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Do mitochondria play a role in remodelling lace plant leaves during programmed cell death? | [
"Programmed cell death (PCD) is the regulated death of cells within an organism. The lace plant (Aponogeton madagascariensis) produces perforations in its leaves through PCD. The leaves of the plant consist of a latticework of longitudinal and transverse veins enclosing areoles. PCD occurs in the cells at the center of these areoles and progresses outwards, stopping approximately five cells from the vasculature. The role of mitochondria during PCD has been recognized in animals; however, it has been less studied during PCD in plants. The following paper elucidates the role of mitochondrial dynamics during developmentally regulated PCD in vivo in A. madagascariensis. A single areole within a window stage leaf (PCD is occurring) was divided into three areas based on the progression of PCD; cells that will not undergo PCD (NPCD), cells in early stages of PCD (EPCD), and cells in late stages of PCD (LPCD). Window stage leaves were stained with the mitochondrial dye MitoTracker Red CMXRos and examined. Mitochondrial dynamics were delineated into four categories (M1-M4) based on characteristics including distribution, motility, and membrane potential (ΔΨm). A TUNEL assay showed fragmented nDNA in a gradient over these mitochondrial stages. Chloroplasts and transvacuolar strands were also examined using live cell imaging. The possible importance of mitochondrial permeability transition pore (PTP) formation during PCD was indirectly examined via in vivo cyclosporine A (CsA) treatment. This treatment resulted in lace plant leaves with a significantly lower number of perforations compared to controls, and that displayed mitochondrial dynamics similar to that of non-PCD cells."
] | [
"ANGUSTIFOLIA (AN), one of the CtBP family proteins, plays a major role in microtubule-dependent cell morphogenesis. Microarray analysis of mammalian AN homologs suggests that AN might function as a transcriptional activator and regulator of a wide range of genes. Genetic characterization of AN mutants suggests that AN might be involved in multiple biological processes beyond cell morphology regulation. Using a reverse genetic approach, we provide in this paper the genetic, biochemical, and physiological evidence for ANGUSTIFOLIA's role in other new biological functions such as abiotic and biotic stress response in higher plants. The T-DNA knockout an-t1 mutant exhibits not only all the phenotypes of previously described angustifolia null mutants, but also copes better than wild type under dehydration and pathogen attack. The stress tolerance is accompanied by a steady-state modulation of cellular H(2)O(2) content, malondialdehyde (MDA) derived from cellular lipid peroxidation, and over-expression of stress responsive genes. Our results indicate that ANGUSTIFOLIA functions beyond cell morphology control through direct or indirect functional protein interaction networks mediating other biological processes such as drought and pathogen attacks."
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Landolt C and snellen e acuity: differences in strabismus amblyopia? | [
"Assessment of visual acuity depends on the optotypes used for measurement. The ability to recognize different optotypes differs even if their critical details appear under the same visual angle. Since optotypes are evaluated on individuals with good visual acuity and without eye disorders, differences in the lower visual acuity range cannot be excluded. In this study, visual acuity measured with the Snellen E was compared to the Landolt C acuity. 100 patients (age 8 - 90 years, median 60.5 years) with various eye disorders, among them 39 with amblyopia due to strabismus, and 13 healthy volunteers were tested. Charts with the Snellen E and the Landolt C (Precision Vision) which mimic the ETDRS charts were used to assess visual acuity. Three out of 5 optotypes per line had to be correctly identified, while wrong answers were monitored. In the group of patients, the eyes with the lower visual acuity, and the right eyes of the healthy subjects, were evaluated. Differences between Landolt C acuity (LR) and Snellen E acuity (SE) were small. The mean decimal values for LR and SE were 0.25 and 0.29 in the entire group and 0.14 and 0.16 for the eyes with strabismus amblyopia. The mean difference between LR and SE was 0.55 lines in the entire group and 0.55 lines for the eyes with strabismus amblyopia, with higher values of SE in both groups. The results of the other groups were similar with only small differences between LR and SE."
] | [
"To measure critical (foveal) flicker fusion frequencies (CFF) in normal eyes, unilateral maculopathies and neuropathies and in orthoptic amblyopias. A newly developed apparatus (4F) with LED's measured subjective foveal CFF by ascending and descending mode in a group of normals and patients. The apparatus (4F) measures temporal resolution. Foveal CFF ist more reduced in neuropathies than in maculopathies. In contrast, CFF in amblyopic eyes is hardly reduced, in most cases equal or better than in the dominant fellow eye. This is independent from the visual acuity of the amblyopic eye."
] | pubmedqa | {
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Syncope during bathing in infants, a pediatric form of water-induced urticaria? | [
"Apparent life-threatening events in infants are a difficult and frequent problem in pediatric practice. The prognosis is uncertain because of risk of sudden infant death syndrome. Eight infants aged 2 to 15 months were admitted during a period of 6 years; they suffered from similar maladies in the bath: on immersion, they became pale, hypotonic, still and unreactive; recovery took a few seconds after withdrawal from the bath and stimulation. Two diagnoses were initially considered: seizure or gastroesophageal reflux but this was doubtful. The hypothesis of an equivalent of aquagenic urticaria was then considered; as for patients with this disease, each infant's family contained members suffering from dermographism, maladies or eruption after exposure to water or sun. All six infants had dermographism. We found an increase in blood histamine levels after a trial bath in the two infants tested. The evolution of these \"aquagenic maladies\" was favourable after a few weeks without baths. After a 2-7 year follow-up, three out of seven infants continue to suffer from troubles associated with sun or water."
] | [
"Although the commonest form of hypokalemic paralysis is the hereditary variety, some patients during course of thyrotoxicosis or with chronic potassium depletion, may exhibit episodic weakness. Approach to the patient with hypokalemic paralysis should be a careful search for the etiology and potassium replacement therapy. In this report, two hypokalemic paralysis cases are described. Case 1 is a 29-year-old Caucasian male who developed thyrotoxic periodic paralysis. Case 2 is a 50-year-old female who experienced hypokalemic paralysis due to primary aldosteronism."
] | pubmedqa | {
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Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? | [
"The transanal endorectal pull-through (TERPT) is becoming the most popular procedure in the treatment of Hirschsprung disease (HD), but overstretching of the anal sphincters remains a critical issue that may impact the continence. This study examined the long-term outcome of TERPT versus conventional transabdominal (ABD) pull-through for HD. Records of 41 patients more than 3 years old who underwent a pull-through for HD (TERPT, n = 20; ABD, n = 21) were reviewed, and their families were thoroughly interviewed and scored via a 15-item post-pull-through long-term outcome questionnaire. Patients were operated on between the years 1995 and 2003. During this time, our group transitioned from the ABD to the TERPT technique. Total scoring ranged from 0 to 40: 0 to 10, excellent; 11 to 20 good; 21 to 30 fair; 31 to 40 poor. A 2-tailed Student t test, analysis of covariance, as well as logistic and linear regression were used to analyze the collected data with confidence interval higher than 95%. Overall scores were similar. However, continence score was significantly better in the ABD group, and the stool pattern score was better in the TERPT group. A significant difference in age at interview between the 2 groups was noted; we therefore reanalyzed the data controlling for age, and this showed that age did not significantly affect the long-term scoring outcome between groups."
] | [
"The surgical procedure for treating congenital duodenal atresia has normally been performed by an upper abdominal transverse incision. Recently, duodenoduodenostomy has been attempted using an umbilical crease incision to improve the cosmetic results. Eighteen cases of duodenal obstruction, including 15 atresia, 2 stenosis, and 1 atresia and stenosis, were treated from June 2001 to August 2009, in which 8 cases were performed via the umbilical crease incision and 10 cases via the conventional transverse incision. The clinical records of all cases were evaluated retrospectively. All cases underwent radical operation safely. There were no differences in the operating time between the two kinds of incision. Two cases of umbilical crease incision showed minor complications. All the cases operated via the umbilical crease incision achieved a scarless abdomen within a few months after the operation."
] | pubmedqa | {
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Can tailored interventions increase mammography use among HMO women? | [
"Telephone counseling and tailored print communications have emerged as promising methods for promoting mammography screening. However, there has been little research testing, within the same randomized field trial, of the efficacy of these two methods compared to a high-quality usual care system for enhancing screening. This study addressed the question: Compared to usual care, is tailored telephone counseling more effective than tailored print materials for promoting mammography screening? Three-year randomized field trial. One thousand ninety-nine women aged 50 and older recruited from a health maintenance organization in North Carolina. Women were randomized to 1 of 3 groups: (1) usual care, (2) tailored print communications, and (3) tailored telephone counseling. Adherence to mammography screening based on self-reports obtained during 1995, 1996, and 1997. Compared to usual care alone, telephone counseling promoted a significantly higher proportion of women having mammograms on schedule (71% vs 61%) than did tailored print (67% vs 61%) but only after the first year of intervention (during 1996). Furthermore, compared to usual care, telephone counseling was more effective than tailored print materials at promoting being on schedule with screening during 1996 and 1997 among women who were off-schedule during the previous year."
] | [
"Low adherence to cervical and breast cancer (CBC) screening recommendations contributes to high CBC mortality among Latinas. To estimate the prevalence of, and factors associated with, last 12-month Pap smear and mammogram receipt among a Midwest community sample of low-acculturated Latinas. We conducted a cross-sectional study with 278 Latina immigrants in Dane County, Wisconsin. Participants completed a self-administered questionnaire. We estimated multivariate logistic regression models to identify factors associated with CBC screening receipt. Rates of last 12-month Pap smear and mammogram receipt were 56.8% and 39.4%, respectively. Age, knowledge of screening recommendations, and having a regular health care provider were independently associated with both Pap smear and mammogram receipt. Having ever used Planned Parenthood and fear of cancer were uniquely correlated with Pap smear and mammogram receipt, respectively."
] | pubmedqa | {
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Double balloon enteroscopy: is it efficacious and safe in a community setting? | [
"From March 2007 to January 2011, 88 DBE procedures were performed on 66 patients. Indications included evaluation anemia/gastrointestinal bleed, small bowel IBD and dilation of strictures. Video-capsule endoscopy (VCE) was used prior to DBE in 43 of the 66 patients prior to DBE evaluation. The mean age was 62 years. Thirty-two patients were female, 15 were African-American; 44 antegrade and 44 retrograde DBEs were performed. The mean time per antegrade DBE was 107.4±30.0 minutes with a distance of 318.4±152.9 cm reached past the pylorus. The mean time per lower DBE was 100.7±27.3 minutes with 168.9±109.1 cm meters past the ileocecal valve reached. Endoscopic therapy in the form of electrocautery to ablate bleeding sources was performed in 20 patients (30.3%), biopsy in 17 patients (25.8%) and dilation of Crohn's-related small bowel strictures in 4 (6.1%). 43 VCEs with pathology noted were performed prior to DBE, with findings endoscopically confirmed in 32 cases (74.4%). In 3 cases the DBE showed findings not noted on VCE."
] | [
"The aim of this study was to investigate the outcome of endoluminal stenting in the management of patients presenting with acute large bowel obstruction. Twenty-eight consecutive patients presenting to one consultant surgeon with large bowel obstruction were considered for the procedure. Twenty-four patients were successfully treated using this modality, which is to date the largest series in the UK. We discuss the complications encountered in detail and discuss the cost effectiveness of this procedure."
] | pubmedqa | {
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30-Day and 1-year mortality in emergency general surgery laparotomies: an area of concern and need for improvement? | [
"Emergency surgery is associated with poorer outcomes and higher mortality with recent studies suggesting the 30-day mortality to be 14-15%. The aim of this study was to analyse the 30-day mortality, age-related 30-day mortality and 1-year mortality following emergency laparotomy. We hope this will encourage prospective data collection, improvement of care and initiate strategies to establish best practice in this area. This was a retrospective study of patients who underwent emergency laparotomy from June 2010 to May 2012. The primary end point of the study was 30-day mortality, age-related 30-day mortality and 1-year all-cause mortality. 477 laparotomies were performed in 446 patients. 57% were aged<70 and 43% aged>70 years. 30-day mortality was 12, 4% in those aged<70 years and 22% in those>70 years (p<0.001). 1-year mortality was 25, 15% in those aged under 70 years and 38% in those aged>70 years (p<0.001)."
] | [
"Abdominal aortic aneurysm repair is associated with significant morbidity and mortality. This study aims to evaluate the efficiency of scoring systems in a group of patients undergoing abdominal aortic aneurysm repair. A prospective study of 152 patients undergoing aneurysm repair was conducted. Each patient was scored according to the Acute Physiology and Chronic Health Evaluation II, Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity and Simplified Acute Physiology Score II systems. The predicted mortality for each patient was calculated. Chi(2) analysis was carried out to determine the accuracy of mortality predictions. Receiver-operator curves were drawn to compare scoring systems in terms of sensitivity and specificity. In the elective aneurysm repair group, all scoring systems tended to overestimate mortality. Receiver-operator curves showed inaccuracies in identifying patients who were at high risk from surgery. In contrast, predicted mortalities underestimated the true death rate among the ruptured aneurysm group. Receiver-operator curves showed better efficiency of scoring systems in the ruptured aneurysm group than in the elective repair group. There was no significant correlation between predicted and observed mortalities in either group."
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Is adjustment for reporting heterogeneity necessary in sleep disorders? | [
"Anchoring vignettes are brief texts describing a hypothetical character who illustrates a certain fixed level of a trait under evaluation. This research uses vignettes to elucidate factors associated with sleep disorders in adult Japanese before and after adjustment for reporting heterogeneity in self-reports. This study also evaluates the need for adjusting for reporting heterogeneity in the management of sleep and energy related problems in Japan. We investigated a dataset of 1002 respondents aged 18 years and over from the Japanese World Health Survey, which collected information through face-to-face interview from 2002 to 2003. The ordered probit model and the Compound Hierarchical Ordered Probit (CHOPIT) model, which incorporated anchoring vignettes, were employed to estimate and compare associations of sleep and energy with socio-demographic and life-style factors before and after adjustment for differences in response category cut-points for each individual. The prevalence of self-reported problems with sleep and energy was 53 %. Without correction of cut-point shifts, age, sex, and the number of comorbidities were significantly associated with a greater severity of sleep-related problems. After correction, age, the number of comorbidities, and regular exercise were significantly associated with a greater severity of sleep-related problems; sex was no longer a significant factor. Compared to the ordered probit model, the CHOPIT model provided two changes with a subtle difference in the magnitude of regression coefficients after correction for reporting heterogeneity."
] | [
"To accommodate and correct identifiable bias and risks of bias among clinical trials of nicotine replacement therapy (NRT). Meta-regression analysis of a published Cochrane Collaboration systematic review of 122 placebo-controlled clinical trials. Both identified risks of bias and potential publication (or reporting or small sample) bias are associated with an increase in the reported effectiveness of NRT. Whenever multiple sources of biases are accommodated by meta-regression, no evidence of a practically notable or statistically significant overall increased rate of smoking cessation remains. Our findings are in stark contrast with the 50% to 70% increase in smoking cessation reported by the Cochrane Collaboration systematic review."
] | pubmedqa | {
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Do mutations causing low HDL-C promote increased carotid intima-media thickness? | [
"Although observational data support an inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD), genetic HDL deficiency states often do not correlate with premature CHD. Carotid intima-media thickness (cIMT) measurements were obtained in cases comprising 10 different mutations in LCAT, ABCA1 and APOA1 to further evaluate the relationship between low HDL resulting from genetic variation and early atherosclerosis. In a 1:2 case-control study of sex and age-related (+/-5 y) subjects (n=114), cIMT was nearly identical between cases (0.66+/-0.17 cm) and controls (0.65+/-0.18 cm) despite significantly lower HDL cholesterol (0.67 vs. 1.58 mmol/l) and apolipoprotein A-I levels (96.7 vs. 151.4 mg/dl) (P<0.05)"
] | [
"Circulating oxidized low-density lipoprotein (LDL) has been shown to be a useful marker for identifying patients with coronary heart disease (CHD) and persons at high cardiovascular risk. The effect of cholesterol-lowering therapy on plasma level of oxidized LDL is not clear. We investigated effects of cholesterol lowering by therapeutic intervention (2 years) with atorvastatin (80 mg daily) and simvastatin (40 mg daily) on circulating oxidized LDL (absolute level and in proportion to plasma apolipoprotein B) in relation to atherosclerosis progression (carotid intima-media thickness, carotid IMT) and to inflammation (high-sensitivity C-reactive protein, hsCRP) in 115 stable patients with heterozygous familial hypercholesterolemia (FH). Atorvastatin and simvastatin reduced plasma-oxidized LDL (-43 and -35%, respectively) in proportion to the decrease in plasma apolipoprotein B. Neither absolute nor relative level of oxidized LDL correlated with carotid IMT or hsCRP at baseline. Also changes in levels of circulating oxidized LDL were not related to changes in carotid IMT and hsCRP."
