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[ "Are survivors of childhood cancer with an unfavourable psychosocial developmental trajectory more likely to apply for disability benefits?<||||>The aim of this study was to investigate whether an unfavourable psychosocial developmental trajectory while growing up with childhood cancer is related to a smaller likelihood of labour participation in adult life.", "Are survivors of childhood cancer with an unfavourable psychosocial developmental trajectory more likely to apply for disability benefits?<||||>A total of 53 childhood cancer survivors (CCS) with and 313 CCS without disability benefits, and 508 peers from the general Dutch population (reference group) completed the Course of Life Questionnaire (CoLQ) about the achievement of psychosocial developmental milestones. Differences between the three groups were tested by conducting analysis of variance with contrasts (scale scores CoLQ) and logistic regression analysis (individual milestones). Effect sizes and odds ratios were calculated.", "Are survivors of childhood cancer with an unfavourable psychosocial developmental trajectory more likely to apply for disability benefits?<||||>Compared with the reference group, both CCS with and CCS without benefits reported lower scale scores with respect to social and psychosexual development. CCS with disability benefits had lower social (d = - 0.6; p<0.001) and psychosexual (d = -0.4; p<0.01) scale scores than the CCS without disability benefits. CCS with disability benefits scored less favourably (p<0.01) than peers from the general population on 14 out of 22 psychosocial milestones whereas the number was only six for those without disability benefits." ]

[ "Is routine pre-operative blood testing in children necessary?<||||>To determine the value of routine pre-operative investigations in children scheduled to undergo routine minor elective surgical procedures under general anesthesia.", "Is routine pre-operative blood testing in children necessary?<||||>We conducted a retrospective chart review of 342 children who presented for elective minor surgical procedures in the Division of Pediatric Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2004 to December 2004. Pre-operative investigations (full blood count, urea and electrolytes) were analyzed in terms of frequency of abnormalities and whether or not the preoperative management was changed when the results were abnormal. We also examined the relationship between abnormal results and complications and the costing of the tests.", "Is routine pre-operative blood testing in children necessary?<||||>During a one year period, 342 children were admitted to the pediatric surgical unit for routine minor elective surgery. A total of 684 tests were performed, of which 63 (9.2%) were abnormal. Nine children had abnormal hemoglobin results (the lowest was 8.5 g/dL). Thirty-two children had clinically insignificant platelets or white blood cell counts. There were 22 abnormal electrolyte results. These abnormalities were very insignificant. No case was postponed because of these investigations. Three complications arose, none of which could have been predicted by the pre-operative screening tests." ]

[ "Do the American College of Surgeons' \"major resuscitation\" trauma triage criteria predict emergency operative management?<||||>We wish to assess whether individual or collective American College of Surgeons' \"major resuscitation\" criteria accurately identify injured patients who receive emergency operative treatment.", "Do the American College of Surgeons' \"major resuscitation\" trauma triage criteria predict emergency operative management?<||||>In this observational secondary registry analysis of 8,289 consecutive trauma team activations during a 7.5-year period, we evaluated the test performance of 5 American College of Surgeons' major criteria in predicting emergency (within 1 hour) operative management by general (for adults) or pediatric (for children) surgeons.", "Do the American College of Surgeons' \"major resuscitation\" trauma triage criteria predict emergency operative management?<||||>In adults, the individual major resuscitation criteria each predicted emergency operative management as follows (sorted from highest to lowest test performance): gunshot wounds to the neck or torso (likelihood ratio positive [LR+] 7.5; 95% confidence interval [CI]6.2 to 9.1); confirmed hypotension (LR+ 5.3; 95% CI 4.0 to 7.1); interhospital transfers requiring blood transfusions (LR+ 4.6; 95% CI 2.6 to 8.2); respiratory compromise (LR+ 2.9; 95% CI 2.2 to 3.7), and Glasgow Coma Scale score less than 8 (LR+ 2.1; 95% CI 1.6 to 2.7). The collective strategy of using any of these 5 criteria exhibited a LR+ of 3.5 (95% CI 3.2 to 3.8), sensitivity 82% (95% CI 75% to 87%), and specificity 76% (95% CI 75% to 77%). Our findings in children were similar, but their precision was limited by the low baseline prevalence of emergency operative intervention." ]

[ "Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?<||||>It was the aim of this study to determine if intraoperative digital dilatation of the closed internal cervical ostium affects the healing of the uterine scar after a cesarean section (CS).", "Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?<||||>In this randomized, prospective study, 94 term pregnant patients who elected to have a CS were assigned to two groups: intraoperative digital dilatation of the internal cervical ostium (group I, n = 48) or no dilatation (group II, n = 46). Vaginal ultrasound was used to check the integrity of the cesarean scar at the uterine incision site 40-42 days after the operation. We calculated the healing ratio based on ultrasonographic results and compared the groups as to the amount of incomplete healing.", "Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?<||||>The frequency of abnormal scarring was significantly higher in group II (14.3 vs. 40.6%; p<0.05). The mean healing ratio was significantly higher in group I (0.95 ± 0.12) than in group II (0.87 ± 0.1; p<0.05). In the multiple logistic regression model, digital dilatation remained the most significant factor affecting abnormal scar formation (odds ratio = 7.7)." ]

[ "Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions?<||||>Randomized controlled trials have proven the efficacy of implantable cardioverter/defibrillators (ICDs) to prevent sudden cardiac death (SCD) in primary prevention. However,long-term data on the incidence of appropriate and inappropriate interventions in real life and on the predictive value of commonly used clinical variables to guide patient selection are scarce.", "Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions?<||||>We retrospectively studied 101 patients who received an ICD for primary prophylaxis of SCD: 63.4% with ischaemic heart disease (IHD) and 36.6% with idiopathic dilated cardiomyopathy (IDCM). The mean follow-up period was 26.2 (+/- 14.8; median 27.8; range 5.6-70.5) months. Age, left ventricular ejection fraction (LVEF), QRS duration, NYHA class and electrophysiological study (EPS) outcome were evaluated as predictors of ICD intervention.", "Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions?<||||>At 2 years the cumulative incidence of appropriate (17.5% in IHD; 28% in IDCM; P= 0.63) and inappropriate (12.8% in IHD, 15.4% in IDCM; P = 0.62) interventions was similar in both groups. Atrial fibrillation was the most common cause of inappropriate interventions in the IHD group, sinus tachycardia in the IDCM group. Advanced age was associated with less inappropriate interventions (HR: 0.96 (95% confidence interval (CI) 0.94-0.98); P<0.01), and a better LVEF with less appropriate interventions (HR: 0.97 (95% Cl 0.94-0.99); P<0.01). This amounted in a significant absolute difference in the number of appropriate interventions between the group with a LVEF<25% and 25-34% after 3 years of follow-up of 42% in IHD (48% vs 6%). A prolonged QRS duration was associated with a slightly elevated risk for appropriate interventions only in the IHD group (HR: 1.01 (95% CI 1.00-1.03); P = 0.04). On the other hand, increased NYHA class was only associated with increased risk for appropriate interventions in the IDCM group (HR: 5.24 (95% CI1.11-24.74); P= 0.04). No significant statistical association was found between a positive EPS and appropriate or inappropriate interventions." ]

[ "Shorter hepatic transit time can suggest coming metastases: through-monitoring by contrast-enhanced ultrasonography?<||||>The aim of this study was to assess the value of the hepatic transit time in suggesting coming liver metastases by contrast-enhanced ultrasonography (CEUS).", "Shorter hepatic transit time can suggest coming metastases: through-monitoring by contrast-enhanced ultrasonography?<||||>Fifty patients with identified liver metastasis (metastasis group [Gmet]), 26 patients without liver metastasis (unclear group [Gunc]) who had proven extrahepatic malignant tumors, and 27 healthy control volunteers (control group [Gcon]) were included in this study. The Gmet group was divided into small and large subgroups. The Gmet group was also divided into pauci and multi subgroups. Every patient was examined by CEUS. The hepatic artery and hepatic vein arrival times were measured, and the difference between them was calculated as the hepatic artery-vein transit time (HAVTT). Patients in Gunc were given a CEUS examination and an enhanced computed tomography or magnetic resonance imaging examination 3 to 4 months later.", "Shorter hepatic transit time can suggest coming metastases: through-monitoring by contrast-enhanced ultrasonography?<||||>The HAVTTs in Gmet were significantly shorter than those in Gcon (P<.05), but there were no statistical differences among the subgroups. A normal cutoff point of 8 seconds in the HAVTTs could distinguish Gmet and Gcon with accuracy, sensitivity, and specificity of 97.40%, 92.59%, and 100%, respectively. As for Gunc, when an HAVTT shorter than 8 seconds was used to predict liver metastasis, the accuracy, sensitivity, and specificity were 92.30%, 100%, and 91.67%." ]

[ "Are quit attempts among U.S. female nurses who smoke different from female smokers in the general population?<||||>Smoking is a significant women's health issue. Examining smoking behaviors among occupational groups with a high prevalence of women may reveal the culture of smoking behavior and quit efforts of female smokers. The purpose of this study was to examine how smoking and quitting characteristics (i.e., ever and recent quit attempts) among females in the occupation of nursing are similar or different to those of women in the general population.", "Are quit attempts among U.S. female nurses who smoke different from female smokers in the general population?<||||>Cross-sectional data from the Tobacco Use Supplement of the Current Population Survey 2006/2007 were used to compare smoking behaviors of nurses (n = 2, 566) to those of non-healthcare professional women (n = 93, 717). Smoking characteristics included years of smoking, number of cigarettes, and time to first cigarette with smoking within the first 30 minutes as an indicator of nicotine dependence. Logistic regression models using replicate weights were used to determine correlates of ever and previous 12 months quit attempts.", "Are quit attempts among U.S. female nurses who smoke different from female smokers in the general population?<||||>Nurses had a lower smoking prevalence than other women (12.1% vs 16.6%, p<0.0001); were more likely to have ever made a quit attempt (77% vs 68%, p = 0.0002); but not in the previous 12 months (42% vs 43%, p = 0.77). Among those who ever made a quit attempt, nurses who smoked within 30 minutes of waking, were more likely to have made a quit attempt compared to other women (OR = 3.1, 95% CI: 1.9, 5.1). When considering quit attempts within the last 12 months, nurses whose first cigarette was after 30 minutes of waking were less likely to have made a quit attempt compared to other females (OR = 0.69, 95% CI: 0.49, 0.98). There were no other significant differences in ever/recent quitting." ]

[ "Are current back protectors suitable to prevent spinal injury in recreational snowboarders?<||||>Back protectors for snowboarders were analysed with respect to their potential to prevent spinal injury.", "Are current back protectors suitable to prevent spinal injury in recreational snowboarders?<||||>In 20 Swiss skiing resorts, athletes were interviewed on the slope. In addition, an online survey was conducted. The performance of 12 commercially available back protectors was investigated by means of mechanical testing. A currently used drop test according to standard EN1621 (motorcycle protectors), testing energy damping was supplemented by penetration tests according to standard EN1077, which reflects snowsport safety concerns.", "Are current back protectors suitable to prevent spinal injury in recreational snowboarders?<||||>6 out of 12 back protectors fulfilled the higher safety level defined in EN1621. Protectors making use of energy-absorbing layers performed particularly well. In contrast, hard shell protectors exhibited a higher potential to withstand the penetration test. The surveys confirmed that approximately 40-50% of snowboarders use a back protector. A large majority of users expect protection from severe spinal injury such as vertebral fractures or spinal cord injury." ]

[ "Alterations in mucosal neuropeptides in patients with irritable bowel syndrome and ulcerative colitis in remission: a role in pain symptom generation?<||||>Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain. The transient receptor potential vanilloid 1 (TRPV1) channel, which is involved in visceral pain signalling, has been shown to be up-regulated in IBS. Activation of TRPV1 leads to the release of neuropeptides, such as somatostatin and substance P (SP). We hypothesized that increased pain perception in IBS could be explained by increased transcription in TRPV1 and/or altered levels of neuropeptides. We therefore assessed the transcription of TRPV1 and the mucosal concentration of somatostatin and SP in IBS in comparison to healthy volunteers and patients with ulcerative colitis (UC) in remission as disease controls, and to ascertain their relationship to pain symptoms.", "Alterations in mucosal neuropeptides in patients with irritable bowel syndrome and ulcerative colitis in remission: a role in pain symptom generation?<||||>Sigmoid colonic mucosal samples were collected from 12 patients with IBS, 34 patients with UC in remission and 9 healthy volunteers, in which groups TRPV1 mRNA levels were determined using quantitative polymerase chain reaction and neuropeptide concentrations by radioimmunoassay. Pain symptom intensity was determined by questionnaires.", "Alterations in mucosal neuropeptides in patients with irritable bowel syndrome and ulcerative colitis in remission: a role in pain symptom generation?<||||>Transcription of TRPV1 as well as the concentration of neuropeptides were significantly higher in IBS, but only the former correlated with pain symptom severity." ]

[ "Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?<||||>The Glasgow Coma Scale (GCS) is used commonly for assessing patients' neurologic condition and outcome in intensive care units (ICUs); however, its reliability in cardiac surgical patients has been questioned. It has been claimed that active sedation is the cause of its unsuitability for these patients. This study aimed to compare the accuracy of GCS in cardiac surgical patients with and without active sedation to find out if the inapplicability of GCS in surgical patients is related to active sedation.", "Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?<||||>This was an observational cohort study.", "Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?<||||>The study was conducted in a cardiac surgical intensive care unit between January 1, 2007 and December 31, 2009.", "Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?<||||>All consecutive adult cardiac surgical patients were included in this study.", "Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?<||||>All types of cardiac surgical procedures performed during the study period were included without any exceptions. The study population was divided into 2 groups: sedated and non-sedated.", "Glasgow Coma Scale for outcome prediction after cardiac surgery: is it applicable?<||||>GCS was calculated daily for the first 7 postoperative days. The authors developed a new 4-point neurologic descriptor (ND): (1) neurologically free, (2) ICU psychosis, (3) actively sedated, and (4) documented focal neurologic deficits. The accuracy of both scales (GCS and ND) at predicting ICU mortality was compared by replacing the GCS in the Sequential Organ Failure Assessment (SOFA) score with the new ND, producing a modified SOFA. GCS was not an accurate outcome predictor in non-sedated or sedated patients. The ND was superior to GCS. Correspondingly, the modified SOFA showed a significantly higher accuracy of ICU-mortality prediction than the original SOFA." ]

[ "Severity of coronary artery disease in type 2 diabetes mellitus: Does the timing matter?<||||>In this cross-sectional study, 175 patients, who underwent coronary angiogram for the evaluation of the coronary artery disease (CAD), were recruited. Based on the angiographic findings, syntax score, vessel score, and coronary collaterals grading were analyzed. The biochemical analysis was done by using the auto analyzer.", "Severity of coronary artery disease in type 2 diabetes mellitus: Does the timing matter?<||||>A significant increase in the mean syntax score (p=0.019), vessel score (p=0.007), and coronary collateral grade (p=0.008) was observed in the patients with 5-10 years of diabetes when compared to those with less than 5 years of diabetic duration. There was no significant difference in the mean syntax score (p=0.979), vessel score (p=0.299), and collateral grade (p=0.842) between the patients with 5-10 years and more than 10 years of diabetes. The difference in the mean syntax score (p=0.791), vessel score (p=0.098), and collateral grade (p=0.661) between the nondiabetic and the patients with less than 5 years of diabetes was not significant." ]

[ "Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens?<||||>To compare the safety and efficacy of morcellation with the electrical prostate morcellator (EPM) or manual morcellation of the kidney, using an internal view within the morcellation sac.", "Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens?<||||>Thirty porcine kidneys, mean renal mass 174.5 g, were divided into three groups of 10. All morcellations were performed inside the LapSac. Groups 1 and 2 underwent morcellation using the EPM, monitored inside the LapSac using the nephroscope and outside the LapSac with the laparoscope, respectively. Group 3 underwent manual morcellation with ring forceps. The groups were assessed for morcellation time, fragment size, and LapSac integrity.", "Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens?<||||>In group 1, one pinhole perforation occurred; in group 2, nine perforations occurred (five large and four pinhole). No perforations occurred (P<0.001) in group 3 (manual morcellation). The mean morcellation time for groups 1 through 3 was, respectively, 86.9, 47.1, and 15.1 minutes (P<0.0001). The corresponding mean fragment size was 0.011, 0.015, and 1.36 g. The difference in mean fragment size was significantly different between the manual morcellation group and the EPM groups (P<0.001), but not between the two EPM groups (P = 0.12)." ]

