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Answer the question based on the following context: To evaluate CT-attenuation ratio of residual masses in patients with follicular Non-Hodgkin lymphoma (FL) at end-treatment compared to baseline mass density and determine its potential prognostic relevance. 52 consecutive patients with FL presenting with residual masses after chemotherapy receiving whole-body-CECT at baseline, end-treatment, and post-treatment were identified retrospectively by a search of our electronic medical record database from 2002 through 2010. An attenuation ratio (AR), defined as the quotient of CT-attenuation [HU] between tumor and muscle was measured. Size was recorded as the product of long- and short-axis diameter of masses. In 38/52 patients a follow-up period of ≥ 2 years was available to correlate results with relapse-free survival. AR and tumor size of masses significantly decreased in responders when baseline was compared to end-treatment (n = 70; p<0.05, respectively). An increase in both, AR and size was recorded in case of relapse (n = 14; p<0.05, respectively). 12/53 masses initially responded to therapy but relapsed within the consecutive 2-year period. The mean time to relapse was 13.5 months (range 5-24 months). AR measured at the time of end-control was significantly lower in masses remaining stable for ≥ 2 years (n = 41) compared to masses with relapse during 2-year follow-up (n = 12; p<0.05). At a threshold of an AR>1 at end-control the specificity and sensitivity for relapsing disease within 2 years reached 83% and 75%, respectively.

Size and attenuation CT (SACT) of residual masses in patients with follicular non-Hodgkin lymphoma: more than a status quo?

CT-attenuation measurements of residual masses in patients with FL at end-control may aid in the risk stratification of early (≤ 2 years) relapsing disease.

Question: Size and attenuation CT (SACT) of residual masses in patients with follicular non-Hodgkin lymphoma: more than a status quo? Answer: CT-attenuation measurements of residual masses in patients with FL at end-control may aid in the risk stratification of early (≤ 2 years) relapsing disease.

Answer the question based on the following context: To investigate which anthropometric measurements of obesity best predict type 2 diabetes in a population of Pima Indians and whether additional information on diabetes risk could be obtained by combining measures of general obesity with measures of body fat distribution. We conducted a prospective study of 624 men and 990 nonpregnant women>18 years of age without diabetes. Subjects were followed a mean of 5.25 years for the development of type 2 diabetes (using 1997 American Diabetes Association criteria). A total of 322 new cases of type 2 diabetes (107 men and 215 women) were diagnosed during follow-up. Baseline obesity measurements were highly correlated and predicted diabetes in proportional hazards models adjusted for age. BMI had the highest hazard ratio in men and women, with age-adjusted hazard ratios per SD of 1.73 (95% CI 1.44-2.07) and 1.67 (1.45-1.91), respectively. According to receiver-operating characteristic analysis, BMI and waist-to-height ratio were the best predictors of diabetes in men, while in women BMI, waist-to-height ratio, waist circumference, and waist-to-thigh ratio were the best predictors. The predictive abilities of models containing BMI were not significantly improved by including other measures of general obesity or measures of the body fat distribution.

Do measures of body fat distribution provide information on the risk of type 2 diabetes in addition to measures of general obesity?

Throughout its range, BMI was an excellent predictor of type 2 diabetes risk in Pima Indians and was not significantly improved by combining it with other measures of general adiposity or body fat distribution.

Question: Do measures of body fat distribution provide information on the risk of type 2 diabetes in addition to measures of general obesity? Answer: Throughout its range, BMI was an excellent predictor of type 2 diabetes risk in Pima Indians and was not significantly improved by combining it with other measures of general adiposity or body fat distribution.

Answer the question based on the following context: To analyze the trends in male urethral stricture management using the 1992-2001 Medicare claims data and to determine whether certain racial and ethnic groups have a disproportionate burden of urethral stricture disease. We analyzed the Medicare claims for fiscal years 1992, 1995, 1998, and 2001. The "International Classification of Disease, 9th revision," diagnosis codes were used to identify men with urethral stricture. The demographic characteristics assessed included patient age, race, and comorbidities, as measured using the Charlson index. Treatments were identified using the Physician Current Procedural Terminology Coding System, 4th edition, procedure codes and stratified into 4 treatment types: urethral dilation, direct vision internal urethrotomy, urethral stent/steroid injection, and urethroplasty. The overall rates of stricture diagnosis decreased from 10,088/100,000 population in 1992 to 6897 in 2001 (from 1.4% to 0.9%). The stricture prevalence was greatest among black and Hispanic men, although the urethroplasty rates were greatest among white men. Direct vision internal urethrotomy was the most common treatment, followed by urethral dilation, urethral stent/steroid injection, and urethroplasty. The urethroplasty rates remained stable, but quite low (0.6%-0.8%), during the study period.

Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty?

The overall rates of stricture diagnosis decreased from 1992 to 2001. Despite the poor overall efficacy of urethrotomy and urethral dilation relative to urethroplasty and despite the known complications of stent placement in this setting, the urethroplasty rates were the lowest of all treatments. Although we could not determine the treatment success with these data, these findings suggest an underuse of the most efficacious treatment of urethral stricture disease, urethroplasty.

Question: Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty? Answer: The overall rates of stricture diagnosis decreased from 1992 to 2001. Despite the poor overall efficacy of urethrotomy and urethral dilation relative to urethroplasty and despite the known complications of stent placement in this setting, the urethroplasty rates were the lowest of all treatments. Although we could not determine the treatment success with these data, these findings suggest an underuse of the most efficacious treatment of urethral stricture disease, urethroplasty.

Answer the question based on the following context: Hip dislocation as a result of neurogenic hip displacement is a common focal motor symptom in children with infantile cerebral palsy (ICP). In addition to contracture of the hip joint, in up to 65 % of cases patients suffer from pain which leads to further loss of function and often to limitations in important basic functions, such as lying, care, sitting, standing and transfer. In order to avoid hip dislocation and to be able to implement therapy at an early stage, screening programs have been developed in recent years which clearly demonstrate the risks of hip displacement in ICP depending on the ability to walk. An investigation of the natural course is practically impossible because as a rule patients with painful neurogenic hip displacement receive surgical therapy. In this study 96 patients with high hip dislocation grade IV on the Tönnis classification were included and 68 could be followed up. The average age at the time of surgery was 10.9 years and the mean follow-up period was 7.7 years. In the postoperative course 6 out of 91 reconstructed hips became redislocated and a proximal femoral resection was carried out in one female patient. The migration index according to Reimers was 14.0 % at the time of the follow-up examination.

Long-term results of reconstructive surgery in infantile cerebral palsy patients with high hip dislocation: is hip screening necessary?

Revision procedures can be avoided by screening programs. These should be strived for so that the neuro-orthopedic treatment on operation planning is not first initiated when pain occurs and revision procedures, such as angulation osteotomy or proximal femoral resection can be avoided. The reconstruction should also involve minimal deformation of the femoral head. In order to implement this, the interdisciplinary cooperation between neuropediatricians, social pediatriatricians and neuro-orthopedists should be intensified in the future.

Question: Long-term results of reconstructive surgery in infantile cerebral palsy patients with high hip dislocation: is hip screening necessary? Answer: Revision procedures can be avoided by screening programs. These should be strived for so that the neuro-orthopedic treatment on operation planning is not first initiated when pain occurs and revision procedures, such as angulation osteotomy or proximal femoral resection can be avoided. The reconstruction should also involve minimal deformation of the femoral head. In order to implement this, the interdisciplinary cooperation between neuropediatricians, social pediatriatricians and neuro-orthopedists should be intensified in the future.

Answer the question based on the following context: To assess the effect of a single dose of intravenous dexamethasone in addition to routine treatment on visual analogue scale (VAS) pain scores at 24 h in emergency department (ED) patients with low back pain with radiculopathy (LBPR). Double-blind randomised controlled trial of 58 adult ED patients with LBPR, conducted in one tertiary and one urban ED. The intervention was 8 mg of intravenous dexamethasone (or placebo) in addition to current routine care. The primary outcome was the change in VAS pain scores between presentation and 24 h. Secondary outcomes included VAS pain scores at 6 weeks, ED length of stay (EDLOS), straight leg raise (SLR) angles and Oswestry functional scores. Patients treated with dexamethasone had a 1.86 point (95% CI 0.31 to 3.42, p=0.019) greater reduction in VAS pain scores at 24 h than placebo (dexamethasone: -2.63 (95% CI -3.63 to -1.63) versus placebo: -0.77 (95% CI -2.04 to 0.51)). At 6 weeks, both groups had similar significant and sustained decrease in VAS scores compared with baseline. Patients receiving dexamethasone had a significantly shorter EDLOS (median: 3.5 h vs 18.8 h, p=0.049) and improved SLR angle at discharge (14.7°, p=0.040). There was no difference in functional scores.

Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)?

In patients with LBPR, a single dose of intravenous dexamethasone in addition to routine management improved VAS pain scores at 24 h, but this effect was not statistically significant at 6 weeks. Dexamethasone may reduce EDLOS and can be considered as a safe adjunct to standard treatment.

Question: Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)? Answer: In patients with LBPR, a single dose of intravenous dexamethasone in addition to routine management improved VAS pain scores at 24 h, but this effect was not statistically significant at 6 weeks. Dexamethasone may reduce EDLOS and can be considered as a safe adjunct to standard treatment.

Answer the question based on the following context: The present study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders. The present study was based on a sample of 166 adolescents recruited during inpatient AOD abuse treatment. Included in this study were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Data for the present study were drawn from interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment. Twenty six percent of participants had quit smoking for>1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Subjects associated with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points.

Is cigarette smoking related to alcohol use during the 8 years following treatment for adolescent alcohol and other drug abuse?

The significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behaviour may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviours. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes.

Question: Is cigarette smoking related to alcohol use during the 8 years following treatment for adolescent alcohol and other drug abuse? Answer: The significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behaviour may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviours. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes.

Answer the question based on the following context: To ascertain if the polymerization reaction also contributes additionally to the antibacterial effects of two commonly used cyanoacrylate tissue adhesives. Fresh liquid ethyl-cyanoacrylate (EC) and N-butyl-cyanoacrylate (BC) adhesives were applied onto 6-mm sterile filter paper discs. In the first group, the adhesive-soaked discs were immediately placed onto confluent monolayer cultures of bacteria, allowing the polymerization reaction to proceed while in culture. In the second group, the adhesive-soaked disc was allowed to first polymerize prior to being placed onto the bacterial cultures. Four types of bacteria were studied: Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. Immediately after the discs were applied, the cultures were incubated at 35 degrees C for 24 h. Bacterial inhibitory halos were measured in the cultures at the end of the incubation period. For EC, exposure of the bacteria to the cyanoacrylate polymerization reaction increased the bacterial inhibitory halos in Streptococcus pneumonia, Staphylococcus aureus and Escherichia coli. For BC, it increased the bacterial inhibitory halos in Staphylococcus aureus and Streptococcus pneumoniae. No inhibitory halos were observed in Pseudomonas aeruginosa. The bactericidal effect was higher in actively polymerizing EC, compared to previously polymerized EC in Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli; however, no such differences were observed for BC.