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A short stay or 23-hour ward in a general and academic children's hospital: are they effective? | [
"We evaluated the usefulness of a short stay or 23-hour ward in a pediatric unit of a large teaching hospital, Westmead Hospital, and an academic Children's hospital, The New Children's Hospital, to determine if they are a useful addition to the emergency service. This is a descriptive comparison of prospectively collected data on all children admitted to the short stay ward at Westmead Hospital (WH) during 1994 and the short stay ward at the New Children's Hospital (NCH) during 1997-98. These hospitals service an identical demographic area with the latter (NCH) a tertiary referral center. The following outcome measures were used: length of stay, appropriateness of stay, rate of admission to an in-hospital bed, and rate of unscheduled visits within 72 hours of discharge. Adverse events were reported and patient follow-up was attempted at 48 hours after discharge in all cases. The short stay ward accounted for 10.3% (Westmead Hospital) and 14.7% (New Children's Hospital) of admissions, with 56% medical in nature, 30% surgical, and the remainder procedural or psychological. Admission patterns were similar, with asthma, gastroenteritis, convulsion, pneumonia, and simple surgical conditions accounting for most short stay ward admissions. The short stay ward increased hospital efficiency with an average length of stay of 17.5 hours (Westmead Hospital) compared to 20.5 hours (New Children's Hospital). The users of the short stay ward were children of young age less than 2 years, with stay greater than 23 hours reported in only 1% of all admissions to the short stay ward. The rate of patient admission to an in-hospital bed was low, (4% [Westmead Hospital] compared to 6% [New Children's Hospital]), with the number of unscheduled visits within 72 hours of short stay ward discharge less than 1%. There were no adverse events reported at either short stay ward, with parental satisfaction high. The short stay ward was developed through reallocation of resources from within the hospital to the short stay ward. This resulted in estimated savings of $1/2 million (Westmead Hospital) to $2.3 million (New Children's Hospital) to the hospital, due to more efficient bed usage."
] | [
"To evaluate the effectiveness of the role of a discharge coordinator whose sole responsibility was to plan and coordinate the discharge of patients from medical wards. An intervention study in which the quality of discharge planning was assessed before and after the introduction of a discharge coordinator. Patients were interviewed on the ward before discharge and seven to 10 days after being discharged home. The three medical wards at the Homerton Hospital in Hackney, East London. 600 randomly sampled adult patients admitted to the medical wards of the study hospital, who were resident in the district (but not in institutions), were under the care of physicians (excluding psychiatry), and were discharged home from one of the medical wards. The sampling was conducted in three study phases, over 18 months. Phase I comprised base line data collection; in phase II data were collected after the introduction of the district discharge planning policy and a discharge form (checklist) for all patients; in phase III data were collected after the introduction of the discharge coordinator. The quality and out come of discharge planning. Readmission rates, duration of stay, appropriateness of days of care, patients' health and satisfaction, problems after discharge, and receipt of services. The discharge coordinator resulted in an improved discharge planning process, and there was a reduction in problems experienced by patients after discharge, and in perceived need for medical and healthcare services. There was no evidence that the discharge coordinator resulted in a more timely or effective provision of community services after discharge, or that the appropriateness or efficiency of bed use was improved."
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Did Chile's traffic law reform push police enforcement? | [
"The objective of the current study is to determine to what extent the reduction of Chile's traffic fatalities and injuries during 2000-2012 was related to the police traffic enforcement increment registered after the introduction of its 2005 traffic law reform. A unique dataset with assembled information from public institutions and analyses based on ordinary least square and robust random effects models was carried out. Dependent variables were traffic fatality and severe injury rates per population and vehicle fleet. Independent variables were: (1) presence of new national traffic law; (2) police officers per population; (3) number of traffic tickets per police officer; and (4) interaction effect of number of traffic tickets per police officer with traffic law reform. Oil prices, alcohol consumption, proportion of male population 15-24 years old, unemployment, road infrastructure investment, years' effects and regions' effects represented control variables. Empirical estimates from instrumental variables suggest that the enactment of the traffic law reform in interaction with number of traffic tickets per police officer is significantly associated with a decrease of 8% in traffic fatalities and 7% in severe injuries. Piecewise regression model results for the 2007-2012 period suggest that police traffic enforcement reduced traffic fatalities by 59% and severe injuries by 37%."
] | [
"In 1994, Arizona voters approved Proposition 200 which increased the tobacco tax and earmarked 23% of the new revenues for tobacco education programmes. To describe the campaign to pass Proposition 200, the legislative debate that followed the passage of the initiative, and the development and implementation of the tobacco control programme. This is a case study. Data were collected through semi-structured interviews with key players in the initiative campaign and in the tobacco education programme, and written records (campaign material, newspapers, memoranda, public records). Despite opposition from the tobacco industry, Arizonans approved an increase in the tobacco tax. At the legislature, health advocates in Arizona successfully fought the tobacco industry attempts to divert the health education funds and pass preemptive legislation. The executive branch limited the scope of the programme to adolescents and pregnant women. It also prevented the programme from attacking the tobacco industry or focusing on secondhand smoke. Health advocates did not put enough pressure at the executive branch to force it to develop a comprehensive tobacco education programme."
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Therapeutic anticoagulation in the trauma patient: is it safe? | [
"Trauma patients who require therapeutic anticoagulation pose a difficult treatment problem. The purpose of this study was to determine: (1) the incidence of complications using therapeutic anticoagulation in trauma patients, and (2) if any patient factors are associated with these complications. An 18-month retrospective review was performed on trauma patients>or= 15 years old who received therapeutic anticoagulation using unfractionated heparin (UH) and/or fractionated heparin (FH). Forty different pre-treatment and treatment patient characteristics were recorded. Complications of anticoagulation were documented and defined as any unanticipated discontinuation of the anticoagulant for bleeding or other adverse events. One-hundred-fourteen trauma patients were initiated on therapeutic anticoagulation. The most common indication for anticoagulation was deep venous thrombosis (46%). Twenty-four patients (21%) had at least 1 anticoagulation complication. The most common complication was a sudden drop in hemoglobin concentration requiring blood transfusion (11 patients). Five patients died (4%), 3 of whom had significant hemorrhage attributed to anticoagulation. Bivariate followed by logistic regression analysis identified chronic obstructive pulmonary disease (OR = 9.2, 95%CI = 1.5-54.7), UH use (OR = 3.8, 95%CI = 1.1-13.0), and lower initial platelet count (OR = 1.004, 95%CI = 1.000-1.008) as being associated with complications. Patients receiving UH vs. FH differed in several characteristics including laboratory values and anticoagulation indications."
] | [
"To evaluate data addressing use of anticoagulation in elderly patients with atrial fibrillation (AF), in particular those at risk of falls. Primary literature was identified through PubMed MEDLINE (1966-December 2007) and EMBASE (1980-December 2007) using the search terms anticoagulation, warfarin, aspirin, elderly, falls, older persons, atrial fibrillation, bleeding, education, stroke, and use. Additional references were obtained through review of references from articles obtained. Clinical studies evaluating warfarin and aspirin efficacy in AF, as well as studies evaluating anticoagulation and falls, elderly patients, and bleeding were considered for inclusion. Selection emphasis was placed on randomized studies of AF and those evaluating anticoagulation and falls. Uncertainties over the optimal treatment for elderly patients with AF still exist. Variance in the guidelines is reflected in current practice, as some discrepancies are present. Warfarin is underprescribed in elderly patients, with only about 50% of eligible patients receiving therapy. Falls are most often cited as the reason for not using anticoagulants in an elderly patient. Three risk-benefit analyses have been performed, and all found that despite risks associated with warfarin, its benefits outweigh its risks even in patients who fall. Warfarin should be used rather than aspirin or no therapy in elderly patients at risk of falls. Anticoagulation education has been shown to reduce the risk of bleeding in the elderly and should be a vital part of warfarin management."
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Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful? | [
"Specific markers for differentiation of nonalcoholic (NASH) from alcoholic steatohepatitis (ASH) are lacking. We investigated the role of routine laboratory parameters in distinguishing NASH from ASH. Liver biopsies performed at our hospital over a 10-year period were reviewed, 95 patients with steatohepatitis identified and their data prior to biopsy reevaluated. The diagnosis NASH or ASH was assigned (other liver diseases excluded) on the basis of the biopsy and history of alcohol consumption (<140 g/week). Logistic regression models were used for analysis. NASH was diagnosed in 58 patients (61%; 30 f) and ASH in 37 (39%; 9 f). High-grade fibrosis (59% vs. 19%, P<0.0001) and an AST/ALT ratio>1 (54.1% vs 20.7%, P = 0.0008) were more common in ASH. The MCV was elevated in 53% of ASH patients and normal in all NASH patients (P<0.0001). Multivariate analysis identified the MCV (P = 0.0013), the AST/ALT ratio (P = 0.011) and sex (P = 0.0029) as relevant regressors (aROC = 0.92). The AST/ALT ratio (P<0.0001) and age (P = 0.00049) were independent predictors of high-grade fibrosis. Differences in MCV were more marked in high-grade fibrosis."
] | [
"Hepatic encephalopathy is a frequent complication of cirrhosis. The present retrospective investigation was conducted to characterize metabolic alterations in cirrhotic patients with and without hepatic encephalopathy. We tested the hypothesis that reduced nutritional status or the degree of tissue catabolism are associated with the presence of hepatic encephalopathy. We investigated 223 patients with histologically confirmed nonalcoholic cirrhosis without hepatic encephalopathy and with hepatic encephalopathy (grades 1-3). To assess liver function, nutritional status, and energy metabolism, a variety of biochemical and clinical tests were performed including anthropometric measurements, bioelectrical impedance analysis, and indirect calorimetry. Nutritional status and tissue catabolism were not significantly different between patients with and without hepatic encephalopathy."
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Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work? | [
"Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior. Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease. The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5%), discussed family history (n = 159, 22.9%), not addressed (n = 155, 22.3%), and reviewed family history and ordered tests/referrals (n = 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases."
] | [
"Parents often accompany adolescent and young adult (AYA) pediatric cancer survivors to follow-up oncology clinic visits and remain involved in their care, although little is known about their reasons for doing so. This mixed methods (qualitative-quantitative) study of 76 mothers of AYA survivors of childhood cancer uses content analysis and logistic regression to identify and explore reasons mothers provided for coming to the visit. Demographic and treatment data are examined as potentially explanatory factors. Ten reasons (in decreasing order of frequency) were derived: Concern for Child's Health and Well-Being, Practical Support, Transportation, Familial Experience, General Support, Companionship, Personal Interest in Follow-up Care, Characteristics of their Child, Emotional Support, and Parental Duty. The reasons were not related to demographic or treatment factors."
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Do emergency ultrasound fellowship programs impact emergency medicine residents' ultrasound education? | [
"Recent years have seen a rapid proliferation of emergency ultrasound (EUS) programs in the United States. To date, there is no evidence supporting that EUS fellowships enhance residents' ultrasound (US) educational experiences. The purpose of this study was to determine the impact of EUS fellowships on emergency medicine (EM) residents' US education. We conducted a cross-sectional study at 9 academic medical centers. A questionnaire on US education and bedside US use was pilot tested and given to EM residents. The primary outcomes included the number of US examinations performed, scope of bedside US applications, barriers to residents' US education, and US use in the emergency department. The secondary outcomes were factors that would impact residents' US education. The outcomes were compared between residency programs with and without EUS fellowships. A total of 244 EM residents participated in this study. Thirty percent (95% confidence interval, 24%-35%) reported they had performed more than 150 scans. Residents in programs with EUS fellowships reported performing more scans than those in programs without fellowships (P = .04). Significant differences were noted in most applications of bedside US between residency programs with and without fellowships (P<.05). There were also significant differences in the barriers to US education between residency programs with and without fellowships (P<.05)."
] | [
"Surgical residents typically receive limited exposure to business and practice management during their training. As a result, residents are ill-prepared for issues related to starting a practice, coding, collecting, and taking a meaningful role within the medical community in promoting quality and safety and in containing health care costs. With the introduction of the core competencies and the current overhaul of surgical education, we believe there is an opportunity to include business and practice management into resident training. Program directors in general surgery (189 of 242) responded to a 9-question mailed survey inquiring about their opinions regarding training surgical residents in business and practice management. Most program directors agreed or strongly agreed (87%) that residents should be trained in business and practice management. Seventy percent believed that their current trainees were inadequately trained in this area. Over half (63%) believed that this training should begin during postgraduate years 2 to 5."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant documents:",
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Patient-Controlled Therapy of Breathlessness in Palliative Care: A New Therapeutic Concept for Opioid Administration? | [
"Breathlessness is one of the most distressing symptoms experienced by patients with advanced cancer and noncancer diagnoses alike. Often, severity of breathlessness increases quickly, calling for rapid symptom control. Oral, buccal, and parenteral routes of provider-controlled drug administration have been described. It is unclear whether patient-controlled therapy (PCT) systems would be an additional treatment option. To investigate whether intravenous opioid PCT can be an effective therapeutic method to reduce breathlessness in patients with advanced disease. Secondary aims were to study the feasibility and acceptance of opioid PCT in patients with refractory breathlessness. This was a pilot observational study with 18 inpatients with advanced disease and refractory breathlessness receiving opioid PCT. Breathlessness was measured on a self-reported numeric rating scale. Richmond Agitation Sedation Scale scores, Palliative Performance Scale scores, vital signs, and a self-developed patient satisfaction questionnaire were used for measuring secondary outcomes. Descriptive and interference analyses (Friedman test) and post hoc analyses (Wilcoxon tests and Bonferroni corrections) were performed. Eighteen of 815 patients (advanced cancer; median age = 57.5 years [range 36-81]; 77.8% female) received breathlessness symptom control with opioid PCT; daily morphine equivalent dose at Day 1 was median = 20.3 mg (5.0-49.6 mg); Day 2: 13.0 mg (1.0-78.5 mg); Day 3: 16.0 mg (8.3-47.0 mg). Numeric rating scale of current breathlessness decreased (baseline: median = 5 [range 1-10]; Day 1: median = 4 [range 0-8], P < 0.01; Day 2: median = 4 [range 0-5], P < 0.01). Physiological parameters were stable over time. On Day 3, 12/12 patients confirmed that this mode of application provided relief of breathlessness."
] | [
"To revise the South African Guideline for the Management of Chronic Obstructive Pulmonary Disease (COPD) based on emerging research that has informed updated recommendations."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant documents:",
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Is there still a need for living-related liver transplantation in children? | [
"To assess and compare the value of split-liver transplantation (SLT) and living-related liver transplantation (LRT). The concept of SLT results from the development of reduced-size transplantation. A further development of SLT, the in situ split technique, is derived from LRT, which itself marks the optimized outcome in terms of postoperative graft function and survival. The combination of SLT and LRT has abolished deaths on the waiting list, thus raising the question whether living donor liver transplantation is still necessary. Outcomes and postoperative liver function of 43 primary LRT patients were compared with those of 49 primary SLT patients (14 ex situ, 35 in situ) with known graft weight performed between April 1996 and December 2000. Survival rates were analyzed using the Kaplan-Meier method. After a median follow-up of 35 months, actual patient survival rates were 82% in the SLT group and 88% in the LRT group. Actual graft survival rates were 76% and 81%, respectively. The incidence of primary nonfunction was 12% in the SLT group and 2.3% in the LRT group. Liver function parameters (prothrombin time, factor V, bilirubin clearance) and surgical complication rates did not differ significantly. In the SLT group, mean cold ischemic time was longer than in the LRT group. Serum values of alanine aminotransferase during the first postoperative week were significantly higher in the SLT group. In the LRT group, there were more grafts with signs of fatty degeneration than in the SLT group."
] | [
"Kidney transplantation is generally regarded as the best treatment option for patients with end-stage renal disease. Because of an increase in the elderly population, the number of elderly patients with end-stage renal disease is expected to increase. The scope of this paper is to present existing knowledge about the survival after kidney transplantation of patients over 70 years of age at the time of transplantation. The paper is based on existing literature retrieved through a systematic search in MEDLINE as well as on the authors' own experience and research. Among patients who fulfill the established medical criteria, kidney transplantation results in better survival than lifelong dialysis treatment. The best prognosis is achieved if time on dialysis prior to transplantation is reduced and acute rejection episodes are avoided after transplantation."
] | pubmedqa | {
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Do patterns of knowledge and attitudes exist among unvaccinated seniors? | [
"To examine patterns of knowledge and attitudes among adults aged>65 years unvaccinated for influenza. Surveyed Medicare beneficiaries in 5 areas; clustered unvaccinated seniors by their immunization related knowledge and attitudes. Identified 4 clusters: Potentials (45%) would receive influenza vaccine to prevent disease; Fearful Uninformeds (9%) were unsure if influenza vaccine causes illness; Doubters (27%) were unsure if vaccine is efficacious; Misinformeds (19%) believed influenza vaccine causes illness. More Potentials (75%) and Misinformeds (70%) ever received influenza vaccine than did Fearful Uninformeds (18%) and Doubters (29%)."
