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Answer the question based on the following context: Because the implications of micrometastases found on sentinel node biopsy (SNB) for ductal carcinoma in situ (DCIS) or ductal carcinoma in situ with microinvasion (DCISM) are largely unknown, we wished to determine if SNB pathology predicted recurrence risk in DCIS/DCISM. Retrospective chart review identified patients with DCIS/DCISM who underwent SNB. SNB findings and all local and distant recurrences were determined. A total of 322 patients underwent SNB for DCIS/DCISM. There were 13 local recurrences (4.0%) and 1 (.03%) distant recurrence at a median follow-up of 47.9 months (range 0 to 110.6), 12 in patients with negative SNBs; 1 patient had a positive SNB. There were 4 recurrences after mastectomy and 9 after lumpectomy. In 29 patients with positive SNBs, there was only 1 recurrence (3.4%).

Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion?

Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of local or distant recurrence. Other features of DCIS and DCISM may be important in predicting recurrence risk.

Question: Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion? Answer: Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of local or distant recurrence. Other features of DCIS and DCISM may be important in predicting recurrence risk.

Answer the question based on the following context: Although increased prevalence of transfusion transmissible infections (TTI) among "men who have sex with men" (MSM) has been well documented, the exclusion of MSM as blood donors is contested. The aim of this systematic review is to find studies that describe the risk of TTI in MSM blood donors. We searched MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, Cinahl, and Web of Science, and used GRADE for determining evidence quality. We included studies comparing MSM and non-MSM blood donors (or people eligible to give blood), living in areas most relevant for our Blood Service. Out of 18 987 articles, 14 observational studies were included. Two studies directly compared MSM with non-MSM donors showing that MSM donors have a statistically significant higher risk of HIV-1 infections. In one of these studies it was shown that this was related to recent (<12 months) MSM contact. In two additional studies no evidence was shown in favour of a certain deferral period for MSM. Ten studies, applying permanent deferral for MSM, compared infected versus non-infected donors. One study found that MSM is a statistically significant risk factor for HIV-1 infection in blood donors. For other TTI such as HBV or HCV, an increased risk of infection could not be demonstrated, because the precision of the results was affected by the low numbers of donors with MSM as risk factor, or because of risk of bias in the included studies. All studies included low level evidence, because of risk of bias and imprecision of the results.

Is having sex with other men a risk factor for transfusion-transmissible infections in male blood donors in Western countries?

High-quality studies investigating the risk of TTI in MSM who donate blood are scarce. The available evidence suggests a link between MSM blood donors and HIV-1 infection, but is too limited to be able to unambiguously/clearly recommend a certain deferral policy.

Question: Is having sex with other men a risk factor for transfusion-transmissible infections in male blood donors in Western countries? Answer: High-quality studies investigating the risk of TTI in MSM who donate blood are scarce. The available evidence suggests a link between MSM blood donors and HIV-1 infection, but is too limited to be able to unambiguously/clearly recommend a certain deferral policy.

Answer the question based on the following context: The impact of the obesity epidemic on cardiovascular health in young people is of increasing concern. However, data on secular trends in CVD indicators are outdated and mixed. This study compared lipid profiles and insulin of 9-10 year olds in 2008 (n = 605) and 1999 (n = 779). Data were drawn from two population-based samples of youth: the 1999 Québec Child and Adolescent Health and Social Survey and the 2008 Québec Longitudinal Study of Child Development. Mean body mass index (BMI) Z-scores were higher in 2008 than in 1999 in both boys (0.37 vs 0.12, p = 0.004) and girls (0.32 vs 0.05, p = 0.0004). After adjusting for maturity stage, height, BMI Z-score, age and household income, high-density lipoprotein cholesterol was 0.12 mmol/L (p<0.05) and 0.10 mmol/L (p<0.05) higher in 2008 than 1999 in boys and girls, respectively. Total cholesterol, low density lipoprotein cholesterol and insulin were not significantly different between 2008 and 1999.

Is the obesity epidemic worsening the cardiovascular risk factor profile of children?

Despite higher BMI Z-scores in 2008, differences in cardiometabolic indicators between 1999 and 2008 were small and may not be clinically meaningful. Surveillance to closely monitor trends in cardiometabolic indicators in Canadian youth is needed.

Question: Is the obesity epidemic worsening the cardiovascular risk factor profile of children? Answer: Despite higher BMI Z-scores in 2008, differences in cardiometabolic indicators between 1999 and 2008 were small and may not be clinically meaningful. Surveillance to closely monitor trends in cardiometabolic indicators in Canadian youth is needed.

Answer the question based on the following context: The function and patency of standard 6-mm Goretex (W.L. Gore and Associates, Flagstaff, AZ) and Impra (Impra, Inc., Tempe, AZ) expanded polytetrafluoroethylene (e-PTFE) grafts for hemodialysis as radial-antecubital linear arteriovenous fistulae for dialysis are compared. A randomized clinical trial was conducted in two community dialysis centers and in one hospital-based center serviced by one vascular surgical practice, that performed the access surgery. Selection of linear forearm access, as opposed to other hemodialysis graft configurations, was at the discretion of the surgeon. Candidates for linear grafts had palpable radial pulses with a normal Allen test and normal digital Doppler flow in the hand. Linear grafts were placed using end-to-side anastomoses to the artery and vein, and the graft type was determined by randomization. Primary patency was determined by first episode of thrombosis, first revision, or angioplasty of the graft. Secondary patency after thrombectomy, revision, or angioplasty was determined when the graft was no longer clinically usable, and a new graft needed to be placed as a parallel conduit in the forearm or in another site. Statistical analysis was by actuarial life-table methods. There were 131 linear forearm grafts in 117 patients. The Impra and Goretex groups were equally matched for gender and major risk factors, except for smoking, which was more common in the Goretex group. Minimum followup was 24 months. Life table primary patencies at 1 year (Impra 43%, Goretex 47%) and at 2 years (Impra 30%, Goretex 26%) were not statistically different (p = 0.78); secondary patency was also equal at 1 year (Impra 49%, Goretex 69%) and at 2 years (Impra 33%, Goretex 41%) (p = 0.15). Discontinuance of use of a patent graft, complications, episodes of thrombosis, and the need to replace the original graft occurred in the two groups without a statistically significant difference.

A prospective comparison of two expanded polytetrafluoroethylene grafts for linear forearm hemodialysis access: does the manufacturer matter?

In the linear forearm position from the radial artery to an antecubital vein, there is no difference in the performance of 6-mm standard e-PTFE grafts on the basis of manufacturer, whether Goretex or Impra. On the basis of performance, linear forearm dialysis grafts are an acceptable method for hemodialysis access.

Question: A prospective comparison of two expanded polytetrafluoroethylene grafts for linear forearm hemodialysis access: does the manufacturer matter? Answer: In the linear forearm position from the radial artery to an antecubital vein, there is no difference in the performance of 6-mm standard e-PTFE grafts on the basis of manufacturer, whether Goretex or Impra. On the basis of performance, linear forearm dialysis grafts are an acceptable method for hemodialysis access.

Answer the question based on the following context: In the framework of PartecipaSalute--an Italian research project aimed to involve lay people, patients' associations and scientific-medical representatives on the health debate --we carried out a survey with the Italian Federation of Medical Societies. The aims of the survey were to know medical societies attitude vs. patients involvement in research activities and healthcare setting and to find out possible projects conducted in partnership with patients associations. A web-questionnaire with 17 closed questions, and three open questions has been prepared on the basis of some experiences published on the literature and through the collaboration of members of the Italian Federation of Medical Societies. A total of 205 medical societies has been contacted by e-mail with a cover letter explaining the aims of the survey. At the end 74 medical societies completed the survey. Medical societies participating to the survey varied widely in terms of years of activity, number of members, and geographical distribution. Remarkably, 36 medical societies respondent organized collaborative initiatives with patients/consumers associations during the last three years. Among these, the most frequent were the preparation of written material for patients, organization of conferences or workshops, and health awareness campaigns. Moreover, 6 medical societies published documents on patients' rights but patients or their associations were involved in only 2 of these initiatives. Advantages and disadvantages reported by medical societies answering are also presented and discussed.

Are Italian medical societies bridging the distance from citizen and patients' associations?

In conclusion, to our knowledge this is the first survey on the value of patients' involvement conducted together with medical societies in Italy, and the results point the way to stronger collaboration in future between patients' associations and medical societies.

Question: Are Italian medical societies bridging the distance from citizen and patients' associations? Answer: In conclusion, to our knowledge this is the first survey on the value of patients' involvement conducted together with medical societies in Italy, and the results point the way to stronger collaboration in future between patients' associations and medical societies.

Answer the question based on the following context: When in May 1983 the acquired immunodeficiency syndrome (AIDS) was first securely attributed to a virus, eventually called the human immunodeficiency virus (HIV), many controversies arose. Among these was one centering on HIV's origin. A startling hypothesis, called here the "HIV-from-Fort-Detrick myth," asserted that HIV had been a product, accidental or intentional, of bioweaponry research. While its earliest identifiable contributors were in the West, this myth's most dynamic propagators were in the East. The Soviet security service, the KGB, took "active measures" to create and disseminate AIDS disinformation beginning no later than July 1983 and ending no earlier than October 1987. The East German security service, a complex bureaucracy popularly known as "the Stasi," was involved, too, but how early, how deeply, how uniformly, how ably, and how successfully has not been clear. Following German reunification, claims arose attributing to the Stasi the masterful execution of ingenious elements in a disinformation campaign they helped shape and soon came to dominate. We have tested these claims. Was the HIV-from-Fort-Detrick myth a Stasi success? Primary sources were documents and photographs assembled by the Ministry of State Security (MfS) of the German Democratic Republic (GDR or East Germany), the Ministry of Interior of the People's Republic of Bulgaria, and the United States Department of State; the estate of myth principals Jakob and Lilli Segal; the "AIDS box" in the estate of East German literary figure Stefan Heym; participant-observer recollections, interviews, and correspondence; and expert interviews. We examined secondary sources in light of primary sources. The HIV-from-Fort-Detrick myth had debuted in print in India in 1983 and had been described in publications worldwide prior to 1986, the earliest year for which we found any Stasi document mentioning the myth in any context. Many of the myth's exponents were seemingly independent conspiracy theorists. Its single most creative exponent was Jakob Segal, an idiosyncratic Soviet biologist long resident in, and long retired in, the GDR. Segal applied to the myth a thin but tenacious layer of plausibility. We could not exclude a direct KGB influence on him but found no evidence demonstrating it. The Stasi did not direct his efforts and had difficulty tracking his activities. The Stasi were prone to interpretive error and self-aggrandizement. They credited themselves with successes they did not achieve, and, in one instance, failed to appreciate that a major presumptive success had actually been a fiasco. Senior Stasi officers came to see the myth's propagation as an embarrassment threatening broader interests, especially the GDR's interest in being accepted as a scientifically sophisticated state. In 1986, 1988, and 1989, officers of HV A/X, the Stasi's disinformation and "active measures" department, discussed the myth in meetings with the Bulgarian secret service. In the last of these meetings, HV A/X officers tried to interest their Bulgarian counterparts in taking up, or taking over, the myth's propagation. Further efforts, if any, were obscured by collapse of the East German and Bulgarian governments.

Disinformation squared: was the HIV-from-Fort-Detrick myth a Stasi success?

No, the HIV-from-Fort-Detrick myth was not a Stasi success. Impressions to the contrary can be attributed to reliance on presumptions, boasts, and inventions. Presumptions conceding to the Stasi an extraordinary operational efficiency and an irresistible competence - qualities we could not confirm in this case - made the boasts and inventions more convincing than their evidentiary basis, had it been known, would have allowed. The result was disinformation about disinformation, a product we call "disinformation squared."

Question: Disinformation squared: was the HIV-from-Fort-Detrick myth a Stasi success? Answer: No, the HIV-from-Fort-Detrick myth was not a Stasi success. Impressions to the contrary can be attributed to reliance on presumptions, boasts, and inventions. Presumptions conceding to the Stasi an extraordinary operational efficiency and an irresistible competence - qualities we could not confirm in this case - made the boasts and inventions more convincing than their evidentiary basis, had it been known, would have allowed. The result was disinformation about disinformation, a product we call "disinformation squared."

Answer the question based on the following context: This study compared serum cotinine and thiocyanate in assessment of self-reported smoking behavior among 1400 men and 1809 women from two New England communities. Serum thiocyanate and serum cotinine levels were analyzed on 2411 and 798 survey respondents, respectively, in an attempt to provide an objective measurement for validation of self-reported smoking behaviors that were obtained through an in-home interviewer-administered questionnaire. Cross-sectional household surveys were conducted with randomly selected men and women, aged 18-65, between 1981 and 1993 as part of the evaluation of the Pawtucket Heart Health Program. Among smokers, the thiocyanate test had similar rates of agreement for women(88.0%) and for men (89.3%). However, among nonsmokers, thiocyanate had higher rates of agreement for women (91.5%) than for men (85.2%). For cotinine, the rates of agreement among smokers were higher for women (91.6%) than for men (89.7%). Similarly, the rates of agreement among nonsmokers were also higher for women (93.9%) than for men (91.9%). Overall,serum cotinine had a higher concordance rate than serum thiocyanate for both men and women.

Are there gender differences in self-reported smoking practices?

Although our results suggested that there were some differences in self-reporting of smoking status by gender, results were quite similar between self-reports of smoking and both biochemical tests. The results obtained from this large population-based study from two New England communities lend credibility to the use of self-reports as a low-cost accurate approach to obtaining information on smoking behaviors among both men and women in large population-based health surveys.

Question: Are there gender differences in self-reported smoking practices? Answer: Although our results suggested that there were some differences in self-reporting of smoking status by gender, results were quite similar between self-reports of smoking and both biochemical tests. The results obtained from this large population-based study from two New England communities lend credibility to the use of self-reports as a low-cost accurate approach to obtaining information on smoking behaviors among both men and women in large population-based health surveys.

Answer the question based on the following context: Analysis of international language, communication and nursing literature revealed the essential role language consistency plays in promoting competency and desirable behavioural outcomes. It also revealed the difficulty nursing has had in gaining consistency of language associated with theory, research and reasoning. Six nursing theory, research and terminology texts with international circulation were analysed to identify key words related to theory, research and reasoning and to determine consistency of definitions among texts. Next, 97 nursing educators were surveyed to determine their ability to define the same key words. Educators were recruited during three national nursing education meetings in the United States of America between 2006 and 2007. Analysis revealed significant variability in definitions of key words among texts and in nursing educators' ability to match any defining words used by the texts and by each other.

Language consistency: a missing link in theory, research and reasoning?

Epistemologically, the use of inconsistent language among texts and educators may be playing a role in the continuing marginalization of theory, research and reasoning in nursing education and practice; ultimately, hindering the profession's epistemological growth. Recommendations include a call for consensus of key words and meanings associated with theory, research and reasoning and the development of a language essentials document to support development of competency.

Question: Language consistency: a missing link in theory, research and reasoning? Answer: Epistemologically, the use of inconsistent language among texts and educators may be playing a role in the continuing marginalization of theory, research and reasoning in nursing education and practice; ultimately, hindering the profession's epistemological growth. Recommendations include a call for consensus of key words and meanings associated with theory, research and reasoning and the development of a language essentials document to support development of competency.

Answer the question based on the following context: Abnormal activations of neural networks implicated in auditory stimuli processing are hypothesized to generate auditory hallucinations (AH) in schizophrenia spectrum disorders. Because repetitive transcranial magnetic stimulation (rTMS) has the potential to modulate neural network activity, several studies have explored its use in treating medication-resistant AH, with mixed results in small-to-medium patient samples. Our aim is to apply a metaanalytic approach to exploring the efficacy of rTMS in treating medication-resistant AH. A search of the electronic databases for studies comparing low-frequency (1 Hz) rTMS over the left temporoparietal cortex to sham stimulation in patients suffering from medication- resistant AH was performed. Our search was completed by cross-referencing the articles, searching the Current Controlled Trials website, and direct contact with relevant researchers. From 265 possible abstracts, 6 parallel-arm, double-blind placebo-controlled and 4 crossover controlled trials, all randomized, matched the inclusion and exclusion criteria (n = 232). The primary outcome measure (effect of active treatment on AH at the end of the treatment) was tested with a random effect model and reached a significant homogeneous ES estimate (Hedges' g = 0.514; P = 0.001; 95CI%, 0.225 to 0.804; Q = 13.022; P = 0.162).

Should we treat auditory hallucinations with repetitive transcranial magnetic stimulation?

We found that low-frequency rTMS over the left temporoparietal cortex has a medium ES action on medication-resistant AH. This result has implications for understanding the pathophysiology of psychotic symptoms (specifically AH) and supports the use of rTMS as a complementary treatment approach in patients suffering from treatment-resistant AH.

Question: Should we treat auditory hallucinations with repetitive transcranial magnetic stimulation? Answer: We found that low-frequency rTMS over the left temporoparietal cortex has a medium ES action on medication-resistant AH. This result has implications for understanding the pathophysiology of psychotic symptoms (specifically AH) and supports the use of rTMS as a complementary treatment approach in patients suffering from treatment-resistant AH.

Answer the question based on the following context: To investigate gender differences in locus of control in an alcohol-dependent population. Locus of control helps to explain behaviour in terms of internal (the individual is responsible) or external (outside forces, such as significant other people or chance, are responsible) elements. Past research on gender differences in locus of control in relation to alcohol dependence has shown mixed results. There is a need then to examine gender and locus of control in relation to alcohol dependence to ascertain the veracity of any locus of control differences as a function of gender. The Multidimensional Health Locus of Control form-C was administered to clients from alcohol dependence treatment centres in the West of Scotland. Independent t-tests were carried out to assess gender differences in alcohol dependence severity and internal/external aspects of locus of control. One hundred and eighty-eight (53% females) participants were recruited from a variety of alcohol dependence treatment centres. The majority of participants (72%) came from Alcoholics Anonymous groups. Women revealed a greater internal locus of control compared with men. Women also had a greater 'significant others' locus of control score than men. Men were more reliant on 'chance' and 'doctors' than women. All these trends were not, however, statistically significant.

Are there gender differences in locus of control specific to alcohol dependence?

Gender differences in relation to locus of control and alcohol dependence from past studies are ambiguous. This study also found no clear statistically significant differences in locus of control orientation as a function of gender.

Question: Are there gender differences in locus of control specific to alcohol dependence? Answer: Gender differences in relation to locus of control and alcohol dependence from past studies are ambiguous. This study also found no clear statistically significant differences in locus of control orientation as a function of gender.

Answer the question based on the following context: The relation between panic disorder and suicidal behavior has been surrounded by perennial controversy. A significant number of reports suggest that PD is associated with suicidal behavior. Alternatively, it has been proposed that comorbid depression may account for the increased suicidality identified in this population. A total of n=474 consecutive psychiatric outpatient subjects were assessed for Axes I and II psychopathology and personality traits, as well as suicidal behavior, using structured interviews. Approximately half of the sample (n=250) reported suicidal ideation, either lifetime or during the 6 months prior to evaluation. In total, 200 subjects reported a history of suicide attempts. When comorbidity with depressive disorders (DD) was not taken into account, patients with Panic Disorder (PD) did not differ from those with a primary diagnosis of depressive disorder in terms of age, current or lifetime suicide ideation or number of suicide attempts. After separating the group characterized by PD comorbid with DD, PD only subjects had significantly lower number of suicide attempts compared to either DD (p<0.01) or comorbid PD-DD (p<0.05). Similar levels of SI were noted between PD, DD and PD-DD, both current and lifetime. Suicide attempters with PD, DD or both did not differ in terms of suicide intent or lethality. They were also similar on impulsivity, aggressive behavior and state-trait anxiety measures. Cross-sectional design, the limited sample size in the PD only group, retrospectively collected data with the possibility of recall bias.

Panic disorder and suicidality: is comorbidity with depression the key?

In this clinical outpatient sample, the association between panic disorder and suicidal behavior was primarily explained by comorbidity with depressive disorders. No differences were observed between different groups for measures of severity of the suicidal behavior. Physicians should be aware of these associations when assessing adults with panic disorder for suicidality.

Question: Panic disorder and suicidality: is comorbidity with depression the key? Answer: In this clinical outpatient sample, the association between panic disorder and suicidal behavior was primarily explained by comorbidity with depressive disorders. No differences were observed between different groups for measures of severity of the suicidal behavior. Physicians should be aware of these associations when assessing adults with panic disorder for suicidality.