Antibacterial properties of cyanoacrylate tissue adhesive: Does the polymerization reaction play a role?

The polymerization reaction may also be an important factor in the antibacterial properties of EC and BC.

Question: Antibacterial properties of cyanoacrylate tissue adhesive: Does the polymerization reaction play a role? Answer: The polymerization reaction may also be an important factor in the antibacterial properties of EC and BC.

Answer the question based on the following context: To investigate the attitudes, knowledge and practices of general dental practitioners (GDPs), specialists and consultants in paediatric dentistry in London, towards child protection. Additionally, to determine if children attending paediatric dental casualty at the Eastman Dental Hospital (EDH) and those who need treatment of caries under general anaesthesia (GA) are on the child protection register (CPR). The survey was conducted by postal questionnaires with 14 closed questions. A total of 228 dentists were invited to participate in the study. Children who attended EDH and required treatment under GA or at paediatric dental casualty were checked against the CPR. The respond rate was 46% (105/228). Overall 15% (16/105) of dentists had seen at least one patient with suspected child abuse in the last six months, but only 7% (7/105) referred or reported cases to child protection services. Reasons for dentists not referring included: fear of impact on practice (10%; 11/105); fear of violence to child (66%; 69/105); fear of litigation (28%; 29/105); fear of family violence against them (26%; 27/105); fear of consequences to the child (56%; 59/105); lack of knowledge regarding the procedures for referral (68%; 71/105); and lack of certainty about the diagnosis (86%; 90/105). Of the 220 children attending for dental GA and casualty from October 2004 to March 2005, one child was found to be on the CPR.

A survey of attitudes, knowledge and practice of dentists in London towards child protection. Are children receiving dental treatment at the Eastman Dental Hospital likely to be on the child protection register?

More information and training is required to raise awareness of the potential importance of the role of dentists in child protection. Improved communication between dental and medical departments is important for safeguarding children.

Question: A survey of attitudes, knowledge and practice of dentists in London towards child protection. Are children receiving dental treatment at the Eastman Dental Hospital likely to be on the child protection register? Answer: More information and training is required to raise awareness of the potential importance of the role of dentists in child protection. Improved communication between dental and medical departments is important for safeguarding children.

Answer the question based on the following context: Motoneurons are the focus of most investigations of amyotrophic lateral sclerosis (ALS), while the astrocyte reaction is regarded as a phenomenon secondary to neuron degeneration. Since astroglial reactivity differed in different studies of human and animal ALS models and often varied from case to case, we examined and compared astrocyte reactivity within the anterior horns of the spinal cord in a transgenic rat model of familial ALS and in human sporadic ALS (sALS) cases. Routine histological staining and immunohistochemical reactions to cytoskeletal proteins [neurofilaments, glial fibrillary acidic protein (GFAP), vimentin and tau] and proliferative markers (proliferating cell nuclear antigen and Ki-67). In human sALS cases and in rats at the early pre-symptomatic and symptomatic stages of the disease, the astroglial reaction was very weak, although there was visible evidence of the morphological manifestations of motoneuron degeneration. Poor immunoreactivity to the GFAP and vimentin antigens and increased expression of tau protein were observed in astrocytes, particularly in the rat model. The astrocyte reaction was evident during a short ‘transient’ phase of the disease in animals, between the asymptomatic and paretic stages. Proliferating cell nuclear antigen immunoreactivity in glial and neuronal nuclei was observed only in animal material.

Is the spinal cord motoneuron exclusively a target in ALS?

Abnormalities in astrocyte cytoskeletal proteins are characteristic features for ALS, both in acquired and congenital forms of the disease. The cytoskeletal aberrations may lead to astroglial dysfunction and disturbances in glutamate uptake that may in turn increase the degeneration of motoneurons.

Question: Is the spinal cord motoneuron exclusively a target in ALS? Answer: Abnormalities in astrocyte cytoskeletal proteins are characteristic features for ALS, both in acquired and congenital forms of the disease. The cytoskeletal aberrations may lead to astroglial dysfunction and disturbances in glutamate uptake that may in turn increase the degeneration of motoneurons.

Answer the question based on the following context: To evaluate whether preoperative ultrasonographic assessment of the number and size of gallbladder stones can identify patients at increased risk of having asymptomatic common bile duct stones. Ultrasonographic data for 300 consecutive patients undergoing laparoscopic cholecystectomy were analyzed. Patients were divided into a group in which multiple small (<or = 5 mm) or multiple variably sized (both<or = 5 and>5 mm) gallbladder stones were present ("positive" stones) and a group with multiple large (>5 mm) or single gallbladder stones, considered "negative." The ultrasonographic description was compared with surgical findings; finally, the prevalence of asymptomatic common bile duct stones in the 2 groups was compared. Ultrasonographic classification of gallbladder stones was confirmed at surgery in 285 cases (95%). Asymptomatic common bile duct stones were diagnosed in 9.5% of patients with an ultrasonographic diagnosis of positive gallbladder stones and in only 2.3% of patients with a diagnosis of negative gallbladder stones (P<.05).

Preoperative ultrasonographic assessment of the number and size of gallbladder stones: is it a useful predictor of asymptomatic choledochal lithiasis?

Ultrasonography is able to accurately show gallbladder stones; the appearance of multiple small and variably sized gallbladder stones represent a risk factor for synchronous asymptomatic common bile duct stones.

Question: Preoperative ultrasonographic assessment of the number and size of gallbladder stones: is it a useful predictor of asymptomatic choledochal lithiasis? Answer: Ultrasonography is able to accurately show gallbladder stones; the appearance of multiple small and variably sized gallbladder stones represent a risk factor for synchronous asymptomatic common bile duct stones.

Answer the question based on the following context: To evaluate the cumulative effect of repeated transcutaneous electrical nerve stimulation (TENS) on chronic osteoarthritic (OA) knee pain over a four-week treatment period, comparing it to that of placebo stimulation and exercise training given alone or in combination with TENS. Sixty-two patients, aged 50-75, were stratified according to age, gender and body mass ratio before being randomly assigned to four groups. Patients received either (1) 60 minutes of TENS, (2) 60 minutes of placebo stimulation, (3) isometric exercise training, or (4) TENS and exercise (TENS&Ex) five days a week for four weeks. Visual analogue scale (VAS) was used to measure knee pain intensity before and after each treatment session over a four-week period, and at the four-week follow-up session. Repeated measures ANOVA showed a significant cumulative reduction in the VAS scores across the four treatment sessions (session 1, 10, 20 and the follow-up) in the TENS group (45.9% by session 20, p<0.001) and the placebo group (43.3% by session 20, p = 0.034). However, linear regression of the daily recordings of the VAS indicated that the slope in the TENS group (slope = -2.415, r = 0.943) was similar to the exercise group (slope = -2.625, r = 0.935), which were steeper than the other two groups. Note that the reduction of OA knee pain was maintained in the TENS group and the TENS&Ex group at the four-week follow-up session, but not in the other two groups.

Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?

The four treatment protocols did not show significant between-group difference over the study period. It was interesting to note that isometric exercise training of the quadriceps alone also reduced knee pain towards the end of the treatment period.

Question: Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Answer: The four treatment protocols did not show significant between-group difference over the study period. It was interesting to note that isometric exercise training of the quadriceps alone also reduced knee pain towards the end of the treatment period.

Answer the question based on the following context: Optimized anaesthetic management might improve the outcome after cancer surgery. A retrospective analysis was performed to assess the association between spinal anaesthesia (SpA) or general anaesthesia (GA) and survival in patients undergoing surgery for malignant melanoma (MM). Records for 275 patients who required SpA or GA for inguinal lymph-node dissection after primary MM in the lower extremity between 1998 and 2005 were reviewed. The follow-up ended in 2009. Survival was calculated as days from surgery to the date of death or last patient contact. The primary endpoint was mortality during a 10 yr observation period. Of 273 patients included, 52 received SpA and 221 GA, either as balanced anaesthesia (sevoflurane/sufentanil, n=118) or as total i.v. anaesthesia (propofol/remifentanil, n=103). The mean follow-up period was 52.2 (sd 35.69) months after operation. Significant effects on cumulative survival were observed for gender, ASA status, tumour size, and type of surgery (P=0.000). After matched-pairs adjustment, no differences in these variables were found between patients with SpA and GA. A trend towards a better cumulative survival rate for patients with SpA was demonstrated [mean survival (months), SpA: 95.9, 95% confidence interval (CI), 81.2-110.5; GA: 70.4, 95% CI, 53.6-87.1; P=0.087]. Further analysis comparing SpA with the subgroup of balanced volatile GA confirmed this trend [mean survival (months), SpA: 95.9, 95% CI, 81.2-110.5; volatile balanced anaesthesia: 68.5, 95% CI, 49.6-87.5, P=0.081].

Can regional anaesthesia for lymph-node dissection improve the prognosis in malignant melanoma?

These data suggest an association between anaesthetic technique and cancer outcome in MM patients after lymph-node dissection. Prospective controlled trials on this topic are warranted.

Question: Can regional anaesthesia for lymph-node dissection improve the prognosis in malignant melanoma? Answer: These data suggest an association between anaesthetic technique and cancer outcome in MM patients after lymph-node dissection. Prospective controlled trials on this topic are warranted.

Answer the question based on the following context: The aims of this study were (1) to evaluate the reliability of ultrasound (US) examination in the identification and measurement of the metatarsophalangeal plantar plate (MTP-PP) in asymptomatic subjects and (2) to establish the correlation of US findings with those of physical examination and magnetic resonance imaging (MRI), once it is an important tool in the evaluation of the instability syndrome of the second and third rays. US examinations of the second and third MTP-PPs were performed in eight asymptomatic volunteers, totaling 32 MTP joints, by three examiners with different levels of experience in musculoskeletal US. Plantar plate dimensions, integrity and echogenicity, the presence of ruptures, and confidence level in terms of structure identification were determined using conventional US. Vascular flow was assessed using power Doppler. US data were correlated with data from physical examination and MRI. MTP-PPs were ultrasonographically identified in 100% of cases, always showing homogeneous hyperechoic features and no detectable vascular flow on power Doppler, with 100% certainty in identification for all examiners. There was excellent US inter-observer agreement for longitudinal measures of second and third toe MTP-PPs and for transverse measures of the second toe MTP-PP. The MTP drawer test was positive for grade 1 MTP instability in 34.4% of joints with normal US results. Transverse MTP-PP measures were significantly higher in individuals with positive MTP drawer test. US measures and characteristics of MPT-PPs were positively correlated with those of MRI.