] | [
"AIDS is still a major cause of death. To combat this disease, researchers are developing a vaccine. Although blacks account for most new infections in the United States, they account for a low percent of experimental vaccine recipients. This study, conducted in a mid-sized U.S. city where vaccine trials are held, seeks to learn why. We conducted 11 in-depth ethnographic interviews. Two groups were targeted: blacks who had not participated in HIV vaccine trials and blacks who had. Overall, three major causes of nonparticipation were identified: misinformation, fear/mistrust and stigma. Factors that favored participation included having close friends with HIV and being homosexual."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant paragraphs:",
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Is there a model to teach and practice retroperitoneoscopic nephrectomy? | [
"Although the retroperitoneal approach has been the preferred choice for open urological procedures, retroperitoneoscopy is not the preferred approach for laparoscopy. This study aims to develop a training model for retroperitoneoscopy and to establish an experimental learning curve. Fifteen piglets were operated on to develop a standard retroperitoneoscopic nephrectomy (RPN) training model. All procedures were performed with three ports. Intraoperative data (side, operative time, blood loss, peritoneal opening) were recorded. Animals were divided into groups A, the first eight, and B, the last seven cases. Data were statistically analyzed. We performed fifteen RPNs. The operative time varied from 15 to 50 minutes (median 30 minutes). Blood loss varied from 5 to 100 mL (median 20 mL). We experienced five peritoneal openings; we had two surgical vascular complications managed laparoscopically. There was statistical difference between groups A and B for peritoneal opening (p = 0.025), operative time (p = 0.0037), and blood loss (p = 0.026). RPN in a porcine model could simulate the whole procedure, from creating the space to nephrectomy completion. Experimental learning curve was eight cases, after statistical data analysis."
] | [
"Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. A 72-year-old woman with a 2cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant documents:",
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Cardiovascular risk in a rural adult West African population: is resting heart rate also relevant? | [
"Elevated resting heart rate (RHR) is a neglected marker in cardiovascular risk factor studies of sub-Saharan African populations. This study aimed to determine the prevalence of elevated RHR and other risk factors for cardiovascular disease (CVD) and to investigate any associations between RHR and these risk factors in a rural population in Ghana. Cross-sectional analysis. A total of 574 adults aged between 18-65 years were randomly sampled from a population register. Data collected included those on sociodemographic variables and anthropometric, blood pressure (BP), and RHR measurements. Within-person variability in RHR was calculated using data from repeat measurements taken 2 weeks apart. Of study participants, 36% were male. Prevalence of casual high BP was 19%. In the population, 10% were current cigarette smokers and habitual alcohol use was high at 56%. As measured by body mass index, 2% were obese and 14% had abdominal obesity. RHR was elevated (>90 bpm) in 19%. Overall, 79% of study participants were found to have at least one CVD risk factor. RHR was significantly associated with age, waist circumference, and BP. Individuals with an elevated RHR had a higher risk (OR 1.94, 95% CI 1.15-3.26%, p = 0.013) of casual high BP compared with participants with normal RHR independently of several established CVD risk factors. The regression dilution ratio of RHR was 0.75 (95% CI 0.62-0.89)."
] | [
"Is intake of fatty acids related to semen quality among young men?"
] | pubmedqa | {
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Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted? | [
"The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as>or=10 casualties or>or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was<or=52. Based on severity scores and ED discharges 1022 (79.2%) casualties did not necessitate immediate medical treatment."
] | [
"There are many reasons for the development of patient pathways in burn surgery introduced at the Royal Adelaide Hospital in South Australia at the beginning of January 2005. These include education, standardization of technique, scheduling of surgical episodes and rationalization of the use of expensive therapies. A critical appraisal of both evidence based on published work and personal/peer experience has been used to generate the current pathways. The year 2005 was the busiest in the history of the hospital, both in numerical terms and in the proportion of major burn injuries. These protocols were effective in enabling us to cope with negligible mortality."
] | pubmedqa | {
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Acute respiratory distress syndrome in children with malignancy--can we predict outcome? | [
"The purpose of this study was to delineate early respiratory predictors of mortality in children with hemato-oncology malignancy who developed acute respiratory distress syndrome (ARDS). We conducted a retrospective chart review of children with malignant and ARDS who needed mechanical ventilation and were admitted to a pediatric intensive care unit from January 1987 to January 1997. Seventeen children with ARDS and malignancy aged 10.5 +/- 5.1 years were identified. Six of the 17 children (35.3%) survived. Sepsis syndrome was present in 70.6% of all the children. Peak inspiratory pressure, positive end-expiratory pressure (PEEP), and ventilation index values could distinguish outcome by day 3. A significant relationship between respiratory data and outcome related to efficiency of oxygenation, as determined by PaO(2)/FIO(2) and P(A-a)O(2), was present from day 8 after onset of mechanical ventilation."
] | [
"Sepsis is a leading cause of acute lung injury (ALI); however, the characteristics and outcome of sepsis-associated ALI are poorly understood. We aimed to elucidate factors that predict patient outcome in sepsis-associated ALI. Secondary analysis of a multicenter, prospective, observational study was performed. Among 624 patients with severe sepsis and septic shock, 251 (40.2%) fulfilled the definition of American-European Consensus Conference definition of ALI. All-cause 28-day and in-hospital mortalities were 30.7% and 38.6%, respectively. More than 40% of ALI patients had neurological, cardiovascular and haematological dysfunctions or disseminated intravascular coagulation, all of which were associated with higher mortality. We report a significant correlation between infection site and mortality in patients with ALI, but not in those without ALI. The proportion of ALI was significantly higher in pulmonary sepsis; further, a complication of ALI was associated with higher mortality in sepsis from pulmonary and other sources, but not in abdominal sepsis. Among the other sepsis sites, urinary tract, central nervous system, catheter-related and undetermined foci of infection had worse outcomes when associated with ALI. None of the individual severe sepsis bundles, including fluid resuscitation and early antibiotic administration, correlated with mortality. Compliance with a set of sepsis management bundles was associated with better outcomes."
] | pubmedqa | {
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Secondhand smoke risk in infants discharged from an NICU: potential for significant health disparities? | [
"Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated>12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans. Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected. Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p<.01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p<.05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p<.02)."
] | [
"Even though the prevalence of tobacco smoking has declined in the general population and among white-collar workers, the prevalence of tobacco smoking among blue-collar workers remains unacceptably high. Blue-collar workers experience greater exposure to workplace toxins which can add to, or even multiply, their risk of adverse health effects from tobacco smoking. Among blue-collar workers, workers in the restaurant, bar, and gaming industries are exposed to much higher levels of environmental tobacco smoke (ETS) than are office workers, and are at increased risk of cancer and cardiovascular diseases even if they are non-smokers themselves. The literature on health risks, and the disparity between white and blue collar workers in smoking prevalence, and the literature on various tobacco control strategies provide the sources on which this review is based."
] | pubmedqa | {
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Do nomograms designed to predict biochemical recurrence (BCR) do a better job of predicting more clinically relevant prostate cancer outcomes than BCR? | [
"To examine the ability of various postoperative nomograms to predict prostate cancer-specific mortality (PCSM) and to validate that they could predict aggressive biochemical recurrence (BCR). Prostate-specific antigen (PSA), grade, and stage are the classic triad used to predict BCR after radical prostatectomy (RP). Multiple nomograms use these to predict risk of BCR. A previous study showed that several nomograms could predict aggressive BCR (prostate-specific antigen doubling time [PSADT] <9 months) more accurately than BCR. However, it remains unknown if they can predict more definitive endpoints, such as PCSM. We performed Cox analyses to examine the ability of 4 postoperative nomograms, the Duke Prostate Center (DPC) nomogram, the Kattan postoperative nomogram, the Johns Hopkins Hospital (JHH) nomogram, and the joint Center for Prostate Disease Research(CPDR)/Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) nomogram to predict BCR and PCSM among 1778 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent RP between 1990 and 2009. We also compared their ability to predict BCR and aggressive BCR in a subset of men. We calculated the c-index for each nomogram to determine its predictive accuracy for estimating actual outcomes. We found that each nomogram could predict aggressive BCR and PCSM in a statistically significant manner and that they all predicted PCSM more accurately than they predicted BCR (ie, with higher c-index values)."
] | [
"Risk stratification in medullary thyroid cancer (MTC) has traditionally relied on standardized anatomic staging systems that, despite providing valuable prognostic information, do not adequately predict the risk of persistent or recurrent disease. As dynamic risk stratification has been demonstrated to be clinically valuable in nonmedullary thyroid cancer, we adapted our response to therapy definitions in order to apply them to MTC. In this study, we evaluate and compare the clinical utility of our previously proposed MTC response to therapy stratification with a traditional standardized anatomic staging system. Both the Tumor, Node, Metastasis/American Joint Cancer Committee (TNM/AJCC) staging system and our previously proposed response to initial therapy staging system was evaluated in 287 MTC patients followed for a median of five years. The TNM/AJCC staging system provided adequate risk stratification with regard to disease-specific mortality and the likelihood of having no evidence of disease at final follow-up, but did not adequately stratify patients with regard to the likelihood of having structural persistent disease, biochemical persistent disease, or recurrence. However, the response to initial therapy risk stratification system provided clinically useful risk stratification with regard to disease-specific mortality, the likelihood of having no evidence of disease at final follow-up, the likelihood of having a biochemical persistent disease at final follow-up, and the likelihood of having structural persistent disease at final follow-up. Furthermore, the response to therapy risk stratification system demonstrated a higher proportion of variance explained (54.3%) than the TNM/AJCC system (23.9%)."
] | pubmedqa | {
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Are reports of mechanical dysfunction in chronic oro-facial pain related to somatisation? | [
"(i) To examine the association between self-reported mechanical factors and chronic oro-facial pain. (ii) To test the hypothesis that this relationship could be explained by: (a) reporting of psychological factors, (b) common association of self-reported mechanical factors with other unexplained syndromes. A population based cross-sectional study of 4200 randomly selected adults registered with a General Medical Practice in North West, England. The study examined the association of chronic oro-facial pain with a variety of self-reported mechanical factors: teeth grinding, facial trauma, missing teeth and the feeling that the teeth did not fit together properly. Information was also collected on demographic factors, psychological factors and the reporting of other frequently unexplained syndromes. An adjusted response rate of 72% was achieved. Only two mechanical factors: teeth grinding (odds ratio (OR) 2.0, 95% CI 1.3-3.0) and facial trauma (OR 2.0; 95% CI 1.3-2.9) were independently associated with chronic oro-facial pain after adjusting for psychological factors. However, these factors were also commonly associated with the reporting of other frequently unexplained syndromes: teeth grinding (odds ratio (OR) 1.8, 95% CI 1.5-2.2), facial trauma (OR 2.1; 95% CI 1.7-2.6)."
] | [
"No previous studies have investigated the psychiatric characteristics of patients with postherpetic neuralgia (PHN). Similarly, no studies have been performed on patients with different chronic somatic symptoms due to a defined medical disease to compare the characteristics of psychiatric morbidity associated with each etiology. After completing the subscales of the Symptom Checklist 90-R, a psychiatrist administered the Diagnostic Interview Schedule to all subjects. The psychiatric comorbidity in 35 patients with pain due to PHN was compared with a control group of 34 patients with the nonpainful aversive symptom of vertigo due to a peripheral vestibular disorder that caused unilateral hypofunction. PHN patients had significantly more symptoms of major depression and somatization disorder. No significant differences were found between groups for psychiatric diagnoses. Patients with PHN reported significantly less acutely distressing somatic symptoms."
] | pubmedqa | {
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Amblyopia: is visual loss permanent? | [
"The records of 465 patients with an established diagnosis of age related macular degeneration who had attended a specialist macular clinic between 1990 and 1998 were scrutinised. A full clinical examination and standardised refraction had been carried out in 189 of these cases on a minimum of two occasions. Cases were looked for where an improvement of one or more lines of either distance or near acuity was recorded in the eye unaffected by macular disease. In each one of these cases the improvement in visual acuity could not be attributed to treatment of other existing pathology. 12 such cases were detected. In nine of these the eye showing improvement of acuity had a history of amblyopia. The mean improvement in distance and near acuity in amblyopic eyes by 12 months was 3.3 and 1.9 lines logMAR respectively. The improvement in acuity generally occurred between 1 and 12 months from baseline and remained stable over the period of follow up."
] | [
"To present two cases of pediatric Cogan Syndrome and to highlight the differences between the adult and pediatric forms of the disease, as well as the importance of early diagnosis and treatment. Interventional case report. Institutional setting. Corneal lesions were much more diffuse than those observed in adult Cogan syndrome. Immunosuppressive drug combination therapy successfully resolved systemic and ocular inflammation, but the involvement of the pupillary area caused permanent low vision in one case and amblyopia in the other."
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Implementation of epidural analgesia for labor: is the standard of effective analgesia reachable in all women? | [
"Social and cultural factors combined with little information may prevent the diffusion of epidural analgesia for pain relief during childbirth. The present study was launched contemporarily to the implementation of analgesia for labor in our Department in order to perform a 2 years audit on its use. The goal is to evaluate the epidural acceptance and penetration into hospital practice by women and care givers and safety and efficacy during childbirth. This audit cycle measured epidural analgesia performance against 4 standards: (1) Implementation of epidural analgesia for labor to all patients; (2) Acceptance and good satisfaction level reported by patients and caregivers. (3) Effectiveness of labor analgesia; (4) No maternal or fetal side effects. During the audit period epidural analgesia increased from 15.5% of all labors in the first trimester of the study to 51% in the last trimester (p<0.005). Satisfaction levels reported by patients and care givers were good. A hierarchical clustering analysis identified two clusters based on VAS (Visual Analogue Scale) time course: in 226 patients (cluster 1) VAS decreased from 8.5±1.4 before to 4.1±1.3 after epidural analgesia; in 1002 patients (cluster 2) VAS decreased from 8.12±1.7 before (NS vs cluster 1), to 0.76±0.79 after (p<0.001 vs before and vs cluster 2 after). No other differences between clusters were observed."
] | [
"Transversus abdominis plane blocks have been recently utilized for analgesia after cesarean delivery. However, little data concerning continuous transversus abdominis plane blocks has been reported in the existing literature. Available studies mainly examine the efficacy of single-injection blocks, and only one small case series has been published regarding continuous blocks for analgesia after cesarean delivery. First-hand experiences and observations of three acute pain medicine specialists who received a continuous transversus abdominis plane block for analgesia after cesarean delivery are presented. Three physicians specialized in acute and perioperative pain medicine personally underwent continuous transversus abdominis plane block placements for analgesia after cesarean delivery via a disposable infusion pump at the same teaching hospital. In a very motivated, well-supported, and informed patient after uncomplicated cesarean delivery, the use of continuous transversus abdominis plane blocks for analgesia offers the significant advantages of early functional recovery and excellent prolonged analgesia."
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Does HER2 immunoreactivity provide prognostic information in locally advanced urothelial carcinoma patients receiving adjuvant M-VEC chemotherapy? | [
"To evaluate the impact of HER2 immunoreactivity on clinical outcome in locally advanced urothelial carcinoma patients who received surgery alone, or methotrexate, vinblastine, epirubicin, and cisplatin (M-VEC) as adjuvant chemotherapy. We studied 114 formalin-fixed paraffin-embedded specimens obtained from locally advanced urothelial carcinoma patients receiving surgery alone or adjuvant M-VEC. The authors evaluated HER2 immunoreactivity using immunohistochemical staining and explored the influence of pathological parameters and HER2 immunoreactivity on progression-free survival (PFS) and disease-specific overall survival (OS) using univariate and multivariate Cox's analyses. Urothelial carcinoma of the bladder had a significantly higher frequency of HER2 immunoreactivity than that of the upper urinary tract (60.7 vs. 20.7%, p<0.0001). Overall, nodal status was a strong and independent prognostic indicator for clinical outcome. The HER2 immunoreactivity was significantly associated with PFS (p = 0.02) and disease-specific OS (p = 0.005) in advanced urothelial carcinoma patients. As for patients with adjuvant M-VEC, HER2 immunoreactivity was a significant prognostic factor for PFS (p = 0.03) and disease-specific OS (p = 0.02) using univariate analysis, but not multivariate analysis, and not for patients receiving watchful waiting."
] | [
"This article reviews the recent seminal studies in esophagogastric cancer. Regular low aspirin use may reduce the risk of esophagogastric cancer. Laparoscopic resection of locally advanced gastric cancer appears equivalent to open resection. There is no survival benefit for the addition of postoperative radiation therapy to adjuvant chemotherapy after primary gastric cancer resection. For tumors of the esophagus and gastroesophageal junction, the combination of preoperative radiation therapy with concurrent chemotherapy may be required to ensure achievement of a negative surgical margin and to reduce local tumor recurrence. Epirubicin may not add benefit to fluorinated pyrimidine and platinum-based chemotherapy, either in the preoperative setting or in the treatment of metastatic disease. The Her2-targeted agents lapatinib and trastuzumab emtansine failed to improve outcome when either added to or compared with chemotherapy. Immune checkpoint inhibition appears to be active in metastatic gastric cancer."
] | pubmedqa | {
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Is halofantrine ototoxic? | [
"Halofantrine is a newly developed antimalarial drug used for the treatment of Plasmodium falciparum malaria. The introduction of this drug has been delayed because of its possible side effects, and due to insufficient studies on adverse reactions in humans. There have been no studies investigating its effect on hearing. Thirty guinea pigs were divided into three groups: a control group, a halofantrine therapeutic dose group and a halofantrine double therapeutic dose group. One cochlea specimen from each animal was stained with haematoxylin and eosin and the other with toluidine blue. No changes were detected in the control group. The halofantrine therapeutic dose group showed loss and distortion of inner hair cells and inner phalangeal cells, and loss of spiral ganglia cells. In the halofantrine double therapeutic dose group, the inner and outer hair cells were distorted and there was loss of spiral ganglia cells."
] | [
"What is the effect of estrogen on heparanase procogulant activity?"