Answer the question based on the following context: Definitive therapy with radical prostatectomy, cryotherapy, or radiation therapy generally follows the initial diagnosis of prostate cancer, particularly when men have at least 10 additional years of life expectancy. There is growing concern regarding the optimal conservative treatment for patients who decline or do not otherwise qualify for such definitive curative treatment. For those patients who choose a watchful waiting approach, it would be beneficial to know what specific dietary and nutritional methods could potentially slow the progression of their disease. In this prospective study, it was our goal to analyze the efficacy and safety of treating prostate cancer conservatively using the principles of a Mediterranean diet in association with a specific prostate nutritional supplement. Twenty-three men aged 43-74 (median age: 64) with biopsy proven, organ-confined prostate cancer who had already declined immediate hormonal therapy and attempts at a curative cancer treatment agreed to participate in a Chronic Disease Management (CDM) protocol highlighted by diet with a specific prostate nutritional supplement. The diet recommended was a modified Mediterranean diet while a patented nutritional prostatitis formula (Peenuts) was the supplement common to all patients. Prostate specific antigen (PSA), a recognized marker of prostate disease and prostate cancer activity, was the primary indicator to validate exacerbation or suppression of disease. All men were followed with serial PSA testing, a digital rectal exam, an International Prostate Symptom Score index (IPSS-Index) and an expressed prostatic secretion (EPS) examination. The primary Gleason sum/score represented in this study was 6 (n = 11), while Gleason sum patterns 5, 5/6, 6/7, and 7 were also evaluated. Referencing the Partin Tables, organ confinement was predicted to be 66%. Eighty-seven percent of men (n = 20) noted a 58% reduction (range of improvement: 13%-90%) in PSA over an average of 38.5 months (range: 13-84 months). The remaining 13% of men included three men who experienced a mild elevation in PSA of 0.3 ng/ml, 0.7 ng/ml, and 0.9 ng/ml over 14 months, 42 months, and 34 months, respectively. Fifteen men had completed an initial and secondary IPSS-Index while 14 men had undergone an initial and secondary EPS. The mean percentage reduction in IPSS-Index was 61% (range: 20%-100% with a median of 55%), while men evaluated with EPS examinations noted a mean percentage reduction in white blood cells of 77.5% (range: 33%-99% with a median of 82%). These results were evaluated using the t-test, Wilcoxon Analysis and the Null Hypothesis and found to be statistically significant.

Is it necessary to cure prostate cancer when it is possible?

Clearly there is a need to develop effective alternative conservative therapies for the increasing numbers of prostate cancer patients who will not tolerate definitive curative measures or simply choose a conservative approach. Although this prospective study had no control arm, was of limited duration and included only 23 participants, it did appear to show significant benefit to the majority of prostate cancer patients treated with selective nutritional and dietary therapy alone. Such treatments may provide a safe and effective long-term treatment alternative for some patients. Further study is encouraged.

Question: Is it necessary to cure prostate cancer when it is possible? Answer: Clearly there is a need to develop effective alternative conservative therapies for the increasing numbers of prostate cancer patients who will not tolerate definitive curative measures or simply choose a conservative approach. Although this prospective study had no control arm, was of limited duration and included only 23 participants, it did appear to show significant benefit to the majority of prostate cancer patients treated with selective nutritional and dietary therapy alone. Such treatments may provide a safe and effective long-term treatment alternative for some patients. Further study is encouraged.

Answer the question based on the following context: Crohn's disease is characterized by a high incidence of perianastomotic recurrence after ileocolonic resection. The influence of anastomotic configuration on the incidence of reoperation was evaluated in patients undergoing resection for Crohn's disease. 106 patients affected by ileocolonic Crohn's disease were divided in two groups: group I with a hand-sewn end-to-side or side-to-side isoperistaltic anastomosis (30 patients) and group II with functional end-to-end anastomosis made with linear staplers (76 patients). The morbidity was 4.7%: 3 complications and a postoperative death occurred in group I and two complications occurred in group II. There were 5 recurrences (16.7%) in the hand-sewn group and 2 recurrences (2.6%) in the stapled group, with a recurrence rate of 3.54 and 0.92, respectively.

Does stapled functional end-to-end anastomosis affect recurrence of Crohn's disease after ileocolonic resection?

Our non-randomized study suggests a better trend toward the functional stapled technique, in terms of recurrence rate. These observations need further investigation with randomized controlled trials, to compare the two different anastomotic procedures.

Question: Does stapled functional end-to-end anastomosis affect recurrence of Crohn's disease after ileocolonic resection? Answer: Our non-randomized study suggests a better trend toward the functional stapled technique, in terms of recurrence rate. These observations need further investigation with randomized controlled trials, to compare the two different anastomotic procedures.

Answer the question based on the following context: Fournier's gangrene was originally described as scrotal gangrene in young males. Today, it is generally accepted as synergistic necrotizing fasciitis of perineal, genital, or perianal regions, and the epidemiologic data have changed. However, there are still limited data about females due to the lack of female patients, even in large case series. A retrospective review of the medical records of all patients who received surgery for emergency conditions over the past 22 years was performed to identify patients with Fournier's gangrene. Data from these patients were then reviewed to determine the age, gender, etiology, causative bacteria, predisposing factors, treatment modalities, length of hospital stay, and morbidity and mortality rates associated with Fournier's gangrene. Data were evaluated using multivariate analyses. Sixty-five patients (20 female) were identified with the diagnosis of Fournier's gangrene. The mean age was 50.8 years. The most common etiology was hemorrhoidectomy in male and perianal abscess in female patients. The most commonly isolated microorganism in both male and female patients was Escherichia coli. Twenty-nine patients had diabetes mellitus, which was the most common predisposing factor. Mean hospitalization time was 24.4 days and the overall mortality was 27.70%.

Fournier's gangrene: is it scrotal gangrene?

Fournier's gangrene is still an important disease with high mortality rates in spite of the developments in intensive care units and new-generation antibiotics. It seems that there are no major differences between male and female patients in the characteristics of the condition.

Question: Fournier's gangrene: is it scrotal gangrene? Answer: Fournier's gangrene is still an important disease with high mortality rates in spite of the developments in intensive care units and new-generation antibiotics. It seems that there are no major differences between male and female patients in the characteristics of the condition.

Answer the question based on the following context: To review our experience with laparoscopic adrenalectomy (LA), to evaluate the effectiveness and safety of this procedure in patients with adrenal malignancy. The study included patients who underwent LA from 1995 to 2002, with histologically identified adrenocortical cancer (ACC) or metastasis. Indications for LA were adrenal masses with no radiological evidence of involvement of the surrounding structures, or solitary metastasis with well-controlled primary cancer. The variables evaluated were: size of the lesion, operative duration, estimated blood loss, intraoperative complications, local, port-site and intra-abdominal recurrence, distant metastasis, and survival time. Fourteen malignant adrenal lesions in 205 LAs (7%) were confirmed with histological diagnoses that showed a primary ACC in six and metastasis in another seven (in one there was bilateral metastasis). The mean (sd) size of the malignant lesions was 5.9 (2.8) cm. The 12 unilateral procedures required a mean operative duration of 164 (47) min; the bilateral procedure lasted 215 min. There was one conversion to open surgery caused by local infiltration, whereas there were no intraoperative complications. The mean follow-up was 30 months, during which three patients died, one from endoperitoneal and trocar port-site seeding.

Is laparoscopic adrenalectomy feasible for adrenocortical carcinoma or metastasis?

When the malignancy is confined to the adrenal gland, LA seems to be a feasible option if the principles of oncological surgery are respected. Nevertheless, further investigations are required to evaluate the appropriateness of this operation.

Question: Is laparoscopic adrenalectomy feasible for adrenocortical carcinoma or metastasis? Answer: When the malignancy is confined to the adrenal gland, LA seems to be a feasible option if the principles of oncological surgery are respected. Nevertheless, further investigations are required to evaluate the appropriateness of this operation.

Answer the question based on the following context: In a web survey, we presented Belgian cardiologists, neurologists and vascular surgeons with two fairly uncomplicated case vignettes on asymptomatic carotid stenosis differing only in the degree of stenosis (70-80% in case 1 and>80% in case 2). In both cases the suggested therapies were different per medical specialty (P<0.000002 and P<0.00002, respectively). Cardiologists were more conservative and vascular surgeons were more aggressive. Preferred therapies for both cases differed statistically significantly (odds ratio 8.63; 95% confidence interval 5.11-14.58). Suggesting a different therapy or not for case 1 and case 2 was also different per medical specialty (P<0.035). Cardiologists were most inclined to suggest a different therapy and vascular surgeons the least. Nobody switched to a more conservative treatment. Younger physicians suggested a more conservative approach (P<0.014).

Does medical specialty influence the treatment of asymptomatic carotid stenosis?

Different medical specialties prefer different treatments for asymptomatic carotid stenosis. Also, younger physicians seem more conservative. We elaborate on the different reasons that could explain these findings.

Question: Does medical specialty influence the treatment of asymptomatic carotid stenosis? Answer: Different medical specialties prefer different treatments for asymptomatic carotid stenosis. Also, younger physicians seem more conservative. We elaborate on the different reasons that could explain these findings.

Answer the question based on the following context: In 1995, California adopted a bill that brought laboratory laws in line with the 1988 Clinical Laboratory Improvement Amendments' standards for clinical laboratories and mandated a study comparing results in physicians' office laboratories (POLs) with other settings. To determine whether persons conducting tests in POLs produce accurate and reliable test results comparable to those produced by non-POLs. Survey of clinical laboratories using proficiency testing data. All California clinical laboratories participating in the American Association of Bioanalysts proficiency testing program in 1996 (n=1110). "Unsatisfactory" (single testing event failure) and "unsuccessful" (repeated testing event failure) on proficiency testing samples. The unsatisfactory failure rate for POLs was nearly 3 times (21.5% vs 8.1%) the rate for the non-POLs and about 1.5 times (21.5% vs 14.0%) for POLs that used laboratory professionals as testing or supervisory personnel (P<.001). The POL unsuccessful rate was more than 4 times (4.4% vs 0.9%) the rate for non-POLs and more than twice (4.4% vs 1.8%) the rate for the POLs using laboratory professionals (P<.001).

Are physicians' office laboratory results of comparable quality to those produced in other laboratory settings?

Significant differences exist among POLs, POLs using licensed clinical laboratory scientists (medical technologists), and non-POLs. Testing personnel in many POLs might lack the necessary education, training, and oversight common to larger facilities. We must better understand the contributing factors that result in the poorer results of POLs relative to non-POLs. In the meantime, patients should be aware that preliminary findings suggest that differences in quality of laboratory tests based on testing site may exist. Laboratory directors at all testing sites must ensure that they understand laboratory practice sufficiently to minimize errors and maximize accuracy and reliability. Directors must understand their obligation when they elect to oversee those assigned testing responsibility. Legislators may wish to reconsider the wisdom of further easing restrictions on those to whom we entrust our laboratory specimens.

Question: Are physicians' office laboratory results of comparable quality to those produced in other laboratory settings? Answer: Significant differences exist among POLs, POLs using licensed clinical laboratory scientists (medical technologists), and non-POLs. Testing personnel in many POLs might lack the necessary education, training, and oversight common to larger facilities. We must better understand the contributing factors that result in the poorer results of POLs relative to non-POLs. In the meantime, patients should be aware that preliminary findings suggest that differences in quality of laboratory tests based on testing site may exist. Laboratory directors at all testing sites must ensure that they understand laboratory practice sufficiently to minimize errors and maximize accuracy and reliability. Directors must understand their obligation when they elect to oversee those assigned testing responsibility. Legislators may wish to reconsider the wisdom of further easing restrictions on those to whom we entrust our laboratory specimens.

Answer the question based on the following context: Pancreatic metastases are rare and only sparse data exists on treatment options. After recent advances in pancreatic surgery, metastasectomies have become promising treatment alternatives. Twenty-six patients underwent pancreatic metastasectomy between 1991 and 2010 at our institution. Data was evaluated retrospectively. Renal cell carcinoma was the most common origin of pancreatic metastases (n = 16; 62%). Other primaries include gall bladder carcinoma, leiomyosarcoma, colon cancer (all n = 2), and others. The median time interval between primary tumor and pancreatic resection was 5.3 years [0-24]. Eleven pancreatic head resections (42%), fourteen distal pancreatectomies (54%), and one total pancreatectomy were performed (4%). The estimated 3- and 5-year survival rates were 73.2% and 52.3%, respectively. The estimated median overall survival was 63 months (CI: 37.8-88.1 months). There' was no perioperative death. The complication rate and relaparotomy rate was 31% and 19%, respectively. Patients suffering from synchronous metastases at the time of pancreatic surgery had a statistically significant shorter median overall survival time (11 months vs. 64 months).

Surgery for metastasis to the pancreas: is it safe and effective?

Despite the operative risk involved, we believe that pancreatic resection should be considered in selected patients with good performance status, stable disease and isolated pancreatic metastases.

Question: Surgery for metastasis to the pancreas: is it safe and effective? Answer: Despite the operative risk involved, we believe that pancreatic resection should be considered in selected patients with good performance status, stable disease and isolated pancreatic metastases.

Answer the question based on the following context: The Austrian long-term care system covers all types of long-term chronic diseases and handicaps and is based on a payment for care scheme. The benefit is directed to care recipients, who are - in the outpatient sector - largely free in how to use it. Herewith, the payment for care scheme also has a significant impact on the provision of informal care. The paper studies this impact for the particular case of informal care provided for mentally ill people. The analysis is based on a questionnaire survey of persons that are providing informal care to mentally ill people in Austria. The data is confronted with results from other studies on informal care provision in Austria. The study shows specific characteristics of informal long-term care for people with mental illness which is associated with specific burdens for the informal carers. Carers and care recipients benefit only to a moderate extent from public long-term care benefits and bear comparably high material and social costs.

Informal care of people with mental disorders: does the Austrian long-term care system provide adequate support?

The cash-oriented long-term care system in Austria offers only limited support for the particular case of informal care provided for mentally ill people. The long-term care system needs to be tailored to the special needs of both carer and care recipient in order to achieve the stated aim of self-determination and freedom of choice.

Question: Informal care of people with mental disorders: does the Austrian long-term care system provide adequate support? Answer: The cash-oriented long-term care system in Austria offers only limited support for the particular case of informal care provided for mentally ill people. The long-term care system needs to be tailored to the special needs of both carer and care recipient in order to achieve the stated aim of self-determination and freedom of choice.

Answer the question based on the following context: In the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved. We developed a model that simulates the progression of retinopathy in type 2 diabetic patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies. RESULTS The simulation model predicts that implementing a 2-year screening interval for type 2 diabetic patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ~25%.

Can the retinal screening interval be safely increased to 2 years for type 2 diabetic patients without retinopathy?

Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.

Question: Can the retinal screening interval be safely increased to 2 years for type 2 diabetic patients without retinopathy? Answer: Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.

Answer the question based on the following context: Fibrillation/sharp-waves (fibs-sw) are considered an essential neurophysiological marker in Amyotrophic Lateral Sclerosis (ALS). We investigated how frequently an initial electrophysiological (EMG) evaluation, performed in ALS patients, revealed no fibs-sw. The initial EMG studies from 68 ALS patients were analysed. The presence of fibs-sw in at least two muscles of each limb and two cranial-innervated muscles was assessed. We observed no fibs-sw in cranial-innervated muscles, and 7/15 bulbar-onset patients had no fibs-sw in limb muscles. Two of 28 upper-limb-onset patients, who had a short history before EMG, showed no fibs-sw. All lower-limb-onset patients had fibs-sw. Generally patients with no fibs-sw had diffuse abundant fasciculations.

Fibrillation and sharp-waves: do we need them to diagnose ALS?

The absence of fibs-sw should not necessarily preclude the neurophysiological diagnosis of ALS in bulbar-onset patients. Early affected upper-limb-onset patients might show no fibs-sw, but profuse fasciculations associated with mild to moderate denervation-reinnervation in weak muscles are found.

Question: Fibrillation and sharp-waves: do we need them to diagnose ALS? Answer: The absence of fibs-sw should not necessarily preclude the neurophysiological diagnosis of ALS in bulbar-onset patients. Early affected upper-limb-onset patients might show no fibs-sw, but profuse fasciculations associated with mild to moderate denervation-reinnervation in weak muscles are found.

Answer the question based on the following context: Diabetes mellitus is a major risk factor for cardiovascular disease (CVD). We investigated the relationship among biochemical and cardiac risk parameters with the methylenetetrahydrofolate reductase (MTHFR) C677T genotype in type 2 diabetes mellitus (T2DM) patients. One hundred seven T2DM subjects with severe CVD diagnosed by angiography were included consecutively in this cross-sectional study. Biochemical and clinical parameters were obtained from patients who were not positive for nephropathy and retinopathy. MTHFR C677T genotypes were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. Normally and abnormally distributed continuous variables were analyzed using student t- and Mann-Whitney U tests. Categorical variables were analyzed using chi-square test. In the study, 31 T2DM subjects had the CC (29.0%), 62 had the CT (57.9%), and 14 had the TT (13.1%) genotypes. There were no significant differences between subjects with wild-type (677CC) and with mutant (677CT+677TT) alleles in terms of diabetes duration, visceral fat area, total cholesterol, triglyceride, fasting plasma glucose, systolic blood pressure, diastolic blood pressure, high-sensitivity C-reactive protein, homocysteine (Hcy), and carotid intima-media thickness values.

Does the MTHFR C677T gene polymorphism indicate cardiovascular disease risk in type 2 diabetes mellitus patients?

This study suggests that MTHFR gene polymorphisms can not be used as a marker for the assessment of cardiovascular risk in T2DM patients.

Question: Does the MTHFR C677T gene polymorphism indicate cardiovascular disease risk in type 2 diabetes mellitus patients? Answer: This study suggests that MTHFR gene polymorphisms can not be used as a marker for the assessment of cardiovascular risk in T2DM patients.

Answer the question based on the following context: All infants less than 37 weeks gestation discharged in one month from the special care baby unit at National Womens Hospital were studied. Data on the infants and their in hospital course was recorded from the neonatal records. The mothers were contacted by telephone 3 to 4 months after discharge, to elicit the subsequent breast feeding rates. Thirty of 33 preterm infants (29 to 36 weeks gestation) were breast fed at discharge from hospital: 93% of singletons, and 89% of twins. The twins were older and heavier at discharge (p<0.004) due to their longer hospital stays (28.4 vs 16.3 days, p<0.05). All but 2 infants progressed to exclusive breast feeding. There was a similar rate of decline in the rates of breast feeding in singletons and twins to 68% at 8-12 weeks and 49% at 12-16 weeks after birth.

Can preterm twins breast feed successfully?

Preterm twins can breast feed as successfully as preterm singleton infants; as with sufficient assistance and encouragement, their rates of breast feeding were comparable to those of term infants. Although the resources of this hospital do not allow preterm infants to become fully breast fed before discharge, the current programme at National Womens Hospital is effective in establishing successful breast feeding in these high risk infants.

Question: Can preterm twins breast feed successfully? Answer: Preterm twins can breast feed as successfully as preterm singleton infants; as with sufficient assistance and encouragement, their rates of breast feeding were comparable to those of term infants. Although the resources of this hospital do not allow preterm infants to become fully breast fed before discharge, the current programme at National Womens Hospital is effective in establishing successful breast feeding in these high risk infants.

Answer the question based on the following context: PURPOSE. Some changes in tissue iron concentration have been reported in animals exposed to electromagnetic fields. In other studies, variations in the haemoglobin level were occasionally observed. In the present experiment, the effects of exposing a rat to a 50 Hz magnetic field (MF) were therefore investigated for the possible induction of anaemia due to changes in iron metabolism. Male Brown Norway rats (n=225) were exposed to a sinusoidal 50 Hz MF of 500 microT for 15 weeks. Haematological parameters, differential bone marrow cell counts and sideroblasts were investigated. Blood parameters of iron metabolism were measured. Iron concentration and total iron content were also determined in the spleen and liver, to assess iron storage in these organs. Significant differences between the exposed and control rat were only detected for iron storage in the spleen, and for the percentage of bone marrow cells of the red cell lineage.

Can 50 Hz magnetic fields alter iron metabolism and induce anaemia?

The changes observed were not associated with anaemia during the 15 weeks of MF exposure. However, the decrease in bone marrow cells of the red cell lineage and the changes in iron storage detected at the end of the experiment did not allow the possibility to be ruled out that exposure to 50 Hz MFs may induced delayed biological effects.

Question: Can 50 Hz magnetic fields alter iron metabolism and induce anaemia? Answer: The changes observed were not associated with anaemia during the 15 weeks of MF exposure. However, the decrease in bone marrow cells of the red cell lineage and the changes in iron storage detected at the end of the experiment did not allow the possibility to be ruled out that exposure to 50 Hz MFs may induced delayed biological effects.