Can ultrasound of plantar plate have normal appearance with a positive drawer test?

US is efficient in identifying and measuring MPT-PPs and may complement physical examination. A grade 1 positive MTP drawer test may be found in asymptomatic individuals with normal MPT-PPs, as assessed by imaging.

Question: Can ultrasound of plantar plate have normal appearance with a positive drawer test? Answer: US is efficient in identifying and measuring MPT-PPs and may complement physical examination. A grade 1 positive MTP drawer test may be found in asymptomatic individuals with normal MPT-PPs, as assessed by imaging.

Answer the question based on the following context: Ancient and medieval herbal books are often believed to describe the same claims still in use today. Medieval herbal books, however, provide long lists of claims for each herb, most of which are not approved today, while the herb's modern use is often missing. So the hypothesis arises that a medieval author could have randomly hit on 'correct' claims among his many 'wrong' ones. We developed a statistical procedure based on a simple probability model. We applied our procedure to the herbal books of Hildegard von Bingen (1098- 1179) as an example for its usefulness. Claim attributions for a certain herb were classified as 'correct' if approximately the same as indicated in actual monographs. The number of 'correct' claim attributions was significantly higher than it could have been by pure chance, even though the vast majority of Hildegard von Bingen's claims were not 'correct'. The hypothesis that Hildegard would have achieved her 'correct' claims purely by chance can be clearly rejected.

Are the correct herbal claims by Hildegard von Bingen only lucky strikes?

The finding that medical claims provided by a medieval author are significantly related to modern herbal use supports the importance of traditional medicinal systems as an empirical source. However, since many traditional claims are not in accordance with modern applications, they should be used carefully and analyzed in a systematic, statistics-based manner. Our statistical approach can be used for further systematic comparison of herbal claims of traditional sources as well as in the fields of ethnobotany and ethnopharmacology.

Question: Are the correct herbal claims by Hildegard von Bingen only lucky strikes? Answer: The finding that medical claims provided by a medieval author are significantly related to modern herbal use supports the importance of traditional medicinal systems as an empirical source. However, since many traditional claims are not in accordance with modern applications, they should be used carefully and analyzed in a systematic, statistics-based manner. Our statistical approach can be used for further systematic comparison of herbal claims of traditional sources as well as in the fields of ethnobotany and ethnopharmacology.

Answer the question based on the following context: Body mass index (BMI) was determined in a population of school students from three provinces of central Italy. Fasting serum leptin concentrations were assayed in a large number of subjects from the same area, to determine their distribution as plotted against the standard deviation score (z-score) of BMI. Height and weight were recorded from 31170 subjects (16175 male and 14995 female), aged 3-18 y, to construct BMI charts of children and adolescents from central Italy. Percentiles and z-score were calculated using the LMS method of Cole. Serum leptin concentrations were assayed in 1929 subjects (996 male and 933 female) after overnight fasting. BMI percentiles of central Italy were higher than those from standards of other European and USA populations. When plotted against the z-score of BMI, serum leptin values were distributed according to an exponential curve, showing a steep pattern and a wide distribution, as BMI values increased. The hypothesis of the existence of two subgroups, based on a different relation between leptin and BMI, was verified and a separation point between the two subgroups was identified using cluster analysis, discriminant analysis and a novel method developed by our group, hereafter referred to as 'regression clustering'. This method allows identification of the value of the independent variable (z-score of BMI) which can be taken as a separation point. This analysis provided the best results and indicated the following separation points: central Italy standard, z-score = 0.72 (76.4th percentile) for males and z-score = 0.69 (75.5th percentile) for females; French standard (the one suggested for a European population by the European Childhood Obesity Group, ECOG), z-score = 1.46 (92.8th percentile) for males and z-score = 1.96 (97.5th percentile) for females. Similar but variable results were obtained when the same analysis was performed on serum leptin concentration, subdivided according to pubertal development (stage I, stage II-III, stage IV-V).

Fasting serum leptin levels in the analysis of body mass index cut-off values: are they useful for overweight screening in children and adolescents?

Children and adolescents from central Italy had greater BMI percentiles when compared to other European populations. Fasting serum leptin concentrations showed a distribution pattern related to z-score, thus allowing to identification of two different subgroups. The z-scores of BMI, identified as separation points, indicated a trend to leptin production by adipocytes that could be taken as indicators of significant increases of fat mass. This study proposes criteria and a statistical approach that could be useful in the identification of BMI cut-off values when screening children and adolescents for overweight.

Question: Fasting serum leptin levels in the analysis of body mass index cut-off values: are they useful for overweight screening in children and adolescents? Answer: Children and adolescents from central Italy had greater BMI percentiles when compared to other European populations. Fasting serum leptin concentrations showed a distribution pattern related to z-score, thus allowing to identification of two different subgroups. The z-scores of BMI, identified as separation points, indicated a trend to leptin production by adipocytes that could be taken as indicators of significant increases of fat mass. This study proposes criteria and a statistical approach that could be useful in the identification of BMI cut-off values when screening children and adolescents for overweight.

Answer the question based on the following context: Classification of pleural effusions into transudates and exudates is based on pleural fluid absolute lactic dehydrogenase value (FLDH), fluid to serum ratio of LDH (LDHR) and fluid to serum ratio of total protein (TPR) used in a parallel combination strategy. Combining multiple tests in a parallel strategy to improve diagnostic accuracy is useful only if the pair-wise correlation of the individual tests is less than 0.75. So far, this concept has not been tested in patients with pleural effusions.MATERIAL/ Biochemical data from our 200-patient series with a known cause of pleural effusion were included in this study. Correlation between the three possible combinations of tests was determined. There were 116 males and 84 females. The mean age was 62+/-1.1 years (mean+/-SEM). Of the 200 effusions, 156 were exudates and 44 were transudates. There was a significant correlation between FLDH and LDHR (r=0.93, p<0.00). However, the correlation between FLDH and TPR (r=0.27) and TPR and LDHR (r=0.22) was not significant.

Do we need all three criteria for the diagnostic separation of pleural fluid into transudates and exudates?

The operative mechanism for LDHR and FLDH used in the classification of transudate and exudates appears to be similar, and therefore unsuitable for a parallel combination strategy in the diagnostic separation of pleural effusion. FLDH and TPR have a dissimilar operating mechanism, and can therefore be combined in this process. Therefore, the diagnostic separation of pleural effusion can be done cost effectively by utilizing FLDH and TPR alone, as the cost for estimating serum LDH is eliminated in this approach.

Question: Do we need all three criteria for the diagnostic separation of pleural fluid into transudates and exudates? Answer: The operative mechanism for LDHR and FLDH used in the classification of transudate and exudates appears to be similar, and therefore unsuitable for a parallel combination strategy in the diagnostic separation of pleural effusion. FLDH and TPR have a dissimilar operating mechanism, and can therefore be combined in this process. Therefore, the diagnostic separation of pleural effusion can be done cost effectively by utilizing FLDH and TPR alone, as the cost for estimating serum LDH is eliminated in this approach.

Answer the question based on the following context: In 87 patients who were operated because of isolated VSD (Group I), VSD was closed under cardioplegic arrest and right atriotomy or right ventriculotomy were closed in the beating heart after aortic cross-clamp removal. The VSD patch was watched out for residual shunt and additional sutures were placed if it existed. Results of this technique have been compared with the other 216 (Group II) in which all procedures of the VSD closure were performed under cardioplegic arrest. Transosephageal echocardiography (TEE) was performed for evidence of residual shunting intraoperatively and postoperatively in all patients. In group I, additional sutures were placed for residual shunt in 14 patients (16.1%), and insignificant residual shunt was detected in only one (1.1%) patient at early postoperative period (p<0.05, according to group II). In group II, there was hemodynamically insignificant residual shunt in 31 patients (14.5%), and 9 patients (4.2%) were reoperated for significant shunt (p<0.05).

Does direct visualization of peripatch areas in beating heart eliminate the risk of residual ventricular septal defect in adult patients?

Transatrial or transventricular inspection to peripatch areas in the beating heart is a safe technique to detect a residual shunt, an observation that may eliminate reoperation.

Question: Does direct visualization of peripatch areas in beating heart eliminate the risk of residual ventricular septal defect in adult patients? Answer: Transatrial or transventricular inspection to peripatch areas in the beating heart is a safe technique to detect a residual shunt, an observation that may eliminate reoperation.

Answer the question based on the following context: Homeopathic Pathogenetic Trials (HPTs) are a pillar of homeopathy, a key source of the symptoms characteristic of a particular homeopathic medicine. Homeopaths choose homeopathic medicines by comparing these remedy pictures with the symptoms the patient is presenting. Thus, recognition of these symptom sets underpins the clinical practice of homeopathy. To test whether HPTs generate consistent and recognisable sets of symptoms in consecutive trials. Practising homeopaths, blinded to the homeopathic medicine under investigation, were given the set of symptoms generated during an unpublished HPT and asked to identify the homeopathic medicine used. Ozone, prepared by homeopathic method to the ultramolecular dilution of 30c (10(-60) dilution), was chosen at random from twenty potential medicines. Seven practising homeopaths were asked to make three guesses as to the identity of the remedy. Initially from the full list of possible remedies (N = 2372). Two of the seven homeopaths guessed the identity of the remedy correctly (p < 0.0001). Subsequently, when their choice of possible medicines was restricted to a list of 20, the same two homeopaths selected the correct medicine, however none of the other practising homeopaths did so (p = 0.2). The selection of the correct homeopathic medicine from the unrestricted list (N = 2372 medicines) by two homeopaths is noteworthy given that the homeopathic medicine used during the HPT was diluted well beyond Avogadro's number and would not be expected to produce any detectable or recognisable symptomatology. Possible reasons why the remaining five homeopaths did not guess correctly are discussed.

Do Homeopathic Pathogenetic Trials generate recognisable and reproducible symptom pictures?

The results show that practising homeopaths may be able to correctly identify a homeopathic medicine from the set of symptoms generated during an HPT. This suggests that such symptom pictures generated by taking an ultramolecular homeopathic medicine are recognisable and specific to the substance taken. Since identification of the remedy was based on past HPT information held in the materia medica, this demonstrates that HPT-generated symptom pictures are reproducible, thus validating the HPT methodology. These promising preliminary findings warrant replication; possible improvements to the trial design to be incorporated in future studies were identified.