[ "Do results of transoesophageal echocardiography during closure of patent foramen ovale influence interventional therapy?<||||>The aim of the present study was to characterise the morphology of patent foramen ovale (PFO) by a standardised protocol during transoesophageal echocardiography and to estimate the final and successful position of PFO-occluding devices (PFO-Star) by evaluation of parameters determined by echocardiography. The echoacardiographic parameters of septum- and PFO-morphology determined before the intervention were analysed with regard to choosing the optimal device-system for transcatheter PFO-closure.", "Do results of transoesophageal echocardiography during closure of patent foramen ovale influence interventional therapy?<||||>Transoesophageal echocardiography combined with application of contrast-media was performed in 31 patients before, during and after PFO-closure by using the PFO-Star-Device. The pre-interventional morphological parameters were compared with the result after PFO-closure.", "Do results of transoesophageal echocardiography during closure of patent foramen ovale influence interventional therapy?<||||>Quantitative contrast-bubble-shunting, PFO-channel-length and Vena contracta detected by colour flow Doppler do not show any correlation. PFO-channel-length in cases with small angles between aorta and septum seems to be associated with higher risk of clinically irrelevant device-shift as well as residual shunt." ]

[ "Is antenatal screening for hepatitis C virus cost-effective?<||||>This study aims to assess the cost-effectiveness of a routine universal antenatal hepatitis C virus (HCV) screening programme at a London centre.", "Is antenatal screening for hepatitis C virus cost-effective?<||||>Ten years' retrospective antenatal screening and outcome data informed a cost-effectiveness analysis using the previously validated MONARCH model. The cost and quality of life outcomes associated with the screening and treatment of newly identified hepatitis C cases were used to generate cost-effectiveness estimates for the screening programme.", "Is antenatal screening for hepatitis C virus cost-effective?<||||>A total of 35,355 women were screened between 1st November 2003 and 1st March 2013; 136 women (0.38%) were found to be HCV antibody positive. Of 78 (0.22%) viraemic cases, 44 (0.12%) were newly diagnosed. In addition, the screening programme identified three (6.8%) vertical transmissions in children of newly diagnosed mothers. Of 16 newly diagnosed mothers biopsied, all were in the F0-F2 METAVIR disease stages, and 50% had HCV genotype 1. Postnatal treatment with pegylated interferon and ribavirin was initiated in 19 women, with 14 (74%) achieving sustained virologic response. The total cost of screening and confirmation of diagnoses was estimated to be £240,641. This translates to £5469 per newly diagnosed individual. The incremental cost-effectiveness ratio of this screening and treatment strategy was £2400 per QALY gained. Treatment with newer direct-acting antiviral regimens would have a projected cost of £9139 per QALY gained, well below the £20,000-30,000/QALY gained willingness-to-pay threshold applied by policy advisory bodies." ]

[ "Domestic abuse in the emergency department: can a risk profile be defined?<||||>The main purpose of this study was to determine whether any clinical or demographic characteristics could identify adult female patients presenting to the emergency department (ED) with a history of domestic abuse. A second objective was to describe the frequency, types, and severity of this abuse.", "Domestic abuse in the emergency department: can a risk profile be defined?<||||>This study was a crosssectional survey of 611 women conducted in an academically-affiliated, urban ED. Domestic abuse was described as \"recent\" (within the preceding 12 months) or \"lifetime\" (recent or past). This included emotional, physical, and sexual abuse.", "Domestic abuse in the emergency department: can a risk profile be defined?<||||>Recent (7.9%, n = 48) and lifetime (38%, n = 232) domestic abuse was reported. For recently abused women, violence had been severe (87.5%, n = 42) and was associated with 1) trauma (OR 5.4, 95% CI = 2.6 to 11.6), 2) obstetrical and gynecological syndromes (OR 5.6, 95% CI = 2.4 to 13.2), and 3) psychiatric symptoms and substance use (OR 7.3, 95% CI = 2.4 to 22.0). The sensitivities and positive predictive values of these risk factors individually (<27.1% and<25.0%, respectively) and in aggregate (56.3% and 20.9%, respectively) were low. These indicators predicted only 27 (56.3%) of recently abused women. Lifetime domestic violence was more likely in homeless women (OR 5.8, 95% CI = 2.2 to 15.0), although less likely in immigrants (OR 0.4, 95% CI = 0.3 to 0.7)." ]

[ "Is plasma symmetric dimethylarginine a suitable marker of renal function in children and adolescents?<||||>The purpose of this cross-sectional study was to identify whether plasma symmetric dimethylarginine (pSDMA) is a useful marker of renal function in children.", "Is plasma symmetric dimethylarginine a suitable marker of renal function in children and adolescents?<||||>The study group consisted of 35 patients with chronic kidney disease (CKD) stages 1-5 (median age 11.5 years), classified on the basis of estimated glomerular filtration rate (eGFR) and divided into three groups: group A, patients with CKD stages 1 and 2; group B, CKD stage 3; and group C, CKD stages 4 and 5. A control group included 42 age-matched healthy children. Commercial enzyme-linked immunosorbent assay kits were used to measure pSDMA and serum cystatin C (sCysC) concentrations.", "Is plasma symmetric dimethylarginine a suitable marker of renal function in children and adolescents?<||||>The pSDMA and sCysC levels were significantly elevated in all CKD patients in comparison with healthy controls (p<0.05). The pSDMA level in children was increased in the mild CKD (group A) (p<0.01). There were also a significant difference in pSDMA concentration between groups A and B (p<0.01). No differences in pSDMA levels were found between groups B and C. Receiver operating characteristics analyses showed that pSDMA was a better diagnostic tool than sCysC for identifying CKD stage among all the examined children and for detecting patients from group A (eGFR>60 ml/min/1.73 m(2))." ]

[ "Do impalpable stage T1c prostate cancers visible on ultrasound differ from those not visible?<||||>We assessed whether the appearance of cancer within the prostate on sonography is associated with different pathological features and/or prognoses compared with nonvisible impalpable cancers defined as stage T1c by the TNM staging system.", "Do impalpable stage T1c prostate cancers visible on ultrasound differ from those not visible?<||||>We analyzed the clinical and pathological features, and progression rate in 323 patients with clinical stage T1cNX M0 cancer treated with radical prostatectomy between 1983 and 1998. Mean followup was 46.8 months (range 1 to 186).", "Do impalpable stage T1c prostate cancers visible on ultrasound differ from those not visible?<||||>Of 323 impalpable stage T1c cancers 170 (53%) were visible and the remainder was not visible on ultrasound. There were no significant differences in clinical or pathological features of the cancers in these 2 groups. The prostate specific antigen nonprogression rate at 5 years was also similar for patients with impalpable cancer regardless of whether the lesion was or was not revealed by ultrasound (mean +/- SE 87% +/- 6% and 91% +/- 6%, respectively, p = 0.3767). Of the 170 visible cancers 55 patients had a hypoechoic lesion considered highly suspicious for cancer. These cancers were higher grade, more extensive, less likely to be confined to the prostate and the prognosis was significantly worse than that of impalpable cancer whether or not they were visible at a less suspicious level (IV or less, p = 0.011). However, such highly suspicious visible cancers are rarely visualized today. Initial serum prostate specific antigen more accurately predicts the pathological stage of impalpable cancer than transrectal ultrasound results." ]

[ "Does serum lactate combined with soluble endothelial selectins at ICU admission predict sepsis development?<||||>Using a cohort previously studied in another context, in this retrospective investigation we plotted receiver operating characteristic (ROC) curves using sepsis development as the classification variable and serum lactate levels and their linear combinations with soluble sE-selectin and/or sP-selectin levels at intensive care unit (ICU) admission, as prognostic variables.", "Does serum lactate combined with soluble endothelial selectins at ICU admission predict sepsis development?<||||>Lactate levels combined with sE- and sP-selectin levels have the best prognostic accuracy showing a sensitivity and specificity of 76% and 84%, respectively, and an area under the curve (AUC) at 0.854 (95% confidence interval (CI)=0.775-0.932; p<0.001)." ]

[ "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>To develop a highly challenging and progressive group balance training regime specific to Parkinson's disease (PD) symptoms and to investigate its feasibility in older adults with mild to moderate PD.", "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>Intervention study, before-after trial with a development and feasibility design.", "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>University hospital setting.", "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>Feasibility was evaluated in older adults (N=5; mean age, 72y; age range, 69-80y) with mild to moderate idiopathic PD.", "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>A balance training regime emphasizing specific and highly challenging exercises, performed 3 times per week for 12 weeks, was developed through discussion and workshops by a group of researchers and physiotherapists.", "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>Indicators of feasibility included attendance rate, safety (adverse events, physical function, and pain), participants' perceptions of the intervention (level of difficulty of the exercises, motivation level, and appreciation), and efficacy of the intervention (balance performance assessed with the Mini-Balance Evaluation Systems Test [Mini-BESTest]).", "Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease?<||||>The incidence rate was high (93%) for attendance and low (1.2%) for adverse events. Ratings by the participants indicated progression throughout the training period. All participants considered the training motivational and stated that they would recommend it to others. The efficacy of the intervention measured with the Mini-BESTest showed that 4 out of 5 participants improved their balance performance." ]

[ "Cost-utility analysis conducted alongside randomized controlled trials: are economic end points considered in sample size calculations and does it matter?<||||>Many randomized controlled trials (RCTs) collect cost-effectiveness data. Without appropriate sample size calculations, patient recruitment may cease before the cost-effectiveness of the intervention can be established or continue after the cost-effectiveness of the intervention is established beyond doubt.", "Cost-utility analysis conducted alongside randomized controlled trials: are economic end points considered in sample size calculations and does it matter?<||||>We determined the frequency with which cost-effectiveness is considered in sample size calculations and whether RCT-based economic evaluations are likely to come to inconclusive results at odds with the clinical findings.", "Cost-utility analysis conducted alongside randomized controlled trials: are economic end points considered in sample size calculations and does it matter?<||||>We searched the National Health Service Economic Evaluation Database (NHS EED) to identify RCT-based cost-utility analyses. RCTs that collected individual patient data on costs and quality-adjusted life years (QALYs) were eligible. Studies using models to extrapolate the results of RCTs or with insufficient information on incremental costs and QALYs were excluded.", "Cost-utility analysis conducted alongside randomized controlled trials: are economic end points considered in sample size calculations and does it matter?<||||>In total, 38 trials met eligibility criteria. Only one considered cost-effectiveness in sample size calculations. RCTs were less likely to reach definitive conclusions based on the cost-effectiveness results than the primary clinical outcome (15.8% vs. 42.1%; McNemar; p = 0.01). In trials that provided sufficient data, exploratory analysis indicated that the median power to detect important differences was 29.5% for QALYs, 94.1% for costs, and 78.7% for the primary clinical outcome. In three trials (7.9%), a definitely more effective intervention was found to be expensive and probably not cost-effective.", "Cost-utility analysis conducted alongside randomized controlled trials: are economic end points considered in sample size calculations and does it matter?<||||>Our results reflect trials where authors considered within-trial estimates of cost-effectiveness to be meaningful. In focusing on one primary clinical outcome from each RCT, we have simplified the clinical effectiveness results, although the primary outcome will usually be one that policy makers use in judging the 'success' of the intervention." ]

[ "Effect of epicardial or biventricular pacing to prolong QT interval and increase transmural dispersion of repolarization: does resynchronization therapy pose a risk for patients predisposed to long QT or torsade de pointes?<||||>The present study examined pacing site-dependent changes in QT interval and transmural dispersion of repolarization (TDR) and their potential role in the development of torsade de pointes (TdP).", "Effect of epicardial or biventricular pacing to prolong QT interval and increase transmural dispersion of repolarization: does resynchronization therapy pose a risk for patients predisposed to long QT or torsade de pointes?<||||>In humans, the QT interval, JT interval, and TDR were measured in 29 patients with heart failure during right ventricular endocardial pacing (RVEndoP), biventricular pacing (BiVP), and left ventricular epicardial pacing (LVEpiP). In animal experiments, pacing site--dependent changes in ventricular repolarization were examined with a rabbit left ventricular wedge preparation in which action potentials from endocardium and epicardium could be simultaneously recorded with a transmural ECG. In humans, LVEpiP and BiVP led to significant QT and JT prolongation. LVEpiP also enhanced TDR. Frequent R-on-T extrasystoles generated by BiVP and LVEpiP but completely inhibited by RVEndoP occurred in 4 patients, of whom 1 developed multiple episodes of nonsustained polymorphic ventricular tachycardia and another suffered incessant TdP. In rabbit experiments, switching from endocardial to epicardial pacing produced a net increase in QT interval and TDR by 17+/-5 and 22+/-5 ms, respectively (n=6, P<0.01), without parallel increases in ventricular transmembrane action potential durations. Epicardial pacing facilitated transmural propagation of early afterdepolarization, leading to the development of R-on-T extrasystoles and TdP in the presence of action potential duration-prolonging agents." ]

[ "Pragmatic critical realism: could this methodological approach expand our understanding of employment relations?<||||>This paper seeks to highlight the need for employment relations academics and researchers to expand their use of research methodologies in order for them to enable the advancement of theoretical debate within their discipline. It focuses on the contribution that pragmatical critical realism has made to the field of perception and argues that it would add value to the subject of employment relations.", "Pragmatic critical realism: could this methodological approach expand our understanding of employment relations?<||||>It is a theoretically centred review of pragmatical critical realism and the possible contribution this methodology would make to the field of employment relations." ]

[ "The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?<||||>To assess the degree to which premium reductions will increase the participation in employer-sponsored health plans by low-income workers who are employed in small businesses.DATA SOURCES/", "The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?<||||>Sample of workers in small business (25 or fewer employees) in seven metropolitan areas. The data were gathered as part of the Small Business Benefits Survey, a telephone survey of small business conducted between October 1992 and February 1993.", "The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?<||||>Probit regressions were used to estimate the demand for health insurance coverage by low-income workers. Predictions based on these findings were made to assess the extent to which premium reductions might increase coverage rates.DATA COLLECTION/", "The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?<||||>Workers included in the sample were selected, at random, from a randomly generated set of firms drawn from Dun and Bradstreet's DMI (Dun's Market Inclusion). The response rate was 81 percent.", "The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?<||||>Participation in employer-sponsored plans is high when coverage is offered. However, even when coverage is offered to employees who have no other source of insurance, participation is not universal. Although premium reductions will increase participation in employer-sponsored plans, even large subsidies will not induce all workers to participate in employer-sponsored plans. For workers eligible to participate, subsidies as high as 75 percent of premiums are estimated to increase participation rates from 89.0 percent to 92.6 percent. For workers in firms that do not sponsor plans, similar subsidies are projected to achieve only modest increases in coverage above that which would be observed if the workers had access to plans at unsubsidized, group market rates." ]

[ "Can I cut it?<||||>Recent years have seen a significant drop in applications to surgical residencies. Existing research has yet to explain how medical students make career decisions. This qualitative study explores students' perceptions of surgery and surgeons, and the influence of stereotypes on career decisions.", "Can I cut it?<||||>Exploratory questionnaires captured students' perceptions of surgeons and surgery. Questionnaire data informed individual interviews, exploring students' perceptions in depth. Rigorous qualitative interrogation of interviews identified emergent themes from which a cohesive analysis was synthesized.", "Can I cut it?<||||>Respondents held uniform stereotypes of surgeons as self-confident and intimidating; surgery was competitive, masculine, and required sacrifice. To succeed in surgery, students felt they must fit these stereotypes, excluding those unwilling, or who felt unable, to conform. Deviating from the stereotypes required displaying such characteristics to a level exceptional even for surgery; consequently, surgery was neither an attractive nor realistic career option." ]

[ "Are lower urinary tract symptoms associated with erectile dysfunction in aging males of Taiwan?<||||>This study was conducted to evaluate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging males of Taiwan.", "Are lower urinary tract symptoms associated with erectile dysfunction in aging males of Taiwan?<||||>A free health screening for aging males (>or=45 years old) was conducted in Kaohsiung Medical University Chung-Ho Memorial Hospital in August 2004. LUTS and ED were assessed by validated symptom scales: the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 (IIEF-5). The subjects also completed a health and demographics questionnaire and underwent detailed physical examination, serum prostate-specific antigen level determination, and transrectal ultrasonography.", "Are lower urinary tract symptoms associated with erectile dysfunction in aging males of Taiwan?<||||>The final study population consisted of 141 patients with a mean age of 59.8 years. The severity of LUTS and ED increased with age. After controlling for comorbidities, age (p<0.001) and IPSS score (p<0.001) were significantly associated with the IIEF-5 score. Furthermore, men with moderate to high IPSS scores were more likely to have ED as compared with those with mild symptoms after age adjustment (age-adjusted odds ratio 3.27, p=0.002)." ]