Answer the question based on the following context: To study whether the metabolic information provided by a prior PET/computed tomography (CT) scan can add valuable information and an incremental benefit while performing image-guided biopsies. Fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT findings of 112 patients were available before biopsy and were considered for analysis. Biopsies were performed using standard techniques only after the needle tip was confirmed to be in the portion of the lesion corresponding to the hypermetabolic area seen on PET. This was achieved by visual coregistration and also by software registration algorithms that registered the intraprocedural CT images with the preselected PET/CT data. Only those biopsies for which a definitive histopathological diagnosis could be made were considered 'diagnostic'. Cases in which PET/CT added an incremental value were divided into three categories. A total of 112 patients (66 male and 46 female, age range 16-74 years) underwent a biopsy based on PET findings. The biopsy sites were as follows: lung, 54; lymph nodes, 27; bone, 12; and soft-tissue masses/deposits, 19. Out of the 112 biopsies, an incremental benefit was seen overall in 53 patients (47.3%): in 40.7% (22/54) of patients who underwent lung biopsies, 44.4% (12/27) of those who underwent lymph node biopsies, 66.6% (8/12) of those who underwent bone biopsies and 57.8% (11/19) of those who underwent soft-tissue biopsies. Out of the cases that showed an incremental benefit, the highest number (30) belonged to the category in which the biopsy sample was obtained from the focal hypermetabolic portion of the apparently larger morphological lesion seen on CT.

18F-FDG PET/CT-directed biopsy: does it offer incremental benefit?

PET/CT data coregistered with intraprocedural CT images can guide needle placement in the viable portion of the lesion, thus increasing the chances of achieving a definitive diagnosis. This approach can offer a significant incremental benefit while performing image-guided biopsies.

Question: 18F-FDG PET/CT-directed biopsy: does it offer incremental benefit? Answer: PET/CT data coregistered with intraprocedural CT images can guide needle placement in the viable portion of the lesion, thus increasing the chances of achieving a definitive diagnosis. This approach can offer a significant incremental benefit while performing image-guided biopsies.

Answer the question based on the following context: Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization. A cross-sectional study of present and former smoking habits in relation to atopic disorders from data on 6909 young and middle-aged adults (16-49 years) and their 4472 children (3-15 years) from the Swedish Survey of Living Conditions in 1996-97. The prevalence of allergic asthma and allergic rhino-conjunctivitis decreased, in a dose-response manner (P = 0.03 and P = 0.004, respectively), with increasing exposure to tobacco smoke in the adult study population. This pattern was little changed when potential confounders (sex, age, education, domicile, country of birth) were entered into a multivariate analysis: the adjusted odds ratio (OR) for allergic rhino-conjunctivitis was 0.5 (0.4-0.7) for those who smoked at least 20 cigarettes a day and OR 0.7 (0.6-0.9) for those smoking 10-19 cigarettes, compared with those who reported that they never had smoked Former smokers had a tendency for a slightly lower risk: OR 0.9 (0.8-1.0). In a multivariate analysis, children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6-0.7). Children of fathers who had smoked at least 15 cigarettes a day had a similar tendency (ORs 0.7-0.9).

Does tobacco smoke prevent atopic disorders?

This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. There is a need for further studies with a prospective design to certify the causal direction of this association. Smoking habits and atopic disorder in parents should not be considered independent variables in epidemiological studies of the connection between exposure to tobacco smoke and atopy in children.

Question: Does tobacco smoke prevent atopic disorders? Answer: This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. There is a need for further studies with a prospective design to certify the causal direction of this association. Smoking habits and atopic disorder in parents should not be considered independent variables in epidemiological studies of the connection between exposure to tobacco smoke and atopy in children.

Answer the question based on the following context: The association between excess body weight and colorectal cancer screening is not well established. The purpose of this analysis was to explore, in the context of patients receiving navigation, whether obesity influences receipt of screening colonoscopy among lower-income Latinos and African Americans. This sub-analysis was conducted among Latinos and African American participants who received patient navigation and had complete body mass index (BMI) data (n = 520). Cross-sectional survey data were collected at baseline among individuals 50 years and older who were referred by their primary care providers for a colonoscopy at Mount Sinai's Primary Care Clinic. BMI was based on height and weight data from chart review at baseline, and colonoscopy completion status was collected at 1 year post-baseline. The mean BMI of the sample was 31.17 kg/m(2), with over half (53 %) of the sample categorized as obese. Rates of colonoscopy screening were high (~80 %), regardless of weight status. Adjusting for age, gender, race/ethnicity, family history of colorectal cancer, smoking status, comorbid conditions, income, marital status, insurance, and education, obesity status was not significantly associated with screening behavior among the entire sample (adjusted OR 0.81, CI 0.49-1.32, p = 0.39) or among stratified race/ethnicity and gender groups.

Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation?

These findings suggest that obesity may not negatively influence receipt of colonoscopy screening in the context of patient navigation among minority participants. Further studies are needed to determine whether this finding will be observed in other populations, with and without the assistance of a patient navigator.

Question: Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation? Answer: These findings suggest that obesity may not negatively influence receipt of colonoscopy screening in the context of patient navigation among minority participants. Further studies are needed to determine whether this finding will be observed in other populations, with and without the assistance of a patient navigator.

Answer the question based on the following context: The development of therapeutic strategies for children depends unequivocally on the commercial launching of drugs with pediatric indications. New therapeutic drugs differ from one country to another, particularly considering children. The objective of this study was to compare access to new drugs by children in France (FR) and Canada (CA). Retrospective study comparing newly marketed drugs in FR and CA from 1 January to 31 December 2009. Data were collected through independent sources: (HAS, Thériaque, ANSM for FR and CEPMB, BDPP for CA). Respectively, 37 and 30 new drugs were put on the market in 2009 in FR and CA. Among them, 38% (n=14) and 27% (n=8) had a pediatric indication. For 91% (FR) and 95% (CA) of the drugs not indicated for children, no clinical study has been planned to define pediatric indications. All the drugs (100%) with pediatric indications presented dosages based on age or weight, but it should be noted that two drugs had no form adapted to children. Fifty-seven percent of these drugs were first available on the French market and later on the Canadian market, with a median delay of 8.5months.

Is pediatrics excluded from pharmaceutical innovation?

This study highlights the obvious lack of pediatric drugs contributing to large prescriptions of off-label drugs for children, with no dosage or adapted pharmaceutical form for this population.

Question: Is pediatrics excluded from pharmaceutical innovation? Answer: This study highlights the obvious lack of pediatric drugs contributing to large prescriptions of off-label drugs for children, with no dosage or adapted pharmaceutical form for this population.

Answer the question based on the following context: Scabies, or mange as it is called in animals, is an ectoparasitic contagious infestation caused by the mite Sarcoptes scabiei. Sarcoptic mange is an important veterinary disease leading to significant morbidity and mortality in wild and domestic animals. A widely accepted hypothesis, though never substantiated by factual data, suggests that humans were the initial source of the animal contamination. In this study we performed phylogenetic analyses of populations of S. scabiei from humans and from canids to validate or not the hypothesis of a human origin of the mites infecting domestic dogs. Mites from dogs and foxes were obtained from three French sites and from other countries. A part of cytochrome c oxidase subunit 1 (cox1) gene was amplified and directly sequenced. Other sequences corresponding to mites from humans, raccoon dogs, foxes, jackal and dogs from various geographical areas were retrieved from GenBank. Phylogenetic analyses were performed using the Otodectes cynotis cox1 sequence as outgroup. Maximum Likelihood and Bayesian Inference analysis approaches were used. To visualize the relationship between the haplotypes, a median joining haplotype network was constructed using Network v4.6 according to host. Twenty-one haplotypes were observed among mites collected from five different host species, including humans and canids from nine geographical areas. The phylogenetic trees based on Maximum Likelihood and Bayesian Inference analyses showed similar topologies with few differences in node support values. The results were not consistent with a human origin of S. scabiei mites in dogs and, on the contrary, did not exclude the opposite hypothesis of a host switch from dogs to humans.

Are humans the initial source of canine mange?

Phylogenetic relatedness may have an impact in terms of epidemiological control strategy. Our results and other recent studies suggest to re-evaluate the level of transmission between domestic dogs and humans.

Question: Are humans the initial source of canine mange? Answer: Phylogenetic relatedness may have an impact in terms of epidemiological control strategy. Our results and other recent studies suggest to re-evaluate the level of transmission between domestic dogs and humans.

Answer the question based on the following context: To determine if face-to-face and telephone administration of questionnaires produce comparable results in rehabilitation research studies. METHOD A total of 80 participants who used eyeglasses as their primary visual assistive device agreed to participate. All completed the Life Orientation Test and the Psychosocial Impact of Assistive Devices Scale. Approximately half of the participants completed the forms after being approached by an interviewer and then were contacted by telephone 2 weeks later to complete the forms a second time. The other half of the participants initially completed the forms over the telephone and then met with an interviewer 2 weeks later and completed the forms face-to-face. For the forms used no statistically significant differences were found between groups or over time.

Is telephone assessment a valid tool in rehabilitation research and practice?

For some questionnaires telephone administration may provide a convenient and cost-effective method of data collection. However, it should not be automatically assumed that all questionnaires will yield the same results regardless of the mode of administration used.

Question: Is telephone assessment a valid tool in rehabilitation research and practice? Answer: For some questionnaires telephone administration may provide a convenient and cost-effective method of data collection. However, it should not be automatically assumed that all questionnaires will yield the same results regardless of the mode of administration used.

Answer the question based on the following context: In clinical practice the gold standard method to assess BRAF status in patients with metastatic melanoma is based on molecular assays. Recently, a mutation-specific monoclonal antibody (VE1), which detects the BRAF V600E mutated protein, has been developed. With this study we aimed to confirm the clinical value of the VE1 Ventana® antibody, as today a univocal validated and accredited immunohistochemical procedure does not exist, to preliminary detect BRAF status in our routine diagnostic procedures. Moreover, we explored the biological meaning of BRAF immunohistochemical labeling both as a predictor marker of response to target therapy and, for the first time, as a player of acquired tumor drug resistance. We analyzed a retrospective series of 64 metastatic melanoma samples, previously investigated for molecular BRAF status, using a fully automatized immunohistochemical method. We correlated the data to the clinicopathologic characteristics of patients and their clinical outcome. The sensitivity and the specificity of the Ventana® VE1 antibody were 89.2 and 96.2% respectively, while the positive predictive value and negative predictive value were 97.1 and 86.2%, respectively. For six mutated patients the histological sample before treatment and when disease progressed was available. The immunohistochemical BRAF V600E expression in the specimens when disease progressed was less intense and more heterogeneous compared to the basal expression. Multivariate analysis revealed that a less intense grade of positive expression is an independent predictor of a less aggressive stage at diagnosis (p = 0.0413).

Is immunohistochemistry of BRAF V600E useful as a screening tool and during progression disease of melanoma patients?

Our findings encourage the introduction of immunohistochemistry as a rapid screening tool for the assessment of BRAF status in melanoma patients in routine diagnostic procedures and prepare the ground for other studies to highlight the role of immunohistochemical BRAF V600E expression in patients at the time of progression.

Question: Is immunohistochemistry of BRAF V600E useful as a screening tool and during progression disease of melanoma patients? Answer: Our findings encourage the introduction of immunohistochemistry as a rapid screening tool for the assessment of BRAF status in melanoma patients in routine diagnostic procedures and prepare the ground for other studies to highlight the role of immunohistochemical BRAF V600E expression in patients at the time of progression.

Answer the question based on the following context: To assess the cytologic criteria for distinguishing neoplastic from nonneoplastic follicular cell and Hürthle cell thyroid lesions. Ten previously described and commonly used cytologic criteria were evaluated and graded on a 0-4 scale in a consecutive series of thyroid fine needle aspirations (FNAs) reported as follicular or Hürthle cell neoplasms or lesions. Scoring was compared to subsequent surgical outcome. A total of 93 (57fo llicular cell and 36 Hühle cell) cases was analyzed. No individual cytologic feature was helpful in distinguishing benign neoplarms from malignancy in either category (p>0.05), but 4 or more coexistent cytologic features in combination were identified in 50.0% of follicular neoplasms, 13.6% of Hürthle cell neoplasms and none of the nonneoplastic lesions. An unexpected number (13 of 93, 14.0%) of unrecognized papillary carcinomas, some of follicular subtype, was encountered.

Follicular and Hürthle cell lesions of the thyroid: can inconclusive results be minimized?

In this series, the indeterminate thyroid FNA category could have been reduced by diagnosis of samples with 4 or more of the studied criteria as definite follicular (50% of cases) or Hürthle cell (13.6% of cases) neoplasms and by more astute recognition of papillary carcinomas (14.0% of cases), which blend into this category, often as a result of less-than-optimal sampling or preservation.

Question: Follicular and Hürthle cell lesions of the thyroid: can inconclusive results be minimized? Answer: In this series, the indeterminate thyroid FNA category could have been reduced by diagnosis of samples with 4 or more of the studied criteria as definite follicular (50% of cases) or Hürthle cell (13.6% of cases) neoplasms and by more astute recognition of papillary carcinomas (14.0% of cases), which blend into this category, often as a result of less-than-optimal sampling or preservation.

Answer the question based on the following context: Endothelial dysfunction as a possible prognostic parameter seems to play a role in the course of diabetic retinopathy. Flicker-induced endothelial NO release may be used as an indicator for endothelial functionality of the central retinal vessels. Flicker-induced arterial vasodilation as well as complete internal medicine status were determined in 65 type 1 and 170 type 2 diabetics. Diabetic retinopathy was classified according ETDRS criteria. Furthermore, a group of 55 healthy subjects was used as control group. Diabetic subjects showed with 2.1+/-2.2 (type 1) and 2.2+/-2.4 (type 2) a significantly decreased percent arterial vasodilation in comparison to healthy subjects (3.6+/-2.1; p<or=0.001). With increasing stage of the diabetic retinopathy dilation of the retinal arterioles decreased significantly (p=0.002) while static arterial measurements before flicker testing did not show significant differences in the different stages of diabetic retinopathy. Diabetic patients without retinopathy already showed a noticeably reduced arterial dilation in comparison to healthy controls. These changes could be seen both in type 1 and type 2 diabetics. Patients with type 1 diabetes with proliferative diabetic retinopathy showed a mean percent dilation of 1.80+/-2.11, while these reactions had nearly disappeared in patients with type 2 diabetes (0.31+/-1.08).

Endothelial dysfunction of central retinal vessels: a prognostic parameter for diabetic retinopathy?

Both type 1 and type 2 diabetics showed significantly decreased flicker-induced arterial dilation as a sign of endothelial dysfunction in comparison to healthy controls. With increasing stage of the diabetic retinopathy dilation of the retinal arterioles decreased significantly. Diabetics without retinopathy already showed decreased flicker-induced reactions in comparison to healthy controls. Measurement of arterial flicker response may be useful for prognostic approaches in the case diabetes care.

Question: Endothelial dysfunction of central retinal vessels: a prognostic parameter for diabetic retinopathy? Answer: Both type 1 and type 2 diabetics showed significantly decreased flicker-induced arterial dilation as a sign of endothelial dysfunction in comparison to healthy controls. With increasing stage of the diabetic retinopathy dilation of the retinal arterioles decreased significantly. Diabetics without retinopathy already showed decreased flicker-induced reactions in comparison to healthy controls. Measurement of arterial flicker response may be useful for prognostic approaches in the case diabetes care.

Answer the question based on the following context: This study aimed to assess whether participants in an HIV-intensive prevention program and participants in a general women's health promotion program reported greater HIV risk-reduction than participants in a wait-list control group immediately following program participation and at three-month follow-up. The authors studied 162 Hispanic women ages 18 to 35 years, most of them immigrants. Three-fourths of the sample (74%) reported earning less than $800 a month, 29% did not have a high school degree, and 90% had children. Data were gathered through surveys at baseline, at intervention completion, and at three-month follow-up. Information was collected on sociodemographics, HIV risk factors, and risk behaviors. Crude and adjusted (for demographics and dose) logistic regression analyses were used to assess program effects on participants' risk reduction. Crude logistic regression analyses reveal that both programs resulted in increased condom use at post-test and follow-up. Only participants in the HIV-intensive prevention program reported increased safer sex negotiation at post-test and follow-up, however, and only participants in the women's health promotion program reported increased HIV testing at post-test.

Is a general women's health promotion program as effective as an HIV-intensive prevention program in reducing HIV risk among Hispanic women?

Both interventions increased condom use. The HIV-intensive prevention program appeared to be more effective in promoting safer sex negotiation, and the women's health promotion program appeared more effective in promoting HIV testing. The findings suggest that both approaches may be viable ways to package HIV prevention for short-term behavior change in this population.

Question: Is a general women's health promotion program as effective as an HIV-intensive prevention program in reducing HIV risk among Hispanic women? Answer: Both interventions increased condom use. The HIV-intensive prevention program appeared to be more effective in promoting safer sex negotiation, and the women's health promotion program appeared more effective in promoting HIV testing. The findings suggest that both approaches may be viable ways to package HIV prevention for short-term behavior change in this population.

Answer the question based on the following context: To determine whether the presence of an isolated fetal cardiac echogenic focus should be an indication for fetal echocardiography. We reviewed our fetal echocardiography and obstetrics databases from January 1992 through July 1999. The study groups were formulated from patients referred for fetal echocardiography. Patients referred for echocardiography because of a single isolated fetal cardiac echogenic focus were compared with patients referred for other indications. The sensitivity, specificity, and positive and negative predictive values were calculated for an isolated echogenic focus as a marker for structural cardiac abnormalities as detected by fetal echocardiography. Of 10,406 fetuses seen for ultrasonography, 1908 had fetal echocardiography. Cardiac abnormalities were identified in 3.4% (65 of 1908) of the fetuses that had echocardiography. The prevalence of an isolated echogenic focus was 2.2% (230 of 10,406) and was the indication in 12.1% (230 of 1908) of our echocardiograms. Only 1 of the 230 fetuses with an isolated echogenic focus had a structural cardiac defect (membranous ventricular septal defect). An isolated echogenic focus as a marker for congenital cardiac defects resulted in sensitivity and specificity of 1.5% and 87.6%, respectively. The positive and negative predictive values were 0.4% and 96.2%, respectively The relative risk for an echogenic focus in predicting congenital cardiac defects was 0.11 (95% confidence interval, 0.02-0.82).

Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography?

An isolated fetal cardiac echogenic focus is not an efficacious marker for congenital cardiac defects. It should not be the sole indication for fetal echocardiography.

Question: Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography? Answer: An isolated fetal cardiac echogenic focus is not an efficacious marker for congenital cardiac defects. It should not be the sole indication for fetal echocardiography.

Answer the question based on the following context: Both maternal height and ethnicity may influence the gestation length, but their independent effect is unclear.AIM: This study was performed to examine the relationship between maternal height and gestational length in women with singleton pregnancies in a Chinese and southeast Asian population. A retrospective cohort study was performed on women carrying singleton pregnancies with spontaneous labour in a 48-month period managed under our department to determine the relationship between maternal height, expressed in quartiles, with the mean gestational age and incidence of preterm labour. Of the 16 384 women who delivered within this period, the 25th, 50th and 75th percentile values of maternal height were 153 cm, 156 cm and 160 cm respectively. Excluded from analysis were 6597 women because of multifetal pregnancy, teenage pregnancy (maternal age<or = 19 years old), induction of labour or elective caesarean section, or incomplete data due to no antenatal booking in our hospital. Significant differences were found in the maternal weight and body mass index, incidences of multiparity and smokers, gestational age and birthweight among the four quartiles. There was significantly increased incidence of preterm birth between 32 and 37 weeks gestation in women with shorter stature.

Maternal height and length of gestation: does this impact on preterm labour in Asian women?

In our population, maternal height has an influence on gestational length, and the lower three quartiles was associated with increased odds of labour at>32 to<37 weeks. This effect should be taken into consideration in the adoption of international recommendations in obstetric management and intervention.

Question: Maternal height and length of gestation: does this impact on preterm labour in Asian women? Answer: In our population, maternal height has an influence on gestational length, and the lower three quartiles was associated with increased odds of labour at>32 to<37 weeks. This effect should be taken into consideration in the adoption of international recommendations in obstetric management and intervention.

Answer the question based on the following context: Regular physical exercise has numerous benefits. However, there is a subset of the exercising population who may develop a compulsion to exercise excessively and who may, as a consequence, display physiological and psychological changes that have a direct influence on their quality of life. Our objective was to determine if there are differences between male and female athletes' scores on measures of negative addiction symptoms, quality of life, mood and sleep. 144 female and 156 male athletes participated in this study by answering the following questionnaires: Negative Addiction Scale, Beck Depression Inventory, Trait Anxiety Inventory, Profile of Mood States, SF-36 Quality of Life, Pittsburgh Sleep Quality and Epworth Sleepiness Scale. Higher dedication to training sessions in the male group, and members of the female group with symptoms of negative addiction to exercise showed a lower score on vigor observed by the Profile of Mood States compared to the males in both situations. We also observed depression symptoms in both members of groups who had negative addiction symptoms when compared with their peers without symptoms, and these figures were even higher in females compared with the male group in the same situation.