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant passages:",
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Visceral adipose tissue area measurement at a single level: can it represent visceral adipose tissue volume? | [
"Measurement of visceral adipose tissue (VAT) needs to be accurate and sensitive to change for risk monitoring. The purpose of this study is to determine the CT slice location where VAT area can best reflect changes in VAT volume and body weight. 60 plain abdominal CT images from 30 males [mean age (range) 51 (41-68) years, mean body weight (range) 71.1 (101.9-50.9) kg] who underwent workplace screenings twice within a 1-year interval were evaluated. Automatically calculated and manually corrected areas of the VAT of various scan levels using \"freeform curve\" region of interest on CT were recorded and compared with body weight changes. The strongest correlations of VAT area with VAT volume and body weight changes were shown in a slice 3 cm above the lower margin of L3 with r values of 0.853 and 0.902, respectively."
] | [
"A number of anatomic sites are used for the measurement of waist circumference. A number of studies have documented differences in the absolute values of waist circumference measurements across these common sites in adults. It is unclear whether waist circumference measurement site alters the relationship with abdominal adiposity and cardiometabolic risk factors in children."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant documents:",
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Necrotizing fasciitis: an indication for hyperbaric oxygenation therapy? | [
"The accepted treatment protocol for necrotizing fasciitis (NF) consists of extensive surgery and wide spectrum antibiotics. Hyperbaric oxygenation (HBO) has been recommended as adjuvant therapy for NF, improving patient mortality and outcome. However, the beneficial effect of HBO for NF remains controversial. A retrospective evaluation of treatment outcome in 37 patients treated for NF between 1984 and 1993 was carried out. The mortality rate, morbidity criteria, and risk factors for grave prognosis were compared between a group of 25 patients who received HBO as part of their treatment protocol and a group of the remaining 12 patients treated by surgical excision and antibiotics alone. The two groups were found to be similar with regard to age, gender, the incidence of individual risk factors for ominous prognosis, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score for disease's severity on presentation. The mortality rate among the HBO-treated patients was 36%, as opposed to 25% in the non-HBO group. The mean number of surgical débridements required per patient was significantly higher in the HBO group: 3.3 compared with 1.5 in the non-HBO-treated patients. Although the average length of hospitalization for survivors was shorter for the HBO group, the difference between the groups did not reach statistical significance."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant paragraphs:",
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} |
Is the Hawkins sign able to predict necrosis in fractures of the neck of the astragalus? | [
"To assess if the Hawkins sign can predict whether or not astragalus fractures of the neck will develop avascular necrosis. It is also assessed whether the occurrence of this complication is related to the displacement of the fracture, soft tissue injury, or delay in the reduction or surgery. The results were compared with those found in the literature. A retrospective study was conducted on 23 talar neck fractures recorded over a a period of thirteen years. The following variables were analysed: displacement of the fracture, soft tissue injury, delay and type of treatment, complications, observation of the Hawkins sign, and functional outcome. There were 7 type I Hawkins fractures, 11 type II, and 4 type III and 1 type IV. Four cases developed avascular necrosis (2 Hawkins type II and 2 type III). Hawkins sign was observed in 12 cases, of which none developed necrosis. Four cases with negative Hawkins sign developed necrosis. No statistically significant differences were found when comparing the development of avascular necrosis with the displacement of the fracture, soft tissue injury, or delay in treatment. Differences were found when comparing the development of avascular necrosis with the Hawkins sign (P=.03)."
] | [
"It is known that posterior malleolar fracture is often associated with tibial diaphyseal fractures. However, in literature there are very few studies on tibial shaft fractures with respect to posterior malleolus fragment. We hypothesized that the incidence of posterior malleolar fracture is higher than in previous studies. A total of 74 closed tibial shaft fractures were treated with intramedullary nailing in Turku University Central Hospital between January 1994 and December 1998. There were 55 men and 19 women, with a mean age of 39 years (range, 16 to 58 years). Two cases were excluded and 72 tibial shaft fractures were analyzed retrospectively. Posterior malleolar fracture was observed in 18 cases (25.0%). Only 10 were observed preoperatively in plain films, seven were detected postoperatively and one was not detected at all during the treatment. Retrospectively, all 18 posterior malleolar fractures were detectable in preoperative plain films."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant documents:",
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Is a mandatory general surgery rotation necessary in the surgical clerkship? | [
"Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question. We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were assessed by written examination, objective structured clinical examination (OSCE), ward evaluations, self-assessment objectives questionnaire, and satisfaction survey. Data for 54 students showed no differences in scores between groups on any parameter. No specific concerns related to the absence of general surgery were identified."
] | [
"To provide an updated report on the status of urology education in the United States. Forty-one randomly selected accredited medical schools in the United States were surveyed concerning their urology curriculum. All schools were included in the randomization, even those that had not produced any successful urology applicants during the past 5 years. In 48% of the schools, there were no urology lectures or coursework required before third-year clinical rotations. Two schools (5%) had a mandatory urology clinical clerkship. All schools offered an elective urology clerkship during either the third or fourth year of medical school. Fifty-five percent of medical schools used a core curriculum, and 31% based their curriculum on the American Urological Association's medical student core curriculum. Twenty-nine percent used Web-based resources during their clerkship, and 21% had a urology interest group."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant passages:",
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} |
Is Acupuncture Efficacious for Treating Phonotraumatic Vocal Pathologies? | [
"To investigate the effectiveness of acupuncture in treating phonotraumatic vocal fold lesions.STUDY DESIGN/ A total of 123 dysphonic individuals with benign vocal pathologies were recruited. They were given either genuine acupuncture (n = 40), sham acupuncture (n = 44), or no treatment (n = 39) for 6 weeks (two 30-minute sessions/wk). The genuine acupuncture group received needles puncturing nine voice-related acupoints for 30 minutes, two times a week for 6 weeks, whereas the sham acupuncture group received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. The no-treatment group did not receive any intervention but attended just the assessment sessions. One-hundred seventeen subjects completed the study (genuine acupuncture = 40; sham acupuncture = 43; and no treatment = 34), but only 84 of them had a complete set of vocal functions and quality of life measures (genuine acupuncture = 29; sham acupuncture = 33; and no-treatment = 22) and 42 of them with a complete set of endoscopic data (genuine acupuncture = 16; sham acupuncture = 15; and no treatment = 11). Significant improvement in vocal function, as indicated by the maximum fundamental frequency produced, and also perceived quality of life, were found in both the genuine and sham acupuncture groups, but not in the no-treatment group. Structural (morphological) improvements were, however, only noticed in the genuine acupuncture group, which demonstrated a significant reduction in the size of the vocal fold lesions."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant paragraphs:",
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} |
Is aneurysm repair justified for the patients aged 80 or older after aneurysmal subarachnoid hemorrhage? | [
"With the advancement of an aging society in the world, an increasing number of elderly patients have been hospitalized due to aneurysmal subarachnoid hemorrhage (aSAH). There is no study that compares the elderly cases of aSAH who receive the definitive treatment with those who treated conservatively. The aim of this study was to investigate the feasibility of the definitive surgery for the acute subarachnoid cases aged 80 or older. We reviewed 500 consecutive cases with acute aSAH with surgical indication for aneurysm repair. Inoperable cases such as dead-on-arrival and the cases with both pupils dilated were excluded. We compared the cases aged 80 or older that received clipping or coil embolization with the controls that the family selected conservative treatment. 69 cases were included in this study (ranged 80-98, male:female=9:60). 56 cases (81.2%) had an aneurysm in the anterior circulation. 23 cases received clipping, 20 cases coil embolization and 26 cases treated conservatively. The cases with aneurysm repair showed significantly better clinical outcome than the controls, while World Federation of Neurological Surgeons (WFNS) grade on admission and premorbid modified Rankin Scale showed no difference between them."
] | [
"Infective endocarditis is often associated with cerebral complications, the most serious of which is intraoperative hemorrhagic stroke owing to anticoagulation for cardiopulmonary bypass. However, its prevalence and risk factors are unknown. We evaluated the prevalence and risk factors of intraoperative hemorrhagic stroke in patients with infective endocarditis. In 246 patients who underwent valve surgery for active endocarditis between 2005 and 2012, 127 patients had both preoperative and postoperative intracranial neuroimaging. The prevalence and risk factors of intraoperative stroke were analyzed in those 127 patients. Valve surgery was performed in 127 patients 19.6 ± 27.1 days after infective endocarditis diagnosis. Fourteen experienced intraoperative hemorrhagic stroke, and 1 died. None of 29 patients with preoperative hemorrhagic stroke showed exacerbation of hemorrhagic lesions, whereas 1 of 57 patients with preoperative cerebral infarction showed hemorrhagic transformation of infarct lesions. Thirteen of 14 hemorrhagic complications were new ectopic intracranial hemorrhage. Multivariate analysis showed not preoperative cerebral lesions but preoperative low hemoglobin level as the only risk factor for intraoperative hemorrhagic stroke (odds ratio, 0.51; 95% confidence interval, 0.26 to 0.87; p = 0.03). A preoperative hemoglobin cutoff value of 9.2 g/dL was determined by receiver operating curve analysis. Of 41 patients with preoperative hemoglobin level less than 9.2 g/dL, 9 (22%) had intraoperative new hemorrhage, whereas 4 (5%) of 86 patients with hemoglobin level of at least 9.2 g/dL had ectopic new hemorrhage."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant passages:",
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} |
Do general practice characteristics influence uptake of an information technology (IT) innovation in primary care? | [
"Recent evaluations of IT innovations in primary care have highlighted variations between centres and practices in uptake and use. We evaluated whether structural characteristics of a general practice were associated with variations in use of a web-based clinical information system underpinning a Managed Clinical Network in diabetes, between the years 2001 and 2003. Using a computerised audit trail, we calculated the numbers of web-based operations that occurred in each practice, stratified by staff type and year, and adjusted for the numbers of registered diabetic patients. In regression analyses, we determined whether total use was associated with structural characteristics of the practice (total list size, training status, numbers of GPs (general practitioners), mean age of the GPs, numbers of female GPs, level of deprivation of the population and whether staff had received advanced training in diabetes care). Initially there were a few practices which made very frequent use of the information system, with relatively high numbers of practices using the facility infrequently. However, overall use gradually became more evenly spread. This effect was particularly evident among nurse users. Frequent use by GPs was evident in only a small number of practices, with mean GP use decreasing over the three years. In linear regression analyses, none of the general practice variables were associated with online use, either overall or stratified by staff type, except for the numbers of diabetes-educated staff. This was consistently associated with increased use by nurses and GPs."
] | [
"Quality improvements achieved by applying the systems approach to assess the clinical effectiveness, operational efficiency, and financial feasibility of a pharmacist-managed vancomycin dosing service are described."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant passages:",
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} |
Prognosis of well differentiated small hepatocellular carcinoma--is well differentiated hepatocellular carcinoma clinically early cancer? | [
"The purpose of this study is to examine whether or not well differentiated (w-d) hepatocellular carcinoma (HCC) is indeed clinically early cancer. Seventy six patients with solitary small HCCs up to 3 cm in diameter, who underwent hepatectomy, were observed for at least 2 years for possible recurrence. These patients were divided into two groups: 10 patients with w-d HCCs (Edmondson and Steiner's grade I) and 66 patients with less differentiated (l-d) HCCs (Edmondson and Steiner's grade I-II, II-III, and III). The histological analysis revealed that w-d HCCs had lower incidences of fibrous capsule formation (P<0.01), when compared to l-d HCCs. There were no significant differences in the incidence of intrahepatic metastasis, or portal vein invasion. In a resected specimen of w-d HCC, barium sulfate and gelatin were injected into portal vein and a transparent specimen was made. The transparent specimen showed that the portal vein in the tumor seemed to be intact. Microscopically, cancer cell infiltration into the fibrous frame of the portal tract was present. There were no significant differences in the disease free survival between the two groups. An analysis of tumor volume doubling time in recurrent foci suggested that minute cancerous foci had been present at the time of operation."
] | [
"Identification of the risk factors of multicentric hepatocarcinogenesis is important for the clinical management of hepatocellular carcinoma. We investigated hyperplastic foci in non-cancerous liver parenchyma, and clarified their pathological features and clinical significance. Hyperplastic foci were defined as hypercellular areas, which architecturally and cytologically resembled early hepatocellular carcinoma or adenomatous hyperplasia but did not form macroscopically detectable nodules. Surgically resected livers from 155 patients with hepatocellular carcinoma were examined histopathologically and immunohistochemically. Hyperplastic foci were found in 26 of 155 patients (16.8%). All the patients with hyperplastic foci had chronic liver diseases, and the incidence did not differ between those with chronic hepatitis and those with liver cirrhosis. Six of 92 (6.5%) patients with single primary hepatocellular carcinoma nodules, 8 of 42 (19.0%) with two nodules, and 12 of 21 (57.0%) with more than three nodules had hyperplastic foci. The incidence of hyperplastic foci showed a significant positive correlation with the multiplicity of hepatocellular carcinoma nodules. Immunohistochemically, hyperplastic foci were masses of proliferative hepatocytes similar to adenomatous hyperplasia and early hepatocellular carcinoma."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant paragraphs:",
"pos": "Represent the Biomedical paragraph for retrieval:",
"neg": "Represent the Biomedical paragraph for retrieval:"
} |
Do follow-up recommendations for abnormal Papanicolaou smears influence patient adherence? | [
"To compare adherence to follow-up recommendations for colposcopy or repeated Papanicolaou (Pap) smears for women with previously abnormal Pap smear results. Retrospective cohort study. Three northern California family planning clinics. All women with abnormal Pap smear results referred for initial colposcopy and a random sample of those referred for repeated Pap smear. Medical records were located and reviewed for 90 of 107 women referred for colposcopy and 153 of 225 women referred for repeated Pap smears. Routine clinic protocols for follow-up--telephone call, letter, or certified letter--were applied without regard to the type of abnormality seen on a Pap smear or recommended examination. Documented adherence to follow-up within 8 months of an abnormal result. Attempts to contact the patients for follow-up, adherence to follow-up recommendations, and patient characteristics were abstracted from medical records. The probability of adherence to follow-up vs the number of follow-up attempts was modeled with survival analysis. Cox proportional hazards models were used to examine multivariate relationships related to adherence. The rate of overall adherence to follow-up recommendations was 56.0% (136/243). Adherence to a second colposcopy was not significantly different from that to a repeated Pap smear (odds ratio, 1.40; 95% confidence interval, 0.80-2.46). The use of as many as 3 patient reminders substantially improved adherence to follow-up. Women without insurance and women attending 1 of the 3 clinics were less likely to adhere to any follow-up recommendation (hazard ratio for no insurance, 0.43 [95% confidence interval, 0.20-0.93], and for clinic, 0.35 [95% confidence interval, 0.15-0.73])."
] | [
"Is optimal adherence to guideline recommendations in intrauterine insemination (IUI) care cost-effective from a societal perspective when compared with suboptimal adherence to guideline recommendations?"
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant documents:",
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} |
Biomolecular identification of allergenic pollen: a new perspective for aerobiological monitoring? | [
"Accurate and updated information on airborne pollen in specific areas can help allergic patients. Current monitoring systems are based on a morphologic identification approach, a time-consuming method that may represent a limiting factor for sampling network enhancement. To verify the feasibility of developing a real-time polymerase chain reaction (PCR) approach, an alternative to optical analysis, as a rapid, accurate, and automated tool for the detection and quantification of airborne allergenic pollen taxa. The traditional cetyl trimethyl ammonium bromide-based method was modified for DNA isolation from pollen. Taxon-specific DNA sequences were identified via bioinformatics or literature searches and were PCR amplified from the matching allergenic taxa; based on the sequences of PCR products, complementary or degenerate TaqMan probes were developed. The accuracy of the quantitative real-time PCR assay was tested on 3 plant species. The setup of a modified DNA extraction protocol allowed us to achieve good-quality pollen DNA. Taxon-specific nuclear gene fragments were identified and sequenced. Designed primer pairs and probes identified selected pollen taxa, mostly at the required classification level. Pollen was properly identified even when collected on routine aerobiological tape. Preliminary quantification assays on pollen grains were successfully performed on test species and in mixes."