[ "Transfusions in the less severely injured: does age of transfused blood affect outcomes?<||||>Prior studies have demonstrated that transfusion of older stored blood is associated with an increased risk of multiple organ failure, infection, and death. These reports were primarily comprised of severely injured patients, and it remains unknown whether this phenomenon is observed in relatively less injured patients. The purpose of this study was to evaluate the association between the age of stored blood and the morbidity and mortality in a mild to moderately injured patient cohort.", "Transfusions in the less severely injured: does age of transfused blood affect outcomes?<||||>Blunt trauma patients with Injury Severity Score<25 admitted to a Trauma Intensive Care Unit during 7.5 years who received no blood during the first 48 hours of hospitalization were selected for inclusion. Patients who died within 48 hours of admission were excluded from analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between morbidity or mortality and the age and amount of blood transfused (>48 hours postadmission), adjusted for age, sex, injury severity, thoracic injury, mechanical ventilation, and transfusion volume.", "Transfusions in the less severely injured: does age of transfused blood affect outcomes?<||||>During 7.5 years, 1,624 patients met the study criteria. The mean Injury Severity Score was 14.4. Receipt of blood stored beyond 2 weeks was associated with mortality (OR 1.12 [CI 1.02-1.23]), renal failure (OR 1.18 [CI 1.07-1.29]), and pneumonia (OR 1.10 [CI 1.04-1.17]). No such associations were identified, however, concerning the transfusion of blood with a lesser storage age." ]

[ "Do cardiovascular risk factors in men depend on their spouses' occupational category?<||||>To analyse the relationships between major cardiovascular risk factors in French men and their spouses' occupational category (OC), taking their own OC into account.", "Do cardiovascular risk factors in men depend on their spouses' occupational category?<||||>A large sample of volunteers working in the French National Electricity and Gas Company (GAZEL). As a check of the robustness, the same analysis was performed in a population-based survey (French multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) registers).", "Do cardiovascular risk factors in men depend on their spouses' occupational category?<||||>Any site of the company in France. Representative sample from the population of the three registers (Lille, Strasbourg, Toulouse).", "Do cardiovascular risk factors in men depend on their spouses' occupational category?<||||>9486 and 534 men respectively, in working activity, living in couple and aged 40 to 50 years.", "Do cardiovascular risk factors in men depend on their spouses' occupational category?<||||>Self-reported arterial hypertension, diabetes, hypercholesterolemia, leisure time sedentary lifestyle, smoking status, body mass index (BMI) and alcohol consumption.", "Do cardiovascular risk factors in men depend on their spouses' occupational category?<||||>In the GAZEL study, diabetes, smoking status, and alcohol consumption in men were associated with their own OC. In contrast, spouses' OC was independently associated with men's hypertension, hypercholesterolemia, sedentary lifestyle, and BMI: men whose spouses were unoccupied or workers have higher risk factors levels. In the MONICA study, the results were mostly comparable, at least for hypercholesterolemia, sedentary lifestyle, smoking status and alcohol consumption." ]

[ "Do patients with amyotrophic lateral sclerosis (ALS) have increased energy needs?<||||>Nutritional status is a prognostic factor for survival in amyotrophic lateral sclerosis (ALS) patients. We investigated the contribution of some of the components contributing to resting energy expenditure (REE) in order to determine whether potentially higher energy needs should be considered for these patients.", "Do patients with amyotrophic lateral sclerosis (ALS) have increased energy needs?<||||>Thirty three ALS patients and 33 age- and gender-matched healthy controls participated. REE was measured by an open-circuit indirect calorimeter, body composition by dual energy X-ray absorptiometry, and estimated caloric intake by 7-day food records.", "Do patients with amyotrophic lateral sclerosis (ALS) have increased energy needs?<||||>Patients had lower body mass indices and lower lean body mass (LBM) than healthy controls. REE values (as a percentage of predicted) was similar but increased when normalized by LBM (P<0.001). LBM and REE decreased while REE/LBM increased in ten patients who were reassessed 6 months later. A model for predicting measured REE was constructed based on the different components, with 86% prediction of its variability." ]

[ "Does pulse stacking improve the results of treatment with variable-pulse pulsed-dye lasers?<||||>It has been suggested that multiple stacked pulses of lower fluence may have a similar effect on targets as a single pulse of higher fluence. When treating vascular lesions, increasing the fluence beyond a certain point will increase the risk of purpura given a constant pulse duration. Stacking pulses of lower fluence may have the advantage of heating vessels to a critical temperature without creating purpura.", "Does pulse stacking improve the results of treatment with variable-pulse pulsed-dye lasers?<||||>To determine whether stacking low-fluence pulses of a variable-pulse pulsed-dye laser would improve clinical results without significantly increasing side and adverse effects.", "Does pulse stacking improve the results of treatment with variable-pulse pulsed-dye lasers?<||||>Twenty-five patients between the ages of 18 and 65 years with facial telangiectasia and skin types I-IV were enrolled in the study. For each subject, the cheek or nasal ala areas on either side of the facial midline with similar telangiectasia density ratings were randomized to single pulse and multiple stacked pulse groups. One side of the cheek or nasal ala was treated with single nonoverlapping pulses with the Candela Vbeam 595-nm pulsed-dye laser. The opposite side of the cheek or nose was treated with the same parameters but with three or four pulses stacked on top of each other at a 1.5-Hz repetition rate. Patients were asked to rate the pain of the procedure on each side on a 0 to 3 scale. Investigators rated the erythema and edema after the procedure as well as vessel clearing and overall telangiectasia density scale at 1 and 6 weeks after the procedure.", "Does pulse stacking improve the results of treatment with variable-pulse pulsed-dye lasers?<||||>Twenty-three patients completed the study. The mean pain rating was 1.58 for the pulse stacked side and 1.38 for the single-pass side. The mean erythema score after the procedure was 1.17 for the pulsed stacked side and 1.09 for the single pulsed side. The mean vessel clearing 1 week after the treatment was 74.3% for the pulse stacked side and 58.5% for the single pulsed side. The mean vessel clearing 6 weeks after the treatment was 87.6% for the pulse stacked side and 67.4% for the single pulsed side. The mean telangiectasia density scale score before treatment was 2.67 for the pulse stacked side and 2.59 for the single pulsed side. At 1 week after treatment, the mean telangiectasia density scale score was 1.06 for the pulsed stacked side and 1.5 for the single pulsed side. At 6 weeks after treatment, the mean telangiectasia density scale score was 0.72 for the pulsed stacked side and 1.30 for the single pulsed side. No patients experienced purpura in either group, and there were no cases of hyperpigmentation, hypopigmentation, or scar formation. One patient experienced significant edema on the side of the cheeks treated with pulse stacking." ]

[ "Is the temporal artery thermometer a reliable instrument for detecting fever in children?<||||>We aimed to study the diagnostic accuracy of the temporal artery thermometer vs. rectal temperature in a large group of children with and without fever, aged 0-18 years.", "Is the temporal artery thermometer a reliable instrument for detecting fever in children?<||||>Many have studied the diagnostic accuracy of the temporal artery thermometer in children compared with a reference method, with contradictory outcomes. No studies have been carried out in a large group of children of all ages.", "Is the temporal artery thermometer a reliable instrument for detecting fever in children?<||||>Diagnostic accuracy/validation study.", "Is the temporal artery thermometer a reliable instrument for detecting fever in children?<||||>Children (0-18 years) with fever (T>38·0°C) were recruited through the emergency department and children with normal temperatures through the day-care department of the Children's Hospital. All children routinely had rectal temperature recordings. Temporal artery temperature was recorded shortly after the rectal recording. The mean absolute difference in temperature, the level of agreement (intraclass correlation coefficient) and the sensitivity and specificity of detecting fever were calculated.", "Is the temporal artery thermometer a reliable instrument for detecting fever in children?<||||>A total number of 198 children (121 boys) participated, with a mean age of 5·1 (SD 4·7) years. Of those children, 81 had fever according to the rectal recording. Mean difference between temporal artery temperature and rectal temperature was -0·11 (SD 0·63)°C, with an agreement of 0·812. The sensitivity and specificity of the temporal artery thermometer for detecting fever were 67·9 and 98·3%, respectively." ]

[ "Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?<||||>Patients who undergo a Hartmann's procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann's procedure.", "Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?<||||>Patients who underwent a Hartmann's procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann's procedure.", "Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?<||||>One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3-22 months) post-Hartmann's procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal." ]

[ "Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury?<||||>Extensive dissection of recurrent laryngeal nerve (RLN) is inevitable in some complicated thyroid operations. The study aimed to determine whether extensive dissection of RLN increases the risk of nerve injury.", "Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury?<||||>Three hundred thirty-one patients (506 nerves at risk) who underwent thyroid operations with intraoperative neuromonitoring were included. The study chiefly focused on the 101 RLNs on which extensive nerve dissection from the thoracic inlet to the entry of larynx was performed and for which the nerve exposure was longer than 5 cm. Electromyographic (EMG) signals were obtained from the RLN and vagus nerve before and after complete RLN dissection, and these were defined as R(1), V(1) and R(2), V(2) signals, respectively. The RLN palsy rates and the change of EMG signals were evaluated and analyzed.", "Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury?<||||>Among 101 nerves with extensive dissection, 13 nerves were due to the operation for recurrent goiter; 41 nerves, for large goiter with substernal extension; and 47 nerves, for thyroid cancer with paratracheal nodal metastasis. No permanent palsy occurred, but 2 nerves experienced loss of EMG signal after complete RLN dissection from a large recurrent goiter and developed temporary palsy. The palsy rates were 2% (2/101) in the extensive dissection group and 2.5% (10/405) in the nonextensive dissection group (P = .77). Among 99 nerves with normal vocal function after operation, none experienced weakened signal after complete RLN dissection, and the mean amplitudes of R(2) and V(2) signals were not significantly different from those of R(1) and V(1) signals (R(2) vs R(1); 1038 vs 1030 μV; P = .74; V(2) vs V(1); 824 vs 816 μV; P = .75)." ]

[ "The prostate cancer gene 3 (PCA3) urine test in men with previous negative biopsies: does free-to-total prostate-specific antigen ratio influence the performance of the PCA3 score in predicting positive biopsies?<||||>to determine the performance characteristics of the prostate cancer gene 3 (PCA3) score on the outcome of biopsy relative to different ranges of free-to-total prostate-specific antigen (PSA) ratio (f/tPSA) in men with a previous negative biopsy and a PSA level of 2.5-10 ng/mL, as urine tests like PCA3 are currently under investigation in order to improve prostate cancer diagnosis and to decrease the rate of unnecessary rebiopsies.", "The prostate cancer gene 3 (PCA3) urine test in men with previous negative biopsies: does free-to-total prostate-specific antigen ratio influence the performance of the PCA3 score in predicting positive biopsies?<||||>data from the previous prospective European multicentre study were reviewed. Only patients with a PSA level of 2.5-10 ng/mL were included in the present study. In all, 301 patients had complete data. The diagnostic accuracy of the PCA3 score for predicting a positive biopsy outcome was studied using sensitivity, specificity, negative and positive predictive values. The PCA3 performance was evaluated relative to three different subgroups of f/tPSA, as follows:>20% (group 1), 10-20% (group 2) and<10% (group 3).", "The prostate cancer gene 3 (PCA3) urine test in men with previous negative biopsies: does free-to-total prostate-specific antigen ratio influence the performance of the PCA3 score in predicting positive biopsies?<||||>the prostate cancer detection rates were 18.8%, 23.9% and 34.8% in groups 1, 2 and 3, respectively. The area under the receiver operating characteristic curve of the PCA3 score, total PSA and f/tPSA was 0.688, 0.553 and 0.571, respectively. The percentage of men with positive biopsies was 30.6%, 37.0% and 44.4% in those with a PCA3 score of>30, vs 10.3%, 15.5% and 28.6% when the PCA3 score was<30, in groups 1, 2 and 3, respectively. The difference was significant only in groups 1 and 2. In men with a f/tPSA of ≤ 10% the difference in detection rates relative to the PCA3 score was not statistically significant regardless of which PCA3 threshold was used. A high PCA3 score was significantly associated with age, clinical T2 stage and positive biopsy (P<0.001, 0.013 and<0.001, respectively). In bivariate analysis accounting for the PCA3 score and the f/tPSA, a PCA3 score of>30 was a significant independent predictor of positive biopsies (odds ratio 3.01; 95% confidence interval 1.74-5.23; P<0.001)." ]

[ "Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?<||||>Within the present era of worldwide travel, it is important for all clinicians to consider the possibility of tropical sprue (TS) in returning patients with persistent diarrhoea after travel. The symptoms and histologic findings of TS can resemble but also be confused with celiac disease (CD).", "Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?<||||>Patients at our institute diagnosed with CD or TS in the period January 2000-December 2010 were eligible for inclusion. Of all patients, demographic, clinical, laboratory and endoscopy data on admission and in follow-up were collected retrospectively.", "Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?<||||>28 CD and 7 TS patients were included. There were no differences in baseline clinical characteristics, duration of stay in a tropical region or in laboratory findings on admission. However, in the majority of CD patients antibodies against endomysium (EMA) or tissue transglutaminase (tTG) were present at presentation but absent in all TS patients at presentation." ]

[ "Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve?<||||>Dehydroepiandrosterone (DHEA) and its sulphate (DHEAS) are pleiotropic adrenal hormones with immunostimulating and antiglucocorticoid effects. The present study was conducted to evaluate the time course of DHEAS levels in critically ill patients and to study their association with the hypothalamic-pituitary-adrenal axis.", "Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve?<||||>This was a prospective observational clinical and laboratory study, including 30 patients with septic shock, eight patients with multiple trauma, and 40 age- and sex-matched control patients. We took serial measurements of blood concentrations of DHEAS, cortisol, tumour necrosis factor-alpha and IL-6, and of adrenocorticotrophic hormone immunoreactivity over 14 days or until discharge/death.", "Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve?<||||>On admission, DHEAS was extremely low in septic shock (1.2 +/- 0.8 mol/l) in comparison with multiple trauma patients (2.4 +/- 0.5 micromol/l; P<0.05) and control patients (4.2 +/- 1.8; P<0.01). DHEAS had a significant (P<0.01) negative correlation with age, IL-6 and Acute Physiology and Chronic Health Evaluation II scores in both patient groups. Only during the acute phase did DHEAS negatively correlate with dopamine. Nonsurvivors of septic shock (n = 11) had lower DHEAS levels (0.4 +/- 0.3 micromol/l) than did survivors (1.7 +/- 1.1 micromol/l; P<0.01). The time course of DHEAS exhibited a persistent depletion during follow up, whereas cortisol levels were increased at all time points." ]

[ "Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?<||||>Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evaluate the results of EGD in our institution and compare them with a neurologically matched group of children who had Nissen fundoplication.", "Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?<||||>Twenty consecutive patients who had EGD were retrospectively evaluated and the results were compared with a neurologically matched group of 20 consecutive patients who had Nissen fundoplication.", "Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?<||||>Twenty patients had EGD, 17 as a primary procedure. There was no operative mortality but 5 have died of other causes. Resolution of reflux-associated symptoms occurred in all patients. Of the 15 survivors, 5 remain on antireflux medication. Twenty patients had fundoplication. There was no operative mortality, but 8 patients have died of other causes. Failure occurred in 5 patients necessitating further surgery. Of the 10 unreoperated survivors, 6 remain on antireflux medication." ]

[ "Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?<||||>Involuntary weight loss frequently poses a diagnostic challenge. Patient and physician alike want to exclude malignant and other major organic illness. The present study aimed to evaluate whether a negative baseline evaluation (consisting of clinical examination, standard laboratory examination, chest X-ray, and abdominal ultrasound) lowers the probability of evolving organic illness in patients with significant unexplained weight loss.", "Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?<||||>Prospective observational study of 101 consecutive patients presenting to a general internal medicine department of a university hospital with an unexplained unintentional weight loss of at least 5% within 6-12 months. Laboratory tests of interest included C-reactive protein, albumin, haemoglobin, and liver function tests.", "Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?<||||>Weight loss of the 101 patients [age (mean, interquartile range): 64 (51-71) years, 46% male] averaged 10 (7-15) kg. Organic causes were found in 57 patients (56%), including malignancy in 22 (22%). In 44 patients without obvious organic cause for the weight loss (44%), a psychiatric disorder was implicated in 16 (16%) and no cause was established in 28 (28%), despite vigorous effort and follow-up of at least 6 months. Baseline evaluation was entirely normal in none of the 22 patients (0%) with malignancy, in 2 of the 35 (5.7%) with non-malignant organic disease, and in 23 of the 44 (52%) without physical diagnosis. Additional testing, oftentimes extensive, after a normal baseline evaluation led to one additional physical diagnosis (lactose intolerance)." ]