Negative addiction to exercise: are there differences between genders?

No differences were seen in the development of negative addiction exercise symptoms in males and females and there were no changes in the quality of life and mood of these athletes. Further studies of eating disorders associated with changes in body image perception could contribute to a better understanding of negative addiction to exercise.

Question: Negative addiction to exercise: are there differences between genders? Answer: No differences were seen in the development of negative addiction exercise symptoms in males and females and there were no changes in the quality of life and mood of these athletes. Further studies of eating disorders associated with changes in body image perception could contribute to a better understanding of negative addiction to exercise.

Answer the question based on the following context: To evaluate serum levels of osteoprotegerin (OPG) and receptor activator of nuclear factor kB-ligand (RANK-L) in patients with juvenile idiopathic arthritis (JIA); to correlate these values with disease activity variables, radiological bone damage, and bone mass; and to correlate OPG gene polymorphisms with bone mass. Eighty-four patients (66 girls and 18 boys) with JIA and 40 sex and age-matched controls were enrolled. Serum OPG and RANK-L were measured using an enzyme-linked immunosorbent assay. OPG genotyping was performed by polymerase chain reaction. Patients with JIA had significantly higher levels of serum OPG than controls (p = 0.001) and lower levels of RANK-L in comparison with controls (p = 0.0003). The OPG/RANK-L ratio in patients was higher than in controls (p = 0.004). No significant correlations were found between disease duration, erythrocyte sedimentation rate, and C-reactive protein values with either OPG or RANK-L serum levels. A significant difference in serum OPG levels (but not in RANK-L) was found between patients with and without erosions (p = 0.008). No correlation was found between OPG and RANK-L levels and bone mass (DXA Z scores). A higher prevalence of OPG CC genotype was found in both patients (65.4%) and controls (82.5%) (p = 0.006). Subjects with CC genotype had a higher lumbar spine bone mineral density (LS-BMD).

Osteoprotegerin (OPG)/RANK-L system in juvenile idiopathic arthritis: is there a potential modulating role for OPG/RANK-L in bone injury?

We evaluated for the first time levels of OPG and RANK-L in children with JIA. The higher OPG/RANK-L ratio in JIA might be the result of a compensatory production of OPG. The presence of the T allele of the OPG gene appears to be associated with low BMD.

Question: Osteoprotegerin (OPG)/RANK-L system in juvenile idiopathic arthritis: is there a potential modulating role for OPG/RANK-L in bone injury? Answer: We evaluated for the first time levels of OPG and RANK-L in children with JIA. The higher OPG/RANK-L ratio in JIA might be the result of a compensatory production of OPG. The presence of the T allele of the OPG gene appears to be associated with low BMD.

Answer the question based on the following context: In Western populations, waist circumference (WC) is more predictive of cardiovascular disease (CVD) risk than is body mass index (BMI). It is unclear whether the same is true in Asian populations. The objective was to examine the independent effects of WC and BMI on CVD risk factors in China. CVD risk factors, BMI, and WC were measured in a nationally representative cross-sectional study of 15 540 Chinese adults aged 35-74 y. Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. In men, the odds of hypertension, dyslipidemia, and the metabolic syndrome (MS) increased with successive WC tertiles (1.0, 1.1, and 1.8, respectively, for hypertension; 1.0, 1.4, and 2.0, respectively, for dyslipidemia; and 1.0, 2.3, and 4.8, respectively, for MS; P for trend<0.001 for all), even after adjustment for BMI. Similarly, the odds of hypertension, dyslipidemia, and MS increased with successive BMI tertiles (1.0, 1.5, and 2.6, respectively, for hypertension; 1.0, 1.3, and 1.8, respectively, for dyslipidemia; 1.0, 1.3, and 2.9, respectively for MS; P for trend<0.001 for all), even after adjustment for WC. However, BMI tertiles were not associated with the odds of diabetes after adjustment for WC (P for trend = 0.67), whereas tertiles of WC were significantly associated with the odds of diabetes after adjustment for BMI (1.0, 1.6, and 2.1, respectively; P for trend = 0.002). The results were similar in women.

Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults?

These data show that WC adds additional risk information to that of BMI in Chinese adults. Measurement of both WC and BMI in Chinese adults may enhance CVD risk stratification.

Question: Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults? Answer: These data show that WC adds additional risk information to that of BMI in Chinese adults. Measurement of both WC and BMI in Chinese adults may enhance CVD risk stratification.

Answer the question based on the following context: Although hepatitis B virus (HBV) primarily affects hepatocytes, it has also been shown to cause complications in the skin, joints, muscles, and kidneys. Thyroid dysfunction is uncommon in cases of acute HBV infection. In this report, we describe a case of a 46-year-old woman with incipient acute hepatitis B virus (HBV) infection who presented clinically with Graves' hyperthyroidism. She showed typical symptoms of hyperthyroidism, and laboratory tests revealed high levels of HBV DNA and alanine transaminase (ALT). The patient was not administered with antithyroid medicine or radioiodine, but she was given antiviral therapy and symptomatic treatment with propranolol. Follow-up studies showed that as the HBV DNA levels decreased, the thyroid function recovered.

Graves' hyperthyroidism accompanied with acute hepatitis B virus infection: an extrahepatic manifestation?

Graves' disease maybe an extrahepatic manifestation of acute HBV infection. Antiviral therapy is likely to be beneficial for this condition as without severe thyrotoxicosis.

Question: Graves' hyperthyroidism accompanied with acute hepatitis B virus infection: an extrahepatic manifestation? Answer: Graves' disease maybe an extrahepatic manifestation of acute HBV infection. Antiviral therapy is likely to be beneficial for this condition as without severe thyrotoxicosis.

Answer the question based on the following context: To determine possible differences in morbidity and mortality between early and late onset of septic shock in ICU patients. Systematic data collection. Thirty-one-bed, mixed, medicosurgical ICU in a university hospital. All 65 patients who acquired septic shock after admission to the ICU between February 1999 and April 2000. None. Forty-one of the 65 patients presented with septic shock within 24 h of admission to the ICU (early septic shock [ESS]); the other 21 patients acquired septic shock>24 h after ICU admission (late septic shock [LSS]). Eleven patients had a second episode (7 patients in the ESS group, and 4 patients in the LSS group), and 1 patient in the LSS group had a third episode of septic shock. Patients with ESS had higher APACHE (acute physiology and chronic health evaluation) II (mean +/- SD, 26 +/- 6 vs 20 +/- 6; p = 0.002) and sequential organ failure assessment (SOFA) scores (11 +/- 3 vs 7 +/- 3, p<0.001) on ICU admission, and a higher blood lactate concentration at the onset of shock (median 3.70 mEq/L; interquartile range, 2.6 to 6.6 mEq/L; vs median, 2.50 mEq/L [interquartile range, 1.8 to 4.0 mEq/L], p = 0.03) than patients with LSS. However, the duration of septic shock (median, 42 h [interquartile range, 21 to 97 h]vs median, 93 h [interquartile range, 32 to 241 h], p = 0.058) and the length of ICU stay after the onset of septic shock (median, 75 h; [interquartile range, 38 to 203 h]vs median, 321 h [interquartile range, 96 to 438 h], p = 0.018), was shorter in patients with ESS than patients with LSS. The ICU mortality rate was 63% (26 patients) in the ESS group, and 88% (21 patients) in the LSS group (p = 0.071). At the onset of the first episode of shock, patients with ESS had higher SOFA scores (11 +/- 3 vs 9 +/- 3, p = 0.045), lower pH (7.24 +/- 0.15 vs 7.33 +/- 0.12, p = 0.01), and were treated with higher doses of dopamine (median, 20 microg/kg/min [interquartile range, 14 to 20 microg/kg/min]vs median, 12 microg/kg/min [interquartile range, 8 to 20 microg/kg/min], p = 0.028) than patients with LSS.

Septic shock of early or late onset: does it matter?

Septic shock is more severe when of early onset, as reflected by more severe organ dysfunction, greater lactic acidosis, and higher vasopressor requirements, yet the outcome is better, as reflected by a shorter duration of the shock episode, shorter ICU stay, and slightly lower mortality rates. These differences may influence clinical trials of therapeutic agents for sepsis, and should be taken into account when analyzing the results.

Question: Septic shock of early or late onset: does it matter? Answer: Septic shock is more severe when of early onset, as reflected by more severe organ dysfunction, greater lactic acidosis, and higher vasopressor requirements, yet the outcome is better, as reflected by a shorter duration of the shock episode, shorter ICU stay, and slightly lower mortality rates. These differences may influence clinical trials of therapeutic agents for sepsis, and should be taken into account when analyzing the results.

Answer the question based on the following context: The aim of this study is to report late postoperative complications occurring after oesophagectomy for cancer over a 12-month period and to compare the incidence of these complications according to the level of the anastomosis. This study included 106 consecutive patients 51% with subtotal oesophagectomy (thoracic anastomosis), and 49% with total oesophagectomy (cervical anastomosis). The two groups were comparable for age, mean weight loss before surgery, life expectancy, number of positive margins, TNM grading, size and tumour differentiation. Late morbidity concerned 67.9% of the 106 patients. Predominant complications were dysphagia (32.1% of the 106), gastro-esophageal reflux (25.5% of the 106), and diarrhoea (18.8% of the 106). Among all the factors causing dysphagia, evaluated by logistic regression, the level of anastomosis was only found significant with a 20.4% occurrence for thoracic anastomosis and 44.2% for cervical anastomosis (P = 0.012). All the other complications were similar in the two groups.

Late morbidity after esophagectomy for cancer: is partial esophagectomy preferred?

Functional results of oesophagectomy for cancer are poor. As partial oesophagectomy morbidity is lower, total oesophagectomy should not be proposed in all cases of oesophageal cancer.

Question: Late morbidity after esophagectomy for cancer: is partial esophagectomy preferred? Answer: Functional results of oesophagectomy for cancer are poor. As partial oesophagectomy morbidity is lower, total oesophagectomy should not be proposed in all cases of oesophageal cancer.

Answer the question based on the following context: The dietary habits of interstitial cystitis (IC) patients compared to the average food and fluid consumption of the general population were evaluated and any spontaneous preference or avoidance of specific foodstuffs and fluids of IC patients was investigated. A verbal interview with 16 IC patients provided information on the consumption of foodstuffs and fluids as well as dietary habits. Prior to the dietary interview none of the IC patients were aware of any possible dietary measures in relation to their IC symptoms. The results were compared to the averages of the general population. IC patients consumed statistically significantly less calories and fat (p<0.05), and statistically significantly more fibers (p<0.01) than the general population. Among the IC patients there were significantly fewer consumers of coffee (p<0.01) and significantly more consumers of (herbal) tea (p<0.05). The difference in orange juice consumption was not significant.

Is the diet of patients with interstitial cystitis related to their disease?

According to general standards, IC patients had a more healthy daily diet than the general population. The observation that IC patients consumed less coffee (caffeine) than the general population is consistent with previous reports on irritative IC symptoms exacerbating after caffeine consumption. No rationale for other dietary or fluid intake changes was found.

Question: Is the diet of patients with interstitial cystitis related to their disease? Answer: According to general standards, IC patients had a more healthy daily diet than the general population. The observation that IC patients consumed less coffee (caffeine) than the general population is consistent with previous reports on irritative IC symptoms exacerbating after caffeine consumption. No rationale for other dietary or fluid intake changes was found.

Answer the question based on the following context: To test the hypothesis that in patients under age 50, with a first, arterial, ischemic cerebral infarct, whose family history and medical history do not suggest an inherited coagulation inhibitor deficiency, the yield of a laboratory search for these disorders will be low. In 55 such patients under age 50, we systematically searched for deficiencies of protein C, protein S, and antithrombin III. No abnormalities of protein C or antithrombin III were found. One patient had a deficiency of protein S, which was most likely acquired rather than inherited.

Is testing for inherited coagulation inhibitor deficiencies in young stroke patients worthwhile?

In patients who lack clinical features of a prothrombotic state, the yield of testing for protein C, S and AT III deficiency is likely to be low.

Question: Is testing for inherited coagulation inhibitor deficiencies in young stroke patients worthwhile? Answer: In patients who lack clinical features of a prothrombotic state, the yield of testing for protein C, S and AT III deficiency is likely to be low.

Answer the question based on the following context: Reactive oxygen species have been shown to be initiators/promotors of tumorigenesis. Because evidence supports the role of increased oxidative stress in solid tumors, we sought to establish this relationship in neuroblastoma (NB). The aim of the study was to investigate the extent of oxidative DNA damage and antioxidative status in a progressive animal model of human NB. Tumors were induced in the left kidneys of nude mice by the injection of cultured human NB cells (10(6)). Blood was collected from tumor-bearing mice and controls at 2, 4, and 6 weeks. Peripheral blood leukocyte oxidative DNA damage was determined using single-cell gel electrophoresis (comet assay), and plasma antioxidant capacity was assessed by the Trolox equivalent antioxidant capacity method. Levels of oxidative DNA damage in peripheral blood leukocytes of NB-bearing mice were increased by 166%, 110%, and 87% as compared with healthy controls at 2, 4, and 6 weeks, respectively. Plasma total antioxidant values for tumor-bearing mice were not significantly different from control mice.

Oxidative status in neuroblastoma: a source of stress?

Our results indicate an increase of oxidative stress in an animal model of human NB, especially in the early stages of growth. Yet, we did not observe an appreciable response in plasma antioxidant activity. Because an altered redox status has been implicated in tumor maintenance and progression, these findings support the notion of a complex oxidant-antioxidant imbalance contributing to NB growth.

Question: Oxidative status in neuroblastoma: a source of stress? Answer: Our results indicate an increase of oxidative stress in an animal model of human NB, especially in the early stages of growth. Yet, we did not observe an appreciable response in plasma antioxidant activity. Because an altered redox status has been implicated in tumor maintenance and progression, these findings support the notion of a complex oxidant-antioxidant imbalance contributing to NB growth.

Answer the question based on the following context: Delayed perfusion (DP) sign at MR imaging was reported in stroke patients. We sought to experimentally elucidate its relation to spontaneous reperfusion and ischemic penumbra. Stroke was induced by photothrombotic occlusion of middle cerebral artery in eight rats and studied up to 72 h using a 1.5 T MR scanner with T2 weighted imaging (T2WI), diffusion weighted imaging (DWI), and dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI). Relative signal intensity (rSI), relative lesion volume (rLV), relative cerebral blood flow (rCBF), PWI(rLV)-DWI(rLV) mismatch (penumbra) and DP(rLV) were quantified and correlated with neurological deficit score (NDS), triphenyl tetrazolium chloride (TTC) staining, microangiography (MA) and histopathology. The rSI and rLV characterized this stroke model on different MRI sequences and time points. DSC-PWI reproduced cortical DP in all rats, where rCBF evolved from 88.9% at 1 h through 64.9% at 6 h to 136.3% at 72 h. The PWI(rLV)-DWI(rLV) mismatch reached 10+/-5.4% at 1 h, remained positive through 12 h and decreased to -3.3+/-4.5% at 72 h. The incidence and rLV of the DP were well correlated with those of the penumbra (p<0.01, r(2)=0.85 and p<0.0001, r(2)=0.96, respectively). Shorter DP durations and more collateral arterioles occurred in rats without (n=4) than with (n=4) cortex involvement (p<0.05). Rats without cortex involvement tended to earlier reperfusion and a lower NDS. Microscopy confirmed MRI, MA and TTC findings.

Delayed perfusion phenomenon in a rat stroke model at 1.5 T MR: an imaging sign parallel to spontaneous reperfusion and ischemic penumbra?

In this rat stroke model, we reproduced clinically observed DP on DSC-PWI, confirmed spontaneous reperfusion, and identified the penumbra extending to 12h post-ischemia, which appeared interrelated.

Question: Delayed perfusion phenomenon in a rat stroke model at 1.5 T MR: an imaging sign parallel to spontaneous reperfusion and ischemic penumbra? Answer: In this rat stroke model, we reproduced clinically observed DP on DSC-PWI, confirmed spontaneous reperfusion, and identified the penumbra extending to 12h post-ischemia, which appeared interrelated.

Answer the question based on the following context: The aim of this study was to evaluate the value of terminal complement complex (C5b-9) plasma levels as a marker for complement activation in septic shock with concomitant capillary leak syndrome. In a prospective animal study 10 fasted, anaesthetized, mechanically ventilated and multi-catheterized pigs (20.6 +/- 1.3 kg) were investigated over a period of 8 h. Sepsis was induced by faecal peritonitis (1 g kg(-1) body weight faeces, n = 5) and compared to controls (n = 5). The animals received 6% hydroxyethyl starch 200/0.5 to maintain a central venous pressure of 12 mmHg. To quantify capillary leak syndrome, albumin escape rate was measured using 99mTc-labelled human serum albumin. Plasma levels of terminal complement complex were measured in a double antibody immunoassay (neoepitope-specific MoAb aE 11 as catching antibody). Immunohistological studies of renal specimens were performed to detect terminal complement complex deposition. Albumen escape rate increased in septic animals (+ 52%) compared to controls (+ 3%, P<0.05). Plasma levels of terminal complement complex decreased during the study period in both groups. In septic animals this finding was accompanied by a significant deposition of terminal complement complex in renal specimens (P<0.05).

Terminal complement complex in septic shock with capillary leakage: marker of complement activation?

We found an activation of the complement system proven by marked deposition of terminal complement complex in renal specimen, while its plasma levels decreased during the study period in septic and control animals. These results suggest that in septic shock with capillary leak syndrome plasma level of terminal complement complex may not be a reliable marker of complement activation.

Question: Terminal complement complex in septic shock with capillary leakage: marker of complement activation? Answer: We found an activation of the complement system proven by marked deposition of terminal complement complex in renal specimen, while its plasma levels decreased during the study period in septic and control animals. These results suggest that in septic shock with capillary leak syndrome plasma level of terminal complement complex may not be a reliable marker of complement activation.

Answer the question based on the following context: The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity. MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files. The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture.

Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity?

According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Question: Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity? Answer: According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Answer the question based on the following context: A young people's clinic has been running at the Archway Sexual Health Clinic since 1997. This offers a weekly walk-in service to both young men and women under 20 years old. To review the audit data of over 7 years' experience from the dedicated young people's clinic at the Archway Sexual Health Clinic, the "Arch." These data were collected by retrospective notes review of a consecutive series of all male attendees over a 7 year period from 1997 to the end of 2003 with collection of data in Microsoft Excel database. These figures show an overall increase in attendee numbers, but also a relative rise in the numbers of young men using the service. A high number of bacterial sexually transmitted infections were detected. In 2001 and 2003 respectively, 14.5% and 17.8% of the young men using the service were diagnosed with Chlamydia trachomatis. A user survey aimed to identify factors that may be encouraging the young men to access the service.

Are we getting the message across?

Responding to the views of young men using the service has played a part in service development. Initiatives at the "Arch" such as the condom policy and choice of gender of staff may be factors encouraging increasing attendances. Continuing to work with other agencies to develop ways to engage young men are recommended. Word of mouth recommendation cannot be underestimated in publicising the service.

Question: Are we getting the message across? Answer: Responding to the views of young men using the service has played a part in service development. Initiatives at the "Arch" such as the condom policy and choice of gender of staff may be factors encouraging increasing attendances. Continuing to work with other agencies to develop ways to engage young men are recommended. Word of mouth recommendation cannot be underestimated in publicising the service.

Answer the question based on the following context: To assess the impact of a community based bicycle helmet programme aimed at children aged 5-12 years (about 140,000) from poor and well off municipalities. A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle related head injuries leading to hospitalisation were measured, using rates ratios. Reductions in bicycle related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR= 0.45 95%CI 0.26 to 0.78) as among those from richer municipalities (RR=0.55 95%CI 0.41 to 0.75).

Bicycle helmet campaigns and head injuries among children. Does poverty matter?

Population based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.

Question: Bicycle helmet campaigns and head injuries among children. Does poverty matter? Answer: Population based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.

