the management of obstetric cholestasis.
Regeneration Process After Cervical Conization for Cervical Intraepithelial Neoplasia
Authors: Song Taejong , Seong Seok Ju , Kim Byoung-Gie
Published: November 2016

OBJECTIVE:

To investigate whether there is a regeneration process after cervical conization and, if it exists, how much of the cervix will regenerate and when regeneration will be completed.

METHODS:

This was a prospective observational study of women undergoing conization for cervical intraepithelial neoplasia. Transvaginal ultrasonographic examinations of the cervical volume and length were performed just before conization and were repeated at 1, 3, 6, 9, and 12 months after conization. The volume and length of the cone excised were assessed with a volumetric tube and a vernier caliper, respectively.

RESULTS:

Of 99 women recruited for this study, 75 completed the 12-month follow-up. Cone volume and depth excised were 27.4±9.2% and 38.9±13.8% of the baseline, respectively. The steady increase of cervical volume after conization was statistically significantly until 6 months, but no further increase was observed from 6 to 12 months. At the 12-month follow-up, the cervical volume was 14.0±4.2 cm3, which corresponded to 93.1±19.1% of the baseline with a statistically significant difference between the baseline and 12-month follow-up (P=.006). These cervical regeneration patterns were also observed in cervical length.

CONCLUSION:

The time of regeneration completion was 6 months after conization, and the cervical dimensions after completion of the regeneration process were more than 90% of the initial measurements.
Mechanical and Pharmacologic Methods of Labor Induction
Authors: Levine Lisa D. , Downes Katheryne L. , Elovitz Michal A. , Parry Samuel , Sammel Mary D. , Srinivas Sindhu K.
Published: November 2016

OBJECTIVE:

To evaluate the effectiveness of four commonly used induction methods.

METHODS:

This randomized trial compared four induction methods: misoprostol alone, Foley alone, misoprostol–cervical Foley concurrently, and Foley–oxytocin concurrently. Women undergoing labor induction with full-term (37 weeks of gestation or greater), singleton, vertex-presenting gestations, with no contraindication to vaginal delivery, intact membranes, Bishop score 6 or less, and cervical dilation 2 cm or less were included. Women were enrolled only once during the study period. Our primary outcome was time to delivery. Neither patients nor health care providers were blinded to assigned treatment group because examinations are required for placement of all methods; however, research personnel were blinded during data abstraction. A sample size of 123 per group (n=492) was planned to compare the four groups pairwise (P≤.008) with a 4-hour reduction in delivery time considered clinically meaningful.

RESULTS:

From May 2013 through June 2015, 997 women were screened and 491 were randomized and analyzed. Demographic and clinical characteristics were similar among the four treatment groups. When comparing all induction method groups, combination methods achieved a faster median time to delivery than single-agent methods (misoprostol–Foley: 13.1 hours, Foley–oxytocin: 14.5 hours, misoprostol: 17.6 hours, Foley: 17.7 hours, P<.001). When censored for cesarean delivery and adjusting for parity, women who received misoprostol–Foley were almost twice as likely to deliver before women who received misoprostol alone (hazard ratio 1.92, 95% confidence interval [CI] 1.42–2.59) or Foley alone (hazard ratio 1.87, 95% CI 1.87 1.39–2.52), whereas Foley–oxytocin was not statistically different from single-agent methods.

CONCLUSION:

After censoring for cesarean delivery and adjusting for parity, misoprostol–cervical Foley resulted in twice the chance of delivering before either single-agent method.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01916681.
Effect of Academic Grade Level on Return to Athletic Competition After Anterior Cruciate Ligament Reconstruction
Authors: Bauer Matthew , Feeley Brian T. , Gallo Robert A.
Published: November 2016

Background:

After anterior cruciate ligament (ACL) reconstruction, 63% to 87% of high school athletes return to competition. Although physical and psychological factors are known contributors for failure to return to play, little attention has been paid to effect of academic grade level. Our purpose was to determine the influence of effect of academic grade level on return to competitive play. The primary hypothesis is that high school seniors who undergo ACL reconstruction or knee arthroscopy will be less likely to return to competitive play at 1 year than those in grades 9 to 11.