] | [
"To review the role of immunoglobulin E (IgE)-mediated inflammation in the pathogenesis of asthma, limitations of standard therapies, and IgE as a logical target for therapy with omalizumab aimed at attaining asthma symptom control. Review of worldwide scientific literature on the role of IgE-mediated inflammation in patients with asthma, supplemented with a clinical case study."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant passages:",
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} |
Does diabetes mellitus influence the efficacy of FDG-PET in the diagnosis of cervical cancer? | [
"Compared with computed tomography (CT) and magnetic resonance imaging (MRI), positron emission tomography (PET) may have additional value in the assessment of primary and recurrent cervical cancer. However, the degree of tumour uptake of (18)F-2-fluoro-2-deoxy-D: -glucose (FDG) uptake is sometimes influenced by diabetes mellitus (DM). Therefore, we conducted this prospective study to compare the diagnostic ability of FDG-PET in patients with cervical cancer complicated by DM and those without DM. Patients with untreated locally advanced primary or clinically curable recurrent cervical carcinoma were enrolled. Both FDG-PET and MRI/CT scans were performed within 2 weeks. Patients were categorised into the following groups: hyperglycaemic DM (fasting blood sugar>126 mg/dl), euglycaemic DM and non-DM. The lesions were confirmed histologically or by clinical follow-up. The receiver operating characteristic curve method, with calculation of the area under the curve (AUC), was used to evaluate the discriminative power. From February 2001 to January 2003, 219 patients (75 with primary and 144 with recurrent cervical cancer) were eligible for analysis. Sixteen had hyperglycaemic DM, 12 had euglycaemic DM and 191 were in the non-DM group. The diagnostic power of PET in the hyperglycaemic DM, euglycaemic DM and non-DM groups did not differ significantly with regard to the identification of either metastatic lesions (AUC, 0.967/0.947/0.925, P>0.05) or primary tumours/local recurrence (AUC, 0.950/0.938/0.979, P>0.05). Considering all DM patients, PET showed a significantly higher detection power than MRI/CT scans in respect of metastatic lesions (AUC=0.956 vs 0.824, P=0.012)."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant paragraphs:",
"pos": "Represent the Biomedical paragraph for retrieval:",
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} |
Biomechanical and wound healing characteristics of corneas after excimer laser keratorefractive surgery: is there a difference between advanced surface ablation and sub-Bowman's keratomileusis? | [
"To describe the biomechanical and wound healing characteristics of corneas after excimer laser keratorefractive surgery. Histologic, ultrastructural, and cohesive tensile strength evaluations were performed on 25 normal human corneal specimens, 206 uncomplicated LASIK specimens, 17 uncomplicated sub-Bowman's keratomileusis (SBK) specimens, 4 uncomplicated photorefractive keratectomy (PRK) specimens, 2 uncomplicated advanced surface ablation (ASA) specimens, 5 keratoconus specimens, 12 postoperative LASIK ectasia specimens, and 1 postoperative PRK ectasia specimen and compared to previously published studies. Histologic and ultrastructural studies of normal corneas showed significant differences in the direction of collagen fibrils and/or the degree of lamellar interweaving in Bowman's layer, the anterior third of the corneal stroma, the posterior two-thirds of the corneal stroma, and Descemet's membrane. Cohesive tensile strength testing directly supported these morphologic findings as the stronger, more rigid regions of the cornea were located anteriorly and peripherally. This suggests that PRK and ASA, and secondarily SBK, should be biomechanically safer than conventional LASIK with regard to risk for causing keratectasia after surgery. Because adult human corneal stromal wounds heal slowly and incompletely, all excimer laser keratorefractive surgical techniques still have some distinct disadvantages due to inadequate reparative wound healing. Despite reducing some of the risk for corneal haze compared to conventional PRK, ASA cases still can develop corneal haze or breakthrough haze from the hypercellular fibrotic stromal scarring. In contrast, similar to conventional LASIK, SBK still has the short- and long-term potential for interface wound complications from the hypocellular primitive stromal scar."
] | [
"To evaluate the effect of mitomycin C (MMC) on the exacerbation of corneal opacity that occurs in patients with granular corneal dystrophy type II (GCD II) after refractive corneal surface ablation. Ten eyes of patients with GCD II who underwent refractive corneal surface ablation with MMC were compared with 10 eyes that were not treated with MMC. Best spectacle-corrected visual acuity, the degree of corneal opacity, and contrast sensitivity were evaluated at least 3 years after surgery. Corneal opacities were quantified using Pentacam densitometry maps. No measured between-group value showed a statistically significant difference."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant passages:",
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} |
Does radiotherapy of the primary rectal cancer affect prognosis after pelvic exenteration for recurrent rectal cancer? | [
"Radiotherapy reduces local recurrence rates but is also capable of short- and long-term toxicity. It may also render treatment of local recurrence more challenging if it develops despite previous radiotherapy. This study examined the impact of radiotherapy for the primary rectal cancer on outcomes after pelvic exenteration for local recurrence. We conducted a retrospective review of exenteration databases. The study took place at a quaternary referral center that specializes in pelvic exenteration. Patients referred for pelvic exenteration from October 1994 to November 2012 were reviewed. Patients who did and did not receive radiotherapy as part of their primary rectal cancer treatment were compared. The main outcomes of interest were resection margins, overall survival, disease-free survival, and surgical morbidities. There were 108 patients, of which 87 were eligible for analysis. Patients who received radiotherapy for their primary rectal cancer (n = 41) required more radical exenterations (68% vs 44%; p = 0.020), had lower rates of clear resection margins (63% vs 87%; p = 0.010), had increased rates of surgical complications per patient (p = 0.014), and had a lower disease-free survival (p = 0.022). Overall survival and disease-free survival in patients with clear margins were also lower in the primary irradiated patients (p = 0.049 and p<0.0001). This difference in survival persisted in multivariate analysis that corrected for T and N stages of the primary tumor. This study is limited by its retrospective nature and heterogeneous radiotherapy regimes among radiotherapy patients."
] | [
"The timing of surgery and postoperative radiotherapy--especially if combined with chemotherapy--has been a subject of interest over the past years. This analysis was based on a literature review of mostly retrospective publications. Data concerning the interval between surgery and radiotherapy were correlated with the locoregional control, incidence of distant metastases and prognosis of breast cancer, lung carcinoma, and head and neck carcinomas."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant passages:",
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} |
Can a practicing surgeon detect early lymphedema reliably? | [
"Lymphedema may be identified by simpler circumference changes as compared with changes in limb volume. Ninety breast cancer patients were prospectively enrolled in an academic trial, and seven upper extremity circumferences were measured quarterly for 3 years. A 10% volume increase or greater than 1 cm increase in arm circumference identified lymphedema with verification by a lymphedema specialist. Sensitivity and specificity of several different criteria for detecting lymphedema were compared using the academic trial as the standard. Thirty-nine cases of lymphedema were identified by the academic trial. Using a 10% increase in circumference at two sites as the criterion, half the lymphedema cases were detected (sensitivity 37%). When using a 10% increase in circumference at any site, 74.4% of cases were detected (sensitivity 49%). Detection by a 5% increase in circumference at any site was 91% sensitive."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant paragraphs:",
"pos": "Represent the Biomedical paragraph for retrieval:",
"neg": "Represent the Biomedical paragraph for retrieval:"
} |
Colorectal cancer with synchronous liver metastases: does global management at the same centre improve results? | [
"Synchronous liver metastases (SLM) occur in 20% of colorectal cancers (CRC). Resection of SLM and CLC can be undertaken at different centres (separate management, SM) or at the same centre (global management, GM). Retrospective study of SLM and CRC resections carried out during 01/2000 - 12/2006 by SM or GM, using a combined or delayed strategy. Morphologic characteristics and type of CRC and SLM resection were similar for the GM (n = 45) or SM (n = 66) groups. In patients with delayed liver resection (62 SM, 17 GM), chemotherapy prior to liver surgery was used in 92% and 38% of SM and GM patients (P<0.0001) and the median delay between procedures was 212 and 182 days, respectively (P = 0.04). First step of liver resection was more often performed during colorectal surgery in the GM group (62 vs. 6% for SM, P<0.0001) and the mean number of procedures (CRC+SLM) was lower (1.6 vs. 2.3, P = 0.003). Three-month mortality was 3% for GM and 0% for SM (n.s.). Overall survival rates were 67% and 51% for SM and GM at 3 years (n.s.), and 35 and 31% at 5 years (n.s.). Disease-free survival to 5 years was higher in SM patients (14% vs. 11%, P = 0.009)."
] | [
"US and European practices differ with respect to treating hepatoblastoma (HB). Should chemotherapy be given prior to resection in all cases, and even without biopsy confirmation (SIOPEL)? US data indicate that 40% of HBs are primarily resectable with no operative mortality and that those with pure fetal histology and low mitotic rate do not require toxic chemotherapy. They also suggest that those with a significant fraction of small undifferentiated cells do not respond to otherwise effective chemotherapy. Both US and European studies report a significant error rate in the clinical and imaging diagnosis of HB."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant documents:",
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Is motion perception deficit in schizophrenia a consequence of eye-tracking abnormality? | [
"Studies have shown that schizophrenia patients have motion perception deficit, which was thought to cause eye-tracking abnormality in schizophrenia. However, eye movement closely interacts with motion perception. The known eye-tracking difficulties in schizophrenia patients may interact with their motion perception. Two speed discrimination experiments were conducted in a within-subject design. In experiment 1, the stimulus duration was 150 msec to minimize the chance of eye-tracking occurrence. In experiment 2, the duration was increased to 300 msec, increasing the possibility of eye movement intrusion. Regular eye-tracking performance was evaluated in a third experiment. At 150 msec, speed discrimination thresholds did not differ between schizophrenia patients (n = 38) and control subjects (n = 33). At 300 msec, patients had significantly higher thresholds than control subjects (p = .03). Furthermore, frequencies of eye tracking during the 300 msec stimulus were significantly correlated with speed discrimination in control subjects (p = .01) but not in patients, suggesting that eye-tracking initiation may benefit control subjects but not patients. The frequency of eye tracking during speed discrimination was not significantly related to regular eye-tracking performance."
] | [
"To evaluate cognitive control in children with attention-deficit/hyperactivity disorder (ADHD) using oculomotor tests of executive function. Cross-sectional study of children aged 8 to 13 years with ADHD (n = 26) and controls (n = 33) used oculomotor tasks to assess sensorimotor function (visually guided saccades), resistance to peripheral distractors (fixation), response inhibition (antisaccades), and spatial working memory (memory-guided saccades). All children had intact sensorimotor function and working memory. Children with ADHD showed susceptibility to peripheral distractors and deficits in response inhibition. Increased interstimulus (IS) fixation periods on the antisaccade task were associated with improved performance and decreased reaction times on correct trials for controls but not for children with ADHD. Attention-deficit/hyperactivity disorder-combined and inattentive subtypes showed different patterns of reaction time as a function of IS periods."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant documents:",
"pos": "Represent the Biomedical document for retrieval:",
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} |
Transgastric endoscopic splenectomy: is it possible? | [
"We have previously reported the feasibility of diagnostic and therapeutic peritoneoscopy including liver biopsy, gastrojejunostomy, and tubal ligation by an oral transgastric approach. We present results of per-oral transgastric splenectomy in a porcine model. The goal of this study was to determine the technical feasibility of per-oral transgastric splenectomy using a flexible endoscope. We performed acute experiments on 50-kg pigs. All animals were fed liquids for 3 days prior to procedure. The procedures were performed under general anesthesia with endotracheal intubation. The flexible endoscope was passed per orally into the stomach and puncture of the gastric wall was performed with a needle knife. The puncture was extended to create a 1.5-cm incision using a pull-type sphincterotome, and a double-channel endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated with air through the endoscope. The spleen was visualized. The splenic vessels were ligated with endoscopic loops and clips, and then mesentery was dissected using electrocautery. Endoscopic splenectomy was performed on six pigs. There were no complications during gastric incision and entrance into the peritoneal cavity. Visualization of the spleen and other intraperitoneal organs was very good. Ligation of the splenic vessels and mobilization of the spleen were achieved using commercially available devices and endoscopic accessories."
] | [
"Management of postoperative esophagojejunal anastomotic leakage after total gastrectomy represents a very challenging event. Surgical repair is difficult, and conservative treatment can predispose to more severe complications. Endoclips and self-expanding stents are useful endoscopic therapeutic options but present some drawbacks. The Over-The-Scope-Clip (OTSC) system has been shown to be appropriate to close acute small gastrointestinal perforations, but its use in the treatment of chronic leakage remains controversial. The present series reports three consecutive chronic esophagojejunal anastomotic leaks successfully treated with OTSC. In all cases, clip application was simple, safe and effective, without early and late complications."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant passages:",
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It's Fournier's gangrene still dangerous? | [
"Fournier's gangrene is known to have an impact in the morbidity and despite antibiotics and aggressive debridement, the mortality rate remains high. To assess the morbidity and mortality in the treatment of Fournier's gangrene in our experience. The medical records of 14 patients with Fournier's gangrene who presented at the University Hospital Center \"Mother Teresa\" from January 1997 to December 2006 were reviewed retrospectively to analyze the outcome and identify the risk factor and prognostic indicators of mortality. Of the 14 patients, 5 died and 9 survived. Mean age was 54 years (range from 41-61): it was 53 years in the group of survivors and 62 years in deceased group. There was a significant difference in leukocyte count between patients who survived (range 4900-17000/mm) and those died (range 20.300-31000/mm3). Mean hospital stay was about 19 days (range 2-57 days)."
] | [
"To present the evidence that alcoholism is a disease."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant passages:",
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Is it appropriate to implant kidneys from elderly donors in young recipients? | [
"Kidneys from elderly donors tend to be implanted in recipients who are also elderly. We present the results obtained after 10 years of evolution on transplanting elderly kidneys into young recipients. Ninety-one consecutive transplants are studied, carried out in our center with kidneys from cadaver donors older than 60 years implanted in recipients younger than 60 years. The control group is made up of 91 transplants, matched with those from the study group, whose donor and recipient were younger than 60 years. There were no differences between groups with regard to recipient age, sex, cause of death and renal function of the donor, hepatitis C and cytomegalovirus serologies, cold ischemia time, tubular necrosis, immediate diuresis, need for dialysis, human leukocyte antigen incompatibilities, hypersensitized patients, acute rejection, waiting time on dialysis, and days of admission. Survival in both groups at 1, 5, and 10 years was 97.6%, 87.2%, and 76.6% vs. 98.8%, 87.5%, and 69.5% for the patient (P=0.642), 92.9%, 81.3%, and 64.2% vs. 93.9%, 76.4%, and 69.5% for the graft (P=0.980), and 94.4%, 92.6%, and 77.4% vs. 94.3%, 86.7%, and 84.4% for the graft with death censured (P=0.747), respectively. Creatininaemias at 1, 5, and 10 years were 172, 175, and 210 vs. 139, 134, and 155 (P<0.05)."
] | [
"Concern that morbidly obese (body mass index [BMI] 35) kidney transplant recipients have worse outcomes than non-morbidly obese recipients leads many transplant centers to deny them the benefit of kidney transplantation. These concerns are supported by guidelines recently published by the American Society of Transplantation. However, successfully transplanted morbidly obese persons have a survival advantage over those that remain on dialysis. It is our practice to evaluate morbidly obese transplant candidates for transplantation under the same criteria used for nonobese candidates. This report reviews our experience with morbidly obese kidney transplant recipients having a three year follow-up. Outcomes for 23 morbidly obese (BMI 35, range 37 to 56) kidney transplant recipients transplanted between January 1995 and February 2000 were compared with 224 nonobese (BMI 25) kidney recipients transplanted during the same period. Patient and graft survivals were similar between both groups. Although 3-year graft survival for morbidly obese recipients of cadaver organs was 75% compared with 90% for the nonobese group, this finding was not statistically significant, and 3-year graft survival was 100% for morbidly obese recipients of living donor organs compared with 91% for nonobese recipients. Morbidly obese recipients had significantly longer hospital stays, higher readmission rates, and a higher wound infection rate than nonobese recipients."
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Do provider service networks result in lower expenditures compared with HMOs or primary care case management in Florida's Medicaid program? | [
"To determine the impact of Florida's Medicaid Demonstration 4 years post-implementation on per member per month (PMPM) Medicaid expenditures and whether receiving care through HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures.DATA: Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) from two urban Demonstration counties and two urban non-Demonstration counties. A difference-in-difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMOs and PSNs. Claims data were extracted for enrollees in the Demonstration and non-Demonstration counties and collapsed into monthly amounts (N = 26,819,987 person-months). Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non-Demonstration counties ($186), with Demonstration PSNs lowering PMPM expenditures by $7 more than HMOs. Savings were also seen among TANF enrollees but to a lesser extent."
] | [
"Health plans commonly face the conflicting demands of trying to provide access to novel technologies, including new classes of medications, while trying to contain costs. These demands are particularly acute for California's Medicaid program, known as Medi-Cal, which is responsible for delivery of medical care to an unusually large population of mentally ill individuals in the context of a culturally diverse environment. To meet the challenge, Medi-Cal has instituted a formal process for technology assessment of new and existing pharmaceutical products known as the Therapeutic Class Review (TCR). The purpose of this paper is to describe the information produced for Medi-Cal in the TCR process for antidepressant medications and the individual petition review of antipsychotic medications, and to synthesize our experience in a series of policy recommendations designed to improve the quality of coverage decisions. A collaborative process between Medi-Cal and Lilly resulted in a substantive body of new evidence regarding the needs of Medi-Cal recipients, the quality of current treatment, and prospects regarding the cost-effectiveness of introducing newer treatments."
] | pubmedqa | {
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Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary? | [
"Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery (CAB). Although selective and non-selective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant.AIM: To test whether selective carotid screening is as effective as non-selective screening in detecting significant carotid disease. The case records of patients consecutively undergoing CAB were reviewed. Patients were stratified retrospectively into high- or low-risk groups according to risk factors for significant carotid stenosis and perioperative stroke: peripheral vascular disease (PVD), carotid bruit, diabetes mellitus, age>70 years and/or history of cerebrovascular disease. Prevalence of carotid stenosis detected by ultrasonography, surgical management and perioperative stroke rates were determined in each group. Overall, 205 consecutive patients underwent preoperative carotid screening. The prevalence of significant carotid stenosis was 5.8%. Univariate analysis confirmed that PVD (P=0.005), carotid bruit (P=0.003) and diabetes mellitus (P=0.05) were significant risk factors for stenosis. Carotid stenosis was a risk factor for stroke (P=0.03). Prevalence of carotid stenosis was higher in the high-risk group (9.1%) than the low-risk group (1.2%) (P<0.05). All concomitant or staged carotid endarterectomies/CAB (5/205) and all patients who had perioperative strokes (5/205) were in the high-risk group (P=0.01)."