Question: Do Homeopathic Pathogenetic Trials generate recognisable and reproducible symptom pictures? Answer: The results show that practising homeopaths may be able to correctly identify a homeopathic medicine from the set of symptoms generated during an HPT. This suggests that such symptom pictures generated by taking an ultramolecular homeopathic medicine are recognisable and specific to the substance taken. Since identification of the remedy was based on past HPT information held in the materia medica, this demonstrates that HPT-generated symptom pictures are reproducible, thus validating the HPT methodology. These promising preliminary findings warrant replication; possible improvements to the trial design to be incorporated in future studies were identified.

Answer the question based on the following context: Charnley low-friction torque total hip arthroplasty (THA) remains the gold standard in THA. The main cause for failure is wear of the socket. Highly crosslinked polyethylene (HXLPE) has been associated with reduced wear rates. Also, oxidized zirconium has shown in vitro reduced wear rates. However, to our knowledge, there are no data comparing oxidized zirconium femoral heads with metal heads against HXLPE or ultrahigh-molecular-weight polyethylene (UHMWPE) when 22.25-mm bearings were used, which was the same size that performed so well in Charnley-type THAs.QUESTIONS/ We hypothesized that after a minimal 4-year followup (1) use of HXLPE would result in lower radiographic wear than UHMWPE when articulating with a stainless steel head or with an oxidized zirconium head; (2) use of oxidized zirconium would result in lower radiographic wear than stainless steel when articulating with UHMWPE and HXLPE; and (3) there would be no difference in terms of Merle d'Aubigné scores between the bearing couple combinations. One hundred patients were randomized to receive cemented THA with either oxidized zirconium or a stainless steel femoral head. UHMWPE was used in the first 50 patients, whereas HXLPE was used in the next 50 patients. There were 25 patients in each of the four bearing couple combinations. All other parameters were identical in both groups. Complete followup was available in 86 of these patients. Femoral head penetration was measured using a validated computer-assisted method dedicated to all-polyethylene sockets. Clinical results were compared between the groups using the Merle d'Aubigné score. In the UHMWPE series, the median steady-state penetration rate from 1 year onward was 0.03 mm/year (range, 0.003-0.25 mm/year) in the oxidized zirconium group versus 0.11 mm/year (range, 0.03-0.29 mm/year) in the metal group (difference of medians 0.08, p<0.001). In the HXLPE series, the median steady-state penetration rate from 1 year onward was 0.02 mm/year (range, -0.32 to 0.07 mm/year) in the oxidized zirconium group versus 0.05 mm/year (range, -0.39 to 0.11 mm/year) in the metal group (difference of medians 0.03, p<0.001). The Merle d'Aubigné scores were no different between the groups with a median of 18 in each of the groups (range, 16-18).

Do oxidized zirconium femoral heads reduce polyethylene wear in cemented THAs?

This study demonstrated femoral head penetration was reduced by oxidized zirconium when compared with metal on both UHMWPE and HXLPE. However, apart the metal-UHMWE group, all other groups had a steady-state penetration rate well below the osteolysis threshold with a low difference between groups that might not be clinically important at this point. Longer-term followup is needed to warrant whether wear reduction will generate less occurrence of osteolysis and aseptic loosening.

Question: Do oxidized zirconium femoral heads reduce polyethylene wear in cemented THAs? Answer: This study demonstrated femoral head penetration was reduced by oxidized zirconium when compared with metal on both UHMWPE and HXLPE. However, apart the metal-UHMWE group, all other groups had a steady-state penetration rate well below the osteolysis threshold with a low difference between groups that might not be clinically important at this point. Longer-term followup is needed to warrant whether wear reduction will generate less occurrence of osteolysis and aseptic loosening.

Answer the question based on the following context: Macrophages are a heterogeneous cell population which in response to the cytokine milieu polarize in either classically activated macrophages (M1) or alternatively activated macrophages (M2). This plasticity makes macrophages essential in regulating inflammation, immune response and tissue remodeling and a novel therapeutic target in inflammatory diseases such as atherosclerosis. The aim of the study was to describe the transcriptomic profiles of differently polarized human macrophages to generate new hypotheses on the biological function of the different macrophage subtypes. Polarization of circulating monocytes/macrophages of blood donors was induced in vitro by IFN-γ and LPS (M1), by IL-4 (M2a), and by IL-10 (M2c). Unstimulated cells (RM) served as time controls. Gene expression profile of M1, M2a, M2c and RM was assessed at 6, 12 and 24h after polarization with Whole Human Genome Agilent Microarray technique. When compared to RM, M1 significantly upregulated pathways involved in immunity and inflammation, whereas M2a did the opposite. Conversely, decreased and increased expression of mitochondrial metabolism, consistent with insulin resistant and insulin sensitive patterns, was seen in M1 and M2a, respectively. The time sequence in the expression of some pathways appeared to have some specific bearing on M1 function. Finally, canonical and non-canonical Wnt genes and gene groups, promoting inflammation and tissue remodeling, were upregulated in M2a compared to RM.

Transcriptomic analysis of human polarized macrophages: more than one role of alternative activation?

Our data in in vitro polarized human macrophages: 1. confirm and extend known inflammatory and anti-inflammatory gene expression patterns; 2. demonstrate changes in mitochondrial metabolism associated to insulin resistance and insulin sensitivity in M1 and M2a, respectively; 3. highlight the potential relevance of gene expression timing in M1 function; 4. unveil enhanced expression of Wnt pathways in M2a suggesting a potential dual (pro-inflammatory and anti-inflammatory) role of M2a in inflammatory diseases.

Question: Transcriptomic analysis of human polarized macrophages: more than one role of alternative activation? Answer: Our data in in vitro polarized human macrophages: 1. confirm and extend known inflammatory and anti-inflammatory gene expression patterns; 2. demonstrate changes in mitochondrial metabolism associated to insulin resistance and insulin sensitivity in M1 and M2a, respectively; 3. highlight the potential relevance of gene expression timing in M1 function; 4. unveil enhanced expression of Wnt pathways in M2a suggesting a potential dual (pro-inflammatory and anti-inflammatory) role of M2a in inflammatory diseases.

Answer the question based on the following context: At the acute phase of traumatic brain injury (TBI), brain swelling contributes substantially to the development of secondary neurological lesions. Elucidating the pathophysiology of brain swelling is crucial to improve TBI management. In a previous study, specific gravity (SG) of the noncontused hemisphere, as estimated by computed tomography (CT), was higher in patients with high Marshall CT scores and severe brain swelling. The aim of this study was to investigate the relationship between estimated specific gravity (eSG) and clinical variable suggestive of brain swelling. Retrospective study of data from a prospectively established database. Neurology ICU in a teaching hospital in Paris, France. We studied 20 patients with severe traumatic brain injury (TBI), 20 patients with high-grade subarachnoid hemorrhage (SAH) presenting similar brain-swelling criteria, 20 patients with low-grade SAH, and 20 healthy controls. None. Estimated brain specific gravity was acquired from CT images obtained at ICU admission. eSG was estimated in the overall intracerebral content and in a region-of-interest composed of white matter and the diencephalon. eSG in the region of interest was significantly higher in the TBI patients than in the high-grade SAH patients (1.0350 +/- 0.0041 vs. 1.0310 +/- 0.0019 g/ml, P<0.05). eSG was similar in the high-grade SAH, low-grade SAH, and control groups.

Does brain swelling increase estimated specific gravity?

Our findings do not support a causal link between brain swelling and eSG elevation. The eSG increase in severe TBI patients is not due to brain swelling.

Question: Does brain swelling increase estimated specific gravity? Answer: Our findings do not support a causal link between brain swelling and eSG elevation. The eSG increase in severe TBI patients is not due to brain swelling.

Answer the question based on the following context: This study was done to identify risk factors for metachronous manifestation of contralateral inguinal hernia in patients with unilateral inguinal hernia. Characteristics of 156 patients with metachronous contralateral hernia were compared with those of 156 patients with unilateral hernia who were ascertained not to have presented with contralateral hernia. There was a tendency for the hernia to be more often on the left side in 88 of 156 patients (56.4%) with contralateral manifestation compared with 70 of 156 patients (44.9%) in the control group (P =.054). The age at hernia repair of the patients with contralateral manifestation, 1 to 120 months (median, 14 months), was significantly younger than the 1 to 149 months (median, 20 months) of the control patients (P =.016). More patients with contralateral manifestation had a family history of inguinal hernia, and the percentage, 24.4%, was significantly higher than the 14.7% in the control group (P =.046). A univariate analysis with the Cox regression models found that hernia on the left side and a positive family history were significantly associated with the metachronous manifestation of contralateral hernia (hazard ratio [HR], 1.40; P =. 037 and HR, 1.59; P =.013, respectively).

Risk of contralateral manifestation in children with unilateral inguinal hernia: should hernia in children be treated contralaterally?

The risk of metachronous manifestation of contralateral hernia is high in patients with left-side hernia and in those with a family history, and the incidence of contralateral hernia is at most 10% in these patients. The authors think that the incidence is still too low to justify routine exploration and surgery for a patent processus vaginalis. Contralateral exploration should therefore be reserved for high-risk patients in whom second anesthesia and surgery have to be avoided.

Question: Risk of contralateral manifestation in children with unilateral inguinal hernia: should hernia in children be treated contralaterally? Answer: The risk of metachronous manifestation of contralateral hernia is high in patients with left-side hernia and in those with a family history, and the incidence of contralateral hernia is at most 10% in these patients. The authors think that the incidence is still too low to justify routine exploration and surgery for a patent processus vaginalis. Contralateral exploration should therefore be reserved for high-risk patients in whom second anesthesia and surgery have to be avoided.

Answer the question based on the following context: To describe the form of midwifery practice preferred by physicians practising obstetrics, nurses providing maternity care and midwives. Mail survey conducted in 1991. Province of Quebec. A systematic random sample of 844 physicians, 808 nurses and 92 midwives; 597, 723 and 92 respectively completed the questionnaire, for an overall response rate of 80%. Midwife training options, range of responsibilities, location of midwifery care, relationship to other maternity care providers and degree of autonomy. Most of the physicians, nurses and midwives surveyed agreed that if midwifery was legalized, midwives should have a university degree, provide basic care to women with normal pregnancy and delivery, provide prenatal and postnatal care in hospitals and community health centres, perform delivery in hospitals and work in close collaboration with the other maternity care professionals. Disagreement existed concerning the level of university training required, the need for training in nursing first, the scope of medical intervention performed by midwives, out-of-hospital delivery, the autonomy of midwives and control over their practice.