Methods:

We retrospectively reviewed high school athletes who injured their knee during competitive athletic activity and underwent arthroscopic knee surgery, including ACL reconstruction. We included those 14 to 18 years old at time of surgery and analyzed records for grade level, sporting activity, surgery details, and date of return to play. The definition of return to competitive play was return to same preinjury sport within 1 year of surgery and the sport had to be organized.

Results:

Our study group included 225 patients that underwent an ACL reconstruction and 74 had knee arthroscopy. Athletes undergoing ACL reconstructions were less likely to return to preinjury sport within 1 year than those undergoing knee arthroscopy (P=0.0163). Seniors were significantly less likely to return to play at 1 year than athletes in grades 9 to 11 after both ACL reconstruction (P<0.0001) and knee arthroscopy (P=0.0335). Although return to competitive play rates remained fairly constant within grades 9 to 11, a precipitous decline by 28.9% and 29.4% in return to play rates occurred in the ACL reconstruction and knee arthroscopy groups, respectively, between the junior and senior years of high school.

Discussion

Although return to competition rates were lower for high school athletes undergoing ACL reconstruction than those undergoing knee arthroscopy, both had declines in return when the surgery occurs during their senior season. These data are useful when interpreting return to play rates. Future studies would benefit from further defining this relationship, or at least, noting the number of “senior” athletes studied.

Level of Evidence:

Therapeutic study—Level III.
Targeted Muscle Reinnervation for Transradial Amputation: Description of Operative Technique
Authors: Morgan Emily N. , Kyle Potter Benjamin , Souza Jason M. , Tintle Scott M. , Nanos George P.
Published: November 2016

Targeted muscle reinnervation (TMR) is a revolutionary surgical technique that, together with advances in upper extremity prostheses and advanced neuromuscular pattern recognition, allows intuitive and coordinated control in multiple planes of motion for shoulder disarticulation and transhumeral amputees. TMR also may provide improvement in neuroma-related pain and may represent an opportunity for sensory reinnervation as advances in prostheses and haptic feedback progress. Although most commonly utilized following shoulder disarticulation and transhumeral amputations, TMR techniques also represent an exciting opportunity for improvement in integrated prosthesis control and neuroma-related pain improvement in patients with transradial amputations. As there are no detailed descriptions of this technique in the literature to date, we provide our surgical technique for TMR in transradial amputations.
Establishment of a national cervical screening programme in Ireland, CervicalCheck: the first 6 years
Authors: Flannelly Gráinne M. , Mooney Marie T. , Greehy Gráinne M. , Keogh Eoin B. , McNally Sara A. , Fitzpatrick Patricia E.
Published: November 2016

The national cervical screening programme, CervicalCheck, commenced in Ireland in 2008. Free cervical smear tests are offered to over 1.2 million women aged 25–60 every 3 (aged 25–44) and 5 (aged 45–60) years. The purpose of this paper is to highlight the achievements and document the experience of the first 6 years of a new cervical screening programme. Data were extracted from the programme screening register and colposcopy management systems. SAS, version 9.4 was used for statistical analysis. Over 1.98 million smear tests were performed in over 1 million women during the first 6 years of the programme. Overall 5-year coverage at the end of the sixth year was 77.0%, where coverage is presented for the target population of women aged 25–60 years and is adjusted for hysterectomy rates. The numbers of women attending colposcopy increased significantly from 10 000 new patients attending for the first time in the first year to a peak of almost 17 500 in the third year. Increased capacity in colposcopy has delivered significant improvements in waiting times; the percentage of women referred to colposcopy offered an appointment within 8 weeks increased from 41.5% in year 1 to 93.4% in year 4 and has remained above the greater than 90% standard thereafter. The number of biopsies increased markedly, with 33 768 women being diagnosed with cervical intraepithelial neoplasia-grade 2 (CIN2), CIN3 or adenocarcinoma in situ and 860 being diagnosed with invasive cancer by the end of the sixth year. Lessons from CervicalCheck include the importance of capacity planning in programme delivery. The programme continues to evolve, particularly with the increased usage of human papillomavirus testing and planning for future testing of the human papillomavirus (HPV)-vaccinated cohort.
Changes in health behavior 1 year after testing negative at a colorectal cancer screening: a randomized-controlled study
Authors: Knudsen Markus D. , Hjartåker Anette , Olsen Marie K.E. , Hoff Geir , de Lange Thomas , Bernklev Tomm , Berstad Paula
Published: November 2016