] | [
"Statins are an essential component of the therapeutic approach of patients with atherosclerotic disease. Statin use is also associated with improved peri-operative and long-term outcomes in these patients. We aimed to define the role of statin treatment in patients undergoing percutaneous revascularization procedures. We searched Medline for studies assessing the effect of statin treatment on percutaneous interventions. Early statin treatment is associated with improved outcomes in patients undergoing percutaneous coronary intervention procedures. Current evidence implies that statin treatment may also play a beneficial role in the management of patients undergoing percutaneous renal artery revascularization and endovascular abdominal aortic aneurysm repair, carotid angioplasty/stenting and endovascular peripheral arterial interventions."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant paragraphs:",
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Should direct mesocolon invasion be included in T4 for the staging of gastric cancer? | [
"One of the sites most frequently invaded by gastric cancer is the mesocolon; however, the UICC does not mention this anatomical site as an adjacent structure involved in gastric cancer. The purpose of this study was to characterize and classify mesocolon invasion from gastric cancer. We examined 806 patients who underwent surgery for advanced gastric carcinoma from 1992 to 2007 at the Department of Surgery, Gangnam Severance Hospital, Korea. Among these, patients who showed macroscopically direct invasion into the mesocolon were compared to other patients with advanced gastric cancer. The curability, number and extent of nodal metastasis, and the survival of the mesocolon invasion group were significantly worse than these factors in the T3 group. However, the survival of the mesocolon invasion group after curative resection was much better than that of patients who had incurable factors."
] | [
"The clinical and prognostic value of the previous node classification of TNM staging in early gastric cancer (EGC) has been less definitive. The aim was to assess the suitability of the revised node staging for prediction of clinical behavior of EGC. Between 2005 and 2008, 1,845 patients were diagnosed with EGC and underwent surgery at Severance Hospitals. Clinicopathological characteristics were analyzed with comparisons between sixth and seventh TNM staging. When comparing IB with IIA upstaged based on seventh staging, poor differentiation, signet ring cell, diffuse, undifferentiated types, perineural invasion (PNI), larger size and younger age, were more significantly associated with IIA. Clinicopathological factors were compared between N0/N1 and N2/N3 based on both staging. In mucosal cancer, younger age, diffuse and undifferentiated types were more significantly associated with N2/N3 based on seventh staging. In submucosal cancer, larger size, poor differentiation, signet ring cell, diffuse, undifferentiated types, PNI and deeper submucosal invasion, were more significantly associated with N2/N3 based on seventh staging."
] | pubmedqa | {
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Do Surrogates of Injury Severity Influence the Occurrence of Heterotopic Ossification in Fractures of the Acetabulum? | [
"To determine the relationship between injury severity surrogates and other patient factors with the development and severity of heterotopic ossification (HO) following open reduction internal fixation of acetabular fractures treated with a posterior approach. Retrospective review. Academic level 1 trauma center. Two hundred forty-one patients who were treated through a posterior approach with a minimum of 6-month radiographic follow-up were identified from an acetabular fracture database. None. The occurrence and severity (Brooker Grade III/IV) of HO 6 months postsurgery. Length of stay (LOS) in the intensive care unit (ICU), non-ICU LOS>10 days, and HO prophylaxis with external radiation beam therapy (XRT) were significantly associated with the development of HO in a multivariate model [ 1-2 days, odds ratio (OR) = 4.33, 95% confidence interval (CI): 1.03-18.25; 3-6 days, OR = 4.1, 95% CI, 1.27-13.27;>6 days, OR = 11.7, 95% CI, 3.24-42.22; non-ICU LOS>10 days (vs. 0-6 days): OR = 7.6, 95% CI, 2.6-22.25; XRT HO prophylaxis: OR = 0.29, 95% CI, 0.10-0.85]. Other variables evaluated in multivariate modeling not significantly associated with development and severity of HO included age, gender, mechanism of injury, injury severity score, presence of neurologic injury, Letournel fracture type, occurrence of hip dislocation, interval from injury to surgery, operative time, and estimated blood loss."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
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Does pretreatment with statins improve clinical outcome after stroke? | [
"In primary and secondary prevention trials, statins have been shown to reduce the risk of stroke. In addition to lipid lowering, statins have a number of antiatherothrombotic and neuroprotective properties. In a preliminary observational study, we explored whether clinical outcome is improved in patients who are on treatment with statins when stroke occurs. We conducted a population-based case-referent study of 25- to 74-year-old stroke patients with, for each case of a patient who was on statin treatment at the onset of stroke (n=125), 2 referent patients who were not treated with statins but were matched for age, gender, year of onset, and stroke subtype (n=250). The unadjusted odds ratio for early discharge to home (versus late discharge or death) was 1.41 (95% CI 0.91 to 2.17) when patients on statin treatment were compared with referent stroke patients not on statins. Prognostic factors were, in general, more unfavorable among patients on statins. When this was adjusted for in a logistic regression model, the use of statins was a moderately strong but statistically nonsignificant predictor of discharge to home (multiple-adjusted odds ratio 1.42, 95% CI 0.90 to 2.22)."
] | [
"Myocardial damage that is associated with percutaneous coronary intervention (PCI) partially affects the results of the procedure, and is related to medium-term cardiovascular death. Remote postischemic conditioning might reduce the myocardial lesions that are associated with PCI, but perhaps less so in diabetics. The aim of this study was to evaluate the protective effect of remote postischemic conditioning in patients undergoing elective PCI for stable angina or non-ST elevation acute coronary syndrome with troponin<1 ng/ml at the time of randomization. This randomized single-blinded single-center clinical trial involved 320 patients undergoing elective PCI who were randomized to either receive three 5-min cycles of ischemia by inflation of a cuff on the non-dominant arm to 200 mm Hg (remote postischemic conditioning) or to placebo (uninflated cuff). The primary outcome variable was the maximum increase in troponin in the first 24 h. The secondary outcome variable was readmission due to heart failure or cardiovascular mortality after 1 year of follow-up. In addition, a diabetic population was studied."
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Processing fluency effects: can the content and presentation of participant information sheets influence recruitment and participation for an antenatal intervention? | [
"To assess the extent to which the title and font of participant information sheets (PISs) can influence pregnant women's and trainee midwives' perceptions of an antenatal intervention. Pregnant women (n=35) and trainee midwives (n=36) were randomly presented with one of four PISs where the title and font of the PIS had been manipulated to create four experimental conditions (i.e., Double Fluent; Double Awkward; Fluent Title-Awkward Font; Awkward Title-Fluent Font). After reading the PIS, participants rated their perceptions of the intervention (i.e., Attractiveness, Complexity, Expected Risk, Required Effort) using five-point Likert scales. A 4×2 factorial multivariate analysis of variance revealed that pregnant women rated the Double Awkward condition as significantly more complex than the Double Fluent (p=.024) and Awkward Title-Fluent Font (p=.021) conditions."
] | [
"Previous research (Webb, Simmons, & Brandon, 2005) suggested that smokers' reactions to self-help materials were more positive if they believed that the materials had been personally tailored to their individual characteristics and if they held expectancies that tailored interventions are superior to standard, or generic, interventions. The authors' objective in the current study was to replicate and extend this research by testing the efficacy expectancy priming before intervention delivery. In a 2 x 2 factorial experiment, 210 smokers (M = 23 cigarettes/day) recruited from the community (62% female; 92% Caucasian; mean age = 49) were randomly assigned to 1 of 4 conditions: placebo-tailored intervention/no priming, placebo-tailored intervention/priming, standard intervention/no priming, or standard intervention/priming. The tailoring-related expectancies of participants' in the priming conditions were primed before they were presented with the respective intervention booklets. Content evaluations, readiness to quit smoking, cessation self-efficacy, smoking-related knowledge, and progress toward quitting (behavior changes). Assessments occurred by mail at baseline and at 1-month postintervention. Similar to the earlier study, the placebo-tailored booklets produced superior evaluations and smoking-related cognitive and behavioral changes. Moreover, the pretreatment expectancy priming successfully altered participants' tailoring-related expectancies and also produced superior evaluations and outcomes."
] | pubmedqa | {
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Sternal fracture in growing children : A rare and often overlooked fracture? | [
"Sternal fractures in childhood are rare. The aim of the study was to investigate the accident mechanism, the detection of radiological and sonographical criteria and consideration of associated injuries. In the period from January 2010 to December 2012 all inpatients and outpatients with sternal fractures were recorded according to the documentation. A total of 4 children aged 5-14 years with a sternal fracture were treated in 2 years, 2 children were hospitalized for pain management and 2 remained in outpatient care."
] | [
"Tumors and tumorlike lesions of the tubular bones of the hand, often incidentally discovered lesions, present a unique but challenging differential diagnosis."
] | pubmedqa | {
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Is there a correlation between androgens and sexual desire in women? | [
"For women, the correlation between circulating androgens and sexual desire is inconclusive. Substitution with androgens at physiological levels improves sexual function in women who experience decreased sexual desire and androgen deficiency from surgical menopause, pituitary disease, and age-related decline in androgen production in the ovaries. Measuring bioactive testosterone is difficult and new methods have been proposed, including measuring the primary androgen metabolite androsterone glucuronide (ADT-G).AIM: The aim of this study was to investigate a possible correlation between serum levels of androgens and sexual desire in women and whether the level of ADT-G is better correlated than the level of circulating androgens with sexual desire. This was a cross-sectional study including 560 healthy women aged 19-65 years divided into three age groups. Correlations were considered to be statistically significant at P<0.05. Sexual desire was determined as the total score of the sexual desire domain of the Female Sexual Function Index. Total testosterone (TT), calculated free testosterone (FT), androstenedione, dehydroepiandrosterone sulfate (DHEAS), and ADT-G were analyzed using mass spectrometry. Sexual desire correlated overall with FT and androstenedione in the total cohort of women. In a subgroup of women aged 25-44 years with no use of systemic hormonal contraception, sexual desire correlated with TT, FT, androstenedione, and DHEAS. In women aged 45-65 years, androstenedione correlated with sexual desire. No correlations between ADT-G and sexual desire were identified."
] | [
"What are the lifestyle choices and dietary aspects of women about to undergo fertility treatment in New Zealand?"
] | pubmedqa | {
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Does immediate breast reconstruction compromise the delivery of adjuvant chemotherapy? | [
"Immediate breast reconstruction (IBR) provides psychological benefit to many early breast cancer patients however concerns persist regarding its potential impact on chemotherapy delivery. We investigated the association between IBR, complications and adjuvant chemotherapy delivery. Retrospective analysis of patients in an academic breast service, who underwent mastectomy, with or without reconstruction, and received adjuvant chemotherapy. Comparisons were made between 107 patients who received IBR and 113 who received mastectomy alone. Those receiving IBR were on average younger, with lower body mass index (BMI) and better prognoses. Overall complication rates were comparable (mastectomy alone: 45.1% versus IBR: 35.5%, p = 0.2). There was more return to surgery in the IBR group with 11.5% of tissue expanders requiring removal, whilst more seromas occurred in the mastectomy group. There was no significant difference in the median time to chemotherapy."
] | [
"This article reviews the recent seminal studies in esophagogastric cancer. Regular low aspirin use may reduce the risk of esophagogastric cancer. Laparoscopic resection of locally advanced gastric cancer appears equivalent to open resection. There is no survival benefit for the addition of postoperative radiation therapy to adjuvant chemotherapy after primary gastric cancer resection. For tumors of the esophagus and gastroesophageal junction, the combination of preoperative radiation therapy with concurrent chemotherapy may be required to ensure achievement of a negative surgical margin and to reduce local tumor recurrence. Epirubicin may not add benefit to fluorinated pyrimidine and platinum-based chemotherapy, either in the preoperative setting or in the treatment of metastatic disease. The Her2-targeted agents lapatinib and trastuzumab emtansine failed to improve outcome when either added to or compared with chemotherapy. Immune checkpoint inhibition appears to be active in metastatic gastric cancer."
] | pubmedqa | {
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Human papillomavirus and pterygium. Is the virus a risk factor? | [
"Pterygium is a disease of unknown origin and pathogenesis that might be vision threatening. It is characterised by a wing-like conjunctival overgrowth of the cornea. Several studies have investigated human papillomavirus (HPV) as a risk factor for the development of pterygia, but the results are inconclusive.AIM: To investigate a large sample of pterygia for the presence of HPV in order to clarify the putative association between pterygia and HPV. 100 specimens of pterygium from Danish patients and 20 normal conjunctival biopsy specimens were investigated for the presence of HPV with PCR technique using beta-globin primers to access the quality of the extracted DNA and the HPV primers MY09/11 and GP5+/6+. HPV-positive specimens underwent subsequent HPV typing with type-specific HPV primers and further investigation with DNA in situ hybridisation (ISH). 90 of 100 investigated pterygia proved suitable for HPV analysis by PCR. As beta-globin could not be amplified, 10 specimens were excluded from the study. 4 of 90 pterygia harboured HPV. HPV type 6 was identified in all four HPV-positive pterygia. The 20 normal conjunctival biopsy specimens were beta-globin positive and HPV negative. All four pterygia that were HPV type 6 positive were DNA ISH negative."
] | [
"The growth of primary low-grade B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma is an antigen-dependent process We were able to document the influence of Helicobacter pylori on the natural history of primary low-grade B-cell gastric MALT lymphoma in a case investigated by means of polymerase chain reaction for IgH rearrangement. In this case the presence or absence of the bacterium appeared to affect both clinical manifestations and histologic features of the neoplasia, with an acceleration or a slowing down of the neoplastic expansion, respectively."
] | pubmedqa | {
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Can PRISM predict length of PICU stay? | [
"PRISM is claimed to score disease severity which has attributed an impact on length of PICU stay (LOS). To determine the impact of PRISM on LOS, and evaluate an Artificial Neural Network's (ANN) performance to estimate LOS from PRISM item patterns. Retrospectively we performed correlation and regression analyses on routinely scored PRISM data of all consecutive admissions to our level-III PICU from 1994 to 1999 (n>2000) with individual LOS. In addition, an ANN was trained on the chronologically first 75% of those data (inputs, PRISM items + age + sex; output, LOS). The ANN's performance was tested on the remaining most recent 25% of the data sets. The Spearman and Pearson coefficients of correlation between PRISM and LOS were 0.2 (p<0.001) and 0.08 (p = 0.0003), the latter being slightly higher when LOS was logarithmically transformed. Pearson's coefficient of correlation between ANN derived LOS estimate and actual LOS was 0.21 (p<0.001) (LOS logarithmically transformed: 0.34; p<0.001) in the independent validation sample."
] | [
"Readmission to ICU following discharge is associated with increased length of stay (LOS), increased rates of mortality, morbidity and resource consumption. Reducing readmission rates is one of the key aims of the Intensive Care Unit liaison nurse (ICULN). Our objective was to identify factors associated with readmission which were identifiable both from demographics and from each LN visit, and from this develop a clinical markers score. In this case control study, cases were all children who required ICU readmission within 48h of discharge over two years. The comparison group included children who were discharged on the same day as those who required readmission. Using multivariate logistic regression analysis the factors associated with ICU readmission were identified. The factors were further analysed for the development of the clinical markers score. The factors associated with readmission to ICU included high oxygen requirement, tachypnoea, age >10 years, age <2 weeks, LN assessment, high risk of readmission (ROR) score, longer LOS and admission under oncology."
] | pubmedqa | {
"query": "Represent the Biomedical question for retrieving relevant documents:",
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Can predilatation in transcatheter aortic valve implantation be omitted? | [
"The use of a balloon expandable stent valve includes balloon predilatation of the aortic stenosis before valve deployment. The aim of the study was to see whether or not balloon predilatation is necessary in transcatheter aortic valve replacement (TAVI). Sixty consecutive TAVI patients were randomized to the standard procedure or to a protocol where balloon predilatation was omitted. There were no significant differences between the groups regarding early hemodynamic results or complication rates."
] | [
"Statins are an essential component of the therapeutic approach of patients with atherosclerotic disease. Statin use is also associated with improved peri-operative and long-term outcomes in these patients. We aimed to define the role of statin treatment in patients undergoing percutaneous revascularization procedures. We searched Medline for studies assessing the effect of statin treatment on percutaneous interventions. Early statin treatment is associated with improved outcomes in patients undergoing percutaneous coronary intervention procedures. Current evidence implies that statin treatment may also play a beneficial role in the management of patients undergoing percutaneous renal artery revascularization and endovascular abdominal aortic aneurysm repair, carotid angioplasty/stenting and endovascular peripheral arterial interventions."