[ "Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?<||||>Thirty-three skeletally immature patients younger than 12 years of age and having posterior arthrodesis and evidence of solid posterior fusion without \"adding on\" were retrospectively reviewed. All patients had a minimum of 5 years of follow-up.", "Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?<||||>To ascertain factors associated with crankshaft and to determine how accurate a marker the triradiate cartilage was.", "Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?<||||>All patients had Risser Stage 0 curves and all of the girls were premenarchal preoperatively. The average age was 9 years 3 months (range, 2 years-11 years 11 months). Preoperative diagnoses consisted of 14 idiopathic, 11 congenital, five dysplastic, and three neuromuscular etiologies.", "Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?<||||>Preoperatively, within 3 months after surgery, and at 2-year, 5-year, and final postoperative follow-up, the following radiographic parameters were reviewed: coronal Cobb, apical vertebral rotation, apical vertebral translation, rib vertebral angle difference, and trunkshift.", "Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?<||||>The triradiate cartilage was open in 24 patients at the time of operation. Of those 24, only nine (37.5%) had documented proof of crankshaft. Patients with closed triradiate cartilage had no significant postoperative increase in radiographic parameters (0 of 9). The subgroup of patients with idiopathic scoliosis had an average age of 11 years 3 months (range, 9 years 2 months-11 years 11 months). Five of 14 patients had an open triradiate cartilage. All were followed up to skeletal maturity. None had significant progression in postoperative radiographic parameters." ]

[ "Does CPAP treatment in mild obstructive sleep apnea affect blood pressure?<||||>Obstructive sleep apnea (OSA) is associated with significant cardiovascular (CV) morbidity. Continuous positive airway pressure (CPAP) is the standard treatment for moderate to severe OSA, resulting in a reduction in CV morbidity. No studies have compared CV outcomes between CPAP and no CPAP in mild OSA (5>or=AHI<15).", "Does CPAP treatment in mild obstructive sleep apnea affect blood pressure?<||||>Retrospective cohort study of subjects (age>or=18) with mild OSA diagnosed between 2004 and 2006. Subjects with a history of hypertension, angina, stroke and smoking were excluded. Subjects were stratified into two groups: CPAP (n=93) or no CPAP (n=162). The mean blood pressures (MBP) were compared 2 years after the diagnosis of OSA was established.", "Does CPAP treatment in mild obstructive sleep apnea affect blood pressure?<||||>Unmatched for covariates (age, sex, BMI, neck circumference, AHI, arousal index and family h/o CV disorders), subjects with mild OSA on CPAP had a 1.97 point reduction, and no CPAP resulted in a 9.61 point elevation (p<0.0001) in MBP. With propensity score matching for covariates, the mean difference in MBP was -1.97 (95% CI: -14.03, -9.92; p<0.0001) with a sensitivity analysis of 2.646." ]

[ "Is cytology necessary in diagnosis of mediastinal mass?<||||>Mediastinal mass is an uncommon abnormality found in clinical practices of respiratory physicians. The diagnosis of a mediastinal mass arises from a clinical suspicion, and more commonly, by a check-up chest x-ray. Definite diagnosis is necessary because the managements are different in various etiologies of the masses.", "Is cytology necessary in diagnosis of mediastinal mass?<||||>Adequacy of cellular sample recovered from small needle aspiration is the point of question among pathologist and physician in the diagnosis of mediastinal mass. Many centers recommend fine needle aspiration biopsy for cytology (FNAB) as an adequate procedure in this situation. This study is aimed to find the value of cytology and histological examination in the diagnosis of a mediastinal mass.", "Is cytology necessary in diagnosis of mediastinal mass?<||||>The study was done by prospective collected data of patients who were consulted for needle aspiration biopsies of their mediastinal mass since 1999 to 2006 at the Respiratory Diagnostic Unit, Division of Respiratory disease and Tuberculosis, Faculty of Medicine Siriraj Hospital. The protocol in evaluating mediastinal mass was to obtain both cytologic slides and tissue for histology from lesions in the mediastinum by ultrasonic guidance when they were possible.", "Is cytology necessary in diagnosis of mediastinal mass?<||||>During 1999 to 2006, there were 35 patients who had mediastinal masses referred for needle aspiration procedures. Their mean age and standard deviation were 42.37 +/- 16.97 year-old. Among these patients, 22 were men and 13 were women. The mean age (+/- standard deviation) of male patients was 40.47 +/- 17.17 years and 45.5 +/- 16.79 year-old for the female. The histology could make diagnosis in a significantly higher number of patients as compared to cytology (88.57% compared to 40%). There was statistically different higher diagnostic rate of UG-CNB than UG-FNA in non-carcinomatous group. The complications were mild." ]

[ "Is the cystatin-like domain of TSL functionally active in external ocular infections and during the normal diurnal cycle?<||||>To test whether the cystatin-like functional domain in tear specific lipocalin (TSL) is functionally active in tears during the normal diurnal cycle and during external ocular infections.", "Is the cystatin-like domain of TSL functionally active in external ocular infections and during the normal diurnal cycle?<||||>Capillary tube collected reflex (RTF), open (OTF) and closed (CTF) eye tear samples were recovered from six normals and semi-quantitatively western blot assayed for cystatin C and TSL. CTF samples were immunoprecipitated with antibodies raised against TSL, cystatin C and other antiproteases and screened for the co-precipitation of proteases by casein and gelatin zymography. OTF samples recovered from individuals with viral, fungal and bacterial keratitis were similarly screened for TSL-bound proteases. Human tissue was subjected to immunohistochemical study.", "Is the cystatin-like domain of TSL functionally active in external ocular infections and during the normal diurnal cycle?<||||>Western blot analysis reveals a progressive increase in cystatin C in going from RTF to OTF to CTF samples (approximately 3, 7 and 30 ng microl(-1), respectively). In contrast, the concentration of TSL remains constant (approximately 1500 ng microl(-1)). Immunocytochemistry data show staining of the apical surface of the human conjunctiva and some intra-cellular staining for cystatin C, but not for cystatin A. Zymography confirms earlier data that CTF contains exceptionally high levels of proteases bound to a wide range of specific inhibitors. However, only trace amounts of proteases are complexed with cystatin C and no protease can be detected bound to TSL in either the pathological or CTF samples." ]

[ "Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory?<||||>The authors assess the value of liquid contrast medium swallow as a method to detect postoperative complications after laparoscopic adjustable gastric banding (LAGB) for the treatment of morbid obesity.", "Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory?<||||>From January 1996 to January 2001, 350 morbidity obese patients (295 women, 55 men) underwent a LAGB operation. All data were prospectively collected in a computerized databank. All patients underwent a jopomidol swallow (JS) study in the early postoperative phase to exclude perforation of the esophagus or stomach, which is one of the most serious complications occurring after the LAGB operation. Furthermore, the JS was performed to confirm band position and to exclude early pouch dilatation.", "Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory?<||||>Out of the 350 LAGB operations, 6(1.8%) early pouch dilatations and 4(1.2%) stomach perforations occurred. All early pouch dilatations were recognized on postoperative JS and immediately repaired laparoscopically. Of the perforations, one was recognized intraoperatively, and the other three were diagnosed postoperatively, either by contrast media extravasation on the JS (two patients) or by computer tomography." ]

[ "Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers?<||||>Although Helicobacter pylori has been identified as a major cause of chronic gastritis, not all infected patients develop ulcers, suggesting that other factors such as lifestyle may be critical to the development of ulcer disease.", "Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers?<||||>To investigate the role physical activity may play in the incidence of peptic ulcer disease.", "Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers?<||||>The participants were men (n = 8,529) and women (n = 2,884) who attended the Cooper Institute for Aerobics Research, Dallas, Texas, between 1970 and 1990. The presence of gastric or duodenal ulcer disease diagnosed by a physician was determined from a mail survey in 1990. Participants were classified into 3 physical activity groups according to information provided at the baseline clinic visit (before 1990): active, those who walked or ran 10 miles or more a week; moderately active, those who walked or ran less than 10 miles a week or did another regular activity; and the referent group consisting of those who reported no regular physical activity.", "Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers?<||||>With the use of gender-specific proportional hazards regression models that could be adjusted for age, smoking, alcohol use, body mass index, and self-reported tension, active men had a significantly reduced risk for duodenal ulcers (relative hazard [95% confidence interval]for the active group, 0.38 [0.15-0.94], and 0.54 [0.30-0.96]for the moderately active group). No association was found between physical activity and gastric ulcers for men or for either type of ulcer for women." ]

[ "Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications?<||||>Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM-IV classification, compared with the DSM-III, DSM-III-R, and ICD-10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups.", "Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications?<||||>A cross-sectional study was performed on patients (age>or = 70 years) in seven acute geriatric wards (n = 230) and in seven nursing-homes (n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM-III, DSM-III-R, DSM-IV, and clinical criteria of ICD-10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM-IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini-Mental State Examination scores, when available.", "Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications?<||||>According to the DSM-III, DSM-IIIR, DSM-IV and ICD-10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non-demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM-IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia." ]

[ "Influence of platelet rich fibrin (PRF) on proliferation of human preadipocytes and tympanic keratinocytes: A new opportunity in facial lipostructure (Coleman's technique) and tympanoplasty?<||||>Human tympanic keratinocytes and preadipocytes are collected and cultured using the explant technique. 4 series of each type of cells are cultivated either in normal condition (control group) or with PRF (test group). The Petri dishes (of culture) are taken out on the 3rd, 7th, 14th and 21st day, for counting. Evolutions of cells' number are analyzed with a variance test.", "Influence of platelet rich fibrin (PRF) on proliferation of human preadipocytes and tympanic keratinocytes: A new opportunity in facial lipostructure (Coleman's technique) and tympanoplasty?<||||>The number of cells in culture increases of more than 60% on the 7th day, and of almost 150% right from the 14th day when in presence of PRF. The daily proliferation peak occurs around the 14th day. The two cellular tested types react similarly." ]

[ "Behavioral health insurance parity: does Oregon's experience presage the national experience with the Mental Health Parity and Addiction Equity Act?<||||>The Mental Health Parity and Addiction Equity Act of 2008 prohibits commercial group health plans from imposing spending and visit limitations for mental health and substance abuse services that are not imposed on medical-surgical services. The act also restricts the use of managed care tools that apply to behavioral health benefits in ways that differ from how they apply to medical-surgical benefits. The only precedent for this approach is Oregon's state parity law, which was implemented in 2007. The goal of this study was to estimate the effect of Oregon's parity law on expenditures for mental health and substance abuse treatment services.", "Behavioral health insurance parity: does Oregon's experience presage the national experience with the Mental Health Parity and Addiction Equity Act?<||||>The authors compared expenditures for commercially insured individuals in four Oregon health plans from 2005 through 2008 and a matched group of commercially insured individuals in Oregon who were exempt from parity. Using a difference-in-differences analysis, the authors analyzed the effect of comprehensive parity on spending for mental health and substance abuse services.", "Behavioral health insurance parity: does Oregon's experience presage the national experience with the Mental Health Parity and Addiction Equity Act?<||||>Increases in spending on mental health and substance abuse services after implementation of Oregon's parity law were almost entirely the result of a general trend observed among individuals with and without parity. Expenditures per enrollee for mental health and substance abuse services attributable to parity were positive, but they did not differ significantly from zero in any of the four plans." ]

[ "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>To determine if intraoperative autologous transfusion using a Cell Saver (CS) was routinely indicated for open reduction internal fixation (ORIF) of acetabular fractures, and if so, was there a difference between differing surgical approaches.", "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>Retrospective single-center cohort study.", "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>University Level 1 trauma center.PATIENTS/", "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>One hundred forty-five consecutive acetabular fractures using intraoperative autologous transfusion, either treated with an anterior ilioinguinal or a posterior-based Kocher-Langenbeck approach, were compared.", "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>Use of CS in ORIF acetabular cases.", "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>CS utilization and CS blood return for acetabular ORIF. Mean intraoperative blood loss between the 2 approaches.", "Cell Saver Use in Acetabular Surgery: Does Approach Matter?<||||>CS blood was returned in 29 of the 145 total cases [23/65 anterior (ilioinguinal approach) and 6/80 posterior approach (Kocher-Langenbeck)]. Mean intraoperative blood loss was 786 mL for the anterior approach and 485 mL for the posterior approach. Subgroup analysis identified anterior approach as the only risk factor for elevated blood loss and CS blood return." ]

[ "Is L-methionine a trigger factor for Alzheimer's-like neurodegeneration?<||||>L-methionine, the principal sulfur-containing amino acid in proteins, plays critical roles in cell physiology as an antioxidant and in the breakdown of fats and heavy metals. Previous studies suggesting the use of L-methionine as a treatment for depression and other diseases indicate that it might also improve memory and propose a role in brain function. However, some evidence indicates that an excess of methionine can be harmful and can increase the risk of developing Type-2 diabetes, heart diseases, certain types of cancer, brain alterations such as schizophrenia, and memory impairment.", "Is L-methionine a trigger factor for Alzheimer's-like neurodegeneration?<||||>Here, we report the effects of an L-methionine-enriched diet in wild-type mice and emphasize changes in brain structure and function. The animals in our study presented 1) higher levels of phosphorylated tau protein, 2) increased levels of amyloid-β (Aβ)-peptides, including the formation of Aβ oligomers, 3) increased levels of inflammatory response,4) increased oxidative stress, 5) decreased level of synaptic proteins, and 6) memory impairment and loss. We also observed dysfunction of the Wnt signaling pathway." ]

[ "Is it reasonable to treat early gastric cancer with signet ring cell histology by endoscopic resection?<||||>Data from 215 patients who had undergone gastrectomy with D2 lymph-node dissection for EGC with signet ring cell histology between January 1999 and December 2007 were retrospectively reviewed. Associations between various clinicopathological factors and the presence of lymph-node metastasis were analyzed to identify factors predictive of lymph-node metastasis.", "Is it reasonable to treat early gastric cancer with signet ring cell histology by endoscopic resection?<||||>The overall incidence of lymph-node metastasis was 7.9%: 1.9% with intramucosal cancer and 6% with submucosal cancer. Univariate analysis identified the depth of tumor invasion to the submucosa and positive lymphatic-vascular involvement as associated with lymph-node metastasis (both P<0.01). On multivariate analysis, positive lymphatic-vascular involvement was the most significant factor related to lymph-node metastasis (odds ratio: 43.7; 95% confidence interval: 8.7-220.9), followed by the depth of invasion (odds ratio: 4.87; 95% confidence interval: 1.02-23.21). Patients with EGC with signet ring cell histology and a diameter of less than 25 mm, invasion within the sm2 layer, and no lymphatic-vascular involvement had no lymph-node metastasis." ]

[ "Does race still matter in nursing?<||||>The rise in undergraduate enrollment of African-American students has not translated into more African-American faculty members, although they could mentor minority students and promote an ethos that encourages their academic success. Discrimination against African-American faculty members continues, which could lessen their presence.", "Does race still matter in nursing?<||||>This study explored the narratives of 23 African-American faculty members to determine if race still matters in nursing.", "Does race still matter in nursing?<||||>A narrative approach grounded in social constructionism and critical race theory was used to illustrate the journey of African-American faculty into and throughout academia and to reveal factors related to decisions to enter and remain in academia.", "Does race still matter in nursing?<||||>Most of the participants stated that they faced racial discrimination that tested their resilience and reinforced their commitment to the academy." ]

[ "Can paramedics using guidelines accurately triage patients?<||||>We determine whether paramedics, using written guidelines, can accurately triage patients in the field.", "Can paramedics using guidelines accurately triage patients?<||||>This prospective, descriptive study was conducted at an urban county emergency medical services (EMS) system and county hospital. Paramedics triaged patients, for study purposes only, according to 4 categories: (1) needing to come to the emergency department by advanced life support (ALS) transport, (2) needing to come to the ED by any transport, (3) needing to see a physician within 24 hours, or (4) not needing any further physician evaluation. Medical records that provided patient treatment information to the point of ED disposition were subsequently reviewed (blinded to the paramedic rating) to determine which of the categories was appropriate. The protocol of the EMS system of the study site dictates that all patients should be transported except for those who refuse care and leave against medical advice. Only transported patients were included in the present study. Fifty-four paramedics triaged 1,180 patients.", "Can paramedics using guidelines accurately triage patients?<||||>Mean patient age was 43.4+/-17 years; 62.0% were male. Paramedics rated 1,000 (84.7%) of the patients as needing to come to the ED and 180 (15.3%) as not needing to come to the ED. Ratings according to triage category were as follows: 804 (68.1%) category 1, 196 (16.6%) category 2, 148 (12.5%) category 3, and 32 (2.7%) category 4. Seven hundred thirty-six (62.4%) patients were discharged, 298 (25.3%) were admitted, 90 (7.6%) were transferred, 36 (3.1%) left against medical advice, and 20 (1.7%) died. The review panel determined that 113 (9.6%) patients were undertriaged; 55 (48.7%) of these patients were misclassified because the paramedics misused the guidelines. Ninety-nine patients (8.4% of the total sample) were incorrectly classified as not needing to come to the ED. This represented 55% of the patients (99/180) categorized as 3 or 4 by the paramedics. Fourteen patients (1.2% of total) were incorrectly classified as category 4 instead of 3. Of the 113 undertriaged patients, 22 (19.6%) were admitted, 86 (76.1%) were discharged, and 4 (3.5%) were transferred." ]