When planning national screening programs, it is important to investigate potential changes in health behavior initiated by the screening. Knowledge of the consequences of different colorectal cancer (CRC) screening modalities for health behavior is limited. We aimed to investigate differences in 1-year health behavior changes after testing negative in CRC screening by one of two screening modalities. Participants of both sexes aged 50–74 years assigned randomly to five biennial rounds of fecal immunochemical test (FIT), one round of flexible sigmoidoscopy (FS), or no screening (control) were invited to complete a self-reported lifestyle questionnaire on smoking, body weight, physical activity, alcohol intake, and consumption of selected dietary items at baseline and at 1-year follow-up. In total, 1809 and 1327 individuals in the FIT and the FS arm, respectively, completed the lifestyle questionnaire, as did 1029 controls. We analyzed differences in 1-year health behavior changes between the arms at follow-up by analysis of covariance and logistic regression. Overall, 1-year changes in health behavior were moderate and probably of no clinical relevance. Participants with negative CRC screening test results in the first round of the FIT arm reduced their alcohol consumption significantly more than controls [−0.29 glass/week (95% confidence interval −0.54 to −0.04)]. Body weight decreased more in participants with negative screening test results in the FS than in the FIT arm [−0.31 kg (95% confidence interval −0.55 to −0.08)]. The present study did not suggest unfavorable short-term consequences in the health behavior of individuals who received a negative CRC screening test result from either a first round of FIT or a once-only FS screening.
Socioeconomic and healthcare use-related determinants of cervical, breast and colorectal cancer screening practice in the French West Indies
Authors: Menvielle Gwenn , Dugas Julien , Richard Jean-Baptiste , Luce Danièle
Published: November 2016

The aim of this study was to investigate the role of socioeconomic and healthcare use characteristics in the participation in breast, cervical and colorectal cancer screening in the French West Indies. We used data from a national health survey conducted in 2014 in Martinique (n=2026) and Guadeloupe (n=2028). Logistic regressions adjusted for various sociodemographic and morbidity variables were performed. The following determinants were investigated: having hot water at home, having received income support for low-income individuals during the last year, educational level, occupational class, complementary health insurance, healthcare renouncement and visit to the general practitioner (GP) during the last year. Multiple imputations were performed to account for missing values. We observed the following cancer screening rates: 78.1% for cervical cancer, 81.5% for breast cancer and 59.5% (women) and 50.8% (men) for colorectal cancer. Higher cervical cancer screening participation was reported among women with qualified occupation and having visited the GP during the last year and lower participation among women who never worked. Higher screening participation was reported among participants having hot water at home and having visited the GP during the last year for breast and colorectal (men and women) cancer. Unexpectedly, a lower colorectal cancer screening participation was found among women with qualified occupation. We observed social inequalities in participation in cancer screening in the French West Indies, which stresses the need to continue efforts to increase screening rates in this population.
Clinicopathological and Prognostic Evaluations of Mixed Adenoneuroendocrine Carcinoma of the Colon and Rectum: A Case-Matched Study
Authors: Watanabe Jun , Suwa Yusuke , Ota Mitsuyoshi , Ishibe Atsushi , Masui Hidenobu , Nagahori Kaoru , Tsuura Yukio , Endo Itaru
Published: November 2016

BACKGROUND:

Mixed adenoneuroendocrine carcinoma of the colon and rectum is a very rare type of tumor.

OBJECTIVE:

The aim of the present study was to evaluate the clinicopathological characteristics and prognosis of mixed adenoneuroendocrine carcinomas of the colon and rectum.

DESIGN:

This was a retrospective case-matched analysis (from March 2007 to December 2013).

SETTINGS:

This study was conducted at Yokosuka Kyosai Hospital.