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant paragraphs:",
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Autoerotic asphyxiation: secret pleasure--lethal outcome? | [
"Voluntary asphyxiation among children, preteens, and adolescents by hanging or other means of inducing hypoxia/anoxia to enhance sexual excitement is not uncommon and can lead to unintended death. This study addresses autoerotic asphyxiation (AEA) with the intent of increasing pediatricians' knowledge of the syndrome and awareness of its typical onset among young patients. AEA is characteristically a clandestine and elusive practice. Provided with relevant information, pediatricians can identify the syndrome, demonstrate a willingness to discuss concerns about it, ameliorate distress, and possibly prevent a tragedy. A retrospective study was undertaken of published cases both fatal and nonfatal and included personal communications, referenced citations, clinical experience, and theoretical formulations as to causation. Characteristic AEA manifestations, prevalence, age range, methods of inducing hypoxia/anoxia, and gender weighting are presented. All sources were used as a basis for additional considerations of etiology and possibilities for intervention. AEA can be conceptualized as a personalized, ritualized, and symbolic biopsychosocial drama. It seems to be a reenactment of intense emotional feeling-states involving an identification and sadomasochistic relationship with a female figure. Inept AEA practitioners can miscalculate the peril of the situation that they have contrived and for numerous reasons lose their gamble with death."
] | [
"What are the lifestyle choices and dietary aspects of women about to undergo fertility treatment in New Zealand?"
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant passages:",
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Major depression and alcohol use disorder in adolescence: Does comorbidity lead to poorer outcomes of depression? | [
"Comorbid major depression (MD) and alcohol use disorder (AUD), particularly in adolescents, have been shown to be associated with poorer subsequent MD outcomes. Longitudinal data were used to model associations between a four-level classification of MD/AUD during the period 15-18 years (neither; MD-only; AUD-only; comorbid MD/AUD) and MD over the period 18-35 years. These associations were then adjusted for confounding by a series of factors measured in childhood. The three disorder groups had rates of adult MD during the period 18-35 years that were significantly (p<.05) higher than that of the group with no disorder. Furthermore, those in the comorbid MD/AUD group had significantly (p<.05) higher rates of adult MD than those in the AUD-only group, and marginally (p<.10) higher rates of adult MD than those in the MD-only group. After adjustment for confounding, the difference in rates of adult MD between the MD-only group and the MD/AUD group were no longer statistically significant. The factors that explained the associations were gender, childhood behavior problems, and exposure to physical and sexual abuse. The data were obtained by self-report, and may have been subject to biases."
] | [
"Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence. Psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence. In separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use."
] | pubmedqa | {
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Cold preparation use in young children after FDA warnings: do concerns still exist? | [
"To characterize the use and delivery of cough and cold medicines in children younger than 6 presenting to an inner-city pediatric emergency department (PED) following 2007 FDA warnings. A cross-sectional observational study was performed using a convenience sampling of PED patients during the fall of 2010. Caregivers were presented with 6 commonly used cough medicine preparations and were asked to demonstrate if and how they would administer these to their children. In all, 65 patients and their caregivers consented and participated in the study. During the demonstration, 82% (53/65) stated that they would treat with cough or cold medicines, and 72% (38/53) incorrectly dosed the medication they desired to give."
] | [
"What are the lifestyle choices and dietary aspects of women about to undergo fertility treatment in New Zealand?"
] | pubmedqa | {
"query": "Represent the Biomedical query for retrieving relevant paragraphs:",
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Does a 4 diagram manual enable laypersons to operate the Laryngeal Mask Supreme®? | [
"Bystander resuscitation plays an important role in lifesaving cardiopulmonary resuscitation (CPR). A significant reduction in the \"no-flow-time\", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs). Previous studies have demonstrated the ability of inexperienced persons to operate SADs after brief instruction. The aim of this pilot study was to determine whether an instruction manual consisting of four diagrams enables laypersons to operate a Laryngeal Mask Supreme® (LMAS) in the manikin. An instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated. A total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25)."
] | [
"Does age of G-1 PLUS v5 embryo culture medium affect IVF outcome?"
] | pubmedqa | {
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} |
Can we measure mesopic pupil size with the cobalt blue light slit-lamp biomicroscopy method? | [
"The aim of this work is to assess a previously described slit-lamp biomicroscopy-based method (SLBM) for measuring pupil diameter and compare it to Colvard infrared pupillometry (CIP). Two examiners performed three repeated measurements with each instrument in 40 healthy eyes. We determined the agreement of SLBM and CIP, intraobserver and interobserver repeatabilities, and interobserver concordance (kappa) and SLBM ability for detecting pupil sizes over 6.0 mm. The mean (±standard deviation [SD]) pupil diameter was 5.81 ± 0.70 mm with SLBM and 6.26 ± 0.68 mm with CIP (p = 0.01) averaging both examiner's results. Mean differences between the SLBM and CIP were -0.60 mm and -0.30 mm for each examiner using the average of the three readings (p = 0.02), and they were very similar using the first reading. Intraobserver reproducibility: the width of the 95% LoA ranged from 1.79 to 2.30 mm. The ICCs were 0.97 and 0.92 for SLBM, and 0.96 and 0.90 for CIP. Interobserver reproducibility: the width of the LoA ranged from 1.82 to 2.09 mm. Kappa statistics were 0.39 and 0.49 for the first and mean SLBM readings, respectively, and 0.45 for both the first and mean CIP readings. Sensitivity and specificity of SLBM for detection of pupils larger than 6 mm ranged from 55.56% to 73.68% and from 76.19% to 95.45%, respectively. The best trade-off between sensitivity and specificity ranged from 5.4 mm to 6.2 mm."
] | [
"To investigate the factors that govern the manifestation of hyperopic refractive errors of pre-school children when tested with and without the application of cycloplegics. Forty-three pre-school children (mean age, 3.68 +/- 0.59 years) were tested before and during cycloplegia in the following order: retinoscopy with optical fogging; Retinomax K plus; Welch Allyn SureSight (DAV SureSight), and PowerRefractor. In the case of the PowerRefractor, the children viewed a difference of Gaussian target (0.20 cpd) at 3.5 m in addition to viewing the instrument LED sources. Instruments with close working distances (Retinomax) showed the greatest underestimation of hyperopia and the largest variation, followed by the instruments having a greater working distance (PowerRefractor LED view and retinoscopy). The addition of a far target (PowerRefractor difference of Gaussian view) showed the least underestimation, whereas DAV SureSight showed a mean overestimation of the refractive state."
] | pubmedqa | {
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Should circumcision be performed in childhood? | [
"To evaluate prepuce development and retractibility in a group of boys. To point out the value of circumcision and prepucial forced dilation during childhood. Prepuce development and retractibility were evaluated in 400 boys ages between 0-16 year old. In boys under 1 year prepuce retractibility (assessed only in children who did not undergo forced dilation previously) was type I (non retractile) in 71.5% whereas type V (completely retractile) was only 5.5%. In adolescent boys type I prepuce was observed in 1 boy only, 1.6%, whereas type V was observed in 82.3%. Furthermore, it was observed that at the time of examination for the study 106 boys who had undergone forced dilation at an earlier age had balano-prepucial adhesions again, which demonstrates that prepuce adheres again to glans penis in many boys after a forced dilation is performed. Only 11 boys were considered in need for circumcision, three of them for prepucial orifice stenosis, which prevented normal micturition, causing a prepucial sac, one case due to a constrictive ring below the prepucial edge that would have prevented ulterior retractability, two cases with repetitive balanopostitis, and five cases secondary to xerosol balanitis, accounting for 2.7% of all examined boys."
] | [
"To compare fear of circumcision, before, immediately after, and ten days after the operation. This was a case-control study in which participants in the operation group consisted of children admitted for circumcision at the outpatient clinics of a hospital. The Children's Fear Scale and the Venham Picture Test were administered by face-to-face interviews. The sample consisted of 100 boys who were circumcised and 99 who have not been circumcised yet. Children's Fear Scale scores measured before (P = .000) and immediately after the operation (P = .000) were significantly different from scores obtained on the 10th day after the operation. Total fear scores of the Venham Picture Test of boys whose families were in the higher economic level were higher than those of boys from low-income families (P < .05). The primary reason for admission for circumcision was religious, and the reason for the remaining boys was a combination of religious and hygienic factors. The boys who came to have circumcision solely because of religious reasons were found to be less fearful compared with the boys who were brought to surgery for both religious and medical reasons (P < .05). The lowest fear scores were obtained for boys who were six years of age or older. Boys who knew what the circumcision meant were less afraid of circumcision compared with those who were unaware of the procedure."
] | pubmedqa | {
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Does a colonoscopy after acute diverticulitis affect its management? | [
"Medical records of 220 patients hospitalized for acute diverticulitis between June 1, 2002 and September 1, 2009 were reviewed. Acute diverticulitis was diagnosed by clinical criteria and characteristic CT findings. Fifteen patients were excluded either because of questionable CT or hematochezia. Mean age was 61.8±14.3 years (61% females). Clinical parameters, laboratory results, imaging, endoscopic and histopathological reports, and long-term patients' outcome were analyzed. One hundred patients (aged 61.8±13.3 y, 54.1% females), underwent an early (4 to 6 wk) colonoscopy after hospital discharge. There were no significant differences in patients' characteristics or survival between those with or without colonoscopy (4±1.9 vs. 4.2±2.1 y, P=0.62). No colonic malignancy was detected. However, in 32 patients (32%) at least 1 polyp was found. Only 1 was determined as an advanced adenoma. No new or different diagnosis was made after colonoscopy."
] | [
"The optimal diet for uncomplicated diverticulitis is unclear. Guidelines refrain from recommendation due to lack of objective information. The aim of the study was to determine whether an unrestricted diet during a first acute episode of uncomplicated diverticulitis is safe. A prospective cohort study was performed of patients diagnosed with diverticulitis for the first time between 2012 and 2014. Requirements for inclusion were radiologically proven modified Hinchey 1a/b diverticulitis, ASA I-III and the ability to tolerate an unrestricted diet. Exclusion criteria were the use of antibiotics and suspicion of inflammatory bowel disease or malignancy. All included patients were advised to take an unrestricted diet. The primary outcome parameter was morbidity. Secondary outcome measures were the development of recurrence and ongoing symptoms. There were eighty-six patients including 37 (43,0%) males. All patients were confirmed to have taken an unrestricted diet. There were nine adverse events in seven patients. These consisted of readmission for pain [5] recurrent diverticuitis [1] and surgery [3]. for ongoing symptoms [2] and Hinchey stage 3 [1]. Seventeen (19.8%) patients experienced continuing symptoms six months after the initial episode and 4 (4.7%) experienced recurrent diverticulitis."
] | pubmedqa | {
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Do instrumental activities of daily living predict dementia at 1- and 2-year follow-up? | [
"To investigate whether problems in instrumental activities of daily living (IADL) can add to conventionally used clinical measurements in helping to predict a diagnosis of dementia at 1- and 2-year follow-up. Multicenter prospective cohort study. Memory clinics in Europe. Individuals aged 55 and older without dementia. IADLs were measured using pooled activities from five informant-based questionnaires. Structural equation modeling (SEM) was used to investigate the relation between IADLs and dementia. Age, sex, education, depression, and cognitive measures (Mini-Mental State Examination and verbal memory) were included in the model. Five hundred thirty-one participants had baseline and 1-year follow-up assessments; 69 (13.0%) of these had developed dementia at 1-year follow-up. At 2-year follow-up, 481 participants were seen, of whom 100 (20.8%) had developed dementia. Participants with IADL disabilities at baseline had a higher conversion rate (24.4%) than participants without IADL disabilities (16.7%) (chi-square = 4.28, degrees of freedom = 1, P = .04). SEM showed that IADL disability could help predict dementia in addition to the measured variables at 1-year follow-up (odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.51-3.13) and 2-year follow-up (OR = 2.11, 95% CI = 1.33-3.33)."
] | [
"Systemic low-grade inflammation has repeatedly been associated with depression in old age, but the relationship with apathy is less clear. The present study assessed whether C-reactive protein (CRP) is differentially associated with symptoms of apathy and depression. A population-based cohort study was carried-out. At baseline and after two and four years of follow-up, CRP levels were assessed and symptoms of apathy and depression were measured using the 15-item Geriatric Depression Scale. Logistic regression analysis was used to investigate the cross-sectional and longitudinal associations of CRP with symptoms of apathy and depression. Two thousand forty-seven community-dwelling participants (70-78 years) without a history of cardiovascular disease or stroke were studied. A cross-sectional association was found between CRP and apathy symptoms at three time points (odds ratio (OR) per natural log unit increase in CRP: baseline visit = 1.40, 95% CI = 1.12-1.75; two-year follow-up visit = 1.62, 95% CI = 1.17-2.25; four-year follow-up visit = 1.51, 95% CI = 1.03-2.21). This did not change after adjustment for demographics and depressive symptoms, and was slightly attenuated after adjustment for cardiovascular risk factors. No cross-sectional association was found with depressive symptoms. Baseline CRP did not predict incident apathy or depressive symptoms during four years of follow-up."
] | pubmedqa | {
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Does the Simultaneous Use of a Neuroendoscope Influence the Incidence of Ventriculoperitoneal Shunt Infection? | [
"The relationship between the use of an endoscope during ventriculoperitoneal shunt (VPS) procedures and infection remains poorly defined. In this study, we sought to analyze whether the simultaneous use of an endoscope could in fact increase the infection rate associated with VPS procedures. This study included 438 VPS procedures, 49 in which an endoscope was used (11.2%) and 389 in which an endoscope was not used (88.8%). The infection rates in these 2 main groups were calculated and compared. Subsequently, 4 new groups were created, composed of patients with a shunt inserted for the first time (groups 1A and 1B) and patients with a shunt reviewed or inserted for a second time (groups 2A and 2B). Groups 1A and 2A comprised patients in whom an endoscope was used simultaneously with VPS surgery, and groups 1B and 2B comprised patients in whom an endoscope was not used. These groups were compared to determine the infection rate. The overall infection rate was 18.5%, including 22.4% in the groups in which an endoscope was used and 18% in those in which an endoscope was not used (P = 0.449). Groups 1A and 1B and groups 2A and 2B were matched for possible intervening risk factors. The infection rate was 28.6% in group 1A and 16.2% in group 1B (P = 0.27), and 20% in group 2A and 19.8% in group 2B (P = 0.977)."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
] | pubmedqa | {
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Body perception: do parents, their children, and their children's physicians perceive body image differently? | [
"To compare children's, parents' and physicians' perceptions of children's body size. We administered a structured questionnaire of body size perception using a descriptive Likert scale keyed to body image figures to children ages 12 to 18 years. The same scale was given to parents of children ages 5 to 18 years. The sample consisted of 91 children and their parents being seen in the Pediatric Gastroenterology Clinic for concerns unrelated to overweight. Weight and height of the children were measured, and body mass index (BMI) was calculated. The children's BMI percentiles were categorized as underweight (<15th), normal (15th-85th), overweight (85th-95th), and obese (95th and above). The attending physician independently completed the body image and description scale and indicated the figure that most accurately represented the patient without reference to BMI standards. Accuracy of the patients', parents', and doctors' estimates were statistically compared. The sample population consisted of 6.4% underweight, 70.5% normal weight, 7.7% overweight, and 15.4% obese. Forty-four percent of parents underestimated children's body size using word descriptions and 47% underestimated using figures. Forty percent of the children underestimated their own body size using descriptions and 43% underestimated using figures. The physicians in this study had a higher percentage of correct estimates; however, they underestimated 33% of the patients using both word descriptions and figures. Some obese children were not recognized, and several average children were perceived as underweight."
] | [
"To determine whether self-esteem among children with cystic fibrosis (CF) and their healthy siblings differs from that of a healthy reference group and whether there are differences within and between sibling pairs. All Swedish CF children 6-14 y old with a healthy sibling in the same age range (n=65) were invited to participate, 55 sibling pairs and their parents taking part in the study. Five aspects of the children's self-concept-physical characteristics, skills and talents, mental well-being, relations to parents and family, and relations to others-were assessed by the \"I think I am\" self-evaluation questionnaire. Severity of illness was assessed by means of the Shwachman Clinical Evaluation System. Whereas self-evaluation did not differ between groups at a general level, healthy girls as well as those with CF scored lower than girls in the reference group on the \"mental well-being\" and \"relations to parents and family\" subscales. Comparison of gender combinations (sick girl/healthy boy, sick girl/healthy girl, sick boy/healthy boy, sick boy/healthy girl) suggested that girls pay a cost of a lesser sense of psychological well-being and feelings of inadequacy in relation to their parents and family. The Shwachman score of the sick child was not related to the level of self-esteem."
] | pubmedqa | {
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Is a specialised training of phonological awareness indicated in every preschool child? | [
"In a prospective study 218 preschool children were enrolled (stratified in 2 training programs, one specialized for phonologic awareness in order to prevent dyslexia, the other consisting in training of general perception) during the last year of kindergarten. After finishing the first grade 131 children were compared in their reading and writing abilities. In the whole group only a slight difference was found between both training modalities concerning their writing abilities. However, children with a history of hearing loss, actual hearing loss or pathologic middle ear findings profited most from the specialized training program compared to the control in their reading abilities."
] | [
"Results of language therapy with adolescents and children with autistic spectrum disorders. to identify changes, after a six-month period of speech-language therapy, in a group of adolescents and to compare them with a group of children. Data referring to the communicative profile and social-cognitive performance of 12 adolescents and 12 children were analyzed. Just one of the 10 observed areas presented meaningful progress for the group of adolescents and 5 areas presented progress for group of children."