[ "Do patients have an obligation to participate in student teaching?<||||>Patients may participate in teaching in many ways, in different settings and with different degrees of expert supervision. The majority of patients are generally very willing to participate in teaching. At times, however, patients may decline to see students because they are too sick, wish to maintain their privacy, prefer to have more expert care, or simply wish to have no involvement with students. This raises the question as to whether patients have any obligation to participate in education.", "Do patients have an obligation to participate in student teaching?<||||>A number of arguments are advanced to justify the claim that patients have an obligation to participate in student teaching. These include: that patients should participate in training for the benefit of others if they wish to benefit from the care of those who have learnt from others; that, without patient participation in teaching, the entire health system would collapse; that participation in education provides a benefit over and above the provision of individual care; that, as we all benefit from the presence of a functioning health system, we should all be prepared to contribute to it, and that patients should 'pay' for free public health care by participating in teaching." ]

[ "Harvesting the radial artery: does it affect early postoperative hand function?<||||>The radial artery (RA) is increasingly being used as a conduit for coronary artery bypass grafting. Previous studies have demonstrated that there is no significant deterioration in hand function in the long term. The aim of this study was to assess whether removal of the RA caused any alteration in the function or power of the hand 5 days postoperatively that would affect the patient's ability for self care on returning home.", "Harvesting the radial artery: does it affect early postoperative hand function?<||||>A consecutive series of 37 patients undergoing RA harvesting was assessed over a period of 12 months from August 2000 to July 2001 as part of a prospective controlled trial. Grip power and fine motor skills in the operated hand were assessed preoperatively with an elasticated grip strength tester and an 18-hole peg board. This test was repeated 5 days postoperatively. The results were analyzed with a paired-sample t test to assess whether there was a significant difference between preoperative and postoperative hand function.", "Harvesting the radial artery: does it affect early postoperative hand function?<||||>The analysis showed that there was no statistically significant difference in fine motor function or grip power following surgery to harvest the RA." ]

[ "Ultrasound versus MRI: is there a difference in measurements of the fetal lateral ventricles?<||||>To evaluate whether fetal brain lateral ventricle measurements differ between ultrasound (US) and MRI.", "Ultrasound versus MRI: is there a difference in measurements of the fetal lateral ventricles?<||||>We evaluated 115 fetuses with US and MRI performed within 24 h of each other. Ventricular measurements were performed in the axial plane at the level of the atria for both modalities and the right and left ventricles were evaluated separately. We compared mean measurements; mean differences, association with gestational age (GA), association with the presence of a brain anomaly, and agreement between MRI and US.", "Ultrasound versus MRI: is there a difference in measurements of the fetal lateral ventricles?<||||>The LV and RV were measured in 65 and 64 cases, respectively. LV and RV size estimates were significantly greater when measured by MRI compared with US (p < 0.001). Therefore, LV and RV were 0.87 mm and 0.89 mm larger in MRI versus US, respectively. Neither GA at measurement or presence/absence of a brain anomaly was significantly associated with differences in measurements. When comparing the agreement between the US and MRI measurements for ventriculomegaly; the kappa level of agreement for the LV and RV was 0.74 for each." ]

[ "Postoperative choledochoscopy: is routine antibiotic prophylaxis necessary?<||||>Postoperative choledochoscopy-related infection has been reported in the literature. We performed a prospective randomized trial to investigate the value of antibiotic prophylaxis for the prevention of such endoscopy-related infection.", "Postoperative choledochoscopy: is routine antibiotic prophylaxis necessary?<||||>In a 2-year period from 1990 to 1991, 84 patients with biliary lithiasis were included in the study and randomized. Forty-four patients received antibiotic prophylaxis (1 gm cephalothin intravenously 30 minutes before the procedure and 500 mg cephalexin orally every 6 hours for 3 days afterward). Forty patients in the control group did not receive any antibiotics.", "Postoperative choledochoscopy: is routine antibiotic prophylaxis necessary?<||||>There was no significant difference between the groups in age, sex, preprocedure liver function, serum amylase level, white cell count, and duration of the procedure. The results of bacteriologic studies of the bile were also comparable in the two groups. One patient in the control group had transient chill and fever after the procedure. Two patients in the antibiotic group and one patient in the control group had mild abdominal pain. Mild hemobilia was noted in one patient in the antibiotic group. These complications were treated conservatively without any event. No difference was evident in the complications and the success of postoperative choledochoscopy between the two groups." ]

[ "Does litigation influence medical practice?<||||>To assess the relationship between radiologists' perception of and experience with medical malpractice and their patient-recall rates in actual community-based clinical settings.", "Does litigation influence medical practice?<||||>All study activities were approved by the institutional review boards of the involved institutions, and patient and radiologist informed consent was obtained where necessary. This study was performed in three regions of the United States (Washington, Colorado, and New Hampshire). Radiologists who routinely interpret mammograms completed a mailed survey that included questions on demographic data, practice environment, and medical malpractice. Survey responses were linked to interpretive performance for all screening mammography examinations performed between January 1, 1996, and December 31, 2001. The odds of recall were modeled by using logistic regression analysis based on generalized estimating equations that adjust for study region.", "Does litigation influence medical practice?<||||>Of 181 eligible radiologists, 139 (76.8%) returned the survey with full consent. The analysis included 124 radiologists who had interpreted a total of 557 143 screening mammograms. Approximately half (64 of 122 [52.4%]) of the radiologists reported a prior malpractice claim, with 18 (14.8%) reporting mammography-related claims. The majority (n = 51 [81.0%]) of the 63 radiologists who responded to a question regarding the degree of stress caused by a medical malpractice claim described the experience as very or extremely stressful. More than three of every four radiologists (ie, 94 [76.4%]of 123) expressed concern about the impact medical malpractice has on mammography practice, with over half (72 [58.5%] of 123) indicating that their concern moderately to greatly increased the number of their recommendations for breast biopsies. Radiologists' estimates of their future malpractice risk were substantially higher than the actual historical risk. Almost one of every three radiologists (43 of 122 [35.3%]) had considered withdrawing from mammogram interpretation because of malpractice concerns. No significant association was found between recall rates and radiologists' experiences or perceptions of medical malpractice." ]

[ "Should subjects who used psoralen suntan activators be screened for melanoma?<||||>Psoralens are potent tanning activators that have been introduced in France and in Belgium in some tanning lotions and sunscreens. It was shown that poor tanners who ever used psoralen tanning activators display a four-fold increase in melanoma risk when compared to poor tanners using regular sunscreens. Although psoralens have now banned from suntan lotions, it is likely that the increase in melanoma risk linked to their previous use will persist for several years.", "Should subjects who used psoralen suntan activators be screened for melanoma?<||||>The melanoma risk attributable to psoralens use was calculated to evaluate the population at risk in France and Belgium.", "Should subjects who used psoralen suntan activators be screened for melanoma?<||||>Melanoma incidence for the year 1995 was estimated to be of 10.2 per 100,000 in France and of 10.0 per 100,000 in Belgium, representing 5,900 and 1,000 melanoma cases. From the melanoma incidence among poor tanner who ever used psoralens (52 per 100,000) and estimation of the percentage of psoralen users among poor tanners, it can be derived that, for the year 1995, 267 melanoma cases could be attributed to psoralen tanning activators." ]

[ "Objective refraction in black children: cyclopentolate and tropicamide combination, a reliable alternative to atropine?<||||>Cycloplegia allows for an objective refraction in children. Atropine is the gold standard but causes prolonged blurred vision. Cyclopentolate is less effective but less disabling. Tropicamide is a weak cycloplegic. The purpose of this study was to evaluate a cyclopentolate and tropicamide combination (CTA) versus atropine for refraction in black children.", "Objective refraction in black children: cyclopentolate and tropicamide combination, a reliable alternative to atropine?<||||>We performed a prospective study between October 2011 and July 2012 on all children seen in consultation. Objective refraction was performed after cycloplegia with cyclopentolate 0.5% combined with tropicamide 0.5%, and then after cycloplegia with atropine.", "Objective refraction in black children: cyclopentolate and tropicamide combination, a reliable alternative to atropine?<||||>Thirty-three patients were recruited, 14 boys and 19 girls. The average age was 9.9 years. The mean age of the patients was 9.9 years. Astigmatism was found in 96.9% of cases. It was 1.34±1.32 diopters with CTA and 1.35±1.22 diopters with atropine. The mean axis was 98.15 and 99.8, respectively. Hyperopia and myopia were found in 39 and 27 eyes, respectively with ACT (average 1.73 and 5.37 diopters), and in 41 and 19 eyes with atropine (average 2.06 and 6.11 diopters).", "Objective refraction in black children: cyclopentolate and tropicamide combination, a reliable alternative to atropine?<||||>There is a good correlation of results with regards to cylindrical and spherical refractive error between the two protocols. Atropine is the best cycloplegic, however ACT provides reliable results." ]

[ "Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?<||||>Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status.", "Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?<||||>To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas.", "Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?<||||>Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors." ]

[ "The role of extended cervical mediastinoscopy in staging of non-small cell lung cancer of the left lung and a comparison with integrated positron emission tomography and computed tomography: does integrated positron emission tomography and computed tomography reduce the need for invasive procedures?<||||>Extended cervical mediastinoscopy (ECM) is a method for sampling aortopulmonary window (APW) mediastinal lymph nodes. In this study, the efficacy of integrated positron emission tomography/computed tomography (PET/CT) was compared with ECM for the detection of APW lymph node metastasis.", "The role of extended cervical mediastinoscopy in staging of non-small cell lung cancer of the left lung and a comparison with integrated positron emission tomography and computed tomography: does integrated positron emission tomography and computed tomography reduce the need for invasive procedures?<||||>Fifty-five patients diagnosed of non-small cell lung cancer in whom APW or hilar lymph nodes had been reported to be positive on PET/CT, and/or who had had central tumor and/or in whom ECM had been performed for mediastinal staging due to the presence of APW lymph nodes larger than 1 cm in diameter on the CT between 2005 and 2009, were retrospectively analyzed. All patients underwent PET/CT scanning.", "The role of extended cervical mediastinoscopy in staging of non-small cell lung cancer of the left lung and a comparison with integrated positron emission tomography and computed tomography: does integrated positron emission tomography and computed tomography reduce the need for invasive procedures?<||||>Thirty-eight patients were identified as cN0 by standard cervical mediastinoscopy/ECM, and lobectomy, pneumonectomy, and exploratory thoracotomy were performed on 19, 13, and six of these patients, respectively. Mediastinal lymphadenectomy revealed APW lymph node metastases in four patients (ECM false negative). Seventeen patients identified as cN2 by mediastinoscopy, APW lymph node metastasis was present in nine, whereas eight had mediastinal lymph node metastasis that could only be accessed by standard cervical mediastinoscopy but had no APW lymph node metastasis were excluded from the analysis. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of ECM/PET/CT were calculated as 0.69/0.53, 1/0.91, 0.89/0.83, 1/0.70, and 0.91/0.80, respectively." ]

[ "Productivity costs in health-state valuations : does explicit instruction matter?<||||>There has been considerable debate on whether productivity costs should be captured in the numerator or the denominator of the cost-effectiveness ratio. That debate cannot be resolved on the basis of theoretical arguments alone because the final choice also depends on what is incorporated in health-state valuations by respondents and how this influences outcomes. At the moment, little is known about whether the effects of ill health on income are included in health-state valuations, and how instructions on including or excluding the effects on income influence health-state valuations.AIM: To conduct an empirical study of health-state valuations to test: (i) whether or not respondents spontaneously include the effect of ill health on income and leisure time; (ii) the impact on the valuation of inclusion (or exclusion) of such effects; and (iii) the influence of explicit instructions on this matter.", "Productivity costs in health-state valuations : does explicit instruction matter?<||||>Three questionnaires were developed and administered to the general public. Health-state valuations were conducted by visual analogue scale scoring of three health states of differing severity taken from the EQ-5D. Version 1 had no directions regarding inclusion/exclusion of effects of ill health on income. Those respondents who spontaneously included effects on income were subsequently asked to value the same three health states again, excluding these effects. Version 2 had explicit instructions to incorporate the effects on income. Version 3 stated that income was assumed to not change as a result of ill health. Respondents for versions 2 and 3 were also questioned about inclusion of effects on leisure time.", "Productivity costs in health-state valuations : does explicit instruction matter?<||||>Giving explicit instructions on the incorporation or exclusion of effects of ill health on income did not lead to significant differences in subsequent health-state valuations. In the absence of instruction, 36% of respondents included and 64% excluded effects on income, but the health-state valuations of the two groups were not significantly different. Eighty-four percent of respondents included the effects of ill health on leisure activities, and again this had no significant impact on the resulting health-state valuations." ]

[ "Does the septic shock interfere experimental acute pancreatitis in rats?<||||>Acute pancreatitis is a disease involving pro-inflammatory mediators. Two complex and multifactorial pathogenetic ways lead to edematous or necrotizing pancreatitis. The course of the disease is thought to be the consequence of an acute inflammatory response.AIM: The authors examined the impact of Escherichia coli LPS on the acute cerulein pancreatitis in rats.", "Does the septic shock interfere experimental acute pancreatitis in rats?<||||>The study was performed on rats using the ceruleine pancreatitis model. The activation status of polymorphonuclear cells, blood IL-6 concentration, oxidative stress parameters, pancreatic enzymes concentration and microscopic alterations were determined at 5th and 9th h observations.", "Does the septic shock interfere experimental acute pancreatitis in rats?<||||>In acute pancreatitis and acute pancreatitis with LPS groups, the peripheral polymorphonuclear cells activity was lower than in control one. Authors noticed the same neutrophil activation in acute pancreatitis after lipopolysaccharide administration although the peripheral blood polymorphonuclear cells count was significantly higher at the 9th h observation. LPS neither changed the oxidative stress within pancreatic gland, nor amylase or serum lipase activity. LPS given to acute pancreatitis animals resulted in significant increase of serum IL-6 concentration at 5th observation turning normal after 9th h." ]

[ "Combining limb-sparing surgery with radiation therapy in high-grade soft tissue sarcoma of extremities - Is it effective?<||||>Limb-sparing surgery in combination with radiation therapy is a well-established treatment for high-grade soft tissue sarcomas of the extremities. But selection of cases and optimal sequence of irradiation and surgery still remain controversial.", "Combining limb-sparing surgery with radiation therapy in high-grade soft tissue sarcoma of extremities - Is it effective?<||||>769 patients with a high-grade soft tissue sarcoma of the extremities, who underwent a limb-sparing surgery, were retrospectively reviewed. Group 1 (N = 89) was treated with neo-adjuvant radiation therapy, group 2 (N = 315) with adjuvant irradiation and group 3 (N = 365) with surgery alone.", "Combining limb-sparing surgery with radiation therapy in high-grade soft tissue sarcoma of extremities - Is it effective?<||||>After a mean follow up of 45 months 95 local recurrences occurred resulting in a local recurrence-free survival of 83.2% after 5 years and 75.9% after 10 years. Contaminated surgical margins (Odds ratio: 2.42) and previous inadequate surgeries (Odds ratio: 1.89) were identified as risk factors for failed local control. Neo-adjuvant radiation therapy provides the best local recurrence-free rate for 5 years (90.0%), whereas after 10 years (78.3%) adjuvant irradiation showed better local control. The metastatic-free rate was independent from achieved surgical margins (p = 0.179). Group 1 showed the highest rate of revision surgery (9.0%), followed by group 3 (5.5%) and group 2 (4.4%) (p = 0.085). However, the rate of irradiation-correlated side effects was higher in group 2 (15.2%) than in group 1 (11.2%) (p = 0.221)." ]