PATIENTS:

One thousand three hundred six consecutive patients with a preoperative diagnosis of colorectal cancer and who underwent tumor resection were enrolled in the present study. Each patient diagnosed with mixed adenoneuroendocrine carcinoma was 1:2 matched with 2 counterparts who had been diagnosed with adenocarcinoma.

INTERVENTION:

Immunohistochemical staining for neuroendocrine markers (chromogranin A, synaptophysin, and CD56) was performed. Cases in which the neuroendocrine component accounted for >30% of the tumor were diagnosed as mixed adenoneuroendocrine carcinomas.

RESULTS:

Among 1306 patients, 42 patients (3.2%) were diagnosed with mixed adenoneuroendocrine carcinoma and were compared with 84 patients with adenocarcinoma who had been randomly case matched. The average Ki-67–labeling index value was 78.0% (range, 30.0%–99.0%). Chromogranin A, synaptophysin, and CD56 positivity were observed in 42.9% (18/42), 81.0% (34/42), and 33.3% (14/42) of the tumors. Both the disease-free survival and overall survival were significantly worse for mixed adenoneuroendocrine carcinoma than for adenocarcinoma. Ten patients underwent treatment with oxaliplatin-based chemotherapy. The response rate was 40.0%; the median progression-free survival and overall survival were 6.3 months and 18.1 months.

LIMITATIONS:

This was a retrospective single-institution study that included a limited number of cases. The treatment regimens used included different types of oxaliplatin-based chemotherapy.

CONCLUSION:

Mixed adenoneuroendocrine carcinoma of the colon and rectum has a poor prognosis after curative resection and should be distinguished from adenocarcinoma.
Long-term Outcomes of Sphincter-Saving Procedures for Diffuse Crohn’s Disease of the Large Bowel
Authors: Li Yi , Stocchi Luca , Mu Xing , Cherla Deepa , Remzi Feza H.
Published: November 2016

BACKGROUND:

Total abdominal colectomy with ileorectal anastomosis for Crohn’s colitis is acceptable in the presence of a suitable rectum. Intentional IPAA has been proposed for diffuse Crohn’s proctocolitis without enteric or anoperineal disease.

OBJECTIVE:

The aim of this study was to evaluate the long-term outcomes of sphincter-saving procedures for large-bowel Crohn’s disease.

DESIGN:

Patients with preoperative Crohn’s disease diagnosis undergoing intentional IPAA and ileorectal anastomosis were included.

SETTINGS:

The study was conducted at a tertiary care research center.

PATIENTS:

Ileorectal anastomosis was performed in 75 patients with Crohn’s disease, whereas 32 patients underwent intentional IPAA.

MAIN OUTCOME MEASURES:

Long-term functional results and permanent stoma requirement of sphincter-saving operations were assessed. Quality of life and postoperative medication use were also compared with a control group of patients undergoing total proctocolectomy and end ileostomy.

RESULTS:

Patients undergoing ileorectal anastomosis were older and had longer disease duration, higher prevalence of perianal and penetrating disease, and history of small-bowel resection than those receiving IPAA. Indications for surgery, preoperative use of immunomodulators, and postoperative use of biologics were also significantly different. Although functional defecatory outcomes were comparable, reported quality of life 3 years after surgery was significantly better in patients who underwent IPAA than in patients with ileorectal anastomosis. Patients with IPAA were associated with significantly lower cumulative rates of surgical recurrence (HR = 0.28 (95% CI, 0.09–0.84); p = 0.017), indefinite stoma diversion (HR = 0.35 (95% CI, 0.13–0.99); p = 0.039), and proctectomy with end ileostomy (HR = 0.27 (95% CI, 0.07–0.96); p = 0.030) than those with ileorectal anastomosis.

LIMITATIONS:

The study was limited by its retrospective nature and small sample size.