Midwifery defined by physicians, nurses and midwives: the birth of a consensus?

Some consensus on midwifery practice exists between physicians, nurses and midwives. In jurisdictions where opposition to midwives is strong, such consensus could serve as the starting point for the introduction of midwifery.

Question: Midwifery defined by physicians, nurses and midwives: the birth of a consensus? Answer: Some consensus on midwifery practice exists between physicians, nurses and midwives. In jurisdictions where opposition to midwives is strong, such consensus could serve as the starting point for the introduction of midwifery.

Answer the question based on the following context: To evaluate the diagnostic value of the 3rd hour plasma glucose level in the 100 g oral glucose tolerance test (OGTT). Records of all pregnant patients with abnormal 50 g glucose challenge test (GCT) between January 2005 and December 2013 were reviewed (n=1963). The 100 g OGTT results were analyzed separately for both Carpenter&Couston (CC) and National Diabetes Data Group (NDDG) criteria. The number of patients diagnosed with gestational diabetes mellitus (GDM) was 297 (15.1%) according to CC criteria and 166 (8.4%) according to NDDG criteria. The 1st hour plasma glucose level showed the highest correlation with GDM diagnosis (ρ=0.595 for CC and ρ=0.567 for NDDG). However, the 3rd hour plasma glucose level showed the weakest correlation with GDM diagnosis (ρ=0.216 for CC and ρ=0.213 for NDDG). The 3rd hour value of 100 g OGTT was one of the two elevated measurements in 10.8% of patients when CC criteria are used and in 13.8% of patients when NDDG criteria are used.

Is omitting the 3rd hour measurement in the 100 g oral glucose tolerance test feasible?

Omitting 3rd hour plasma glucose measurement in 100 g OGTT results in unacceptable rates of underdiagnosed patients.

Question: Is omitting the 3rd hour measurement in the 100 g oral glucose tolerance test feasible? Answer: Omitting 3rd hour plasma glucose measurement in 100 g OGTT results in unacceptable rates of underdiagnosed patients.

Answer the question based on the following context: We investigated whether routine elective irradiation of a clinically negative inguinal node (IGN) is necessary for patients with locally advanced distal rectal cancer and anal canal invasion (ACI). We reviewed retrospectively 1,246 patients with locally advanced rectal adenocarcinoma managed using preoperative or postoperative chemoradiotherapy and radical surgery between 2001 and 2011. The patients' IGN was clinically negative at presentation and IGN irradiation was not performed. ACI was defined as the lower edge of the tumor being within 3 cm of the anal verge. Patients were divided into two groups, those with ACI (n = 189, 15.2%) and without ACI (n = 1,057, 84.8%). The follow-up period was a median of 66 months (range, 3-142 months). Among the 1,246 patients, 10 developed IGN recurrence; 7 with ACI and 3 without ACI. The actuarial IGN recurrence rate at 5 years was 0.7%; 3.5% and 0.2% in patients with and without ACI, respectively (p < 0.001). Isolated IGN recurrence occurred in three patients, all of whom had ACI tumors. These three patients received curative intent local treatments, and one was alive with no evidence of disease 10 years after IGN recurrence. Salvage treatments in the other two patients controlled successfully the IGN recurrence for>5 years, but they developed second malignancy or pelvic and distant recurrences. Seven patients with non-isolated IGN recurrence died of disease at 5-22 months after IGN recurrence.

Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal?

The low IGN recurrence rate even with ACI and the feasibility of salvage of isolated IGN recurrence indicated that routine elective IGN irradiation is not necessary for rectal cancer with ACI.

Question: Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal? Answer: The low IGN recurrence rate even with ACI and the feasibility of salvage of isolated IGN recurrence indicated that routine elective IGN irradiation is not necessary for rectal cancer with ACI.

Answer the question based on the following context: To study the effect of cigarette use on height and adiposity in adolescents. Data on cigarette use were collected every 3 months for 5 years from adolescents initially 12-13 years of age. Height, weight, and triceps skinfold thickness were measured in survey cycles 1, 12, and 19. Multivariate linear regression models were fitted to estimate the association between cigarette use and the anthropometric measures in a dataset that pooled data over two time periods, from survey cycles 1-12 and from survey cycles 12-19. Data were available for 451 boys and 478 girls. Seven percent of boys and 14% of girls smoked>or =30 cigarettes per month on average during the first time period; 9% of boys and 18% of girls smoked>or =30 cigarettes per month on average during the second time period. In boys, a 100-cigarette per month increment in cigarette use over the preceding 2.5 years was independently associated with lower body mass index (-0.4 kg/m(2)) and shorter height (-0.7 cm). In girls, cigarette use was not associated with height or adiposity.

Does cigarette use influence adiposity or height in adolescence?

While there was no relation in girls, cigarette use appears to decrease body mass index and height in boys. Young girls may be less likely to take up cigarette smoking if tobacco control messages emphasize that cigarette use may not be associated with reduced weight in adolescent females.

Question: Does cigarette use influence adiposity or height in adolescence? Answer: While there was no relation in girls, cigarette use appears to decrease body mass index and height in boys. Young girls may be less likely to take up cigarette smoking if tobacco control messages emphasize that cigarette use may not be associated with reduced weight in adolescent females.

Answer the question based on the following context: The purpose of this study was to determine the number of thyroid nodule workups that could be eliminated and the number of malignant tumors that would be missed if the Society of Radiologists in Ultrasound (SRU) recommendations and the three-tiered system were applied to incidental thyroid nodules (ITN) detected at imaging. This retrospective study included ITN in 390 consecutively registered patients who underwent ultrasound-guided fine-needle aspiration of one or more thyroid nodules from July 2010 to June 2011. Images were reviewed, and nodules were categorized according to two workup criteria: ITN seen on ultrasound images were categorized according to SRU recommendations, and those seen on CT, MR, or PET/CT images were classified according to the three-tiered risk-categorization system. In this study 114 of 390 (29%) patients had nodules first detected incidentally during imaging studies, and 107 patients met the inclusion criteria. These patients had 47 ITN seen at ultrasound and 60 ITN seen at either CT, MRI, or PET/CT. If the SRU recommendations had been applied, 14 of 47 (30%) patients with ITN on ultrasound images would not have received fine-needle aspiration and one of four cases of cancer would have been missed. The missed malignant tumor was a 14-mm localized papillary carcinoma. If the three-tiered system had been applied, 21 of 60 (35%) patients with ITN on CT, MR, or PET/CT images would not have received fine-needle aspiration, but none of the three malignancies would have been missed. Overall, 35 of 107 (33%) of patients with ITN did not meet the SRU recommendations or the three-tiered criteria.

Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system?

Use of the SRU recommendations and three-tiered system can reduce the workup of ITN by one third compared with current practice without specific guidelines. One case of localized papillary carcinoma was missed when the SRU recommendations were used.

Question: Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system? Answer: Use of the SRU recommendations and three-tiered system can reduce the workup of ITN by one third compared with current practice without specific guidelines. One case of localized papillary carcinoma was missed when the SRU recommendations were used.

Answer the question based on the following context: Noninvasive measurements of cerebral blood volume (CBV) and contrast transfer coefficient (K(trans)) have potential benefits in the diagnosis and therapeutic management of adult glioma. This study examines the relationship between CBV, K(trans), and overall survival. Twenty-seven adult patients with glioma underwent T1-weighted dynamic contrast-enhanced MR imaging, and parametric maps of CBV and K(trans) were calculated. The relationship of histologic grade, CBV, K(trans), age, sex, surgical resection, and use of adjuvant therapy to survival were analyzed by using the logrank method and Cox regression analysis. The Kaplan-Meier method for displaying survival curves was used. The relationship of factors such as comorbidity, elevated intracranial pressure, size of nonenhancing tumor, and peritumoral edema were not considered. Both CBV (P<.01) and K(trans) (P<.01) show a significant relationship to histologic grade. CBV (P = .004), K(trans) (P = .008), and histologic grade (P<.001) all demonstrate a significant association with patient survival when analyzed individually. Cox regression analysis identified only histologic grade (P<.01) and K(trans) (P<.05) as independent significant prognostic indicators. Examination of survival data from high-grade (III and IV) tumors demonstrated a linear relationship between K(trans) and patient survival (P<.01).

Do cerebral blood volume and contrast transfer coefficient predict prognosis in human glioma?

This study suggests a direct relationship between K(trans) and length of survival in high-grade gliomas, which could be of clinical importance. CBV relates directly to histologic grade but provides no independent prognostic information over and above that provided by grade. Further large prospective studies should be planned to test whether this observation holds true.

Question: Do cerebral blood volume and contrast transfer coefficient predict prognosis in human glioma? Answer: This study suggests a direct relationship between K(trans) and length of survival in high-grade gliomas, which could be of clinical importance. CBV relates directly to histologic grade but provides no independent prognostic information over and above that provided by grade. Further large prospective studies should be planned to test whether this observation holds true.

Answer the question based on the following context: Adherence to drug treatment and health-related quality of life (HRQL) are two distinct concepts. Generally one would expect a positive relationship between the two. The purpose of this study was to assess the relationship between adherence and HRQL. HRQL was measured using the physical and mental summary measures of the RAND-12 (PHC-12, MHC-12), the SF-12 (PCS-12, MCS-12), HUI-2 and HUI-3. Adherence was assessed using Morisky's instrument. Three longitudinal datasets were used. One dataset included 100 hypertensive patients. Another dataset covered 199 high risk community-dwelling individuals. The third dataset consisted of 365 elderly patients. Spearman's correlation coefficients were used to assess association. Subgroup analyses by type of medication and inter-temporal analyses were also performed. Correlation between adherence and PHC-12 ranged from 0.08 (p = 0.26) to 0.22 (p<0.01). Correlations between adherence and MHC-12 ranged from 0.11 (p = 0.11) to 0.15 (p<0.01). Similar results were observed using HUI-2, HUI-3, and SF-12 as well as by type of medication and in the lagged analyses.

Is adherence to drug treatment correlated with health-related quality of life?

Correlations between HRQL and adherence were positive but typically weak or negligible in magnitude.

Question: Is adherence to drug treatment correlated with health-related quality of life? Answer: Correlations between HRQL and adherence were positive but typically weak or negligible in magnitude.