Answer the question based on the following context: Increasing use of primary arteriovenous fistulae (pAVFs) is a desired goal in hemodialysis patients (National Kidney Foundation /Dialysis Outcome Quality Initiative guidelines). However, in many instances, pAVFs fail to adequately mature due to ill-defined mechanisms. We therefore investigated pAVFs with color duplex ultrasound (CDU) surveillance 4 to 12 weeks postoperatively to identify hemodynamically significant abnormalities that may contribute to pAVF failure. From March 2001 to October 2003, 54 upper extremity pAVFs were subjected to CDU assessment before access. A peak systolic velocity ratio (SVR) of>/=2:1 was used to detect>/=50% stenosis involving arterial inflow and venous outflow, whereas an SVR of>/=3:1 was used to detect>/=50% anastomotic stenosis. CDU findings were compared with preoperative vein mapping and postoperative fistulography when available. Of 54 pAVFs, there were 23 brachiocephalic, 14 radiocephalic, and 17 basilic vein transpositions. By CDU surveillance, 11 (20%) were occluded and 14 (26%) were negative. Twenty-nine (54%) pAVFs had 38 hemodynamically significant CDU abnormalities. These included 16 (42%) venous outflow, 13 (34%) anastomotic, and 2 (5%) inflow stenoses. In seven (18%), branch steal with reduced flow was found. In 35 of 54 (65%) pAVFs, preoperative vein mapping was available and demonstrated adequate vein size (>/=3 mm) and outflow in 86% of cases. Twenty-one fistulograms (38%) were available for verifying the CDU abnormalities. In each fistulogram, the arterial inflow, anastomosis, and venous outflow were compared with the CDU findings (63 segments). The sensitivity, specificity, and accuracy of CDU in detecting pAVF stenoses>/=50% were 93%, 94%, was 97%, respectively.

Frequency of critical stenosis in primary arteriovenous fistulae before hemodialysis access: should duplex ultrasound surveillance be the standard of care?

Before initiation of hemodialysis, an unexpectedly high prevalence of critical stenoses was found in patent pAVFs using CDU surveillance. These de novo stenoses appear to develop rapidly after arterialization of the upper extremity superficial veins and can be reliably detected by CDU surveillance. Turbulent flow conditions in pAVFs may play a role in inducing progressive vein wall and valve leaflet intimal thickening, although stenoses may be due to venous abnormalities that predate AVF placement. Routine CDU surveillance of pAVFs should be considered to identify and correct flow-limiting stenoses that may compromise pAVF long-term patency and use.

Question: Frequency of critical stenosis in primary arteriovenous fistulae before hemodialysis access: should duplex ultrasound surveillance be the standard of care? Answer: Before initiation of hemodialysis, an unexpectedly high prevalence of critical stenoses was found in patent pAVFs using CDU surveillance. These de novo stenoses appear to develop rapidly after arterialization of the upper extremity superficial veins and can be reliably detected by CDU surveillance. Turbulent flow conditions in pAVFs may play a role in inducing progressive vein wall and valve leaflet intimal thickening, although stenoses may be due to venous abnormalities that predate AVF placement. Routine CDU surveillance of pAVFs should be considered to identify and correct flow-limiting stenoses that may compromise pAVF long-term patency and use.

Answer the question based on the following context: The most commonly used survey methods are self-administered questionnaires, telephone interviews, and a mixture of both. But until now evidence out of randomised controlled trials as to whether patient responses differ depending on the survey mode is lacking. Therefore this study assessed whether patient responses to surveys depend on the mode of survey administration. The comparison was between mailed, self-administered questionnaires and telephone interviews. A four-armed, randomised controlled two-period change-over design. Each patient responded to the same survey twice, once in written form and once by telephone interview, separated by at least a fortnight. The study was conducted in 2003/2004 in Germany. 1087 patients taking part in the German Acupuncture Trials (GERAC cohort study), who agreed to participate in a survey after completing acupuncture treatment from an acupuncture-certified family physician for headache, were randomised. Of these, 823 (664 women) from the ages of 18 to 83 (mean 51.7) completed both parts of the study. The main outcome measure was the comparison of the scores on the 12-Item Short-Form Health Survey (SF-12) and the Graded Chronic Pain Scale (GCPS) questionnaire for the two survey modes. Computer-aided telephone interviews (CATI) resulted in significantly fewer missing data (0.5%) than did mailed questionnaires (2.8%; p<0.001). The analysis of equivalence revealed a difference between the survey modes only for the SF-12 mental scales. On average, reported mental status score was 3.5 score points (2.9 to 4.0) lower on the self-administered questionnaire compared to the telephone interview. The order of administration affected results. Patients who responded to the telephone interview first reported better mental health in the subsequent paper questionnaire (mean difference 2.8 score points) compared to those who responded to the paper questionnaire first (mean difference 4.1 score points).

Randomised controlled comparison of the Health Survey Short Form (SF-12) and the Graded Chronic Pain Scale (GCPS) in telephone interviews versus self-administered questionnaires. Are the results equivalent?

Despite the comparatively high cost of telephone interviews, they offer clear advantages over mailed self-administered questionnaires as regards completeness of data. Only items concerning mental status were dependent on the survey mode and sequence of administration. Items on physical status were not affected. Normative data for standardized telephone questionnaires could contribute to a better comparability with the results of the corresponding standardized paper questionnaires.

Question: Randomised controlled comparison of the Health Survey Short Form (SF-12) and the Graded Chronic Pain Scale (GCPS) in telephone interviews versus self-administered questionnaires. Are the results equivalent? Answer: Despite the comparatively high cost of telephone interviews, they offer clear advantages over mailed self-administered questionnaires as regards completeness of data. Only items concerning mental status were dependent on the survey mode and sequence of administration. Items on physical status were not affected. Normative data for standardized telephone questionnaires could contribute to a better comparability with the results of the corresponding standardized paper questionnaires.

Answer the question based on the following context: To establish if the 'myth' about whether the size of a man's penis can be estimated from his shoe size has any basis, in fact. Two urologists measured the stretched penile length of 104 men in a prospective study and related this to their shoe size. The median stretched penile length for the sampled population was 13 cm and the median UK shoe size was 9 (European 43). There was no statistically significant correlation between shoe size and stretched penile length.

Can shoe size predict penile length?

The supposed association of penile length and shoe size has no scientific basis.

Question: Can shoe size predict penile length? Answer: The supposed association of penile length and shoe size has no scientific basis.

Answer the question based on the following context: New concentrated laundry pods, available on the European market for approximately 10 years, are associated with more severe intoxications compared to classic laundry detergents.AIM: To compare symptoms and severity after exposure to classic laundry detergents and new laundry pods in a pediatric population. Retrospective study conducted between 1st January 2002 and 30th June 2013 including all laundry detergent exposure patients admitted to our tertiary level pediatric emergency unit. Collected data were age, sex, date, time and location of exposure, type of product (powder, liquid, tablets, pods), estimated ingested quantity, time of admission, clinical symptoms, severity, complications, and progression. Descriptive analysis: eighty-nine children were included. The mean age was 2.1 ± 1.5 years (range, 36 days to 10 years), 65% of patients were aged less than 2 years. The male:female ratio was 1.5 (males, 60%). After exposure, 57% of children were symptomatic and most frequently developed digestive symptoms (75%). Comparative analysis: compared to classic laundry detergent, children exposed to laundry pods were more symptomatic (96% versus 51%, P<0.0001), had more digestive signs (P=0.003), more frequently had bronchospasm (P=0.02), had a higher risk of ocular lesions (P=0.04), and exposure was more severe (poisoning severity score grade 2, 92% versus 59%, P<0.0001). Laundry pod toxicity is more severe. The chemical composition of laundry pods has a higher concentration of surfactants and ethoxylated alcohols; they have a higher viscosity and hydrotropic power. The addition of water seems to modify the alkalinity, which explains the severity of ENT, gastric, and corneal lesions.

Pediatric exposures to laundry pods or capsules: more toxic than traditional laundry products?

The declaration to national poison centers of these intoxications should be pursued by emergency pediatricians, physicians, and pediatric intensivists. Family physicians can encourage parents to declare adverse effects to the National Consumer Product Safety Commission. Parents need to be better informed of the risk of laundry pods and strictly keep this type of product out of the reach of children. Given that it took 7 years after the first warning by the French poison centers to obtain safety recommendations for manufacturers, it is important to maintain pressure on companies to obtain the necessary modification of the physicochemical properties and child-resistant packaging.

Question: Pediatric exposures to laundry pods or capsules: more toxic than traditional laundry products? Answer: The declaration to national poison centers of these intoxications should be pursued by emergency pediatricians, physicians, and pediatric intensivists. Family physicians can encourage parents to declare adverse effects to the National Consumer Product Safety Commission. Parents need to be better informed of the risk of laundry pods and strictly keep this type of product out of the reach of children. Given that it took 7 years after the first warning by the French poison centers to obtain safety recommendations for manufacturers, it is important to maintain pressure on companies to obtain the necessary modification of the physicochemical properties and child-resistant packaging.

Answer the question based on the following context: To present selected cases that highlight the confusions in daily glaucoma practice. Four cases with raised or normal intraocular pressure (IOP) and definite glaucomatous cupping were investigated. While raised IOP was found in non-glaucomatous etiologies, IOP was normal in established glaucoma in a young patient.

Glaucomatous cupping and raised IOP: sine qua non for glaucoma?

Raised IOP and glaucomatous cupping may not be pathognomonic of glaucoma and alternative etiology should be ruled out for appropriate management.

Question: Glaucomatous cupping and raised IOP: sine qua non for glaucoma? Answer: Raised IOP and glaucomatous cupping may not be pathognomonic of glaucoma and alternative etiology should be ruled out for appropriate management.

Answer the question based on the following context: Lower risk of COPD has been reported in black and Asian people, raising questions of poorer recognition or reduced susceptibility. We assessed prevalence and severity of COPD in ethnic groups, controlling for smoking. A retrospective cross-sectional study using routinely collected primary care data in London. COPD prevalence, severity (% predicted forced expiratory volume in 1 second [FEV1]), smoking status, and treatment were compared between ethnic groups, adjusting for age, sex, smoking, deprivation, and practice clustering. Among 358,614 patients in 47 general practices, 47.6% were white, 20% black, and 5% Asian. Prevalence of COPD was 1.01% overall, 1.55% in whites, 0.58% in blacks, and 0.78% in Asians. COPD was less likely in blacks (adjusted odds ratio [OR], 0.44; 95% confidence interval [CI]0.39-0.51) and Asians (0.82; CI, 0.68-0.98) than whites. Black COPD patients were less likely to be current smokers (OR, 0.56; CI, 0.44-0.71) and more likely to be never-smokers (OR, 4.9; CI, 3.4-7.1). Treatment of patients with similar disease severity was similar irrespective of ethnic origin, except that long-acting muscarinic antagonists were prescribed less in black COPD patients (OR, 0.53; CI, 0.42-0.68). Black ethnicity was a predictor of poorer lung function (% predicted FEV1: B coefficient, -7.6; P<0.0001), an effect not seen when ethnic-specific predicted FEV1 values were used.

Does COPD risk vary by ethnicity?

Black people in London were half as likely as whites to have COPD after adjusting for lower smoking rates in blacks. It seems likely that the differences observed were due either to ethnic differences in the way cigarettes were smoked or to ethnic differences in susceptibility to COPD.

Question: Does COPD risk vary by ethnicity? Answer: Black people in London were half as likely as whites to have COPD after adjusting for lower smoking rates in blacks. It seems likely that the differences observed were due either to ethnic differences in the way cigarettes were smoked or to ethnic differences in susceptibility to COPD.

Answer the question based on the following context: To determine whether inhaled corticosteroids can be discontinued in the stable phase of asthma or chronic obstructive pulmonary disease (COPD) or if this therapy should be continued. Nonrandomized open uncontrolled 5-year trial. Prospective study in general practice. Forty-eight patients with steroid-dependent asthma or COPD who had shown a decline in forced expiratory volume in 1 second (FEV1) of at least 80 mL per year and at least one exacerbation per year during the first 2 years of bronchodilator treatment. Subjects were treated additionally with inhaled steroids for another 2 years and were finally given the option to stop using steroids. Sixteen patients were willing to stop using beclomethasone and were studied for another year. No recruitment bias took place in this consecutive sample in the fifth year of follow-up. Two of 16 patients developed carcinomas and dropped out. Two years of bronchodilator treatment alone (400 micrograms of salbutamol or 40 micrograms of ipratropium bromide four times daily), followed by 2 years of additional inhaled corticosteroid treatment (400 micrograms of beclomethasone two times daily), and finally 1 year of bronchodilator treatment alone. Decline in lung function (FEV1), change in bronchial hyperresponsiveness, indicated by a provocative concentration of histamine causing a 20% fall in FEV1 (PC20), morning peak expiratory flow rate (PEFR), diurnal PEFR, week-to-week variation of PEFR, bronchial symptoms, and exacerbations. The course of FEV1 during the year in which beclomethasone was discontinued was not significantly different when compared with the 2-year period of beclomethasone treatment. Neither did the course of PC20, morning PEFR, diurnal PEFR, symptom score, and exacerbation rate change. Only the week-to-week variation of the PEFR increased after discontinuing steroids.

Periodic treatment regimens with inhaled steroids in asthma or chronic obstructive pulmonary disease. Is it possible?

Discontinuing inhaled steroids is possible in some patients with asthma or COPD after 2 years of regular treatment. This might indicate that for certain groups of patients with mild asthma or COPD, periodic treatment schedules with inhaled steroids is the treatment policy for the future.

Question: Periodic treatment regimens with inhaled steroids in asthma or chronic obstructive pulmonary disease. Is it possible? Answer: Discontinuing inhaled steroids is possible in some patients with asthma or COPD after 2 years of regular treatment. This might indicate that for certain groups of patients with mild asthma or COPD, periodic treatment schedules with inhaled steroids is the treatment policy for the future.

Answer the question based on the following context: We assessed the opinions of patients with nongerm cell urological cancer on sperm banking before undergoing surgical or nonsurgical therapy that could potentially endanger subsequent fertility. Between April 2007 and July 2008, 753 patients visited a urological office and were invited to complete a brief self-administered questionnaire to assess opinions on sperm banking before undergoing any eventual therapy potentially dangerous for male fertility. Logistic regression models tested the association between predictors (age, educational level, relationship status, previous fatherhood and benign disorder vs nongerm cell urological cancer) and patient wishes for sperm banking. Median patient age was 65 years (mean 61.6, range 18 to 76). Overall 522 patients (69.3%) had nongerm cell urological cancer and only 242 (32.1%) were in favor of pretreatment sperm banking. On univariate analysis age (OR 0.961, p<0.001), a stable relationship (OR 0.486, p<0.001) and previous fatherhood (OR 0.390, p<0.001) were inversely associated with the wish for sperm banking, whereas having cancer and educational status were not significantly correlated. Multivariate analysis indicated that aging (OR 0.966, p = 0.001) and previous fatherhood (OR 0.587, p = 0.029) maintained inverse associations. Having urological cancer was positively (OR 1.494, p = 0.045) associated with the wish for sperm banking.

Is sperm banking of interest to patients with nongerm cell urological cancer before potentially fertility damaging treatments?

In urological patients there is a low rate of willingness to bank sperm before any potential fertility damaging therapeutic approach. Having nongerm cell urological cancer is an independent predictor that is positively associated with the wish to bank sperm. It is vitally important to provide comprehensive information about pretreatment sperm banking to young adults with nongerm cell urological cancer.

Question: Is sperm banking of interest to patients with nongerm cell urological cancer before potentially fertility damaging treatments? Answer: In urological patients there is a low rate of willingness to bank sperm before any potential fertility damaging therapeutic approach. Having nongerm cell urological cancer is an independent predictor that is positively associated with the wish to bank sperm. It is vitally important to provide comprehensive information about pretreatment sperm banking to young adults with nongerm cell urological cancer.

Answer the question based on the following context: Media reports convey the impression that the incidence of fatal accidents in the European Alps has increased. Because more specific data are lacking, we analyzed available data from the mountain rescue services in Germany, Austria, southern Tirol, Zermatt/Switzerland, and Chamonix/France from 1987 until 1997. Information was gathered from the annual reports of the Austrian Mountain Rescue Service, the Swiss Alpine Club Rescue Station in Zermatt, the Mountain Rescue Service of the Southern Tirol Alpine Club, the Mountain Rescue Service of the Bavarian Red Cross, and the Department of Mountain Medicine and Traumatology from the Hospital in Chamonix. Although the total number of rescue missions and injured alpinists increased significantly during the period, the number of fatalities retrieved during such rescue missions showed no significant increase.

Mountaineering accidents in the European Alps: have the numbers increased in recent years?

Even taking into account the varying definitions of "mountain accident" used in these countries, available data from the analyzed areas of the European Alps do not demonstrate a drastic increase in the number of fatalities. In the future, data concerning mountain accidents in the European Alps should be monitored according to standard definitions and stored by the International Commission for Alpine Rescue.

Question: Mountaineering accidents in the European Alps: have the numbers increased in recent years? Answer: Even taking into account the varying definitions of "mountain accident" used in these countries, available data from the analyzed areas of the European Alps do not demonstrate a drastic increase in the number of fatalities. In the future, data concerning mountain accidents in the European Alps should be monitored according to standard definitions and stored by the International Commission for Alpine Rescue.

Answer the question based on the following context: Multifocal panhepatic hepatoblastoma (HB) without extrahepatic disease is generally considered as an indication for total hepatectomy and liver transplantation. However, after initial chemotherapy, downstaging of the tumor sometimes allows complete macroscopic resection by partial hepatectomy. This procedure is no longer recommended because of the risk of persistent viable tumor cells in the hepatic remnant. We report our experience with conservative surgery in such cases. Between 2000 and 2005, 4 children were consecutively referred to our unit with multinodular pan-hepatic HBs (classification PRETEXT IV of the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL). Three of them had extrahepatic disease at diagnosis. All patients were treated according to SIOPEL 3 and 4 protocols. Extrahepatic metastases were still viable in 2 of 3 patients after initial chemotherapy. These patients eventually died of tumor recurrence. In the 2 patients without residual extrahepatic disease, liver tumors had regressed, and complete macroscopic excision of hepatic tumor remnants could be achieved by conservative surgery. These 2 children are alive and well and free of tumor 7 years after diagnosis.

Cure of multifocal panhepatic hepatoblastoma: is liver transplantation always necessary?

Conservative surgery may be curative in some multinodular PRETEXT IV HB patients, with a good response to preoperative chemotherapy and complete excision of all macroscopic tumor remnants. However, because of the lack of reliable predictors of sterilization of the microscopic disease in the residual liver, with subsequent poor prognosis, total hepatectomy and liver transplantation remain currently recommended in patients with multinodular PRETEXT IV HB without extrahepatic disease, even though some of these children are probably overtreated.

Question: Cure of multifocal panhepatic hepatoblastoma: is liver transplantation always necessary? Answer: Conservative surgery may be curative in some multinodular PRETEXT IV HB patients, with a good response to preoperative chemotherapy and complete excision of all macroscopic tumor remnants. However, because of the lack of reliable predictors of sterilization of the microscopic disease in the residual liver, with subsequent poor prognosis, total hepatectomy and liver transplantation remain currently recommended in patients with multinodular PRETEXT IV HB without extrahepatic disease, even though some of these children are probably overtreated.

Answer the question based on the following context: To determine whether the mentoring scheme currently used has an impact on the training of senior house officers and also determine if they are willing to accept middle grade mentors. A questionnaire comprising 10 questions was sent to all the senior house officers employed in the emergency departments of two large inner city teaching hospitals and three large district hospitals. Most of the questions required a simple yes/no response. Most of the senior house officers had mentors allocated to them but felt the scheme was not satisfactory probably because they had low expectations. Most were happy to have middle grade doctors as mentors.

Mentoring senior house officers. Is there a role for middle grade doctors?

Senior house officers have a low expectation of the present system and seem willing to accept middle grade doctors as mentors.

Question: Mentoring senior house officers. Is there a role for middle grade doctors? Answer: Senior house officers have a low expectation of the present system and seem willing to accept middle grade doctors as mentors.

Answer the question based on the following context: The purpose of this study was to investigate the most important predictor isokinetic muscle strength determined by different angular velocities and contraction types (i.e. concentric and eccentric) for selected anaerobic power tests in volleyball players. Twenty male and ten female amateur volleyball players participated in this study. Selected anaerobic power tests included Wingate Anaerobic Test (WAnT), squat jump (SJ) and countermovement jump (CMJ). Peak torque values were obtained at 60, 120, 240˚/s for concentric contraction of quadriceps (Qconc) and Hamstring (Hconc) and at 60˚/s for eccentric contraction of quadriceps (Qecc) and Hconc. Moderate to good correlations (r:0.409 to r:0.887) were found between anaerobic tests and isokinetic data including peak torque and total work of both Hconc and Qconc at 60, 120, 240°/s and Qecc at 60°/s (P<0.05). Qconc measured at each of 60, 120, 240°/s was found to be the only significant predictor for anaerobic tests in linear regression models (P<0.05). Correlation coefficient s for Qconc increased with increasing velocity for each of the anaerobic tests. Correlation coefficient of Qconc was highest for CMJ followed by SJ and WAnT at the same angular velocity. As a distinctive feature, both Qecc and Hconc at 60˚/s were significantly predictors for CMJ and SJ.

Do isokinetic angular velocity and contraction types affect the predictors of different anaerobic power tests?