CONCLUSIONS:

Contemporary patients selected to have intentional IPAA for Crohn’s colitis have disease characteristics very different from those selected to have ileorectal anastomosis. Long-term follow-up confirms intentional IPAA as an acceptable option in selected patients with Crohn’s colitis.
The Differential Diagnosis and Treatment of Catatonia in Children and Adolescents
Authors: Hauptman Aaron J. , Benjamin Sheldon
Published: November 2016

Learning objectives

After participating in this activity, learners should be better able to:

• Assess the etiologies associated with catatonia in children and adolescents

• Evaluate the differential diagnosis of pediatric catatonia

• Interpret the literature regarding the treatment of children and adolescents with catatonia

Objective

Pediatric catatonia is associated with many medical and psychiatric conditions. Mortality is high, and proper treatment can be lifesaving. Catatonia is increasingly recognized in pediatric populations, in which about 20% of cases are related to underlying medical conditions. To minimize morbidity, clinicians must rule out underlying disorders while simultaneously managing symptoms and causes. In our review we discuss (1) recommendations to aid rapid decision making, both diagnostic and therapeutic, (2) emergent conditions and management, (3) disorders associated with pediatric catatonia, including developmental, acquired, idiopathic, and iatrogenic etiologies, (4) available treatments, and (5) medicolegal considerations.

Methods

Initial PubMed search without date constraints using MeSH terms related to pediatric catatonia, with subsequent searches on pertinent subtopics using PubMed and Google Scholar.

Results

Pediatric catatonia is a dangerous but treatable neuropsychiatric condition. Psychiatrists need to be aware of differential diagnoses and to be able determine appropriate treatment within a short time frame. With prompt diagnosis and treatment, outcomes can be optimized.

Conclusion

Pediatric catatonia is underdiagnosed and requires rapid evaluation and management.
Shoulder and Elbow Injuries in the Adolescent Athlete
Authors: Smucny Mia , Kolmodin Joel , Saluan Paul
Published: November 2016

With the recent increase in youth sports participation and single-sport youth athletes over the past 30 years, there has been an increase in the number of acute and overuse sports injuries in this population. This review focuses on overuse and traumatic injuries of the shoulder and elbow in young athletes. In particular we discuss little league shoulder, glenohumeral internal rotation deficit, glenohumeral instability, superior labrum anterior posterior lesions, Little League elbow, Panner disease, osteochondritis dissecans of the capitellum, posteromedial elbow impingement, and posterolateral rotatory instability of the elbow. There is a significant emphasis on the evaluation and management of upper extremity injury in the overhead thrower.
A National Survey of the Prevalence and Impact of Cytomegalovirus Infection Among Hospitalized Patients With Ulcerative Colitis
Authors: Grossberg Laurie B. , Ezaz Ghideon , Grunwald Douglas , Cohen Jonah , Falchuk Kenneth R. , Feuerstein Joseph D.
Published: November 2016

Goals:

To estimate the effect of cytomegalovirus (CMV) in patients with ulcerative colitis (UC), and compare these outcomes to patients with CMV without UC.

Background:

The impact of CMV infection in UC is not well understood.

Study:

We analyzed records from the Nationwide Inpatient Sample (NIS) of patients with UC and CMV between 2006 and 2012. Differences in outcomes were determined between patients with UC and CMV and those with UC without CMV. Secondary analysis compared outcomes of patients with UC and CMV to patients with CMV alone.

Results:

Patients with UC and CMV (n=145) had longer length of stay (16.31 vs. 5.52 d, P<0.0001), higher total charges ($111,835.50 vs. $39.895, P=0.001), and were less likely to be discharged home without services (50.0% vs. 81.83%, P<0.0001) compared with patients with UC without CMV (n=32,290). On regression analysis, CMV was significantly associated with higher total charges (P<0.01) and longer length of stay (P<0.01), but not for increased need for colorectal surgery. When comparing patients with UC and CMV to patients with CMV alone (n=14,960), patients with CMV alone had a higher Charlson Comorbidity Index and a trend toward higher in-hospital mortality.

Conclusions:

CMV infection in hospitalized patients with UC is associated with a longer length of stay, increased total charges, and fewer routine discharges, but not increased surgery or mortality. Patients with CMV alone had the worst outcomes of all groups suggesting that CMV in UC patients may not have the same negative impact as in other diseases.
Age-adapted Variation in Screening Interval of Fecal Immunochemical Test May Improve its Participation and Colonoscopy Acceptance
Authors: Kwak Min Seob , Cha Jae Myung , Yoon Jin Young , Jeon Jung Won , Shin Hyun Phil , Joo Kwang Ro , Lee Joung Il
Published: November 2016

Goals:

We determined appropriate intervals for administering the fecal immunochemical test (FIT) and performance outcomes in an Asian national colorectal cancer (CRC) screening program.