[ "Is it safe to omit neoadjuvant chemo-radiation in mucinous rectal carcinoma?<||||>Purpose was to compare the oncologic outcome of neoadjuvant chemoradiotherapy (nCXRT) versus postoperative chemoradiotherapy (pCXRT) for locally advanced mucinous rectal carcinoma (MRC) having curative total mesorectal excision (TME).", "Is it safe to omit neoadjuvant chemo-radiation in mucinous rectal carcinoma?<||||>One hundred and two patients with MRC (T3-4 and/or N1-2) of middle and lower third rectum were included. Patients were non-randomly divided into 2 groups: Group A (N = 61) had nCXRT followed by total mesorectal excision (TME) after 8-11 weeks and Group B (N = 41) had TME followed by pCXRT. Primary end points were disease free survival (DFS) and overall survival (OS). Secondary endpoints were tumor regression grade (TRG) and morbidity.", "Is it safe to omit neoadjuvant chemo-radiation in mucinous rectal carcinoma?<||||>In group A, 29 patients had partial response after nCXRT, 26 patients showed no change and 6 patients had progression. TME was done in 55 patients in group A and 41 patients in group B. Six patients in group A turned to be unresectable after nCXRT due to progressive disease. Mean follow-up was 53 months. In patients received TME, Four-year DFS was higher in group A compared to group B yet not statistically significant (DFS 0.69 [95% CI 0.54-0.85] vs. 0.67 [95% CI 0.47-0.87]; P = 0.39). However, actuarial 4 years OS was comparable in both groups (0.72 [95% CI 0.59-0.91] vs. 0.70 [95% CI 0.55-0.88]; P = 0.46 in groups A and B respectively). Multivariate analysis revealed that age<40, and N2 were risk factors of recurrence." ]

[ "Cardiac resynchronization therapy: do women benefit more than men?<||||>Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Whether there is a gender difference in the benefit derived from CRT has not been well studied.", "Cardiac resynchronization therapy: do women benefit more than men?<||||>This study included 728 consecutive CRT recipients at our institution who met guidelines for placement of a CRT device. Clinical characteristics and echocardiographic parameters were collected at baseline and after CRT; Kaplan-Meier survival analysis was performed using a national death and location database. The effects and outcome of CRT were compared between women and men.", "Cardiac resynchronization therapy: do women benefit more than men?<||||>Of 728 patients, 166 were female (22.8%). Female patients were younger than male patients (66.0 ± 11.9 years vs 69.4 ± 10.9 years; P<0.001) and more often had nonischemic cardiomyopathy (68% vs 36%; P<0.001). Both female and male patients had significantly improved clinical and echocardiographic parameters after CRT. The magnitude of improvement was similar in women and men, except that improvement in New York Heart Association (NYHA) class was greater in women than in men (-0.79 ± 0.78 vs -0.56 ± 0.85; P = 0.009). Although women were at lower risk of death than men after CRT (hazard ratio, 0.51; 95% confidence interval, 0.35-0.75; P<0.001, unadjusted), multivariate analysis indicated gender was not, but age at CRT placement, cardiomyopathy cause, NYHA class, and lead location were independent predictors of survival." ]

[ "Incidental colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy for patients with focal uptake confined to the left-sided colon?<||||>Although access to [18F]2-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography and computed axial tomography (PET/CT) for patients with malignancy has increased, little information is available on the suitability of PET/CT for diagnosis of advanced colonic neoplasms in oncology patients and on the clinical significance of incidental 18F-FDG focal uptake confined to the left-sided colon.", "Incidental colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy for patients with focal uptake confined to the left-sided colon?<||||>Patients who underwent 18F-FDG PET/CT followed, within 90 days, by colonoscopy were identified. Case-control analysis was undertaken to determine whether focal 18F-FDG uptake confined to the left-sided colon was associated with advanced neoplasms in the right-sided colon.", "Incidental colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy for patients with focal uptake confined to the left-sided colon?<||||>One hundred ninety-five patients with colonic 18F-FDG uptake and 561 without colonic (18)F-FDG uptake were identified. Of the 195 patients with focal colonic 18F-FDG activity, 103 patients (52.8%) had 145 advanced colonic neoplasms, including 58 colon cancers and 11 metastatic cancers. In the detection of advanced colonic neoplasms, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were 54.4, 82.4, 46.9, and 86.3%, respectively. Overall accuracy was 76.2%. Ten (8.0%) of the 125 patients with focal 18F-FDG uptake confined to the left-sided colon had three colon cancers and seven advanced adenomas in the right-sided colon. Case-control analysis revealed that focal 18F-FDG uptake confined to the left-sided colon was associated with an advanced neoplasms in the right-sided colon (OR, 3.02; 95% CI, 1.12-8.13; P = 0.023)." ]

[ "Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio associated with prognosis in patients with HER2-positive early breast cancer receiving adjuvant trastuzumab?<||||>To investigate whether the pretreatment neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) have any prognostic significance in patients with HER2-positive early breast cancer receiving adjuvant trastuzumab.", "Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio associated with prognosis in patients with HER2-positive early breast cancer receiving adjuvant trastuzumab?<||||>187 patients were retrospectively analyzed. The patients were separated into two groups according to the mean value of NLR and PLR (low NLR≤2.38, high NLR>2.38; and low PLR≤161.28, high PLR>161.28, respectively). The relationship between pretreatment NLR, PLR and clinicopathological factors was investigated. Univariate and multivariate Cox regression analyses were performed. To evaluate survival rates, the Kaplan-Meier method with log rank test were used.", "Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio associated with prognosis in patients with HER2-positive early breast cancer receiving adjuvant trastuzumab?<||||>The median duration of follow up was 26.0 months (range 6.0-84.0). In high NLR and PLR groups, the mean age was lower, tumor size was larger and the number of hormone receptor positive patients was higher. No statistically significant relationship was found between clinicopathological factors and both NLR and PLR groups. During follow up, the rate of relapse was 12.6% in the low NLR group, 16.2 % in the high NLR group, 12.6% in the low PLR group and 15.8% in the high PLR group (p=non significant). Although median disease free survival (DFS) was shorter in the high NLR than in the low NLR group, the difference was not statistically significant (p=0.45). No statistically significant difference was found between high and low PLR groups with regard to median DFS and overall survival (OS) (p=0.76, p=0.29, respectively)." ]

[ "Do trainees value feedback in case-based discussion assessments?<||||>Feedback is important in learning, including in workplace-based assessments.AIM: To explore trainee's perceptions of the educational value of case-based discussions (CBDs) specifically focusing on feedback.", "Do trainees value feedback in case-based discussion assessments?<||||>An online questionnaire and interviews obtaining detailed descriptions of paediatric trainees at UK specialist training levels 1 and 2 views and experiences were used. Qualitative data were analysed using a thematic framework analysis.", "Do trainees value feedback in case-based discussion assessments?<||||>Trainees viewed CBDs as educationally valuable, aiding reflective learning, improving decision making skills and effecting a change in practice. Opinions varied regarding how useful they found the feedback. Feedback was perceived as more valuable from assessors who had a positive attitude towards CBDs, understood the process and had experience in leading them. Time constraints and assessments performed in less suitable environments had a negative impact on feedback. Trainees felt the choice of case played an important role, with challenging cases resulting in more beneficial feedback." ]

[ "Is the acetazolamide test valid for quantitative assessment of maximal cerebral autoregulatory vasodilation?<||||>The cerebral vasodilating effect of acetazolamide (ACZ) injection has been used as an index of the autoregulatory vasodilation (or cerebral perfusion reserve). The question of whether the ACZ test assesses the maximal autoregulatory vasodilating capacity is not definitely resolved. The effects of ACZ injection on this reserve at a dose producing maximal vasodilation have never been evaluated and may help to resolve this problem.", "Is the acetazolamide test valid for quantitative assessment of maximal cerebral autoregulatory vasodilation?<||||>The effect of ACZ injection on cerebral blood flow (CBF) autoregulation was tested in anesthetized rats. A pilot experiment evaluated the dose-effect relationship of injected ACZ, cumulative doses (n=4, group 1), and independent bolus doses (n=6, group 2). CBF was estimated by laser-Doppler flowmetry, and cerebrovascular resistance (CVR) was calculated from mean arterial blood pressure (MABP) and from CBF (expressed as a percentage of baseline CBF). A bolus of ACZ of 21 mg/kg produced the maximal cerebral vasodilation that could be obtained by ACZ administration. In the main experiment, MABP was lowered from 110 to 20 mm Hg by stepwise bleeding in 3 groups of 6 animals treated 10 minutes before bleeding by injection of saline (group 3), 7 mg/kg ACZ (group 4), or 21 mg/kg ACZ (group 5).", "Is the acetazolamide test valid for quantitative assessment of maximal cerebral autoregulatory vasodilation?<||||>The CVR-MABP relationship was linear in all groups, indicating that CBF autoregulation was still effective after ACZ administration." ]

[ "Are cyanosed adults with congenital cardiac malformations depressed?<||||>To assess the incidence of depression, and the ability to interact socially, in adult patients with chronic cyanosis and congenital cardiac malformations.", "Are cyanosed adults with congenital cardiac malformations depressed?<||||>Prospective study of consecutive patients.", "Are cyanosed adults with congenital cardiac malformations depressed?<||||>Single institution, tertiary referral centre.", "Are cyanosed adults with congenital cardiac malformations depressed?<||||>Between 1993 and 2000, we assessed 76 patients with congenital cardiac malformations and persistent cyanosis, having a median age of 36.5 years, with a range from 19 to 64 years, at the time of referral. Female patients accounted for just under half (48.6%) of the sample. Just under two-fifths of the cohort (39.5%) had functionally univentricular cardiac anatomy, while 14.8% had tetralogy of Fallot with pulmonary atresia and aorto-pulmonary collateral arteries, and 17% had the Eisenmenger syndrome. During the period of follow-up, 17 (22.4%) of the patients died.", "Are cyanosed adults with congenital cardiac malformations depressed?<||||>We used clinical interviews and non-invasive assessment, employing Zung's questionnaire which provides a scale for the self-rating of depression. On this scale, a score above 50 points is indicative of depression.", "Are cyanosed adults with congenital cardiac malformations depressed?<||||>Of the survivors, 32 (54%) completed the self-rating questionnaires. Of these, 20 responders (63%) considered that they lead full lives, including sexual activities, while 26 (81%) had never harboured suicidal thoughts. Depression was diagnosed in 11 responders (34%), with a mean score of 66.9, standard deviation of 8.7, and a range from 53 to 89. The remaining 21 patients (66%) were without signs of depression, scoring a mean of 41.5, with standard deviation of 5.5, and a range from 35 to 46. Depression was associated with older age (40.5 years versus 33.5 years, p = 0.01), worse functional state in the classification of the New York Heart Association (2.95 versus 2.48, p = 0.03), and unemployment (p<0.0001), but independent from the severity of cyanosis, the level of the haematocrit, the saturation of oxygen, or previous surgical treatment." ]

[ "Antibiotics in surgical wards: use or misuse?<||||>Studies exploring the appropriateness of therapeutic antibiotic use among surgical patients are limited, particularly in developing countries. Therefore, the aim of our study was to determine the appropriateness of antibiotics prescribed in a surgical setting in Malaysia.", "Antibiotics in surgical wards: use or misuse?<||||>A prospective observational study was conducted in two surgical wards at a tertiary hospital in Malaysia from November 2012-July 2013. Data was collected using a case report form. The appropriateness of antibiotic therapy was based on compliance with either the Malaysian National Antibiotic Guidelines 2008 or International Clinical Practice Guidelines and determined by an expert panel (consisting of two infectious disease consultants and a pharmacist).", "Antibiotics in surgical wards: use or misuse?<||||>Over the study period, a total of 593 antibiotic courses were prescribed for 129 patients (4.6±3.4 antibiotics/patient). Only 34 (26.4%) patients received appropriate antibiotic therapy, whilst 95 (73.6%) patients received at least one course of inappropriate antibiotic therapy. The prevalence of inappropriate antibiotic use was 214 (66.3%) and 55 (42.0%) for prophylactic and therapeutic purposes, respectively. The most common causes of inappropriate prophylactic antibiotics were inappropriate timing 20 (36.4%) and inappropriate duration of prophylaxis 19 (34.5%). In cases of inappropriate timing, 9 (45%) were administered too late while 6 (30%) were too early. In contrast, inappropriate choice of antibiotics (42.1%) and inappropriate indication (40.7%) were the most common reasons encountered for inappropriate therapeutic antibiotics." ]

[ "Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function?<||||>Daytime sleepiness is a common clinical presentation in both obstructive sleep apnea (OSA) and cardiovascular diseases. The purpose of this study was to assess the relationship between degree of subjective daytime sleepiness and cardiac performance in patients with obstructive sleep apnea.", "Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function?<||||>Observational study.", "Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function?<||||>General Clinical Research Center.", "Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function?<||||>The study sample was comprised of 86 patients (68 men and 18 women) with an average age of 47 years. All were suspected of having obstructive sleep apnea and underwent confirmatory diagnostic polysomnography (respiratory disturbance index>or = 15).", "Sleepiness in obstructive sleep apnea: a harbinger of impaired cardiac function?<||||>Stroke volume and cardiac output were measured using impedance cardiography and corrected for body surface area to yield stroke index and cardiac index. Daytime sleepiness was quantified using the Epworth Sleepiness Scale. A higher Epworth Sleepiness Scale score, suggesting more daytime sleepiness, was significantly related to lower stroke index and cardiac index. In multiple regression analyses, the relationships of Epworth Sleepiness Scale score with both stroke index and cardiac index were significant (p<.05), even after controlling for age, sex, ethnicity, respiratory disturbance index, and mean sleep oxygen saturation." ]

[ "Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy?<||||>Schizophrenia leads to significant personal costs matched by high economic costs. Cognitive function is a strong predictor of disabilities in schizophrenia, which underpin these costs. This study of cognitive remediation therapy (CRT), which has been shown to improve cognition and reduce disability in schizophrenia, aims to investigate associations between improvements in cognition and cost changes.", "Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy?<||||>Eighty-five participants with schizophrenia were randomized to receive CRT or treatment as usual and were assessed at baseline, posttherapy, and 6 month follow-up. Four structural equation models investigated associations between changes in cognitive function and costs of care.", "Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy?<||||>All 4 models provided a good fit. Improvement in 3 individual cognitive variables did not predict total cost changes (model 1). But improvement in a single latent cognition factor was associated with a reduction in depression, which in turn was associated with reduced subsequent total costs (model 2). No significant associations with constituent daycare and special accommodation cost changes were apparent with 3 individual cognitive change variables (model 3). But improvement in a single latent cognitive change variable was associated with subsequent reductions in both daycare and special accommodation costs (model 4)." ]

[ "Inlet conditions for image-based CFD models of the carotid bifurcation: is it reasonable to assume fully developed flow?<||||>Computational fluid dynamics tools are useful for their ability to model patient specific data relevant to the genesis and progression of atherosclerosis, but unavailable to measurement tools. The sensitivity of the physiologically relevant parameters of wall shear stress (WSS) and the oscillatory shear index (OSI) to secondary flow in the inlet velocity profiles was investigated in three realistic models of the carotid bifurcation.", "Inlet conditions for image-based CFD models of the carotid bifurcation: is it reasonable to assume fully developed flow?<||||>Secondary flow profiles were generated using sufficiently long entrance lengths, to which curvature and helical pitch were added. The differences observed were contextualized with respect to effect of the uncertainty of the models' geometry on the same parameters.", "Inlet conditions for image-based CFD models of the carotid bifurcation: is it reasonable to assume fully developed flow?<||||>The effects of secondary velocities in the inlet profile on WSS and OSI break down within a few diameters of the inlet. Overall, the effect of secondary inlet flow on these models was on average more than 3.5 times smaller than the effect of geometric variability, with 13% and 48% WSS variability induced by inlet secondary flow and geometric differences, respectively." ]

[ "Do children and adolescent ice hockey players with and without a history of concussion differ in robotic testing of sensory, motor and cognitive function?<||||>KINARM end point robotic testing on a range of tasks evaluating sensory, motor and cognitive function in children/adolescents with no neurologic impairment has been shown to be reliable. The objective of this study was to determine whether differences in baseline performance on multiple robotic tasks could be identified between pediatric/adolescent ice hockey players (age range 10-14) with and without a history of concussion.", "Do children and adolescent ice hockey players with and without a history of concussion differ in robotic testing of sensory, motor and cognitive function?<||||>Three hundred and eighty-five pediatric/adolescent ice hockey players (ages 10-14) completed robotic testing (94 with and 292 without a history of concussion). Five robotic tasks characterized sensorimotor and/or cognitive performance with assessment of reaching, position sense, bimanual motor function, visuospatial skills, attention and decision-making. Seventy-six performance parameters are reported across all tasks.", "Do children and adolescent ice hockey players with and without a history of concussion differ in robotic testing of sensory, motor and cognitive function?<||||>There were no significant differences in performance demonstrated between children with a history of concussion [median number of days since last concussion: 480 (range 8-3330)] and those without across all five tasks. Performance by the children with no history of concussion was used to identify parameter reference ranges that spanned 95 % of the group. All 76 parameter means from the concussion group fell within the normative reference ranges." ]