Qconc peak torque was the single significant predictor for WAnT, SJ and CMJ and strength of the relation increases with increasing angular velocity. However, both Qecc and Hconc were significant indicators for CMJ and SJ. Training with higher isokinetic angular velocities and with eccentric contraction is desirable in a training program that has a goal of improving anaerobic performance in volleyball players.

Question: Do isokinetic angular velocity and contraction types affect the predictors of different anaerobic power tests? Answer: Qconc peak torque was the single significant predictor for WAnT, SJ and CMJ and strength of the relation increases with increasing angular velocity. However, both Qecc and Hconc were significant indicators for CMJ and SJ. Training with higher isokinetic angular velocities and with eccentric contraction is desirable in a training program that has a goal of improving anaerobic performance in volleyball players.

Answer the question based on the following context: TNF-alpha and IL-2 are important cytokines in macrophage and T-lymphocyte activity against infection and dissemination of malignant cells. We studied the influence of supernatants from stored whole blood and buffy-coat-depleted SAGM (saline, adenine, glucose and mannitol) blood in stimulating TNF-alpha and IL-2 release in an ex vivo assay. Supernatants of 10 units of whole blood and 10 units of SAGM blood were collected after 1, 21 and 35 days of standard blood bank storage. Heparinized blood from 20 healthy volunteers (as 'recipients'), corresponding in ABO and Rh type to the stored blood, were used in a culture system with LPS and PHA as stimulators of TNF-alpha and IL-2 release. The effect of added supernatants, from either stored whole blood or SAGM blood, on cytokine release was evaluated compared to saline as control. TNF-alpha concentration was analyzed by ELISA after culture for 24 h and IL-2 after 72 h, respectively. Supernatants from both stored whole blood and SAGM blood showed a significant decrease in both LPS- and PHA-stimulated TNF-alpha release that was dependent on storage time. IL-2 was not detected in response to LPS stimulation. PHA-stimulated IL-2 release was significantly reduced and related to storage time of both whole blood and SAGM blood.

Immunomodulating effect of blood transfusion: is storage time important?

Recipient cytokine release induced by blood transfusion seems to be dependent on storage time. This may have implications in transfusion-induced immune modulation.

Question: Immunomodulating effect of blood transfusion: is storage time important? Answer: Recipient cytokine release induced by blood transfusion seems to be dependent on storage time. This may have implications in transfusion-induced immune modulation.

Answer the question based on the following context: In the majority of exercise intervention studies, the aggregate reported weight loss is often small. The efficacy of exercise as a weight loss tool remains in question. The aim of the present study was to investigate the variability in appetite and body weight when participants engaged in a supervised and monitored exercise programme. Fifty-eight obese men and women (BMI = 31.8 +/- 4.5 kg/m2) were prescribed exercise to expend approximately 2092 kJ (500 kcal) per session, five times a week at an intensity of 70 % maximum heart rate for 12 weeks under supervised conditions in the research unit. Body weight and composition, total daily energy intake and various health markers were measured at weeks 0, 4, 8 and 12. Mean reduction in body weight (3.2 +/- 1.98 kg) was significant (P<0.001); however, there was large individual variability (-14.7 to +2.7 kg). This large variability could be largely attributed to the differences in energy intake over the 12-week intervention. Those participants who failed to lose meaningful weight increased their food intake and reduced intake of fruits and vegetables.

Exercise alone is not enough: weight loss also needs a healthy (Mediterranean) diet?

These data have demonstrated that even when exercise energy expenditure is high, a healthy diet is still required for weight loss to occur in many people.

Question: Exercise alone is not enough: weight loss also needs a healthy (Mediterranean) diet? Answer: These data have demonstrated that even when exercise energy expenditure is high, a healthy diet is still required for weight loss to occur in many people.

Answer the question based on the following context: The goal of this study was to identify anterior spinal artery (ASA) occlusion by CT angiography in cervical spondylotic myelopathy (CSM) and amyotrophy (CSA) with T2-weighted hyperintensity of MR image of documented small intramedullary high signal intensity known as "snake-eye appearance" (SEA). One hundred and six patients with CSM were admitted to the investigator group between June 2010 and June 2013. Intramedullary high signal intensity was found in 42 cases and was divided into two types, SEA and non-SEA. SEA was observed in 10 patients, including seven CSM patients and three CSA patients. All SEA patients were performed CT angiography of ASA after admission. The ASA was visualized in all 10 patients. ASA incomplete occlusion was found in one CSA patient and one CSM patient. No ASA occlusion was found in other CSA and CSM patients with SEA.

Is the "snake-eye" MRI sign correlated to anterior spinal artery occlusion on CT angiography in cervical spondylotic myelopathy and amyotrophy?

ASA occlusion is not commonly seen in CSM and CSA patients with SEA. Pathological changes about SEA in CSM and CSA have no close correlation with ASA occlusion, but may be with anterior radiculomedullary arteries.

Question: Is the "snake-eye" MRI sign correlated to anterior spinal artery occlusion on CT angiography in cervical spondylotic myelopathy and amyotrophy? Answer: ASA occlusion is not commonly seen in CSM and CSA patients with SEA. Pathological changes about SEA in CSM and CSA have no close correlation with ASA occlusion, but may be with anterior radiculomedullary arteries.

Answer the question based on the following context: The authors determined the usefulness of frozen section (FS) evaluation in the operative management of follicular lesions of the thyroid. Fine-needle aspiration (FNA) cannot reliably discriminate between benign and malignant follicular lesions of the thyroid. Accordingly, FS evaluation is used routinely to guide intraoperative management. One hundred twenty-five consecutive patients with follicular thyroid lesions who underwent surgical exploration at the Johns Hopkins Hospital were reviewed. Frozen sections were categorized in 104 of 120 patients (87%) as "follicular lesion, defer to permanent section," rendering no useful clinical information. In only 4 of 120 patients (3.3%) did FS evaluation correctly modify the operative procedure. Notably, in six cases (5.0%), an incorrect FS evaluation misled the surgeon, resulting in four misguided operations.

Follicular lesions of the thyroid. Does frozen section evaluation alter operative management?

Frozen section evaluation is of minimal diagnostic value for follicular thyroid lesions, rendering no additional information 87% of the time; it prolongs the operation, increases costs, and leads to misguided interventions. Until a more definitive diagnostic tool exists for follicular thyroid lesions, FS evaluation could be omitted, resection of the lobe with the nodule could be performed, and the definitive operative management could be based on the final permanent histology.

Question: Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Answer: Frozen section evaluation is of minimal diagnostic value for follicular thyroid lesions, rendering no additional information 87% of the time; it prolongs the operation, increases costs, and leads to misguided interventions. Until a more definitive diagnostic tool exists for follicular thyroid lesions, FS evaluation could be omitted, resection of the lobe with the nodule could be performed, and the definitive operative management could be based on the final permanent histology.

Answer the question based on the following context: The need for organs for renal transplantation has encouraged the use of grafts from increasingly older donors. Studies of transplantation results with donors older than 70 years are sparse. The main purpose of this study is to compare the results of transplantation with donors older and younger than 70 years old. This retrospective study included 1233 consecutive deceased-donor renal transplantations performed between January 1, 2001, and December 31, 2011. We compared outcomes of grafts from donors older than 70 years (group ≥ 70; n = 82) versus donors younger than 70 years (group<70; n = 1151). Univariate analysis of pretransplantation data showed statistically significant differences (P<.05) among the following variables for the group<70 and group ≥ 70, respectively: recipient age (46 ± 13 versus 61 ± 5 years), donor age (44 ± 16 versus 73 ± 3 years), donor male gender (69.4% versus 47.6%), use of antibody induction immunosuppression (51.7% versus 70.7%), and HLA compatibilities (2.4 versus 2). The group ≥ 70 showed increased postoperative minor complications: bleeding (8.5% versus 3.4%; P = .017), lymphocele formation (3.7% versus 0.5%; P = .011), and incisional hernia (2.4% versus 0.2%; P<.001). Regarding transplantation results, we observed that mean serum creatinine was significantly lower among group<70, at 1, 3, 6, 12, 24, and 60 months after transplantation (P<.05). Cumulative graft survival at 1, 3, and 4 years was 90%, 85%, and 83% in the group<70 versus 87%, 79%, and 72% in the group ≥ 70. In the subgroup of recipients younger than 60 years, we did not verify statistically significant differences in allograft survival between group ≥ 70 and group<70. Using Cox regression for survival analysis, we verified that donor age was not an independent risk factor for graft failure.

Renal transplantation with donors older than 70 years: does age matter?

The group of patients who received kidneys from donors younger than 70 years achieved better transplantation outcomes. Nevertheless, kidneys from older donors represent an excellent alternative for older recipients.

Question: Renal transplantation with donors older than 70 years: does age matter? Answer: The group of patients who received kidneys from donors younger than 70 years achieved better transplantation outcomes. Nevertheless, kidneys from older donors represent an excellent alternative for older recipients.

Answer the question based on the following context: The factor structure and internal consistency of the Lake Louise Score Questionnaire (LLSQ) have not been determined in a large population at high altitude; however, a single-factor structure and a high internal consistency are preferable for accurate clinical and research applications of the LLSQ. A large group of Nepalese pilgrims (n=491) were assessed for acute mountain sickness with a verbal Nepali translation of the LLSQ after rapidly ascending from 1950 m to 4380 m. The factor structure and internal consistency of the LLSQ were determined with a confirmatory factor analysis (CFA) and the ordinal alpha coefficient, respectively. A one-factor structure with all five items of the LLSQ was accepted. Four items (headache, gastrointestinal upset, fatigue/weakness, and dizziness/lightheadedness) loaded strongly on this factor (>0.70), but sleep quality had a low factor loading (0.33). The internal consistency (ordinal alpha coefficient) was 0.79, but removing the sleep quality item improved this value to 0.84.

Is poor sleep quality at high altitude separate from acute mountain sickness?

The sleep quality item of the LLSQ was weakly related to the other items of the LLSQ. Future research should further investigate whether impaired sleep at altitude should be considered separately from other symptoms of AMS.

Question: Is poor sleep quality at high altitude separate from acute mountain sickness? Answer: The sleep quality item of the LLSQ was weakly related to the other items of the LLSQ. Future research should further investigate whether impaired sleep at altitude should be considered separately from other symptoms of AMS.

Answer the question based on the following context: Little is known about trends in renal replacement therapy among patients with chronic kidney disease (CKD) or about changes in the incidence of CKD. We studied the incidence of renal replacement therapy within the population of a health maintenance organization (HMO) both among the entire HMO population and among those with CKD. We calculated yearly incidence rates of renal replacement therapy for each year from 1998 to 2005. We defined CKD using the National Kidney Foundation definition of 2 estimated glomerular filtration rates below 60 ml/min/1.73 m2 90 or more days apart. Poisson regression assessed year-to-year differences. The number of patients with CKD rose consistently from 3,861 in 1998 to 5,242 in 2005. The proportion of patients who had been diagnosed with hypertension rose from 86.7% (starting renal replacement therapy) or 34.5% (with CKD) to 99.1 and 46.9%. The proportion of patients with diabetes changed little throughout the years studied. The mean estimated glomerular filtration rate among CKD patients rose minimally from 38.4 ml/min/1.73 m2 in 1998 to 39.9 ml/min/1.73 m2 in 2005. Age- and sex-adjusted rates of RRT among patients with CKD varied (p=0.0034), but did not follow a consistent pattern over time.

Secular trends in kidney disease: is the decreased incidence of renal replacement therapy due to a decrease in chronic kidney disease incidence?

Incidence of renal replacement therapy among patients with CKD changed little between 1998 and 2005, despite an increase in the number of patients diagnosed with CKD. The discrepancy may be due to increased laboratory identification of CKD.

Question: Secular trends in kidney disease: is the decreased incidence of renal replacement therapy due to a decrease in chronic kidney disease incidence? Answer: Incidence of renal replacement therapy among patients with CKD changed little between 1998 and 2005, despite an increase in the number of patients diagnosed with CKD. The discrepancy may be due to increased laboratory identification of CKD.

Answer the question based on the following context: It is still a matter of debate as to whether resective surgery of the primary tumor may prolong the survival of patients affected by incurable colorectal cancer (CRC). The main goal of this retrospective study, carried out on patients not undergoing any therapy other than surgery, was to quantify the benefit of primary tumor removal in patients with differently presenting incurable CRC. One hundred and thirty consecutive patients were operated on for incurable CRC (83 undergoing resective and 47 non-resective procedures). With the purpose of comparing homogenous populations and of identifying patients who may benefit from primary tumor resection, the patients were classified according to classes of disease, based on the "metastatic pattern" and the "resectability of primary tumor." In patients with "resectable" primary tumors, resective procedures are associated with longer median survival than after non-resective ones (9 months vs 3). Only patients with distant spread without neoplastic ascites/carcinosis benefit from primary tumor removal (median survival: 9 months vs 3). Morbidity and mortality of resective procedures is not significantly different from that of non-resective surgery, either in the population studied or in any of the groups considered.

Palliative resection of colorectal cancer: does it prolong survival?

Palliative resection of primary CRC should be pursued in patients with unresectable distant metastasis (without carcinomatosis), and, intraoperatively, whenever the primary tumor is technically resectable.

Question: Palliative resection of colorectal cancer: does it prolong survival? Answer: Palliative resection of primary CRC should be pursued in patients with unresectable distant metastasis (without carcinomatosis), and, intraoperatively, whenever the primary tumor is technically resectable.

Answer the question based on the following context: Higher knee load and quadriceps weakness are potential factors involved in the pathogenesis of knee osteoarthritis after arthroscopic partial meniscectomy (APM). In people following APM, this study evaluated the association between external knee joint moments and quadriceps strength and 2-yr change in indices of cartilage integrity in the medial tibiofemoral compartment and patella. Seventy people with medial APM were assessed 3 months after APM (baseline) and reassessed 2 yr later (follow-up). At baseline, isokinetic quadriceps strength and the external knee adduction moment (peak and impulse) and knee flexion moment (peak) during walking were assessed. Magnetic resonance imaging was used to assess cartilage (cartilage volume and cartilage defects) in the medial tibial compartment and patella at baseline and follow-up. Increased peak knee adduction moment during fast-pace walking at baseline was associated with onset or deterioration of medial tibiofemoral cartilage defects (OR, 2.06; 95% CI, 1.03-4.12; P = 0.042) over 2 yr. Increased peak knee flexion moment during normal-pace walking at baseline was associated with loss of patellar cartilage volume over 2 yr (β = -0.24; 95% CI, -0.47 to -0.01; P = 0.04). No significant association was observed for quadriceps strength.

Do Moments and Strength Predict Cartilage Changes after Partial Meniscectomy?

In middle-age adults, a higher peak knee adduction moment and peak knee flexion moment at 3 months after medial APM may be associated with adverse structural changes at the medial tibia and patella over the subsequent 2 yr. These preliminary findings warrant further investigation as interventions aimed at reducing these moments may be designed if appropriate.

Question: Do Moments and Strength Predict Cartilage Changes after Partial Meniscectomy? Answer: In middle-age adults, a higher peak knee adduction moment and peak knee flexion moment at 3 months after medial APM may be associated with adverse structural changes at the medial tibia and patella over the subsequent 2 yr. These preliminary findings warrant further investigation as interventions aimed at reducing these moments may be designed if appropriate.

Answer the question based on the following context: To evaluate whether first, second, and third-trimester maternal serum hepcidin levels are different in pregnancies with and without adverse pregnancy outcomes (APO). A 165 nullipar pregnant women were included in this prospective cohort study. Serum hepcidin, ferritin, IL-6, C-reactive protein (CRP) and Hb values were measured at 11-14, 24-28, and 30-34 weeks of gestation. The relation between these parameters and APO and neonatal outcomes were investigated. Preterm delivery, intrauterine growth restriction, pre-eclampsia, gestational hypertension and placental abruption were determined as adverse pregnancy outcomes. The risk of APO was three times higher in women with high IL-6 levels in the second trimester. High hepcidin levels in the second trimester were associated with a 1.6 times increased risk of APO. Newborns of women with high IL-6 levels in the third trimester had a 1.6-fold increased risk of neonatal complications. High ferritin levels in the third trimester were associated with minimally increased risk of neonatal complications.

Do the first, second and third trimester maternal serum hepcidin concentrations clarify obstetric complications?

Mean serum hepcidin levels were similar in all pregnant women, however, elevated second trimester serum hepcidin and IL-6 levels were associated with a higher risk of APO and high third trimester hepcidin, ferritin and IL-6 levels were associated with higher risk of neonatal complications.

Question: Do the first, second and third trimester maternal serum hepcidin concentrations clarify obstetric complications? Answer: Mean serum hepcidin levels were similar in all pregnant women, however, elevated second trimester serum hepcidin and IL-6 levels were associated with a higher risk of APO and high third trimester hepcidin, ferritin and IL-6 levels were associated with higher risk of neonatal complications.

Answer the question based on the following context: To examine the hypothesis that atrial based pacing improves Quality of Life (QoL) after pacing by undertaking a detailed QoL evaluation that includes an individualised assessment as well as disease specific evaluation. Prospective study of patients randomised to VVI(R) or atrial based pacing modes using the Schedule for the Evaluation of Individual QoL (SEIQoL), the 36-item Medical Outcomes Study Short-Form General Health Survey (SF36), and a modified version of the Karolinska Cardiovascular Symptomatology Questionnaire (KCSQ). Seventy-three patients completed the two-year follow up of the study. Pacing improved SEIQoL scores, cardiovascular symptoms and the physical role limitation, social limitation and mental health domains of SF36 from baseline to one month. Pacing mode had no effect on QoL the major determinants of which were baseline QoL and a history of coronary artery disease.

Individualised quality of life after pacing. Does mode matter?

Atrial based pacing does not improve QoL in the two years after pacing when compared with VVI(R) pacing.

Question: Individualised quality of life after pacing. Does mode matter? Answer: Atrial based pacing does not improve QoL in the two years after pacing when compared with VVI(R) pacing.

Answer the question based on the following context: Down syndrome is associated with an increased susceptibility to infections due to a deficiency of both specific and nonspecific immunity.AIM: The aim of the study was to analyze the temporal trends, if any, of some variables related to the immunological status of children affected by Down syndrome. Heparinized blood samples were obtained by venipuncture in 30 children with Down syndrome, who were regularly followed in our department and analyzed for hematologic values, lymphocyte subpopulations, immunoglobulin dosage and zinc level. Results were compared with those of the normal population. In the first 5 years of life, we observed a progressive decrease in the medium values of lymphocytes, CD4(+) and plasma zinc levels, and an increase in CD8(+), immunoglobulin A, immunoglobulin G, immunoglobulin M and natural killer, but generally without exceeding the interval of normality.

Immunological patterns in young children with Down syndrome: is there a temporal trend?

In Down syndrome children, the immune cellular status is similar to the normal population as far as white blood cell, lymphocyte, CD4(+), CD8(+), natural killer and immunoglobulins are concerned. Plasma level of zinc is normal from birth until 5 years but with a temporal trend of progressive reduction. This observation supports the hypothesis that a pharmacological supplementation may be necessary in Down syndrome children only after 5 years of age.

Question: Immunological patterns in young children with Down syndrome: is there a temporal trend? Answer: In Down syndrome children, the immune cellular status is similar to the normal population as far as white blood cell, lymphocyte, CD4(+), CD8(+), natural killer and immunoglobulins are concerned. Plasma level of zinc is normal from birth until 5 years but with a temporal trend of progressive reduction. This observation supports the hypothesis that a pharmacological supplementation may be necessary in Down syndrome children only after 5 years of age.

Answer the question based on the following context: To determine whether docosahexaenoic acid (DHA) is related to visual and neural development in term breast-fed infants. A prospective study of 83 infants who were exclusively breast-fed for at least 3 months. We determined red blood cell and plasma fatty acids at 2 months, visual acuity at 2, 4, 6, and 12 months, speech perception and an object search task at 9 months, Bayley's mental development index and psychomotor development index at 6 and 12 months, and novelty pReference at 6 and 9 months. The infant red blood cell phosphatidylethanolamine DHA was significantly related to visual acuity at 2 months of age (r = 0.32, P =.01) and 12 months of age (r = 0.30, P =.03). The ability to discriminate nonnative retroflex and phonetic contrasts at 9 months of age was related to the plasma phospholipid DHA (r = 0.48, P<.02) and red blood cell phosphatidylethanolamine DHA (r = 0.26, P =.02) at 2 months of age after adjusting for covariates.

Are human milk long-chain polyunsaturated fatty acids related to visual and neural development in breast-fed term infants?

DHA may influence the development of visual acuity and neural pathways associated with the developmental progression of language acquisition in term breast-fed infants. The extent to which our results can be attributed solely to DHA from maternal sources through breast milk or in gestation or other confounding factors remains to be determined.