Background:

The optimal interval for FIT in CRC screening is unclear, especially in Asian populations.

Study:

Between January 2009 and December 2015, 13,480 individuals aged 50 years or older with an initial negative FIT result underwent 2 rounds of FIT screening at intervals of 1 (annual group, 5333), 2 (biennial group, 7363), or 3 years (triennial group, 784). Positive rates of FIT, colonoscopy acceptance, colonoscopy findings, and detection rates for CRC and advanced neoplasia were compared according to FIT intervals.

Results:

The overall positivity rate of FIT in the second screening round was significantly higher in men and in older subjects than in the entire sample. Younger subjects were less likely to undergo annual FIT (36.0% vs. 46.4%, P<0.001). The colonoscopy acceptance rate was decreased in the biennial and triennial groups compared with an annual group among younger subjects (odds ratio, 0.56; 95% confidence interval, 0.33-0.95 for the biennial group vs. odds ratio, 0.19; 95% confidence interval, 0.03-1.37 for the triennial group). Detection rates for CRC and advanced neoplasia in the second round were significantly higher and accompanied by increased FIT screening intervals in older, but not younger subjects.

Conclusions:

Age-adapted variation in FIT screening intervals, such as annual screening for elderly subjects and biennial screening for younger subject, may improve FIT participation and colonoscopy acceptance.
Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis
Authors: Wijarnpreecha Karn , Thongprayoon Charat , Ungprasert Patompong
Published: November 2016

Background/objectives

Nonalcoholic fatty liver disease (NAFLD) is a worldwide public health concern. Coffee might have a protective effect against NAFLD. However, the results of previous reports are conflicting. Therefore, we carried out this meta-analysis to summarize all available data.

Methods

This study consisted of two meta-analyses. The first meta-analysis included observational studies comparing the risk of NAFLD in patients who did and did not drink coffee. The second analysis included studies comparing the risk of liver fibrosis between NAFLD patients who did and did not drink coffee. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated.

Results

Out of 355 articles, five studies fulfilled our eligibility criteria and were included in the analysis. The risk of NAFLD in patients who drank coffee was significantly lower than that in patients who did not pooled RR 0.71 (95% CI, 0.60–0.85). We also found a significantly decreased risk of liver fibrosis among NAFLD patients who drank coffee compared with those who did not, with a pooled RR of 0.70 (95% CI, 0.60–0.82). However, it should be noted that the definition of regular coffee consumption varied between studies, which is the main limitation of this meta-analysis.

Conclusion

Our study found a significantly decreased risk of NAFLD among coffee drinkers and significantly decreased risk of liver fibrosis among patients with NAFLD who drank coffee on a regular basis. Whether consumption of coffee could be considered a preventative measure against NAFLD needs further investigations.
Identifying Children at Risk of Malignant Bordetella pertussis Infection
Authors: Ganeshalingham Anusha , McSharry Brent , Anderson Brian , Grant Cameron , Beca John
Published: November 2016

Objective:

To identify factors associated with malignant pertussis.

Design:

A retrospective case notes review from January 2003 to August 2013. Area under the receiver-operator characteristic curve was used to determine how well vital sign and white cell characteristics within 48 hours of hospital presentation identified children with malignant pertussis.

Setting:

The national children’s hospital in Auckland, New Zealand.

Patients:

One hundred fifty-two children with pertussis.