Answer the question based on the following context: The ability of plant lineages to reach all continents contributes substantially to their evolutionary success. This is exemplified by the Poaceae, one of the most successful angiosperm families, in which most higher taxa (tribes, subfamilies) have global distributions. Due to the old age of the ocean basins relative to the major angiosperm radiations, this is only possible by means of long-distance dispersal (LDD), yet the attributes of lineages with successful LDD remain obscure. Polyploid species are over-represented in invasive floras and in the previously glaciated Arctic regions, and often have wider ecological tolerances than diploids; thus polyploidy is a candidate attribute of successful LDD. The link between polyploidy and LDD was explored in the globally distributed grass subfamily Danthonioideae. An almost completely sampled and well-resolved species-level phylogeny of the danthonioids was used, and the available cytological information was assembled. The cytological evolution in the clade was inferred using maximum likelihood (ML) as implemented in ChromEvol. The biogeographical evolution in the clade was reconstructed using ML and Bayesian approaches. Numerous increases in ploidy level are demonstrated. A Late Miocene-Pliocene cycle of polyploidy is associated with LDD, and in two cases (the Australian Rytidosperma and the American Danthonia) led to secondary polyploidy. While it is demonstrated that successful LDD is more likely in polyploid than in diploid lineages, a link between polyploidization events and LDD is not demonstrated.

Does polyploidy facilitate long-distance dispersal?

The results suggest that polyploids are more successful at LDD than diploids, and that the frequent polyploidy in the grasses might have facilitated the extensive dispersal among continents in the family, thus contributing to their evolutionary success.

Question: Does polyploidy facilitate long-distance dispersal? Answer: The results suggest that polyploids are more successful at LDD than diploids, and that the frequent polyploidy in the grasses might have facilitated the extensive dispersal among continents in the family, thus contributing to their evolutionary success.

Answer the question based on the following context: To evaluate the dose of scatter radiation to infants in a NICU in order to determine the minimal safe distance between isolettes. Dose secondary to scattered radiation from an acrylic phantom exposed to vertical and horizontal beam exposures at 56 kVp was measured at 93 cm and 125 cm from the center of the phantom. This corresponds to 2 and 3 ft between standard isolettes, respectively. For horizontal exposures, the dosimeter was placed directly behind a CR plate and scatter dose at 90-degrees and 135-degrees from the incident beam was also measured. Exposures were obtained at 160 mAs and the results were extrapolated to correspond to 2.5 mAs. Four measurements were taken at each point and averaged. At 125 cm and 93 cm there was minimal scatter compared to daily natural background radiation dose (8.493 microGy). Greatest scatter dose obtained from a horizontal beam exposure at 135 degrees from the incident beam was still far below background radiation.

Scatter radiation from chest radiographs: is there a risk to infants in a typical NICU?

Scatter radiation dose from a single exposure as well as cumulative scatter dose from numerous exposures is significantly below natural background radiation. Infants in neighboring isolettes are not at added risk from radiation scatter as long as the isolettes are separated by at least 2 ft.

Question: Scatter radiation from chest radiographs: is there a risk to infants in a typical NICU? Answer: Scatter radiation dose from a single exposure as well as cumulative scatter dose from numerous exposures is significantly below natural background radiation. Infants in neighboring isolettes are not at added risk from radiation scatter as long as the isolettes are separated by at least 2 ft.

Answer the question based on the following context: Patients with metopic craniosynostosis are traditionally treated with fronto-orbital advancement to correct hypotelorism and trigonocephaly. Alternatively, endoscopic-assisted treatment comprises narrow ostectomy of the fused suture followed by postoperative helmet therapy. Here we compare the preoperative and 1-year postoperative results in open versus endoscopic repairs. We reviewed preoperative and 1-year postoperative three-dimensional reconstructed computed tomography scans of patients treated for nonsyndromic metopic craniosynostosis by either open (n = 15) or endoscopic (n = 13) technique. Hypotelorism was assessed by interzygomaticofrontal distance and intercanthal distance. Trigonocephaly was assessed by 2 independent angles: first, an axial-plane two-dimensional angle between zygomaticofrontal suture bilaterally and the glabella (ZF(R)-G-ZF(L)); second, an interfrontal angle (IFA) between the most anterior point from a reconstructed midsagittal plane and supraorbital notch bilaterally. Age-matched scans of unaffected patients (n = 28) served as controls for each postoperative scan. Patients with open repair (9.5 ± 1.8 months) were older at time of surgery than patients with endoscopic repairs (3.3 ± 0.4 months) (P = 0.004). Male-to-female ratios were equivalent at roughly 7:3 in both groups. Preoperatively, the endoscopic group had worse hypotelorism and ZF(R)-G-ZF(L) than the open group (P ≤ 0.04). After accounting for preoperative differences, all of the postoperative measurements (ie, interzygomaticofrontal distance, intercanthal distance, ZF(R)-G-ZF(L) angle, IFA) of the 2 groups were statistically equivalent (P ≥ 0.135). Trigonocephaly was significantly improved after repair in both the open (8 degrees [ZF(R)-G-ZF(L)] and 18 degrees [IFA]) and endoscopic (13 degrees [ZF(R)-G-ZF(L)] and 16 degrees [IFA]) groups (P<0.001). Postoperative measures in both groups were equivalent to controls (0.12<P<0.89). Intrarater reliability ranged from 0.93 to 0.99 for all measurements.

Are endoscopic and open treatments of metopic synostosis equivalent in treating trigonocephaly and hypotelorism?

Our retrospective series shows that endoscopic and open repairs of metopic craniosynostosis are equivalent in improving hypotelorism and trigonocephaly at 1-year follow-up. Additional studies are necessary to better define minor differences in morphology, which may result from the different techniques.

Question: Are endoscopic and open treatments of metopic synostosis equivalent in treating trigonocephaly and hypotelorism? Answer: Our retrospective series shows that endoscopic and open repairs of metopic craniosynostosis are equivalent in improving hypotelorism and trigonocephaly at 1-year follow-up. Additional studies are necessary to better define minor differences in morphology, which may result from the different techniques.

Answer the question based on the following context: This study compares stigmatizing attitudes of different healthcare professionals towards psychiatry and patients with mental health problems. The Mental Illness Clinicians Attitude (MICA) questionnaire is used to assess stigmatizing attitudes in three groups: general practitioners (GPs, n = 55), mental healthcare professionals (MHCs, n = 67) and forensic psychiatric professionals (FPs, n = 53). A modest positive attitude towards psychiatry was found in the three groups (n = 176). Significant differences were found on the total MICA-score (p < 0.001). GPs scored significantly higher than the FPs and the latter scored significantly higher than the MHCs on all factors of the MICA. Most stigmatizing attitudes were found on professionals' views of health/social care field and mental illness and disclosure. Personal and work experience did not influence stigmatizing attitudes.

Differential stigmatizing attitudes of healthcare professionals towards psychiatry and patients with mental health problems: something to worry about?

Although all three groups have a relatively positive attitude using the MICA, there is room for improvement. Bias toward socially acceptable answers cannot be ruled out. Patients' view on stigmatizing attitudes of professionals may be a next step in stigma research in professionals.

Question: Differential stigmatizing attitudes of healthcare professionals towards psychiatry and patients with mental health problems: something to worry about? Answer: Although all three groups have a relatively positive attitude using the MICA, there is room for improvement. Bias toward socially acceptable answers cannot be ruled out. Patients' view on stigmatizing attitudes of professionals may be a next step in stigma research in professionals.

Answer the question based on the following context: To assess if arylsulfatase A activity (ASA) and sulfatide (SL) concentration in the human endometrium can be predictive of the development of endometrial polyps over the years, since ASA activity reflects the endometrial sensitivity to hormones. ASA activity and SL concentration were determined by biochemical procedures on endometrial samples collected between 1990 and 1994 in non-menopausal women. These women underwent a new endometrial sampling following the clinical indication some years after the first endometrial sampling. The histological assessment of the second endometrial specimens found four patients with normal endometrial pattern and 10 patients with one or more endometrial polyps. ASA activity/years elapsed and SL concentration/years elapsed were compared using two tailed Mann-Whitney test for unpaired data between patients with normal pattern and patients with endometrial polyps. Median ASA activities were 2.62 (normal pattern) versus 1.85 (endometrial polyps) nmol hydrolized substrate/min. Median activity/years elapsed is higher in patients with second endometrial sample presenting normal pattern (p=0.006) and median SL concentration/years elapsed does not differ significantly among groups, even if median SL concentration seems to be higher in patients who subsequently developed polyps (1031 µg/g of fresh tissue versus 341,5 µg/g of fresh tissue).

Can endometrial arylsulfatase A activity predict the onset of endometrial polyps over the years?

ASA activity can predict the onset of endometrial polyps over the years.

Question: Can endometrial arylsulfatase A activity predict the onset of endometrial polyps over the years? Answer: ASA activity can predict the onset of endometrial polyps over the years.

Answer the question based on the following context: Histology has been identified as an important prognostic factor in Hodgkin's disease (HD) in adults. Information regarding the impact of histology on outcome in childhood HD is scarce. This study determines the effect of histology on the overall survival (OS) or progression-free survival (PFS) in a national series of children treated in a standardized manner. The results of treatment of 331 assessable patients, treated between January 1, 1982 and June 30, 1992, in the United Kingdom Children's Cancer Study Group (UKCCSG) Hodgkin's study I were reviewed to evaluate OS, PFS, and deaths according to stage and histology. Treatment was either involved-field radiation alone (stage IA) or chlorambucil, vinblastine, procarbazine, and prednisolone (ChlVPP) chemotherapy with or without mediastinal radiation. All were clinically staged at diagnosis. Nodular sclerosing (NS) HD was the most common histologic subtype (155 of 331 patients [47%]) and was uniformly distributed through all stages. Lymphocyte-depletion (LD) HD was extremely uncommon (<1%). Mixed-cellularity (MC) HD had the highest relapse rate, but this was only significant (P<.05) in stage I patients who received local irradiation alone. There was no other statistically significant difference in OS and PFS between the various histologic subtypes. Multivariate analysis for PFS and OS confirmed that stage was the most important prognostic factor and that histology did not have an effect after stratification by stage.

Does histology influence outcome in childhood Hodgkin's disease?

This study demonstrates that with effective multiagent chemotherapy, histologic subtype does not influence outcome. The high relapse rates in stage I MC subtype indicates that MC HD is biologically aggressive and systemic treatment with or without local irradiation may be indicated. The high relapse rate in stage IV patients appeared to be independent of histology.

Question: Does histology influence outcome in childhood Hodgkin's disease? Answer: This study demonstrates that with effective multiagent chemotherapy, histologic subtype does not influence outcome. The high relapse rates in stage I MC subtype indicates that MC HD is biologically aggressive and systemic treatment with or without local irradiation may be indicated. The high relapse rate in stage IV patients appeared to be independent of histology.