Question: Are human milk long-chain polyunsaturated fatty acids related to visual and neural development in breast-fed term infants? Answer: DHA may influence the development of visual acuity and neural pathways associated with the developmental progression of language acquisition in term breast-fed infants. The extent to which our results can be attributed solely to DHA from maternal sources through breast milk or in gestation or other confounding factors remains to be determined.

Answer the question based on the following context: To test the hypothesis that methylphenidate modifies markers of fall risk in older adults. Randomized, double-blind, placebo-controlled, single-dose cross-over study. Outpatient movement disorders clinic. Twenty-six community-living older adults without dementia (mean age 73.8) with subjective complaints of "memory problems." The study examined the effects of a single dose of 20 mg of methylphenidate (MPH) on cognitive function and gait. Participants were evaluated before and 2 hours after taking MPH or a placebo in sessions 1 to 2 weeks apart. The Timed Up and Go and gait variability quantified mobility and fall risk. A computerized neuropsychology battery quantified memory and executive function (EF). Timed Up and Go times, stride time variability, and measures of EF significantly improved in response to MPH but not in response to the placebo. In contrast, MPH did not significantly affect memory or finger tapping abilities.

Can methylphenidate reduce fall risk in community-living older adults?

In older adults, MPH appears to improve certain aspects of EF, mobility, and gait stability. Although additional studies are required to assess clinical utility and efficacy, the present findings suggest that methylphenidate and other drugs that are designed to enhance attention may have a role as a therapeutic option for reducing fall risk in older adults.

Question: Can methylphenidate reduce fall risk in community-living older adults? Answer: In older adults, MPH appears to improve certain aspects of EF, mobility, and gait stability. Although additional studies are required to assess clinical utility and efficacy, the present findings suggest that methylphenidate and other drugs that are designed to enhance attention may have a role as a therapeutic option for reducing fall risk in older adults.

Answer the question based on the following context: Our aim was to assess international differences in illness behaviour and clinical outcome for patients in Europe with an episode of acute tonsillitis. The subjects were 2423 patients from seven countries whose acute tonsillitis was treated with antibiotics. Each country selected at least 10 GPs who filled in a questionnaire for each episode of acute tonsillitis treated during a 3-month period, November 1989-May 1990. The outcome measure was the number of days of illness. Backwards multiple regression analysis with predictors (age, sex, country, initial temperature, days prior to illness) was performed. The number of days of illness of patients with an episode of acute tonsillitis varied between the European countries, from 3 to 10 days. Country was the most important predictor, whereas disease-specific and patients' characteristics were not important predictors.

Transcultural differences in illness behaviour and clinical outcome: an underestimated aspect of general practice?

Duration of illness was primarily influenced by country. The countries in Eastern Europe especially were characterized by a longer duration of illness. Transcultural differences may influence the duration of illness and need more attention in daily practice.

Question: Transcultural differences in illness behaviour and clinical outcome: an underestimated aspect of general practice? Answer: Duration of illness was primarily influenced by country. The countries in Eastern Europe especially were characterized by a longer duration of illness. Transcultural differences may influence the duration of illness and need more attention in daily practice.

Answer the question based on the following context: Fas ligand expression by endothelial cells is downregulated under proinflammatory conditions, facilitating the vascular infiltration by circulating cells. We have analyzed whether the forearm vasodilatory response to reactive hyperemia is associated with soluble Fas ligand (sFasL) plasma concentrations in subjects with coronary artery disease (CAD). Forearm blood flow to reactive hyperemia, an indicator of endothelial function, and forearm blood flow to nitroglycerin (endothelial-independent) were measured in 110 subjects with stable CAD. sFasL and C-reactive protein (CRP) concentrations were also determined. There was a linear trend for the increase of sFasL and forearm reactive hyperemia (p<0.001). In contrast, no association was observed between sFasL and forearm blood flow to nitroglycerine. sFasL was not related with the presence of cardiovascular risk factors. Partial correlation coefficient adjusted by age and gender remained significant between sFasL and forearm blood flow to reactive hyperemia (r=0.35; p<0.001). No association between CRP concentrations and forearm reactive hyperemia, forearm blood flow to nitroglycerin or sFasL plasma concentrations was noted.

Soluble Fas ligand plasma levels are associated with forearm reactive hyperemia in subjects with coronary artery disease: a novel biomarker of endothelial function?

Our results are consistent with the hypothesis that sFasL levels could reflect endothelial function in subjects with CAD and suggest that sFasL plasma concentrations could be a potential biomarker of endothelial function.

Question: Soluble Fas ligand plasma levels are associated with forearm reactive hyperemia in subjects with coronary artery disease: a novel biomarker of endothelial function? Answer: Our results are consistent with the hypothesis that sFasL levels could reflect endothelial function in subjects with CAD and suggest that sFasL plasma concentrations could be a potential biomarker of endothelial function.

Answer the question based on the following context: Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation. In this study, we compared onset time, conditions for tracheal intubation, and duration of action in obese patients when the intubation dose of rocuronium was based on three different weight corrections. Fifty-one obese patients, with a median (range) body mass index of 44 (34-72) kg/m2, scheduled for laparoscopic gastric banding or gastric bypass under propofol-remifentanil anesthesia were randomized into three groups. The patients received rocuronium (0.6 mg/kg) based on IBW (IBW group, n = 17), IBW plus 20% of excess weight (corrected body weight [CBW]20% group, n = 17), or IBW plus 40% of excess weight (CBW40% group, n = 17). Propofol was administered as a bolus of 200 mg and an infusion at 5 mg x kg(-1) x h(-1) and remifentanil was administered at 1.0 microg x kg(-1) x min(-1), both according to CBW40%.Neuromuscular function was monitored with train-of-four nerve stimulation and acceleromyography. The primary end point was duration of action, defined as time to reappearance of the fourth twitch in train-of-four. The median (range) duration of action was 32 (18-49), 38 (25-66), and 42 (24-66) min in the IBW, CBW20%, and CBW40% groups, respectively (P = 0.001 for comparison of the IBW and CBW40% group). There were no significant differences in onset time (85 vs 84 vs 80 s) or in intubation conditions 90 s after administration of rocuronium.

Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?

In obese patients undergoing gastric banding or gastric bypass, rocuronium dosed according to IBW provided a shorter duration of action without a significantly prolonged onset time or compromised conditions for tracheal intubation.

Question: Should dosing of rocuronium in obese patients be based on ideal or corrected body weight? Answer: In obese patients undergoing gastric banding or gastric bypass, rocuronium dosed according to IBW provided a shorter duration of action without a significantly prolonged onset time or compromised conditions for tracheal intubation.

Answer the question based on the following context: To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness. Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012. We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories. Among chronically ill patients, transition to PCMH status was associated with 5-8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension.

Do patient-centered medical homes reduce emergency department visits?

Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics.

Question: Do patient-centered medical homes reduce emergency department visits? Answer: Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics.

Answer the question based on the following context: Treatment consisted of cold rituximab (250 mg/m2) on day 1 and day 8 and 177Lu-DOTA-Rituximab on day 8. Reassessment was done at week 10. Thirty-one patients (males=17, females=14, median number of pretreatments: 3) were treated in seven cohorts. Escalation of injected activity was carried out in steps of 5 mCi/m². Dosimetry was performed in the first 20 patients. The MTD was found to be 45 mCi/m2. Thrombocytopenia and leukopenia were the dose-limiting toxicities. Significant anemia only occurred at dose level 7. We observed the nadir of platelets after a median of 36 days from treatment with 177Lu-D-R and a nadir of granulocytes after a median of 50 days from 177Lu-D-R treatment. Non-hematological toxicity was negligible. We observed clinical responses at all dose levels and for all lymphoma entities. Some of the responses were durable; the longest follow up in complete remission is currently over eight years.

Is there need for radioimmunotherapy?

The MTD of 177Lu-DOTA-Rituximab was found to be 45 mCi/m². Non hematologic toxicity was negligible. Responses were seen in all lymphoma entities and at all dose levels tested. Further testing seems to be most promising mainly in follicular and marginal zone lymphoma in particular as the results compare well to other therapy options for these patients with regard to effectiveness, toxicity and discomfort for the patients.

Question: Is there need for radioimmunotherapy? Answer: The MTD of 177Lu-DOTA-Rituximab was found to be 45 mCi/m². Non hematologic toxicity was negligible. Responses were seen in all lymphoma entities and at all dose levels tested. Further testing seems to be most promising mainly in follicular and marginal zone lymphoma in particular as the results compare well to other therapy options for these patients with regard to effectiveness, toxicity and discomfort for the patients.

Answer the question based on the following context: Malignant ampullary tumors (AT) require pancreatico-duodenectomy (PD) for curative treatment whereas benign AT can be appropriately treated by local resection. This study evaluated the accuracy of endoscopic exploration combining side-viewing duodenoscopy (SVD) with forceps biopsies, endoscopic sphincterotomy (ES), and endoscopic ultrasonography (EUS) to distinguish benign AT from malignant one. Twenty-six patients with AT had preoperative SVD with forceps biopsies, including 9 with ES, and EUS. Nodal status was evaluated by EUS in all patients, but could not evaluate parietal spread in 6 in whom ES was previously done. Results of endoscopic examination were compared with pathologic examination after resection (2 local excisions for 2 benign AT, and 24 PD for 20 malignant and 4 benign AT). Accuracy of histologic examination of the 26 biopsies of the papilla was 69%. After ES, accuracy of intra-ampullary biopsies was 77%. The EUS had a 75% accuracy for the parietal spread (tumor limited to ampulla or not) and a 69% accuracy for the nodal status. In 11 patients, all explorations were consistent with a benign lesion, but 6 of these patients had a histologically proven malignancy, including one with nodal metastases and two with duodenal involvement.

Are endoscopic procedures able to predict the benignity of ampullary tumors?

Side-viewing duodenoscopy with biopsies, even after ES, combined with EUS is not accurate enough to preoperatively ensure that an AT is benign. Indication for a local resection based on these explorations alone is not safe.

Question: Are endoscopic procedures able to predict the benignity of ampullary tumors? Answer: Side-viewing duodenoscopy with biopsies, even after ES, combined with EUS is not accurate enough to preoperatively ensure that an AT is benign. Indication for a local resection based on these explorations alone is not safe.

Answer the question based on the following context: Transition readiness assessment has focused attention on adolescent knowledge and skills, but data-driven benchmarks have not been established. Patients with inflammatory bowel disease (IBD), ages 25 to 50 years, attending an outpatient gastroenterology clinic, were recruited to complete a voluntary, confidential survey asking patients to recall medications and potential side effects, and to rate their degree of independence performing health maintenance tasks. The 141 respondents (48% response rate) had mean age of 36 years with median disease duration of 11 years. They were 60% female, 54% had Crohn disease, and 23% were diagnosed before age 18. Nearly all patients were fully independent answering doctor's questions during the visit (93%) and scheduling office visits (92%). Excluding pharmacy pick up, full independence seen in only 57%, whereas 16% significantly delegated tasks. No differences by sex, disease type, medication class, age at disease onset, or disease duration were found across levels of self-management. Almost all (97%) respondents could recall medication name, whereas fewer were able to recall dose (63%) or frequency (65%). Side effect knowledge was poor; among 81 patients on a biologic or immunomodulator, only 17 (21%) cited cancer and 22 (27%) cited infection.

Are Expectations Too High for Transitioning Adolescents With Inflammatory Bowel Disease?

Adolescent IBD transition programs now have empirical data from the present study about adult benchmarks for independence in self-management skills. Further research can establish which skills correlate with medication adherence and active collaboration with the medical team. The present study also exposes important gaps in medication risk knowledge and may allow improved patient education for subgroups of adult patients with IBD.

Question: Are Expectations Too High for Transitioning Adolescents With Inflammatory Bowel Disease? Answer: Adolescent IBD transition programs now have empirical data from the present study about adult benchmarks for independence in self-management skills. Further research can establish which skills correlate with medication adherence and active collaboration with the medical team. The present study also exposes important gaps in medication risk knowledge and may allow improved patient education for subgroups of adult patients with IBD.

Answer the question based on the following context: This study examined aspects of reliability, validity and utility of Addiction Severity Index (ASI) data as administered to clients with severe and persistent mental illness (SMI) and concurrent substance abuse disorders enrolled in a publicly-funded community mental health center. A total of 62 clients with SMI volunteered to participate in an interobserver and test-retest reliability study of the ASI. Spearman-Brown and Pearson correlation coefficients were calculated to examine the extent of agreement among client responses. Overall 16% of the composite scores could not be calculated due to missing data and 31% of the clients misunderstood or confused items in at least one of the seven ASI domains. As a whole, the interobserver reliability of the ASI composite scores for those subjects where sufficient data were available was satisfactory. However, there was more variance in the stability of client responses, with four composite scores producing test-retest reliability coefficients below .65.

Is the Addiction Severity Index a reliable and valid assessment instrument among clients with severe and persistent mental illness and substance abuse disorders?

Evidence from this study suggests that the ASI has a number of limitations in assessing the problems of clients with severe and persistent mental illness, and it is likely that other similar instruments based on the self-reports of persons with severe and persistent mental illness would also encounter these limitations.

Question: Is the Addiction Severity Index a reliable and valid assessment instrument among clients with severe and persistent mental illness and substance abuse disorders? Answer: Evidence from this study suggests that the ASI has a number of limitations in assessing the problems of clients with severe and persistent mental illness, and it is likely that other similar instruments based on the self-reports of persons with severe and persistent mental illness would also encounter these limitations.

Answer the question based on the following context: To investigate whether caffeine intake is associated with urinary incontinence (UI) among Japanese adults. A total of 683 men and 298 women aged 40 to 75 years were recruited from the community in middle and southern Japan. A validated food frequency questionnaire was administered face-to-face to obtain information on dietary intake and habitual beverage consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form. Mean daily caffeine intake was found to be similar between incontinent subjects (men 120 mg, women 94 mg) and others without the condition (men 106 mg, women 103 mg), p=0.33 for men and p=0.44 for women. The slight increases in risk of UI at the highest level of caffeine intake were not significant after adjusting for confounding factors. The adjusted odds ratios (95% confidence interval) were 1.36 (0.65 to 2.88) and 1.12 (0.57 to 2.22) for men and women, respectively.

Is caffeine intake associated with urinary incontinence in Japanese adults?

No association was evident between caffeine intake and UI in middle-aged and older Japanese adults. Further studies are required to confirm the effect of caffeine in the prevention of UI.

Question: Is caffeine intake associated with urinary incontinence in Japanese adults? Answer: No association was evident between caffeine intake and UI in middle-aged and older Japanese adults. Further studies are required to confirm the effect of caffeine in the prevention of UI.

Answer the question based on the following context: Colorectal cancer (CRC) screening with colonoscopy was introduced into the National Cancer Prevention Program in Germany in 2002. As compliance for screening is low (around 3% per year), colon capsule endoscopy (CCE) could be an alternative approach. In this study, feasibility and performance of CCE were evaluated in comparison with colonoscopy in ambulatory patients with special attention to a short colon transit time. CCE was prospectively tested in ambulatory patients enrolled for colonoscopy who presented for screening or with positive fecal occult blood test. Study subjects underwent colon preparation and ingested the capsule in the morning. Colonoscopy was performed after excretion of the capsule. Colonoscopy and CCE were performed by independent physicians who were blinded to the results. In total, 38 patients were included. One patient was excluded because the capsule remained in the stomach during the entire period of examination. Another patient had limited time and the procedure had to be stopped when the capsule was still in the transverse colon. We therefore report the results of 36 patients (30 men and 6 women; mean age 56 years, range 23-73 years) who successfully completed CCE and the conventional colonoscopy examination. The capsule was excreted within 6 h in 84% of the patients (median transit time 4.5 h). If oral sodium phosphate was excluded from the preparation, the colon transit time increased to a median of 8.25 h. In total, 7 of 11 small polyps (<6 mm) detected by colonoscopy were identified by CCE. One small polyp detected by CCE was not identified by colonoscopy. In this series, no large polyps were found. One CRC was detected by both methods. The mean rates of colon cleanliness (range from 1=excellent to 4=poor) in the cecum (2.1), transverse colon (1.6), and in the descending colon (1.5) were significantly better than in the rectosigmoid colon (2.6), and the overall mean rate during colonoscopy was significantly better than during CCE. No adverse effects occurred.

Is PillCam COLON capsule endoscopy ready for colorectal cancer screening?

CCE appears to be a promising new modality for colonic evaluation and may increase compliance with CRC screening. To achieve a short colon transit time, sodium phosphate seems to be a necessary adjunct during preparation. The short transit time is a prerequisite to abandon the delay mode of the capsule. With an undelayed PillCam COLON capsule, a "pan-enteric" examination of the gastrointestinal tract would be possible. Further studies are needed to improve the cleanliness, especially in the rectum and to evaluate the method as a potential screening tool.

Question: Is PillCam COLON capsule endoscopy ready for colorectal cancer screening? Answer: CCE appears to be a promising new modality for colonic evaluation and may increase compliance with CRC screening. To achieve a short colon transit time, sodium phosphate seems to be a necessary adjunct during preparation. The short transit time is a prerequisite to abandon the delay mode of the capsule. With an undelayed PillCam COLON capsule, a "pan-enteric" examination of the gastrointestinal tract would be possible. Further studies are needed to improve the cleanliness, especially in the rectum and to evaluate the method as a potential screening tool.

Answer the question based on the following context: Cosmetic breast implants may impair the ability to detect breast cancers. The aims of this study were to examine whether implants and implant characteristics are associated with more advanced breast tumors at diagnosis and poorer survival. Study population includes all invasive breast cancer cases diagnosed during follow-up of the large Canadian Breast Implant Cohort. A total of 409 women with cosmetic breast implants and 444 women with other cosmetic surgery were diagnosed with breast cancer. These women were compared for stage at diagnosis using multinomial logistic regression models. Cox proportional hazards regression models were used for breast cancer-specific mortality analyses. Comparisons were also conducted according to implant characteristics. Compared with women with other cosmetic surgery, those with cosmetic breast implants had at later stage breast cancer diagnosis (OR of having stage III/IV vs. stage I at diagnosis: 3.04, 95% confidence interval (CI): 1.81-5.10; P<0.001). A nonstatistically significant increase in breast cancer-specific mortality rate for women with breast implants relative to surgical controls was observed (HR = 1.32, 95% CI: 0.94-1.83, P = 0.11). No statistically significant differences in stage and breast cancer mortality were observed according to implant characteristics.

Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer?

At diagnosis, breast cancers tended to be at more advanced stages among women with cosmetic breast implants. Breast cancer-specific survival was lower in these women although the reduction did not reach statistical significance.

Question: Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer? Answer: At diagnosis, breast cancers tended to be at more advanced stages among women with cosmetic breast implants. Breast cancer-specific survival was lower in these women although the reduction did not reach statistical significance.

Answer the question based on the following context: Borrelia burgdorferi, the causative agent of Lyme disease, has never been isolated from a patient thought to have acquired Lyme disease in any southeastern state. To investigate 14 cases of an erythema migrans (EM)-like rash illness that occurred during 2 summers at an outdoor camp in central North Carolina in an effort to determine the etiologic, epidemiological, and clinical aspects of this illness. Using active surveillance, we identified cases of clinically diagnosed EM in residents and staff of the camp. We collected clinical and demographic information; history of exposure to ticks; acute and convalescent serum antibodies to B. burgdorferi, Rickettsia rickettsii, and Ehrlichia chaffeensis; and cultures for spirochetes from biopsy specimens of skin lesions. Serum samples from a group of residents and staff who did not develop rashes were tested for the same antibodies. We speciated ticks removed from people and collected from vegetation. We identified 14 cases of EM-like rash illness during the 2 summers. Of the 14 case-patients, 10 had associated mild systemic symptoms and 1 had documented fever. All 14 case-patients had removed attached ticks, and 8 remembered having removed a tick from the site where the rash developed a median of 12 days earlier (range, 2-21 days). One tick removed from the site where a rash later developed was identified as Amblyomma americanum, the Lone Star tick; 97% of ticks collected from vegetation and 95% of ticks removed from people were A. americanum. No spirochetes were isolated from skin biopsy specimens. Paired serum samples from 13 case-patients did not show diagnostic antibody responses to B. burgdorferi or other tick-borne pathogens.

Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease?

This investigation suggests the existence of a new tick-associated rash illness. We suspect that the disease agent is carried by A. americanum ticks. In the southern United States, EM-like rash illness should no longer be considered definitive evidence of early Lyme disease.

Question: Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease? Answer: This investigation suggests the existence of a new tick-associated rash illness. We suspect that the disease agent is carried by A. americanum ticks. In the southern United States, EM-like rash illness should no longer be considered definitive evidence of early Lyme disease.