[ "Does clozapine cause tardive dyskinesia?<||||>The authors attempted to determine if chronic exposure to clozapine can cause tardive dyskinesia.", "Does clozapine cause tardive dyskinesia?<||||>Twenty-eight schizophrenic or schizoaffective patients with no prior history of definite tardive dyskinesia were treated with clozapine for at least 1 year, and their ongoing modified Simpson Dyskinesia Scale ratings were analyzed. These data were then compared with those of another group of similarly diagnosed patients who were treated with a conventional neuroleptic for at least 1 year.", "Does clozapine cause tardive dyskinesia?<||||>Two patients in the clozapine-treated group (both of whom had ratings of questionable tardive dyskinesia at baseline) were later rated by the modified Simpson Dyskinesia Scale as having mild tardive dyskinesia on at least two consecutive ratings 3 months apart. Although there was uncertainty about whether clozapine definitely caused the tardive dyskinesia in those two patients, a survival analysis comparing the clozapine-treated group with the neuroleptic-treated group showed a lower risk of tardive dyskinesia developing in the clozapine-treated group." ]

[ "Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis?<||||>Duodenal adenomatosis is a premalignant condition often not treatable by local resection or endoscopy. An option for treatment is a pylorus-preserving (pp)-Whipple resection. Since the introduction of pancreas-preserving total duodenectomy (PPTD), the question has arisen whether a pp-Whipple resection is still needed to treat duodenal adenomatosis.", "Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis?<||||>In a 5-year period 23 PPTDs were performed for duodenal adenomatosis. In a matched-pairs analysis the outcome following PPTD (16 patients with a follow-up longer than 12 months) was compared with pp-Whipple.", "Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis?<||||>Hospital mortality in all 23 patients was 4.3% and total morbidity 30% after PPTD. Operation time, intensive care and hospital stay, morbidity, and mortality were comparable between the matched paired groups (16 patients). Patients with PPTD had significantly lower intraoperative blood loss. No PPTD patient required pancreatic enzyme substitution, compared with 12 patients after pp-Whipple. Quality-of-life analysis in PPTD patients revealed no difference compared to a normal control population and the pp-Whipple group." ]

[ "Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction?<||||>This study sought to assess the maximal rate of acute Thrombolysis in Myocardial Infarction (TIMI) grade 3 patency that can be achieved in unselected patients.", "Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction?<||||>Early and complete (TIMI grade 3 flow) reperfusion is an important therapeutic goal during acute myocardial infarction. However, thrombolysis, although widely used, is often contraindicated or ineffective. The selective use of primary and rescue percutaneous transluminal coronary angioplasty (PTCA) may increase the number of patients receiving reperfusion therapy.", "Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction?<||||>A cohort of 500 consecutive unselected patients with acute myocardial infarction were prospectively treated using a patency-oriented scheme: Thrombolysis-eligible patients received thrombolysis (n = 257) and underwent 90-min angiography to detect persistent occlusion for treatment with rescue PTCA. Emergency PTCA (n = 193) was attempted in patients with contraindications to thrombolysis, cardiogenic shock or uncertain diagnosis and in a subset of patients admitted under \"ideal conditions.\" A small group of patients (n = 38) underwent acute angiography without PTCA. Conventional medical therapy was used in 12 patients with contraindications to both thrombolysis and PTCA.", "Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction?<||||>Ninety-eight percent of patients received reperfusion therapy (thrombolysis, PTCA or acute angiography), and angiographically proven early TIMI grade 3 patency was achieved in 78%. Among patients with TIMI grade 3 patency, thrombolysis alone was the strategy used in 37%, emergency PTCA in 40% and rescue PTCA after failed thrombolysis in 15%; spontaneous patency occurred in 8%." ]

[ "Follow-up visits after IUD insertion. Are more better?<||||>To determine whether frequent follow-up visits for intrauterine device (IUD) users prevents the development of pelvic inflammatory disease (PID).", "Follow-up visits after IUD insertion. Are more better?<||||>A prospective, cohort design was used to study 1,713 women who received an IUD in 1992 in Mexico. They were divided into two different follow-up regimens and were asked to return for either two or four revisits in the first year after insertion. The main outcome measures included incidence of PID and asymptomatic/symptomatic lower genital tract infections. Time to detection of lower genital tract infections was measured in a proportional hazards regression model; this analysis achieved 90% power to detect differences between the regimens.", "Follow-up visits after IUD insertion. Are more better?<||||>The two regimens were nearly identical in terms of PID incidence. The incidence rates for asymptomatic and symptomatic lower genital tract infection were slightly higher in the four-visit regimen; however, the incidence rate ratios were not statistically elevated: 1.41 (0.77-2.56) and 1.23 (0.67-2.27), respectively. In the regression, the variable denoting follow-up regimen was not associated with time to detection of lower genital tract infection." ]

[ "Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate?<||||>Many studies demonstrate that the elderly consume a nutritionally inadequate diet that includes deficiencies in macro- and microelements; iron and zinc being significant examples of the former.", "Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate?<||||>To assess the adequacy of dietary iron and zinc intakes in the elderly.", "Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate?<||||>The study was conducted on n = 102 elderly persons, participating in the PolSenior Project, aged over 65, of which 44 were women and 58 men. Consumption data were collected by using 3 day dietary record from which a usual intakes of energy, macroelements (iron and zinc) were calculated. The Estimated Average Requirement (EAR) cut point and z-scores methods were used to determine probabilities of whether iron and zinc uptake was adequate per subject.", "Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate?<||||>By using the EAR cut-point method it was stated that iron intake was inadequate for 5% of respondents, whereas 44% showed deficits in zinc (34% women and 52% men). The z-scores demonstrated that 3% of subjects had high probabilities of deficiencies in iron and 52% in zinc. Indeed, very high zinc deficiencies were observed in 20% of cases." ]

[ "Barriers to effective treatment of pediatric solid tumors in middle-income countries: can we make sense of the spectrum of nonbiologic factors that influence outcomes?<||||>The delivery of effective treatment for pediatric solid tumors poses a particular challenge to centers in middle-income countries (MICs) that already are vigorously addressing pediatric cancer. The objective of this study was to improve the current understanding of barriers to effective treatment of pediatric solid tumors in MICs.", "Barriers to effective treatment of pediatric solid tumors in middle-income countries: can we make sense of the spectrum of nonbiologic factors that influence outcomes?<||||>An ecologic model centered on pediatric sarcoma and expanded to country as the environment was used as a benchmark for studying the delivery of solid tumor care in MICs. Data on resources were gathered from 7 centers that were members of the Central American Association of Pediatric Hematologists and Oncologists (AHOPCA) using an infrastructure assessment tool. Pediatric sarcoma outcomes data were available, were retrieved from hospital-based cancer registries for 6 of the 7 centers, and were analyzed by country. Patients who were diagnosed from January 1, 2000 to December 31, 2009 with osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, and other soft tissue sarcomas were included in the analysis. To explore correlations between resources and outcomes, a pilot performance index was created.", "Barriers to effective treatment of pediatric solid tumors in middle-income countries: can we make sense of the spectrum of nonbiologic factors that influence outcomes?<||||>The analyses identified specific deficits in human resources, communication, quality, and infrastructure. The treatment abandonment rate, the proportion of metastatic disease at diagnosis, the relapse rate, and the 4-year abandonment-sensitive overall survival (AOS) rate varied considerably by country, ranging from 1% to 38%, from 15% to 54%, from 24% to 52%, and from 21% to 51%, respectively. The treatment abandonment rate correlated inversely with health economic expenditure per capita (r = -0.86; P = .03) and life expectancy at birth (r = -0.93; P = .007). The 4-year AOS rate correlated inversely with the mortality rate among children aged<5 years (r = -0.80; P = 0.05) and correlated directly with the pilot performance index (r = 0.98; P = 0.005)." ]

[ "Do the choices of airway affect the post-anesthetic occurrence of nausea after knee arthroplasty?<||||>The primary goal of this study was to assess the impact of airway devices on the incidence of nausea after knee arthroplasty and their interaction with the use of nitrous oxide.", "Do the choices of airway affect the post-anesthetic occurrence of nausea after knee arthroplasty?<||||>Charts were reviewed for 499 patients after knee arthroplasty under general anesthesia. Demographic data, type of airway device, nitrous oxide, sevoflurane, desflurane, isoflurane, fentanyl, metoclopramide, ondansetron, dexamethasone, rocuronium and neostigmine were analyzed. Fisher's exact test was used to compare the categorical factors and t-test was used for continuous variables. Sinclair scores were used for post-operative nausea and vomiting (PONV) risk stratification. Multivariate logistic regression model was constructed to identify the factors contributing to the frequency of PONV.", "Do the choices of airway affect the post-anesthetic occurrence of nausea after knee arthroplasty?<||||>PONV was documented in 10.3% of patients. Nitrous oxide was associated with a higher frequency of PONV than those received air mixture (12.5% vs. 8.7%, P<0.01). Prior to risk stratification, the frequency of PONV was 17% in the endotracheal tube (ETT) vs. 6.7% in the laryngeal mask airway (LMA) group (P<0.01). Sinclair score was 0.51 +/- 0.17 for the ETT group and 0.74 +/- 0.12 for the LMA group (P<0.001). After risk stratification and matching, the incidence of PONV was 15.8% with the use of ETT compared with 7.9% for LMA (P<0.05)." ]

[ "Is being breastfed as an infant associated with adult pulmonary function?<||||>Breastfeeding reduces the risk of asthma and respiratory infections in infants. Since respiratory infections are associated with reduced pulmonary function in adolescents, pulmonary function impairment may be carried into adulthood. Our aim was to determine whether a history of having been breastfed as an infant is a determinant of adult pulmonary function.", "Is being breastfed as an infant associated with adult pulmonary function?<||||>We analyzed data from a general population sample of residents of Erie and Niagara Counties between September 1995 and December 1999. We calculated forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) prediction equations and used multiple linear regression models to study the association between having been breastfed as an infant and percentage predicted FEV(1) (FEV(1)%) and percentage predicted FVC (FVC%) after adjustment for covariates.", "Is being breastfed as an infant associated with adult pulmonary function?<||||>Of 2305 subjects, 62% reported having been breastfed. After controlling for age, gender, weight, smoking status, pack-years of smoking, eosinophil counts and dietary factors, there was no association between having been breastfed (yes/no) and FEV(1)% or FVC% (regression coefficients 0.0049, p = 0.46 and 0.0055, p = 0.43, respectively)." ]

[ "Do topical anesthetics reduce periareolar injectional pain before sentinel lymph node biopsy?<||||>Topical anesthetics have been used in various procedures. The purpose of this study was to evaluate efficacy of lidocaine/prilocaine cream in decreasing the pain of injection for sentinel lymph node biopsy.", "Do topical anesthetics reduce periareolar injectional pain before sentinel lymph node biopsy?<||||>A prospective, randomized, placebo-controlled study was conducted on female breast cancer patients undergoing periareolar injection for sentinel lymph node isolation. Subjects applied lidocaine/prilocaine cream or a placebo cream before injection and completed a survey postoperatively.", "Do topical anesthetics reduce periareolar injectional pain before sentinel lymph node biopsy?<||||>Twenty treatment and 19 control patients were studied. There was a trend for control subjects to indicate that the injection was \"painful\" or \"extremely painful\" more often than treatment subjects (52.6% vs 25.0%, respectively, P = .074). The treatment group was more likely to recommend the cream to other cancer patients (70.0% vs 42.1%), with a trend toward significance (P = .076)." ]

[ "Impedance cardiography: a role in vasovagal syncope diagnosis?<||||>vasovagal syncope is the most common cause of syncope in all age groups, with diagnosis usually based on history, examination and basic investigations to exclude alternative causes of syncope. Where doubt exists, the head-up tilt (HUT) test is used for diagnosis but is time consuming and lacks a gold standard to accurately assess sensitivity and specificity. Alternative methods of diagnosing vasovagal syncope would thus be useful.", "Impedance cardiography: a role in vasovagal syncope diagnosis?<||||>to investigate the potential for impedance cardiography (ICG)-derived haemodynamic measures to predict HUT test outcome in unexplained syncope.", "Impedance cardiography: a role in vasovagal syncope diagnosis?<||||>prospective controlled study.", "Impedance cardiography: a role in vasovagal syncope diagnosis?<||||>eighty-six patients with unexplained syncope and 43 non-syncopal controls.", "Impedance cardiography: a role in vasovagal syncope diagnosis?<||||>all subjects underwent continuous heart rate, blood pressure and ICG measurements during 10 min supine rest and during HUT. Vasovagal syncope was diagnosed when patients experienced symptom reproduction with concomitant haemodynamic derangements.", "Impedance cardiography: a role in vasovagal syncope diagnosis?<||||>during rest prior to HUT, the syncopal group had higher mean heart rate (P = 0.0008) and lower baroreceptor effectiveness index (P<0.0001) compared to non-syncopal controls. On comparing patients who presented with unexplained syncope who subsequently had a positive HUT (therefore a diagnosis of vasovagal syncope 55 [64%]; mean age 47 years, range 17-85) to those having a negative tilt test (n = 31; mean age 47 years, range 17-88), there were no significant differences found in cardiovascular or autonomic parameters prior to HUT. A predictive ROC curve model at a 85% threshold allowed using cardiac index (CI), end-diastolic index (EDI) and left ventricular work index (LVWI) would identify those who would have a positive HUT from baseline cardiovascular measurements (CI>3.5, EDI>77, LVWI>4.7) with 93% sensitivity and 17% specificity." ]

[ "Is it possible to stop follow-up of patients with primary T1G3 urothelial carcinoma of the bladder managed with intravesical bacille Calmette-Guérin immunotherapy?<||||>Recurrence and progression of T1 grade 3 (T1G3) urothelial bladder carcinomas (UBCs) treated with bacille Calmette-Guérin (BCG) are common events, but the long-term follow-up of the disease remains controversial.", "Is it possible to stop follow-up of patients with primary T1G3 urothelial carcinoma of the bladder managed with intravesical bacille Calmette-Guérin immunotherapy?<||||>To evaluate the long-term outcomes of BCG intravesical therapy in relation to disease recurrence and progression in primary T1G3 UBCs and upper tract disease.", "Is it possible to stop follow-up of patients with primary T1G3 urothelial carcinoma of the bladder managed with intravesical bacille Calmette-Guérin immunotherapy?<||||>A single-institution, retrospective, population-based analysis of 316 patients with primary T1G3 UBC treated with transurethral resection (TUR) and BCG induction intravesical instillations was performed. Response was determined and monitored by routine periodic urine cytology, cystoscopy, and upper tract imaging.", "Is it possible to stop follow-up of patients with primary T1G3 urothelial carcinoma of the bladder managed with intravesical bacille Calmette-Guérin immunotherapy?<||||>The median follow-up was 70 months (maximum 210 months). Among all of the tumours, 49.4 % did not relapse, 48.7 % recurred in the bladder during the first 5 years of surveillance, and only 6 patients (1.9 %) recurred after being free of disease during the first 5 years of follow-up. Nineteen percentage of the UBCs progressed to stage T2, and only 2 patients (1.2 %) progressed after the first 5 years of surveillance. An upper urinary tract recurrence was detected in 9.2 % of the patients; 65.5 % were diagnosed within the upper urinary tract during the first 5 years of follow-up." ]

[ "Impact of H. pylori on growth: is the infection or mucosal disease related to growth impairment?<||||>Helicobacter pylori (H. pylori) has been recognized as one of the most common chronic bacterial infections in the world. Most children are colonized in early childhood, and the infection will last a lifetime unless the child is treated with appropriate antibiotics.AIM: To evaluate whether H. pylori infection has an influence on growth and whether the severity of endoscopic findings relates to the growth impairment.", "Impact of H. pylori on growth: is the infection or mucosal disease related to growth impairment?<||||>We formed four groups based on the presence or absence of H. pylori infection and gastrointestinal complaints as follows: group I: RAP +/H. pylori+; group II: RAP +/H. pylori-; group III: RAP -/H. pylori+; group IV: RAP -/H. pylori-. The relationship between endoscopic appearances, histological severity of gastritis, and antral H. pylori density with growth parameters was evaluated.", "Impact of H. pylori on growth: is the infection or mucosal disease related to growth impairment?<||||>The BMI standard derivation scores of groups I and II were significantly lower than those of asymptomatic controls independent of their H. pylori status. A significant difference in height for age standard derivation scores was observed only between groups I and IV. When we compared the BMI and height for age standard derivation scores of group III and group IV combined with that of the endoscopically normal children in the recurrent abdominal pain group, there was no significant difference between the two groups." ]