Answer the question based on the following context: Transfer of cryopreserved-warmed embryos into an appropriately prepared uterus unaffected by controlled ovarian hyperstimulation is common in the practice of in vitro fertilization. There is limited information on the effect of blastocyst vitrification and warming on perinatal outcomes. We sought to determine if perinatal outcomes are affected after the transfer of vitrified-warmed blastocysts compared to the transfer of fresh blastocysts, by comparing preeclampsia rate, birthweight, percentage of low birthweight, and preterm delivery rate between embryo transfer types. We performed a retrospective database cohort study of 289 fresh and 109 vitrified-warmed blastocyst transfer cycles at an academic medical center. Cycles were performed from July 2, 2009, through Dec. 8, 2014, and included infants born at ≥20 weeks gestational age, excluding donor egg cycles. We examined the association between transfer type (fresh or vitrified-warmed) and proportion of deliveries complicated by preeclampsia, preterm delivery (gestational age<37 weeks), and low birthweight (<2500 g). We assessed associations using generalized linear models, both unadjusted and adjusted, for maternal age, newborn sex, diabetes status, and parity. We observed more pregnancies complicated by preeclampsia following vitrified-warmed transfers (7.6%) compared to fresh embryo transfers (2.6%) (P = .023) (adjusted odds ratio, 3.1; 95% confidence interval, 1.2-8.4). Newborns resulting from vitrified-warmed embryo transfer cycles were similar to those resulting from fresh embryo transfer cycles with regard to low birthweight (7.4% vs 5.3%, P = .421), mean birthweight (3443 vs 3431 g, P = .865), and preterm delivery rate (9.2% vs 8.7%, P = .869).

Are perinatal outcomes affected by blastocyst vitrification and warming?

We conclude that embryo vitrification with warming may affect some perinatal outcomes since preeclampsia is increased compared to fresh blastocyst transfer. However, other perinatal outcomes such as low birthweight and preterm delivery rate are not affected. Fresh blastocyst transfers should be considered when possible as they may reduce the incidence of preeclampsia.

Question: Are perinatal outcomes affected by blastocyst vitrification and warming? Answer: We conclude that embryo vitrification with warming may affect some perinatal outcomes since preeclampsia is increased compared to fresh blastocyst transfer. However, other perinatal outcomes such as low birthweight and preterm delivery rate are not affected. Fresh blastocyst transfers should be considered when possible as they may reduce the incidence of preeclampsia.

Answer the question based on the following context: Acral melanoma is an uncommon type of melanoma in Caucasian patients. However, acral melanoma is the most common type of melanoma in African and Asian patients. Comparison analyses between hand-acral melanoma and foot-acral melanoma have been rarely reported in the literature. Acral melanoma is an uncommon melanocytic tumor characterized by an intrinsic aggressiveness, with specific histological and clinicopathological features. Acral melanoma involves the palms, soles and sub-ungueal sites. A total of 244 patients with acral melanoma were included in our analysis. The current study was performed in three different medical centers: Sapienza University of Rome, San Gallicano Institute of Rome and University of Magna Graecia (Italy). The Kaplan-Meier product was used to estimate survival curves for disease-free survival and overall survival. The log-rank test was used to evaluate differences between the survival curves. Assuming that the effects of the predictor variables are constant over time, the independent predictive factors were assessed by Spearman's test and subsequently data were analyzed performing Cox proportional-hazard regression. In both univariate and multivariate analyses Breslow thickness (p<0.0001) and ulceration (p = 0.003) remained the main predictors. General BRAF mutation was detected in 13.8% of cases. We found that median Breslow value and the percentage of recurrences were similar in hand-acral melanoma and foot-acral melanoma, as well as there were no differences in both short and long-term.

Is the prognosis and course of acral melanoma related to site-specific clinicopathological features?

The absence of differences in survival between hand-acral melanoma and foot-acral melanoma shows that the aggressiveness of the disease is related to distinct mutational rate, as well as to anatomical site-specific features, rather than to the visibility of the primary lesion.

Question: Is the prognosis and course of acral melanoma related to site-specific clinicopathological features? Answer: The absence of differences in survival between hand-acral melanoma and foot-acral melanoma shows that the aggressiveness of the disease is related to distinct mutational rate, as well as to anatomical site-specific features, rather than to the visibility of the primary lesion.

Answer the question based on the following context: To determine the frequency of coincident diagnoses of pregnancy and pelvic inflammatory disease (PID) in adolescents seeking care at a large urban children's hospital. All inpatient medical records for the period from January 1, 1984 through December 31, 1993 were searched for dual diagnoses of pregnancy and PID (presumed secondary to endometritis, salpingitis, or both). During this period, there were 1205 patients admitted for PID, 67 of whom were also pregnant. Ten of these 67 admissions were eliminated from this study because of incomplete or missing records, errors in diagnosis, or lack of proper examinations. The charts of the remaining 57 subjects were reviewed for demographics, physical findings, and laboratory studies. For the purposes of this study, a diagnosis of suspected PID was defined as lower abdominal tenderness, cervical motion tenderness, and adnexal tenderness ("major criteria"), as well as either a positive cervical specimen for Neisseria gonorrhoeae or Chlamydia trachomatis or adnexal fullness ("minor criteria"). The mean age of the 57 subjects was 16.8 years, and the mean gestational age was 6.7 weeks. Twenty-four (42.1%) of the subjects met the criteria for a concurrent diagnosis of PID and pregnancy; 13 had physical findings and a positive cervical specimen for either N. gonorrhoeae or C. trachomatis, and 11 subjects had the minor criteria of adnexal fullness. Twenty-six (45.6%) of the 57 subjects were primigravida, 35 (61.4%) had a history of a sexually transmitted disease, and 18 (31.6%) had been previously admitted to a hospital for PID.

The coincident diagnosis of pelvic inflammatory disease and pregnancy: are they compatible?

This study found that PID and pregnancy can coexist in adolescents. Therefore, physicians who treat adolescents must consider the possibility of PID in pregnant adolescents presenting with abdominal pain.

Question: The coincident diagnosis of pelvic inflammatory disease and pregnancy: are they compatible? Answer: This study found that PID and pregnancy can coexist in adolescents. Therefore, physicians who treat adolescents must consider the possibility of PID in pregnant adolescents presenting with abdominal pain.

Answer the question based on the following context: Although cam-type femoroacetabular impingement is commonly associated with labral chondral damage and hip pain, a large proportion of asymptomatic individuals will have this deformity. To determine the incidence of hip pain in a prospective cohort of volunteers who had undergone magnetic resonance imaging (MRI) of their hips. Case control study; Level of evidence, 3. A total of 200 asymptomatic volunteers who underwent an MRI of both hips were followed for a mean time of 4.4 years (range, 4.01-4.95 years). Thirty were lost to follow-up, leaving 170 individuals (77 males, 93 females) with a mean age of 29.5 years (range, 25.7-54.5 years). All patients were blinded to the results of their MRI. All completed a follow-up questionnaire inquiring about the presence of hip pain or a history of hip pain lasting longer than 6 weeks since the original MRI. Each patient was asked to draw where the pain was on a body diagram. Eleven patients (5 males, 6 females; 6.5% of sample; mean age, 29.9 years; range, 25.7-45.6 years) reported hip pain, of which 3 (1 male, 2 females) had bilateral pain for a total of 14 hips. Seven of the 14 painful hips had a cam-type deformity at the time of the initial MRI versus 37 of the 318 nonpainful hips (P = .0002). This gave a relative risk of 4.3 (95% confidence interval [CI], 2.3-7.8) of developing hip pain if cam deformity was present. Those 14 painful hips had a significantly greater alpha angle at the radial 1:30 clock position than did those who did not develop pain with a cam deformity: 61.5° (range, 57.3°-65.7°) versus 57.9° (range, 56.9°-59.1°), respectively (P = .05). A significantly greater proportion of patients (12%) with limited internal rotation ≤20° (versus 2.7% with internal rotation>20°) went on to develop hip pain (P = .009; relative risk = 3.1 [95% CI, 1.6-6.0]).

Incidence of hip pain in a prospective cohort of asymptomatic volunteers: is the cam deformity a risk factor for hip pain?

The presence of a cam deformity represents a significant risk factor for the development of hip pain. An elevated alpha angle at the 1:30 clock position and decreased internal rotation are associated with an increased risk of developing hip pain. However, not all patients with a cam deformity develop hip pain, and further research is needed to better define those at greater risk of developing degenerative symptoms.

Question: Incidence of hip pain in a prospective cohort of asymptomatic volunteers: is the cam deformity a risk factor for hip pain? Answer: The presence of a cam deformity represents a significant risk factor for the development of hip pain. An elevated alpha angle at the 1:30 clock position and decreased internal rotation are associated with an increased risk of developing hip pain. However, not all patients with a cam deformity develop hip pain, and further research is needed to better define those at greater risk of developing degenerative symptoms.

Answer the question based on the following context: Several study supported that 18F-Fluoro-deoxy-glucose (FDG) positron emission tomography/computer tomography with low dose CT (standard PET/CT) is more accurate than contrast-enhanced CT (ceCT) in the primary staging of Hodgkin disease.AIM: The authors compared the accuracy of these examinations with this indication in their practice, and analysed the added value of ceCT which was performed as a supplement to standard PET/CT. Twenty-eight patients were categorized based on ceCT, single standard PET/CT and standard PET/CT with ceCT. Twenty-four patients were in the same disease-stage based on all methods. Disease was upstaged by standard PET/CT compared to ceCT in 4 patients. There was no change in stage when comparing standard PET/CT and standard PET/CT with ceCT.

Is ceCT necessary beyond FDG-PET/CT for primary staging in Hodgkin lymphoma?

Standard PET/CT is more accurate than ceCT in the primary staging of Hodgkin disease. The authors established that it is not reasonable to supplement standard PET/CT with ceCT in this indication.

Question: Is ceCT necessary beyond FDG-PET/CT for primary staging in Hodgkin lymphoma? Answer: Standard PET/CT is more accurate than ceCT in the primary staging of Hodgkin disease. The authors established that it is not reasonable to supplement standard PET/CT with ceCT in this indication.

Answer the question based on the following context: Hepatic microcirculation is a main determinant of reperfusion injury and graft quality in liver transplantation. One of the important diagnostic procedures to recognize reperfusion failure is contrast-enhanced computed tomography or magnetic resonance imaging. To examine the additional effect of contrast media (iomeprol and gadopentetate dimeglumine) on hepatic microcirculation and hepatic cellular damage in the phase of early ischemia/reperfusion injury of the rat liver. The partial warm ischemia-reperfusion injury model of rat liver was used. Microcirculation and leukocyte-endothelium interaction were measured by intravital microscopy. Hepatic cellular damage was indicated by liver enzyme activity in the sera. The evaluation parameters were measured at baseline and at 30, 60, and 90 min after reperfusion. The contrast media (iomeprol group, n = 6; gadopentetate dimeglumine group, n = 6) or Ringer's solution (control group, n = 8) were applied after 30 min of reperfusion. No additional injury to the ischemia/reperfusion injury of the liver after intravenous application of radiographic contrast media was found. Some protective effect was even recorded after application of iodinated contrast media.