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Is there any relationship between streptococcal infection and multiple sclerosis? | [
"Multiple sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of uncertain etiology. Although the mechanisms of inducting autoimmunity by some of the infectious agents have been investigated, there is not yet enough research on streptococcal infections.MATERIAL/ To understand the effect of past group A streptococcal infection on MS, antistreptolysin O (ASO) and antideoxyribonuclease B (ADNase B) were measured in 21 patients with relapsing-remitting MS and 21 healthy blood donors by nephelometric assay. ADNase B levels in the patients with MS were found to be significantly higher than in the controls (p<0.001); however, ASO levels were similar in both groups."
] | [
"Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions?"
] | pubmedqa | {
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Is the combination with 2-methoxyestradiol able to reduce the dosages of chemotherapeutices in the treatment of human ovarian cancer? | [
"The endogenous estradiol metabolite, 2-methoxyestradiol (2ME), has been shown to be a potent inhibitor of cell growth and a strong anti-angiogenic substance. We investigated for the first time whether in vitro combinations of 2ME with various chemotherapeutic compounds may result in an additive inhibitory effect on the proliferation of human ovary cancer cells. As a model two different human ovary cancer cell lines were used. All cell lines were incubated with equimolar concentrations of 2ME (0.8-25 microM) and the chemotherapeutics epirubicine, doxorubicine, paclitaxel, docetaxel, carboplatin, vinorelbine, 5-fluorouracil and mafosfamide. Proliferation was measured after four days using the ATP-chemosensitivity test. For both ovary cancer cell lines a significant additive effect of 2ME with epirubicine and carboplatin was observed at the lower concentration range of these chemotherapeutic substances."
] | [
"Chemicals that interfere with reactive oxygen species metabolism can act as potential candidates for the treatment of cancer. Some of the glucosides of citrus limonin inhibit the endogenously generated reactive oxygen species. The aim is to study the interactions of limonin with chemotherapy. Breast cancer cell lines MCF-7 (p53 wild type) and MDA-MB-231 (p53 mutant) as well as the nontumorigenic epithelial cell line MCF-10 were used to screen the effect of limonin at 1-, 5- and 10-µM concentrations with camptothecin for apoptosis and NFĸB, p38 and ERK-MAPK signaling kinase assays. The effect of cyclophosphamide and limonin on MDA MB 231 xenografts was also studied. Our results indicate that limonin did not inhibit camptothecin-induced apoptosis in human breast cancer cells in vitro through noninterference of camptothecin-induced phosphorylation of p38 MAPK and ERK-MAPK. Using an in vivo model of human breast cancer, limonin in combination with cyclophosphamide was not found to inhibit the cyclophosphamide-induced tumor regression through a reduced mitotic index of tumor xenograft cells when compared to treatment with cyclophosphamide alone."
] | pubmedqa | {
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Assessing joint line positions by means of the contralateral knee: a new approach for planning knee revision surgery? | [
"Reconstructing the natural joint line in knee revision surgery improves clinical and functional outcome but may be challenging when both cartilage and bone were removed during previous operations. Assessing joint lines (JLs) by means of bony landmarks is inadvisable because of large variations in human anatomy. Because of the inherent symmetry of the human body, we hypothesised that JLs may be directly assessed by measuring the distances from the bony landmarks to the JL of the contralateral knee by means of radiographic images. Using scaled weight-bearing radiographs in anteroposterior view of both knees, two independent observers measured the distances from the fibular head, the medial and lateral epicondyle, and the adductor tubercle to the JL. A two-sided p value of ≤0.05 was considered statistically significant. Two hundred knees of 100 patients (50 men and 50 women) were examined. For the fibular head, the mean difference between the treated and the control knee was 0.0 mm with narrow confidence limits ranging from -1.1 to 1.1."
] | [
"An important factor in the functional results after total knee arthroplasty is the achieved maximal flexion. The main purpose of this study was to compare the maximal knee flexion one year after surgery in patients who received either the bicruciate substituting knee system or the conventional posterior stabilized system. In a prospective randomized controlled trial, 124 patients presenting with osteoarthritis received the bicruciate substituting or the conventional posterior stabilized prosthesis. The primary outcome was the maximum flexion angle at one year postoperatively on a lateral radiograph made with the supine patient using manual force to bend the knee. Secondary outcomes were active flexion (lying and standing), the Knee Society Score, the Patella Scoring System score, the University of California Los Angeles score, the number and type of adverse device effects, and visual analog scale satisfaction up to two years postoperatively. The outcome measures of both groups were compared using one-sided t tests and non-parametric alternatives, with a significance level of p < 0.05. No significant differences between the two groups were observed in maximal flexion on radiographs and in active flexion at baseline. The median maximal flexion on radiographs was 127° (range, 83° to 150°) for the bicruciate substituting group and 125° (range, 74° to 145°) for the conventional posterior stabilized group. The two groups showed comparable two-year results with respect to the Knee Society Score, the Patella Scoring System, the University of California Los Angeles score, and visual analog scale satisfaction. In the bicruciate substituting group, forty-one adverse device effects in twenty-six patients were reported, including three total system revisions and fourteen manipulations under anesthesia, compared with the conventional posterior stabilized group, in which sixteen adverse device effects were observed in thirteen patients, including six manipulations under anesthesia (p = 0.012)."
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Does the type of tibial component affect mechanical alignment in unicompartmental knee replacement? | [
"There are a number of factors responsible for the longevity of unicompartmental knee replacements (UKR). These include the magnitude of postoperative alignment and the type of material used. The effect of component design and material on postoperative alignment, however, has not been explored. We retrospectively reviewed 89 patients who underwent UKR with robotic guidance. Patients were divided into two groups, according to whether they had received an all-polyethylene inlay component (Inlay group) or a metal-backed onlay component (Onlay group). We explored the magnitude of mechanical alignment correction obtained in both groups. Mean postoperative mechanical alignment was significantly closer to neutral in the Onlay group (mean=2.8°; 95% CI=2.4°, 3.2°) compared to the Inlay group (mean=3.9°; 95% CI=3.4°, 4.4°) (R2=0.65; P=0.003), adjusting for gender, BMI, age, side and preoperative mechanical alignment (Fig. 2). Further exploration revealed that the thickness of the tibial polyethyelene insert had a significant effect on postoperative alignment when added to the model (R2=0.68; P=0.01)."
] | [
"All-polyethylene tibias (APT) are under-utilized in most of the Western countries, due to a shift from the original all-polyethylene design to metal-backed tibia (MBT) components. Only few total knee prostheses allow direct comparison between APT and MBT components, due to different geometric designs in many systems. The Depuy PFC Sigma prostheses have a similar geometric design in both the MBT and the APT, and with the same corresponding femoral component, thus allowing an assessment and comparison between APT and MBT components. This is a retrospective analysis of a consecutive series of osteoarthritic patients who underwent total knee arthroplasties with at least 10-year follow-up comparing a modern congruent APT component to a modular MBT component of the same design. Seventy-three patients (81 knees, mean age 73 years) were available for assessment. Among the cohort, three patients had revision surgery (one from the APT group). In total, 73 patients were available for follow-up (59 MBT prostheses and 22 APT prostheses). There were no differences in knee function (Knee Society score, range of motion, stability) or radiographic parameters between the groups. Of the three revisions due to tibial tray loosening, only one was performed in the APT group and two were performed in the MBT group; another revision in the MBT group was due to loosening of both components; none of the revisions were due to septic complications. Ten-year survivorship of both designs was 92 %."
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Is tumour expression of VEGF associated with venous invasion and survival in pT3 renal cell carcinoma? | [
"To determine whether there is a relationship between VEGF expression and renal vein and vena cava invasion in stage pT3 renal cell carcinoma and to evaluate the impact of VEGF expression on survival in pT3 renal cell carcinoma. 78 patients with a pT3a or pT3b tumour without vena cava invasion or pT3b tumour with vena cava invasion were compared for age, gender, Fuhrman grade and immunohistochemical expression of VEGF. All these variables were submitted to univariate and multivariate analysis to establish their impact on survival. Only tumour size appeared to be significantly different between the 3 groups. On univariate analysis, invasion of the perirenal fat, lymph node involvement, distant metastases and VEGF expression were significantly associated with survival (p<0.01). On multivariate analysis, lymph node involvement, distant metastases and VEGF expression (OR 6.07) were identified as independent predictive factors of survival."
] | [
"EpCAM is an adhesion molecule of the basolateral membranes in a variety of epithelial cells. Over-expression has been detected in many epithelial tumours and has been associated with high stage, high grade and a worse survival in some tumour types. To assess the prognostic value of EpCAM in urothelial carcinoma of the bladder. EpCAM expression was analysed by immunohistochemistry using a monoclonal antibody (clone VU-1D9) on a tissue microarray comprising 99 urothelial carcinomas of the bladder diagnosed between 1994 and 1997. A significant relationship between high grade, advanced stage, and EpCAM expression was found, and expression of EpCAM was associated with a worse overall survival when compared to EpCAM negative tumours (p = 0.033). Multivariate analysis showed that EpCAM expression was not an independent prognostic factor for overall survival in urothelial carcinoma of the bladder."
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Injury and poisoning mortality among young men--are there any common factors amenable to prevention? | [
"Deaths from injury and poisoning (suicide, accidents, undetermined deaths, and homicide) are the major cause of death among young men aged 15-39 years in England and Wales and have been increasing in recent years.AIM: To describe common characteristics among young men who die from injury and poisoning. We employed a retrospective survey methodology to investigate factors associated with deaths by injury and poisoning among young men aged 15-39 years (n = 268) in Merseyside and Cheshire during 1995. Data were collected from Coroner's inquest notes and General Practitioner records. The most common cause of death was poisoning by alcohol and drugs (29.1%, n = 78). A high proportion of cases were unemployed (39.4%, n = 106). Cases were also more likely to be single compared to the general population (74.2% vs 55.5%). Self-destructive behaviour was evident in 77% of deaths (n = 206)."
] | [
"Even though the prevalence of tobacco smoking has declined in the general population and among white-collar workers, the prevalence of tobacco smoking among blue-collar workers remains unacceptably high. Blue-collar workers experience greater exposure to workplace toxins which can add to, or even multiply, their risk of adverse health effects from tobacco smoking. Among blue-collar workers, workers in the restaurant, bar, and gaming industries are exposed to much higher levels of environmental tobacco smoke (ETS) than are office workers, and are at increased risk of cancer and cardiovascular diseases even if they are non-smokers themselves. The literature on health risks, and the disparity between white and blue collar workers in smoking prevalence, and the literature on various tobacco control strategies provide the sources on which this review is based."
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Continuation of pregnancy after antenatal corticosteroid administration: opportunity for rescue? | [
"To determine the duration of continuing pregnancy after antenatal corticosteroid (AC) administration and to evaluate the potential opportunity for rescue AC. Retrospective analysis of women at 24-32 weeks' gestation who received AC at one institution. Six hundred ninety-two women received AC. Two hundred forty-seven (35.7%) delivered at>or = 34 weeks' gestation. Three hundred twenty-one (46.4%) delivered within 1 week of AC; 92 of those women (13.3%) delivered within 24 hours. Only 124 (17.9%) remained pregnant 1 week after AC and delivered at<34 weeks. The latter were compared to women delivering>2 week after AC but>or = 34 weeks. More likely to deliver at<34 weeks were those women who received AC for premature preterm rupture of membranes (OR 3.83, 95% CI 2.06-7.17), twins (OR 2.90, 95% CI 1.42-5.95) or before 28 weeks (OR 2.21, 95% CI 1.38-3.52)."
] | [
"This review should be cited as: Bricker L, Neilson JP. Routine ultrasound in late pregnancy (after 24 weeks gestation) (Cochrane Review). In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software. A substantive amendment to this systematic review was last made on 01 October 1999. Cochrane reviews are regularly checked and updated if necessary. Diagnostic ultrasound is used selectively in late pregnancy where there are specific clinical indications. However, the value of routine late pregnancy ultrasound screening in unselected populations is controversial. The rationale for such screening would be the detection of clinical conditions which place the fetus or mother at high risk, which would not necessarily have been detected by other means such as clinical examination, and for which subsequent management would improve perinatal outcome. To assess the effects on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound, defined as greater than 24 weeks gestation, in women with either unselected or low risk pregnancies. The Cochrane Pregnancy and Childbirth Group Specialised Register of Controlled Trials and the Cochrane Controlled Trials Register were searched. All acceptably controlled trials of routine ultrasound in late pregnancy (defined as after 24 weeks). The principal reviewer assessed trial quality and extracted data, under supervision of the co-reviewer. Seven trials recruiting 25,036 women were included. The quality of trials overall was satisfactory There was no difference in antenatal, obstetric and neonatal intervention or morbidity in screened versus control groups. Routine late pregnancy ultrasound was not associated with improvements in overall perinatal mortality. Placental grading as an adjunct to third trimester examination scan was associated with a significant reduction in the stillbirth rate in the one trial that assessed it. There is a lack of data with regard to long term substantive outcomes such as neurodevelopment. There is a lack of data on maternal psychological effects."
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Does either obesity or OSA severity influence the response of autotitrating CPAP machines in very obese subjects? | [
"The pressures delivered by autotitrating continuous positive airways pressure (CPAP) devices not only treat obstructive sleep apnoea (OSA) effectively but also give potentially interesting physiological information about the forces impinging on the pharynx. In earlier work from this unit, we used correlations between autoCPAP pressure and both OSA severity and obesity, to construct an algorithm to estimate the fixed CPAP pressure a patient required for subsequent clinical use. We wished to discover if these relationships could be reliably extended to a much more obese group. We performed a prospective cohort study in an obese population. Measurements of obesity were made, OSA severity was recorded, and the 95th centile autoCPAP pressure was recorded during 1 week of autoCPAP. Spearman's rank correlation was performed between measurements of obesity and autoCPAP pressure, and between OSA severity and autoCPAP pressure. Fifty-four obese individuals (median body mass index (BMI) 43.0 kg/m(2)), 52 % of whom had OSA (apnoea-hypopnoea index (AHI) ≥ 15), had a median 95th centile autoCPAP pressure of 11.8 cmH2O. We found no significant correlation between autoCPAP pressure and neck circumference, waist circumference or BMI. There was a moderate correlation between autoCPAP pressure and OSA severity (AHI r = 0.34, p = 0.02; oxygen desaturation index (ODI) r = 0.48, p < 0.001)."
] | [
"Sleep-disordered breathing (SDB) differs between genders in terms of the type, signs, and symptoms of the disease. Partial upper airway obstruction is underdiagnosed and undertreated. In this study, we retrospectively investigated respiratory sleep recordings of 601 women, ending up with 240 women for the final statistical analyses. We hypothesized that there are differences between the signs and symptoms of sleep-disordered breathing whether women had partial upper airway obstruction or obstructive sleep apnea. The results showed no difference in sleepiness between women with partial upper airway obstruction or obstructive sleep apnea. Also, the other main symptoms of SDB were the same between the groups. Micrognathia was more common in women with partial upper airway obstruction than with obstructive sleep apnea."
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Does the clinical presentation of a prior preterm birth predict risk in a subsequent pregnancy? | [
"The objective of the study was to determine whether risk of recurrent preterm birth differs based on the clinical presentation of a prior spontaneous preterm birth (SPTB): advanced cervical dilatation (ACD), preterm premature rupture of membranes (PPROM), or preterm labor (PTL). This retrospective cohort study included singleton pregnancies from 2009 to 2014 complicated by a history of prior SPTB. Women were categorized based on the clinical presentation of their prior preterm delivery as having ACD, PPROM, or PTL. Risks for sonographic short cervical length and recurrent SPTB were compared between women based on the clinical presentation of their prior preterm birth. Log-linear regression was used to control for confounders. Of 522 patients included in this study, 96 (18.4%) had prior ACD, 246 (47.1%) had prior PPROM, and 180 (34.5%) had prior PTL. Recurrent PTB occurred in 55.2% of patients with a history of ACD compared with 27.2% of those with PPROM and 32.2% with PTL (P = .001). The mean gestational age at delivery was significantly lower for those with a history of ACD (34.0 weeks) compared with women with prior PPROM (37.2 weeks) or PTL (37.0 weeks) (P = .001). The lowest mean cervical length prior to 24 weeks was significantly shorter in patients with a history of advanced cervical dilation when compared with the other clinical presentations."
] | [
"To examine the effect of method of conception on adverse pregnancy outcome after the 11-13 weeks scan. Prospective screening study for adverse obstetric outcomes in women with singleton pregnancies and live fetus with no obvious defects at 11(+0)-13(+6) weeks. The method of conception was recorded as spontaneous, in vitro fertilization (IVF) and assisted by ovulation induction (OI) drugs without IVF. Regression analysis was performed to examine the association between the method of conception and pregnancy outcome after adjustment for maternal characteristics. In the study population of 41,577 pregnancies, conception was spontaneous in 40,261 (96.9%), by IVF in 634 (1.5%) and by OI in 682 (1.6%). In the pregnancies conceived by assisted reproductive technology, compared to spontaneous conceptions, there was a higher risk of stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, delivery of small for gestational age neonates and caesarean section. However, multiple regression analysis showed that after taking into account maternal characteristics, the only significant contributions of IVF were for pre-eclampsia and elective caesarean section and the contributions of OI were for miscarriage, spontaneous early preterm delivery and small for gestational age."
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