Answer the question based on the following context: From 1991 through 1995, all Latin American countries maintained cholera surveillance systems to track the epidemic that entered the region through Peru in January 1991. These data were used to assess correlations between socioeconomic and demographic indices that might serve as national risk predictors for epidemic cholera in Latin America. Correlations between country-specific cumulative cholera incidence rates from 1991 through 1995 and infant mortality, the Human Development Index [HDI] a numerical value based on life expectancy, education, and income), gross national product (GNP) per capita, and female literacy were tested using the Pearson correlation coefficient. A total of 1,339,834 cholera cases with a cumulative incidence rate of 183 per 100,000 population were reported from affected Western Hemisphere countries from 1991 through 1995. Infant mortality rates were the most strongly correlated with cumulative cholera incidence based on the Pearson correlation coefficient. The HDI had a less strong negative correlation with cumulative cholera incidence. The GNP per capita and female literacy rates were weakly and negatively correlated with cholera cumulative incidence rates.

Are there national risk factors for epidemic cholera?

Infant mortality and possibly the HDI may be useful indirect indices of the risk of sustained transmission of cholera within a Latin American country. Cumulative cholera incidence is decreased particularly in countries with infant mortality below 40 per 1000 live births. The lack of reported cholera cases in Uruguay and the Caribbean may reflect a low risk for ongoing transmission, consistent with socioeconomic and demographic indices. Cholera surveillance remains an important instrument for determining cholera trends within individual countries and regions.

Question: Are there national risk factors for epidemic cholera? Answer: Infant mortality and possibly the HDI may be useful indirect indices of the risk of sustained transmission of cholera within a Latin American country. Cumulative cholera incidence is decreased particularly in countries with infant mortality below 40 per 1000 live births. The lack of reported cholera cases in Uruguay and the Caribbean may reflect a low risk for ongoing transmission, consistent with socioeconomic and demographic indices. Cholera surveillance remains an important instrument for determining cholera trends within individual countries and regions.

Answer the question based on the following context: The analysis by Denaturing Gradient Gel Electrophoresis (DGGE) of the PCR-amplified V3 region of 16S rRNA gene was previously shown to detect and differentiate a large number of human and animal mycoplasmas. In this study, we further assessed the suitability of the technique for epidemiological surveillance of mycoplasmas belonging to the 'Mycoplasma mycoides' cluster, a phylogenetic group that includes major ruminant pathogens. The V3 region of 16S rRNA genes from approx. 50 field strains was amplified and analysed by DGGE. Detection and identification results were compared with the ones obtained by antigenic testing and sequence analysis.

Epidemiological surveillance of mycoplasmas belonging to the 'Mycoplasma mycoides' cluster: is DGGE fingerprinting of 16S rRNA genes suitable?

The DGGE technique is robust and valuable as a first-line test, but the patterns obtained for strains belonging to the 'M. mycoides' cluster were too variable within a taxon and in contrast too conserved between taxa to allow an unequivocal identification of isolates without further analysis.

Question: Epidemiological surveillance of mycoplasmas belonging to the 'Mycoplasma mycoides' cluster: is DGGE fingerprinting of 16S rRNA genes suitable? Answer: The DGGE technique is robust and valuable as a first-line test, but the patterns obtained for strains belonging to the 'M. mycoides' cluster were too variable within a taxon and in contrast too conserved between taxa to allow an unequivocal identification of isolates without further analysis.

Answer the question based on the following context: There is accumulating evidence that greater availability of green space in a neighbourhood is associated with health benefits for the local population. One mechanism proposed for this association is that green space provides a venue for, and therefore encourages, physical activity. It has also been suggested that socio-economic health inequalities may be narrower in greener areas because of the equalised opportunity for physical activity green spaces provide. However, research exploring associations between the availability of green space and physical activity has produced mixed results. Limits to the assessment of the type and amount of physical activity which occurs specifically in green space may account for these mixed findings. This observational study was therefore concerned with the extent to which green space is a venue for physical activity and whether this could account for narrower socio-economic health inequalities in greener neighbourhoods. Secondary analysis of cross sectional data on 3679 adults (16+) living in urban areas across Scotland matched with a neighbourhood level measure of green space availability. Associations between green space availability and both total physical activity, and activity specifically within green space, were explored using logistic regression models. Interactions between socio-economic position and physical activity were assessed. All models adjusted for age, sex and household income. The availability of green space in a neighbourhood was not associated with total physical activity or that specifically in green space. There was no evidence that income-related inequalities in physical activity within green space were narrower in greener areas of Scotland.

Is level of neighbourhood green space associated with physical activity in green space?

Physical activity may not be the main mechanism explaining the association between green space and health in Scotland. The direct effect of perceiving a natural environment on physiological and psychological health may offer an alternative explanation.

Question: Is level of neighbourhood green space associated with physical activity in green space? Answer: Physical activity may not be the main mechanism explaining the association between green space and health in Scotland. The direct effect of perceiving a natural environment on physiological and psychological health may offer an alternative explanation.

Answer the question based on the following context: To determine whether additional pathology details may provide risk stratification for patients with involved surgical margins at radical prostatectomy (RP). Eligible patients underwent RP between 2003 and 2010. Patients with preoperative prostate-specific antigen (PSA) ≥20, follow-up<12 months, lymph node or seminal vesicle involvement, or who received radiation therapy or hormone therapy prior to PSA relapse were excluded. Surgical specimens were reviewed by a study pathologist, blinded to outcomes. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints. Of 355 RP cases, 279 patients were eligible for the present analysis. At a median follow-up of 53 months (range, 16-127), 31/114 (27%) of patients with involved surgical margins experienced PSA relapse, as compared with 7/165 (4%) for negative margins (hazard ratio, 4.997; 95% confidence interval, 2.425-10.296; P<.0001). Detailed pathology review demonstrated associations between PSA relapse and Gleason score at RP, extent of margin involvement (width), capsule penetration, and perineural invasion. Subgroup analysis identified low risk (4%) of 5-year PSA relapse for patients with Gleason ≤6 mm and margin width ≤4 mm (single maximal or cumulative). All subgroups with higher Gleason score or wider margin were associated with>20% risk of PSA relapse at 5 years.

Margin involvement at prostatectomy for clinically localized prostate cancer: does a low-risk group exist?

Within the present study, Gleason score, 6 patients with margin width ≤4 mm appear to have low rates of early PSA relapse following RP. Low-grade cases with larger extent of margin involvement or higher risk Gleason score patients with any margin involvement have high rates of early PSA relapse.

Question: Margin involvement at prostatectomy for clinically localized prostate cancer: does a low-risk group exist? Answer: Within the present study, Gleason score, 6 patients with margin width ≤4 mm appear to have low rates of early PSA relapse following RP. Low-grade cases with larger extent of margin involvement or higher risk Gleason score patients with any margin involvement have high rates of early PSA relapse.

Answer the question based on the following context: Mirror image electrocardiograms (ECGs), obtained by inverting the original signals, and additional precordial leads have been proposed as means to improve ECG diagnosis. The theoretical backgrounds of these proposals are discussed. In 746 body surface potential maps, the mirror areas of the 6 precordial leads, V(3)R, and 2 more leads higher up and 1 lower down the thorax have been determined. The similarity between the original signal and its mirror image was expressed by a similarity index. This was done separately for QRS and ST-T; for the first and second parts of QRS; and for the categories normal, left ventricular hypertrophy, and infarct. In general, high similarity scores were obtained. The mirror images of V(1) and V(2) are almost diametrically located on the back. Inverting these leads could render the V(8) and V(9) leads. The other mirror areas may deviate considerably from where generally expected.

Mirror image electrocardiograms and additional electrocardiographic leads: new wine in old wineskins?

Mirror images can be obtained consistently from all locations, supporting the dipole representation of cardiac electrical activity. Neither mirror image ECGs nor additional chest leads contribute essentially to ECG diagnosis.

Question: Mirror image electrocardiograms and additional electrocardiographic leads: new wine in old wineskins? Answer: Mirror images can be obtained consistently from all locations, supporting the dipole representation of cardiac electrical activity. Neither mirror image ECGs nor additional chest leads contribute essentially to ECG diagnosis.

Answer the question based on the following context: To determine whether ipratropium was associated with premature death in patients with asthma and chronic obstructive pulmonary disease (COPD). A longitudinal cohort of 827 patients with COPD and 273 with asthma who were evaluated for compensation by two specialists in pulmonary medicine. By June 1999, 538 of the patients with COPD and 77 of those with asthma had died. Atthe consultation, 77% ofthe COPD patients and 8.1% of the asthmatic patients were treated with inhaled ipratropium. Ipratropium was associated with mortality risk ratio (RR) of 2.0 (95% confidence interval: 1.5-2.6) for COPD and 3.6 (1.8-7.1) for asthma patients. After adjustment for confounding factors [forced expiratory volume 1 s (FEV1), smoking habits, asthma medication, and presence of cor pulmonale] the RR for COPD was 1.6 (1.2-2.1) and for asthma 24 (1.2-5.0).

Is there any association between inhaled ipratropium and mortality in patients with COPD and asthma?

The increased risk of premature death associated with ipratropium is of concern and necessitates further evaluation, e.g., in a randomised study.

Question: Is there any association between inhaled ipratropium and mortality in patients with COPD and asthma? Answer: The increased risk of premature death associated with ipratropium is of concern and necessitates further evaluation, e.g., in a randomised study.

Answer the question based on the following context: The aetiology of Hodgkin's disease is still unknown more than 160 years after its original description. In recent years a viral aetiology was the preferred hypothesis. Epidemiological, clinical, laboratory, and histological findings, however, point rather to a bacterial aetiology. In the histological work-up of tissues from patients suffering from malignant lymphoma periodic acid-Schiff (PAS) stains are routinely done. In several bacterial infections intracellular PAS-positive material can be observed. We examined PAS-stained slides at magnifications of 1000x of six Hodgkin and twelve Non-Hodgkin patients. We found PAS-positive diastase resistant intracellular rods and spheres in all Hodgkin patients and in all of the six patients suffering from sclerosing mediastinal B-cell lymphomas, but not the other Non-Hodgkin lymphomas.

Intracellular bacteria in Hodgkin's disease and sclerosing mediastinal B-cell lymphoma: sign of a bacterial etiology?

The diastase resistant PAS-positive structures are compatible with intracellular bacteria. After gastric MALT-lymphoma and gastric non-cardia adenocarcinoma it appears that Hodgkin's disease and sclerosing mediastinal B-cell lymphomas may also be human tumors related bacteria.

Question: Intracellular bacteria in Hodgkin's disease and sclerosing mediastinal B-cell lymphoma: sign of a bacterial etiology? Answer: The diastase resistant PAS-positive structures are compatible with intracellular bacteria. After gastric MALT-lymphoma and gastric non-cardia adenocarcinoma it appears that Hodgkin's disease and sclerosing mediastinal B-cell lymphomas may also be human tumors related bacteria.

Answer the question based on the following context: A primary barrier to physician disclosure of terminal prognosis is concern that patients will lose hope. Inpatient palliative care (IPC) teams are especially posed to mediate this barrier, but little is known about patient perceptions and experience of IPC. This study aimed to elicit seriously ill patients' perspective and experience of an IPC consultation, and to explore patient attitudes toward information derived from the consultation. An exploratory, qualitative study was conducted at a large nonprofit community hospital in the Los Angeles area. An established IPC team conducted individualized consults with patients and families within 24 hours of referral. Eligible participants were English-speaking adults, aged 18 or over, who had received an IPC consultation within the previous week during their hospitalization. Purposive recruitment of patients was conducted by the IPC social worker. Interviews were conducted at bedside using a semistructured interview protocol employing open-ended questions. Twelve seriously ill patients were interviewed. Four themes were identified from the interview transcripts: (1) holistic care approach, (2) knowledge/information gained, (3) hope and enlightenment, and (4) patient readiness.

Does Disclosure of Terminal Prognosis Mean Losing Hope?

Results suggest that disclosure of a terminal prognosis does not mean loss of patient hope. Instead, hope was redefined on a goal other than cure. Presenting patients with information and increasing their knowledge about care options and resources may facilitate patients in identifying meaningful goals that are better aligned with their prognosis.

Question: Does Disclosure of Terminal Prognosis Mean Losing Hope? Answer: Results suggest that disclosure of a terminal prognosis does not mean loss of patient hope. Instead, hope was redefined on a goal other than cure. Presenting patients with information and increasing their knowledge about care options and resources may facilitate patients in identifying meaningful goals that are better aligned with their prognosis.

Answer the question based on the following context: Particle size is thought to be a critical factor affecting the bioavailability of nanoparticles following oral exposure. Nearly all studies of nanoparticle bioavailability focus on characterization of the primary particle size of the material as supplied or as dosed, and not on agglomeration behavior within the gastrointestinal tract, which is presumably most relevant for absorption. In the study reported here, snapshots of agglomeration behavior of gold nanospheres were evaluated in vivo throughout the gastrointestinal tract using transmission electron microscopy. Agglomeration state within the gastrointestinal tract was then used to help explain differences in gastrointestinal particle absorption, as indicated by tissue levels of gold detected using inductively coupled plasma mass spectrometry. Mice were dosed (10 mg/kg) with either 23 nm PEG-coated or uncoated gold nanospheres. Transmission electron microscopy demonstrates that PEG-coated gold nanoparticles can be observed as primary, un-agglomerated particles throughout the gastrointestinal tract and feces of dosed animals. In contrast, uncoated gold nanoparticles were observed to form agglomerates of several hundred nanometers in all tissues and feces. Inductively coupled plasma mass spectrometry shows significantly higher levels of gold in tissues from animals dosed with PEG-coated versus uncoated 23 nm gold nanoparticles. Retention of particles after a single oral gavage was also very high, with all tissues of animals dosed with PEG-coated particles having detectable levels of gold at 30 days following exposure.

Oral absorption of PEG-coated versus uncoated gold nanospheres: does agglomeration matter?

Qualitative observation of these particles in vivo shows that dispersed PEG-coated particles are able to reach the absorptive tissues of the intestine while agglomerated uncoated particles are sequestered in the lumen of these tissues. However, the large differences observed for in vivo agglomeration behavior were not reflected in oral absorption, as indicated by gold tissue levels. Additional factors, such as surface chemistry, may have played a more important role than in vivo particle size and should be investigated further.

Question: Oral absorption of PEG-coated versus uncoated gold nanospheres: does agglomeration matter? Answer: Qualitative observation of these particles in vivo shows that dispersed PEG-coated particles are able to reach the absorptive tissues of the intestine while agglomerated uncoated particles are sequestered in the lumen of these tissues. However, the large differences observed for in vivo agglomeration behavior were not reflected in oral absorption, as indicated by gold tissue levels. Additional factors, such as surface chemistry, may have played a more important role than in vivo particle size and should be investigated further.

Answer the question based on the following context: Both Moyamoya disease (MMD) and intracranial atherosclerotic stenosis (ICAS) are more prevalent in Asians than in Westerners. We hypothesized that a substantial proportion of patients with adult-onset MMD were misclassified as having ICAS, which may in part explain the high prevalence of intracranial atherosclerotic stroke in Asians. We analyzed 352 consecutive patients with ischemic events within the MCA distribution and relevant intracranial arterial stenosis, but no demonstrable carotid or cardiac embolism sources. Conventional angiography was performed in 249 (70.7%) patients, and the remains underwent MRA. The occurrence of the c.14429G>A (p.Arg4810Lys) variant in ring finger protein 213 (RNF213) was analyzed. This gene was recently identified as a susceptibility gene for MMD in East Asians. The p.Arg4810Lys variant was observed in half of patients with intracranial stenosis (176 of 352, 50.0%), in no healthy control subjects (n = 51), and in 3.2% of stroke control subjects (4 of 124 patients with other etiologies). The presence of basal collaterals, bilateral involvement on angiography, and absence of diabetes were independently associated with the presence of the RNF213 variant. Among 131 patients who met all three diagnostic criteria and were diagnosed with MMD, three-fourths (75.6%) had this variant. However, a significant proportion of patients who met two criteria (57.7%), one criterion (28.6%), or no criteria (20.0%) also had this variant. Some of them developed typical angiographic findings of MMD on follow-up angiography.

Adult Moyamoya Disease: A Burden of Intracranial Stenosis in East Asians?

Careful consideration of MMD is needed when diagnosing ICAS because differential therapeutic strategies are required for these diseases and due to the limitations of the current diagnostic criteria for MMD.

Question: Adult Moyamoya Disease: A Burden of Intracranial Stenosis in East Asians? Answer: Careful consideration of MMD is needed when diagnosing ICAS because differential therapeutic strategies are required for these diseases and due to the limitations of the current diagnostic criteria for MMD.

Answer the question based on the following context: We aimed to determine the prognostic impact of time between primary breast cancer and diagnosis of distant metastasis (metastatic-free interval, MFI) on the survival of metastatic breast cancer patients. Consecutive patients diagnosed with metastatic breast cancer in 2007-2009 in eight hospitals in the Southeast of the Netherlands were included and categorised based on MFI. Survival curves were estimated using the Kaplan-Meier method. Cox proportional hazards model was used to determine the prognostic impact of de novo metastatic breast cancer vs recurrent metastatic breast cancer (MFI ⩽24 months and>24 months), adjusted for age, hormone receptor and HER2 status, initial site of metastasis and use of prior (neo)adjuvant systemic therapy. Eight hundred and fifteen patients were included and divided in three subgroups based on MFI; 154 patients with de novo metastatic breast cancer, 176 patients with MFI<24 months and 485 patients with MFI>24 months. Patients with de novo metastatic breast cancer had a prolonged survival compared with patients with recurrent metastatic breast cancer with MFI<24 months (median 29.4 vs 9.1 months, P<0.0001), but no difference in survival compared with patients with recurrent metastatic breast cancer with MFI>24 months (median, 29.4 vs 27.9 months, P=0.73). Adjusting for other prognostic factors, patients with MFI<24 months had increased mortality risk (hazard ratio 1.97, 95% CI 1.49-2.60, P<0.0001) compared with patients with de novo metastatic breast cancer. When comparing recurrent metastatic breast cancer with MFI>24 months with de novo metastatic breast cancer no significant difference in mortality risk was found. The association between MFI and survival was seen irrespective of use of (neo)adjuvant systemic therapy.

Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer?

Patients with de novo metastatic breast cancer had a significantly better outcome when compared with patients with MFI<24 months, irrespective of the use of prior adjuvant systemic therapy in the latter group. However, compared with patients with MFI>24 months, patients with de novo metastatic breast cancer had similar outcome.

Question: Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer? Answer: Patients with de novo metastatic breast cancer had a significantly better outcome when compared with patients with MFI<24 months, irrespective of the use of prior adjuvant systemic therapy in the latter group. However, compared with patients with MFI>24 months, patients with de novo metastatic breast cancer had similar outcome.

Answer the question based on the following context: Anemia in pregnancy is one of the public health problems in the developed and developing world. If uncontrolled it is a major indirect cause of maternal and perinatal morbidity and mortality. This is worst in settings with poor prenatal practices. Quality prenatal interventions therefore are expected to prevent or ameliorate this disorder in pregnancy. Nigerian scientific literatures are full of data on anemia in pregnancy, but few of them are on the influence of prenatal care on maternal anemia. This study, therefore, sought to appraise the role of antenatal care (ANC) services in the prevention of anemia in pregnancy at term in Nigerian women. The aim was to estimate the prevalence of anemia at first antenatal visit and determine if antenatal attendance prevents anemia at term among prenatal Nigerian women. To measure the hematocrit levels at booking and at term respectively and compare the proportion anemic at booking with the proportion anemic at term. A retrospective cross-sectional comparative study of 3442 prenatal women in a mission hospital in South-South Nigeria from 2009 to 2013. Venous blood hematocrit was estimated from each woman at booking and at term, and the prevalence of anemia for the two periods were compared. There were 1205 subjects with hematocrit of below 33% at booking, an anemia prevalence of 32.2% at booking in this population. At term or delivery at term 736 (21.4% odds ratio [OR] =2.3, P<0.0001) of the 1052 subjects that fulfilled the study criteria had their anemia corrected, a 69.9% prevention, while 316 (9.2%, OR = 0.43, P<0.0001) persisted despite their antenatal attendance. The subjects were similar in most of the confounding factors like parity, social class, mean age, body mass index and gestational age at delivery (P value: all>0.05).

Does antenatal care attendance prevent anemia in pregnancy at term?

The prevalence of anemia in pregnancy is still high in our setting. Quality ANC appeared a valuable preventive intervention that should be made widely available, accessible and affordable to all pregnant women.

Question: Does antenatal care attendance prevent anemia in pregnancy at term? Answer: The prevalence of anemia in pregnancy is still high in our setting. Quality ANC appeared a valuable preventive intervention that should be made widely available, accessible and affordable to all pregnant women.