Measurements and Main Results:

There were 152 children with confirmed pertussis identified, including 11 children with malignant pertussis. The area under the receiver-operator characteristic curve was 0.88 (95% CI, 0.78–0.97) for maximum heart rate. The optimal cut-point was 180 beats/min, which predicted malignant pertussis with a sensitivity of 73% and a specificity of 91%. The area under the receiver-operator characteristic curve was 0.92 (95% CI, 0.81–1.0) for absolute neutrophil count, 0.85 (95% CI, 0.71–0.99) for total WBC count, 0.80 (95% CI, 0.63–0.96) for neutrophil-to-lymphocyte ratio, and 0.77 (95% CI, 0.58–0.92) for absolute lymphocyte count. All children with malignant pertussis had one or more of heart rate greater than 180 beats/min, total WBC count greater than 25 × 109/L, and neutrophil-to-lymphocyte ratio greater than 1.0 with an area under the receiver-operator characteristic curve of 0.96 (95% CI, 0.91–1.0) for a multivariate model that included these three variables.

Conclusions:

Clinical predictors of malignant pertussis are identifiable within 48 hours of hospital presentation. Early recognition of children at risk of malignant pertussis may facilitate early referral to a PICU for advanced life support and selection for trials of investigational therapies.
An Introduction From the New Psychotherapy Columnist
Authors: PLAKUN ERIC M.
Published: November 2016

Despite psychiatry’s shift toward a biomedical model, emerging research suggests that psychosocial factors make major contributions to the etiology of mental disorders of all kinds and that several types of psychotherapy have been shown to be effective forms of treatment for a range of disorders. Notwithstanding these findings, psychiatrists are doing less psychotherapy and attending less to psychosocial factors in their work with patients. The author surveys some of the underpinnings of this problem and discusses the value of psychotherapy as part of psychiatric practice and training.
Prognostic Value of Computed Tomography–Detected Extramural Venous Invasion to Predict Disease-Free Survival in Patients With Gastric Cancer
Authors: Kim Tae Un , Kim Suk , Lee Nam Kyung , Kim Hak Jin , Han Ga Jin , Lee Jun Woo , Baek Hyun Jung , Jeon Tae Yong , Kim Hyun Sung , Park Do Yoon
Published: November 2016

Objective

This study aimed to investigate whether there is a correlation between the computed tomography–detected extramural venous invasion (ctEMVI) and disease-free survival (DFS) in patients with gastric cancer using pathologic lymphovascular invasion as a reference standard.

Methods

We retrospectively reviewed 153 patients with gastric cancer who underwent computed tomography during 1 year. Differences in pathological findings between the ctEMVI-positive and ctEMVI-negative groups were analyzed. Disease-free survival was estimated using the Kaplan-Meier method. Factors affecting DFS were analyzed with the Cox proportional hazard model.

Results

The ctEMVI-positive group was correlated more with lymphovascular invasion (P = 0.008). The 1- and 2-year DFS rates were 92% and 80%, respectively, in the ctEMVI-negative group, but 77% and 54%, respectively, in the ctEMVI-positive group. A multivariate analysis revealed that tumor size, ctEMVI, and pathological stage remained associated with DFS (Ps = 0.037, 0.015, and 0.002, respectively).

Conclusions

The ctEMVI was an independent prognostic factor for worse DFS in patients with gastric cancer.
The Effect of Patient Diameter on the Dual-Energy Ratio of Selected Contrast-Producing Elements
Authors: Lambert Jack W. , FitzGerald Paul F. , Edic Peter M. , Sun Yuxin , Bonitatibus Peter J. , Colborn Robert E. , Yeh Benjamin M.
Published: November 2016

Objectives

The aim of this study was to assess whether the low- to high-kVp computed tomography (CT) number ratio at dual-energy CT is affected by changes in patient diameter.

Methods

Seven contrast-producing elements were housed sequentially within an abdomen phantom. Fat rings enlarged the phantom diameter from 26 to 44 cm. The phantom was scanned using single-energy CT at tube potentials of 80 and 140 kVp and rapid-kVp-switching dual-energy CT.

Results

CT numbers decreased proportionally (∼20% CT number reduction for smallest to largest phantom diameters) for low- and high-energy acquisitions but resulted in consistent dual-energy ratios for each contrast element. For 17 of 21 material pair combinations, the dual-energy ratio ranges of the two elements did not overlap, implying that discrimination should remain possible for these material pairs at all patient sizes.

Conclusions

The dual-energy ratio for different contrast materials is largely unaffected by changes in phantom diameter. This should allow for robust separation of most contrast material combinations irrespective of patient size.