[ "Assessment of colorectal cancer knowledge and patient attitudes towards screening: is Ireland ready to embrace colon cancer screening?<||||>The level of awareness among the Irish public regarding colorectal cancer (CRC) remains uncertain. This study aimed to characterise CRC knowledge levels among a cohort of Irish patients.", "Assessment of colorectal cancer knowledge and patient attitudes towards screening: is Ireland ready to embrace colon cancer screening?<||||>A survey evaluating CRC knowledge levels was distributed among outpatients at a gastroenterology clinic in a Dublin teaching hospital.", "Assessment of colorectal cancer knowledge and patient attitudes towards screening: is Ireland ready to embrace colon cancer screening?<||||>In total, 472 surveys were distributed of which 465 (98.5%) were returned. Twenty-nine percent of respondents correctly judged CRC to be the commonest cause of cancer death among the options provided while 26% correctly judged the lifetime risk of CRC; 59% underestimated and 15% overestimated the risk. Most patients (91%) were willing to pay 300 euros for a prompt colonoscopy if recommended by their physician while 7% opted to wait 6 months for a free colonoscopy." ]

[ "Regression of coronary disease after bypass surgery: Urban myth or common finding?<||||>Coronary artery disease has been viewed as a relentless, progressive disease. We sought to describe the prevalence and distribution of regression of native vessel disease in coronary artery bypass patients and characterize its relationship with bypass grafting.", "Regression of coronary disease after bypass surgery: Urban myth or common finding?<||||>Among 619 patients who underwent bypass surgery in a radial artery trial, 405 had follow-up angiography available a mean of 6.2 ± 3.1 years (range, 0-14) after surgery. The percentage of diameter stenosis of each major native coronary vessel was reported by 3 cardiac specialists and classified into grades of nonflow limiting (0%-39%), moderate (40%-69%), flow limiting (70%-80%), severely stenosed (81%-99%), and occluded (100%). Native vessel disease regression was defined as decrease in 1 or more grades of stenosis between the pre- and postoperative angiograms.", "Regression of coronary disease after bypass surgery: Urban myth or common finding?<||||>A total of 1742 native coronary arteries had preoperative stenosis of at least 40% and were included in the present analysis, receiving 753 arterial grafts and 391 saphenous vein grafts. Overall, the prevalence of disease regression was 19.7%, and 45% of patients demonstrated regression in 1 or more vessels. The presence of an arterial graft increased the likelihood of disease regression (21.3% compared with 16% for venous bypassed vessels, P = .012) as did the location in the left circulation (22.6% compared with 13.9% for the right circulation, P < .001) and having a flow-limiting (≥70%) lesion (21.9% compared with 9.8% for moderate lesions, P < .001)." ]

[ "Is elevated creatinine a reliable marker for methanol toxicity in nitromethane-containing model fuel ingestions in children?<||||>In the absence of a rapid serum methanol level estimation, it is difficult to assess the risk from unintentional childhood ingestion of model fuels containing methanol and nitromethane (MFNM). Previous reports have documented false elevations of serum creatinine from the nitromethane in these fuels, suggesting its utility as a readily available marker of significant methanol ingestion.", "Is elevated creatinine a reliable marker for methanol toxicity in nitromethane-containing model fuel ingestions in children?<||||>We performed a 2-year retrospective chart review of cases of ingestion of MFNM in children, with both a methanol level and measured creatinine level.", "Is elevated creatinine a reliable marker for methanol toxicity in nitromethane-containing model fuel ingestions in children?<||||>Seven children, ages 19 months to 3 years, ingested MFNM. All seven children were seen in a hospital and had measured methanol and creatinine levels. All blood samples for methanol and creatinine were drawn within 3 hours of ingestion with methanol estimation delayed up to 24 hours. Creatinine ranged from 0.39 (0.034 mmol/l) to 10.7 mg/dl (0.95 mmol/l). All methanol levels were<10 mg/dl (0.31 mmol/l) or reported as negative. Fomepizole was initiated empirically in two patients due to delay in obtaining methanol analysis results.", "Is elevated creatinine a reliable marker for methanol toxicity in nitromethane-containing model fuel ingestions in children?<||||>Transient elevations of creatinine occurred in five of the seven children. Blood urea nitrogen was within normal limits, and there was no history of renal impairment in these children, suggesting the elevated creatinine was mostly related to nitromethane ingestion. No child had a significantly elevated methanol level." ]

[ "Is normothermic cardiopulmonary bypass associated with increased morbidity?<||||>There is some evidence of improved myocardial protection with warm continuous blood cardioplegia. Warm cardioplegia however implies warm (normothermic) cardiopulmonary bypass (CPB). We evaluated retrospectively the influence of bypass temperature on the intra- and postoperative course of 121 patients, operated on for valvular and/or coronary artery disease. Only elective procedures with continuous blood cardioplegia were included. The patients were divided in two groups: warm group (n = 78): normothermic CPB (venous temperature>33 degrees C) cold group (n = 43): hypothermic CPB (<33 degrees C).", "Is normothermic cardiopulmonary bypass associated with increased morbidity?<||||>normothermic CPB resulted in a significantly shorter CPB time (84 + 3 min vs. 98 +/- 6 min, p = 0.02, mean +/- 1 standard error of the mean). In addition there was a higher need for vasoconstrictive drugs during cold CPB (Noradrenalin: 19 +/- 3 micrograms vs. 90 +/- 32 micrograms, p = 0.003). There was no difference in enzyme levels on the first postoperative day (amylase, creatinkinase, creatinin), in postoperative complication rate (resuscitations, rethoracotomies, cerebrovascular incidents) and mortality (warm 3% vs. cold 2%) between the two groups. The postoperative time until extubation however was significantly shorter in the warm group (33 +/- 5 h vs. 60 +/- 11 h, p = 0.04)." ]

[ "Can a fatigue test of the isolated lumbar extensor muscles of untrained young men predict strength progression in a resistance exercise program?<||||>A three-phased fatigue test of the lumbar extensor muscles was designed, consisting of two consecutive measurements of full-range isometric back strength on a lumbar measurement device, separated by a dynamic back extension set to volitional fatigue. Differences between the strength values of the 1st and 3rd step is thought to reflect individual back muscle fatigue characteristics. The training program was primarily aimed at improving lumbar extensor endurance, by using a relative high number of repetition and low training loads. Linear regression analysis was used to evaluate the relationship between lumbar strength progression and several fatigue test parameters.", "Can a fatigue test of the isolated lumbar extensor muscles of untrained young men predict strength progression in a resistance exercise program?<||||>The main fatigue indicator in our regression models (isometric strength decline between 1st and 3rd step) did not show predictive value in lumbar strength progression in training and testing, respectively. On the other hand, the work capacity that subjects delivered in the dynamic set (2nd step) had some predictive value." ]

[ "Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions?<||||>The \"single-needle\" celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated.", "Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions?<||||>Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long-lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed.", "Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions?<||||>The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P<0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P<0.01). A significant difference in long-lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P<0.01). No patients showing two or one quadrant with contrast had long-lasting pain relief." ]

[ "Transcatheter aortic valve implantation after previous mechanical mitral valve replacement: expanding indications?<||||>Cardiac operation for severe aortic stenosis after previous mitral valve replacement is a surgical challenge in older patients with multiple morbidities. Transcatheter aortic valve implantation (TAVI) after previous mechanical mitral valve replacement has been considered a high-risk procedure, owing to possible interference with the mitral valve prosthesis.", "Transcatheter aortic valve implantation after previous mechanical mitral valve replacement: expanding indications?<||||>Since August 2008, 5 female high-risk patients with severe aortic stenosis and previous mitral valve replacement (mean ± SD age, 80 ± 5.1 years; logistic EuroSCORE, 39.3% ± 20.5%) underwent TAVI with a pericardial xenograft valve that was fixed with a stainless steel, balloon-expandable stent (Edwards Lifesciences SAPIEN). We used a transapical approach in 4 patients and a transfemoral approach in 1 patient. Transesophageal echocardiography and multidetector computed tomography were used for preoperative planning and assessment of operation feasibility. The mean distance between the aortic annulus and the mitral valve prosthesis was 10 ± 1 mm (range, 9-11 mm).", "Transcatheter aortic valve implantation after previous mechanical mitral valve replacement: expanding indications?<||||>TAVI was performed successfully in all 5 patients. There was no direct or functional interference with the mechanical mitral valve prostheses. Echocardiography revealed good valve function with no more than mild paravalvular incompetence early in the postoperative period and during routine follow-up. There were no neurologic events. After an initially uneventful course with good aortic valve function at the most recent echocardiography evaluation, however, 2 of the patients died from fulminant pneumonia on postoperative days 4 and 48." ]

[ "Intravascular ultrasound imaging of coronary arteries. Is three layers the norm?<||||>The purpose of this study was to evaluate the significance of the three-layered appearance of coronary arteries in adolescence and adults from intravascular ultrasound scans and to correlate these observations with histopathology.", "Intravascular ultrasound imaging of coronary arteries. Is three layers the norm?<||||>Sixteen intact hearts were excised at autopsy from patients with no clinical history of coronary artery disease. The patients' ages ranged from 13 to 55 years. A 30-MHz ultrasound imaging catheter was used to obtain images throughout the epicardial coronary vasculature. A total of 72 image cross sections was marked by epivascular sutures, and the corresponding histological sections were examined. Ultrasound images were classified into two groups: images exhibiting three-layered appearance and images without distinct layering. Histological analysis revealed a significantly greater degree of intimal thickening in segments with three layers (243 +/- 105 microns) than in nonlayered segments (112 +/- 55 microns). Discriminant analysis of these data predicted the threshold between the two groups to be 178 microns. Measurements of medial thickness were not different between these two groups (235 +/- 61 versus 210 +/- 76 microns). In the nonlayered group, the average patient age was 27.1 +/- 8.5 years, whereas in the three-layered groups, the average age was 42.8 +/- 9.8 years." ]

[ "Are young women with Turner syndrome at greater risk of coronary artery disease?<||||>Turner syndrome is an X chromosome aberration that affects females. Women with Turner syndrome are exposed to a greater risk of coronary artery disease, arterial hypertension and type 2 diabetes mellitus.", "Are young women with Turner syndrome at greater risk of coronary artery disease?<||||>The objective of our study was to assess the prevalence of classic risk factors of coronary artery disease in young women with Turner syndrome in comparison to a representative group of Polish young women from the general population.", "Are young women with Turner syndrome at greater risk of coronary artery disease?<||||>The study enrolled 176 women aged 25 years with Turner syndrome from the whole of Poland. The controls were 231 young women selected to be representative, who took part in the NATPOL PLUS study (website: http://www.natpol.pl).", "Are young women with Turner syndrome at greater risk of coronary artery disease?<||||>Women with Turner syndrome tended to be shorter and lighter than the general population (P<0.0001), they were also found to present higher values of body mass index and waist-hip ratio (P<0.0001). Significantly higher values of diastolic blood pressure (P<0.0001) and levels of total cholesterol and low-density lipoprotein fraction were found in the group of women with Turner syndrome, whereas the high-density lipoprotein fraction level was lower (P<0.05). Similarly, glucose levels on an empty stomach were significantly higher among women with Turner syndrome (P<0.0001)." ]

[ "Does normothermia during cardiopulmonary bypass increase neutrophil-endothelium interactions?<||||>The use of warm blood cardioplegia is usually associated with that of warm cardiopulmonary bypass (CPB). Little is known, however, about the effect of temperature during bypass on neutrophil-endothelium interactions, which are currently considered a key component of the inflammatory response to CPB.", "Does normothermia during cardiopulmonary bypass increase neutrophil-endothelium interactions?<||||>Twenty-five patients operated on under CPB were studied. Core temperature during bypass was kept normothermic (33.5 degrees C to 37 degrees C) in 14 and lowered to 28 degrees C to 30 degrees C in the 11 remaining patients. The two groups were otherwise comparable. Arterial blood samples were collected before CPB and 30 minutes, 4 hours, and 24 hours thereafter. Samples were assayed for interleukin-1 receptor antagonist (IL-1ra), soluble intercellular adhesion molecule 1 (sICAM-1), and elastase, which are markers of cytokine production, cytokine-upregulated endothelial ligands for neutrophil adhesion molecules, and degranulation secondary to adhesion of neutrophils to endothelial cells, respectively. IL-1ra levels (mean +/- SEM) peaked 4 hours after bypass and were significantly higher in the warm group (87,926 +/- 24,067 versus 18,090 +/- 5798 mg/L, P<.02). Peak values of sICAM-1, which occurred 24 hours after bypass, were correspondingly higher in warm patients (414 +/- 74 versus 298 +/- 23 micrograms/L in cold patients). In keeping with these data, warm patients released significantly more elastase at both the 30-minute (703 +/- 101 versus 349 +/- 55 micrograms/L, P<.01) and 4-hour (627 +/- 116 versus 324 +/- 31 micrograms/L, P<.03) post-CPB study points." ]

[ "Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause for concern?<||||>Our objective was to analyze changes in pulmonary artery size after bidirectional cavopulmonary shunt.", "Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause for concern?<||||>All 47 patients who underwent bidirectional cavopulmonary shunt between March 1990 and May 1995 who had preoperative and postoperative angiograms available for review were selected for study. This included 24 patients who had also undergone a modified Fontan operation. Clinical records were reviewed retrospectively and cross-sectional follow-up was obtained by direct physician contact. Angiograms were reveiwed, and the right and left pulmonary artery diameters were each measured at two locations: immediately distal to their origin and at the narrowest point. In addition, the lower lobe pulmonary artery branch was measured just distal to its origin. Cross-sectional areas (left, right, and total) at each point of measurement were indexed to body surface area. Angiographic and hemodynamic data were analyzed.", "Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause for concern?<||||>Changes in the various measures of pulmonary artery size after bidirectional cavopulmonary shunt varied considerably. On average the absolute diameters increased for all measures, but the increase in diameter was significant only for the lower lobe arteries. All pulmonary artery indices decreased on average, but these changes did not approach significance. Patients who underwent pulmonary artery augmentation at the time of bidirectional cavopulmonary shunt had significantly smaller pulmonary artery indices before pulmonary artery augmentation, relative to those who did not undergo pulmonary artery repair, and significantly greater changes (possibly to a large extent owing to pulmonary artery repair) in the right and left pulmonary artery index after bidirectional cavopulmonary shunt. Lower lobe indices did not differ preoperatively or exhibit different degrees of change in size between patients who did and did not undergo pulmonary artery repair. One patient died after Fontan completion (pulmonary artery index: 305 mm2/m2), and none of the factors analyzed correlated with Fontan outcomes." ]

[ "Tying a loop-to-strand suture: is it safe?<||||>This study was undertaken to evaluate the integrity of the loop-to-strand knot when tied with square and nonidentical sliding knots.", "Tying a loop-to-strand suture: is it safe?<||||>The synthetic absorbable monofilament suture poliglecaprone 25 in 0 and 2-0 suture gauges was used in this experiment. For each suture gauge, 3 groups of knots were tested: (1) single strand-to-single strand, flat square knot, (2) loop-to-single strand, flat square knot, and (3) loop-to-single strand, nonidentical sliding knot. All knots were tied with 6 throws. The proportion of knots becoming untied was compared among the 3 groups for each suture gauge. Ultimate load required to untie or break knots within each group was also evaluated.", "Tying a loop-to-strand suture: is it safe?<||||>The loop-to-strand knot performed well in both suture gauges tested as long as it was tied with a flat square knot. The loop-to-strand knot tied with a nonidentical sliding knot had an unacceptably high failure rate." ]

[ "The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?<||||>The abdominal drawing-in manoeuvre (ADIM) is a common clinical tool for manually assessing whether a preferential activation of the deep abdominal muscles in patients with low back pain (LBP) is 'correct' or not. The validity and reliability of manual assessment of the ADIM are, however, as yet unknown. This study evaluated the concurrent and discriminative validity and reliability of the manually assessed ADIM.", "The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?<||||>Single-blinded cross-sectional study.", "The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?<||||>General population in Stockholm County, Sweden.", "The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?<||||>The study sample comprised 38 participants seeking care for LBP, and 15 healthy subjects.", "The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?<||||>The manual ADIM was assessed as correct or not following a standard procedure. Ultrasound imaging (USI) was used as the concurrent reference (gold standard) for the manually assessed ADIM by calculating a ratio of the change in muscle thickness between the resting and the contracted states: the correlation between manual test and USI was calculated. Discriminative validity was analysed by calculating sensitivity and specificity. A sample of 24 participants was analysed with κ coefficients for interobserver reliability between two raters.", "The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?<||||>The concurrent validity between the manual ADIM and the ADIM-USI ratios showed poor correlations (r=0.13-0.40). The discriminative validity of the manually assessed ADIM to predict LBP showed a sensitivity/specificity of 0.30/0.73, while the ADIM-USI ratio to predict LBP showed 0.19/0.87. The interobserver reliability for the manually assessed ADIM revealed substantial agreement: K=0.71, CI (95%) 0.41 to 1.00." ]