Do contrast media (iomeprol, gadopentetate dimeglumine) deteriorate ischemia/reperfusion injury of the liver?

The use of contrast media during diagnostic procedure of the liver seems to be relatively safe, even in the stage of early reperfusion after liver transplantation.

Question: Do contrast media (iomeprol, gadopentetate dimeglumine) deteriorate ischemia/reperfusion injury of the liver? Answer: The use of contrast media during diagnostic procedure of the liver seems to be relatively safe, even in the stage of early reperfusion after liver transplantation.

Answer the question based on the following context: The purpose of this study is to determine if recent innovations in olecranon plates have any advantages in stabilizing osteoporotic olecranon fractures. Five olecranon plates (Acumed, Synthes-SS, Synthes-Ti, US Implants/ITS, and Zimmer) were implanted to stabilize a simulated comminuted fracture pattern in 30 osteoporotic cadaveric elbows. Specimens were randomized by bone mineral density per dual-energy x-ray absorptiometry scan. Three-dimensional displacement analysis was conducted to assess fragment motion through physiological cyclic arcs of motion and failure loading, which was statistically compared using one-way analysis of variance and Tukey honestly significant difference post hoc comparisons with a critical significance level of α = 0.05. Bone mineral density ranged from 0.546 g/cm to 0.878 g/cm with an average of 0.666 g/cm. All implants limited displacement of the fragments to less than 3 mm until sudden, catastrophic failure as the bone of the proximal fragment pulled away from the implant. The maximum load sustained by all osteoporotic specimens ranged from 1.6 kg to 6.6 kg with an average of 4.4 kg. There was no statistical difference between the groups in terms of cycles survived and maximum loads sustained.

Comparison of olecranon plate fixation in osteoporotic bone: do current technologies and designs make a difference?

Cyclic physiological loading of osteoporotic olecranon fracture fixation resulted in sudden, catastrophic failure of the bone-implant interface rather than in gradual implant loosening. Recent plate innovations such as locking plates and different screw designs and positions appear to offer no advantages in stabilizing osteoporotic olecranon fractures. Surgeons may be reassured that the current olecranon plates will probably adequately stabilize osteoporotic fractures for early motion in the early postoperative period, but not for heavy activities such as those that involve over 4 kg of resistance.

Question: Comparison of olecranon plate fixation in osteoporotic bone: do current technologies and designs make a difference? Answer: Cyclic physiological loading of osteoporotic olecranon fracture fixation resulted in sudden, catastrophic failure of the bone-implant interface rather than in gradual implant loosening. Recent plate innovations such as locking plates and different screw designs and positions appear to offer no advantages in stabilizing osteoporotic olecranon fractures. Surgeons may be reassured that the current olecranon plates will probably adequately stabilize osteoporotic fractures for early motion in the early postoperative period, but not for heavy activities such as those that involve over 4 kg of resistance.

Answer the question based on the following context: Ischaemic colitis is an infrequent, but potentially fatal, complication of abdominal aortic surgery. Its presentation is often underestimated on account of a paucity of symptoms, thus the real incidence of ischaemic colitis may be higher.AIM: To determine the prognostic value and sensitivity of endoscopy, early postoperative endoscopic findings were evaluated. Over a period of three years a prospective study was undertaken in a consecutive series of 105 patients (mean age 68.9 years, range 51-85) undergoing routine rectosigmoidoscopy within 72 hours of aortic reconstructive surgery. Colonic ischaemia was found in 12 patients (11.4%); five had endoscopic evidence of mild ischaemic colitis, ulcerations were identified in five and diffuse superficial necrosis in two. Seven of the 12 patients were symptomatic. Laparotomy was never deemed necessary and all patients were successfully treated with a conservative regimen. There were no deaths. Elective reconstruction or urgent procedure did not correlate with the development of colonic ischaemia, nor did duration of aortic cross-clamp time, patency of the inferior mesenteric artery and its possible ligation or reimplantation or patency of the hypogastric arteries.

Is endoscopy useful for early diagnosis of ischaemic colitis after aortic surgery?

Rectosigmoidoscopy is effective for early diagnosis of ischaemic colitis. Early endoscopy should be routinely performed only for patients in whom impaired blood flow is suspected on the basis of the intraoperative objective assessment of the colon and in presence of symptoms.

Question: Is endoscopy useful for early diagnosis of ischaemic colitis after aortic surgery? Answer: Rectosigmoidoscopy is effective for early diagnosis of ischaemic colitis. Early endoscopy should be routinely performed only for patients in whom impaired blood flow is suspected on the basis of the intraoperative objective assessment of the colon and in presence of symptoms.

Answer the question based on the following context: In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient's symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery. At no time was there a statistically significant difference in cheek swelling between the treated groups (P>.05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks.

Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach?

Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.

Question: Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach? Answer: Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.

Answer the question based on the following context: The forgotten ureteral stents remain a urological dilemma and complications related to it can be lethal for the patient. The management of such stents require lithotripsy and endourological techniques. We retrospectively reviewed the records of 19 cases of forgotten stents managed between 1998 and 2003. The mean patient age was 32 +/- l2 years, male to female ratio 17:2 and the mean duration of stents in urinary system was 24.2 months (7 months to l0 years). The stent were complicated in 14 patients and 5 patients had uncomplicated stents. The stents were severely calcified and encrusted in 6 patients, large stone formation seen at upper end of stent in 2 patients and at lower end of stents in 2 patients. The stents were spontaneously fragmented in 2 patients. The advanced renal failure secondary to hydroureteronephrosis because of severe encrustation and stone formation over the stent in solitary kidney was seen in 1 patient and 1 patient had upmigrated stent with infected hydronephrosis, but the duration of upmigration in this case was unknown. The stents were removed by retrograde approach in all 5 uncomplicated cases. In 6 patients of severely calcified and encrusted stents, the retrograde stent removal could be done in 4 patients while stent got broken in proximal ureter in 2 cases when they were being removed. In these 2 cases the stents were removed by percutaneous nephrostomy. The percutaneous nephrolithotomy and stent removal was done in 2 patients who had large stone at the upper end of stent in renal pelvis. In 2 patients who had large stone formation at lower end, stones were fragmented by mechanical lithotripsy in one and by laser lithotripsy in another case and stents removed by retrograde approach. Two cases of spontaneous fragmented stents were managed by retrograde endoscopic approach. The patient of advanced renal failure refused treatment and died. The patient of infective hydronephrosis with upmigrated stent died because of complications related to operative intervention.

Can the complicated forgotten indwelling ureteric stents be lethal?

The management of complicated forgotten ureteral stents need judicious use of endourological techniques and lithotripsy. The stent related complication can be directly lethal for the patient or indirectly can cause death because of complications related to operative intervention.

Question: Can the complicated forgotten indwelling ureteric stents be lethal? Answer: The management of complicated forgotten ureteral stents need judicious use of endourological techniques and lithotripsy. The stent related complication can be directly lethal for the patient or indirectly can cause death because of complications related to operative intervention.

Answer the question based on the following context: In spite of many reports focusing on prognostic factors after hepatectomy in patients with colorectal liver metastases, few studies have investigated pathological factors, eg, fibrous pseudocapsulation, growth pattern at the tumor margin, and proliferation activity of cancer cells, other than histological type and surgical margin. The aim of the present study was to investigate whether absence of pseudocapsulation, infiltrative growth pattern of metastases, and higher proliferation of cancer cells shown by Ki-67 immunohistochemical reactivity were associated with poorer survival after hepatectomy among patients with colorectal liver metastases. Between 1988 and 1998, 221 patients underwent hepatic resection of colorectal metastases with curative intent in our institution. Pathology analyses were focused on pseudocapsulation of liver metastases, growth pattern at the tumor edge, and Ki-67 labelling index (Ki-67 LI) of cancer cell nuclei. Univariate analyses of survival and of disease-free survival were performed for several clinicopathological factors, and multivariate analyses of survival and disease-free survival were also performed. The univariate survival analyses showed that pseudocapsulation, growth pattern, and Ki-67 LI were significant prognostic factors, besides synchronous versus metachronous occurrence of metastases, carcinoembryonic antigen level before hepatectomy, and number of metastases. A multivariate analysis showed that Ki-67 labeling index was the most reliable prognostic factor of survival. In addition, Ki-67 LI and microscopic growth pattern were multivariately predictive factors of disease-free survival.

Is a proliferation index of cancer cells a reliable prognostic factor after hepatectomy in patients with colorectal liver metastases?

This large single-institution study showed that investigation of cancer cell proliferation and pathologic characteristics of the tumor margin are major prognostic factors.

Question: Is a proliferation index of cancer cells a reliable prognostic factor after hepatectomy in patients with colorectal liver metastases? Answer: This large single-institution study showed that investigation of cancer cell proliferation and pathologic characteristics of the tumor margin are major prognostic factors.

Answer the question based on the following context: To determine whether fluid hysteroscopic directed biopsies, in patients with endometrial cancer upstages the tumor and worsens the prognosis. Between January 1996 and September 2001, a total of 62 consecutive patients with endometrial cancer, treated at our institution, were randomized 3:2 to have or not to have a fluid hysteroscopic biopsy just prior to surgery. A total of 38 patients underwent a hysteroscopy after the induction of anesthesia. All patients had pelvic washings performed, followed by a hysterectomy, bilateral salpingooforectomy and pelvic +/- para-aortic lymph node dissections. Only stages I and II endometrioid type tumors or stage IIIa, secondary to positive pelvic washings, were included in the study. Eight patients in the hysteroscopy group and four patients in the control group were excluded for various reasons. Patients received post-operative radiation therapy depending on the surgical-pathological risk factors. The median follow up was 34 months. Fisher's Exact Test was performed to compare differences between the hysteroscopic (n = 30) and the control (n = 20) groups. We found three patients (10%) with positive washings in the hysteroscopic group compared to one (5%) among the controls (P = 0.64), with a statistical power of<20%. If the differences would persist, we would need 588 patients in each arm to obtain a power of 80%, and reach definitive conclusions. The Odds Ratio (OR) of performing a hysteroscopy and upstaging the tumor in this study was: 2.1 95% CI (0.20-21.09). Prognostic variables were compared between both groups and no differences were observed. All patients but one (dead due to intercurrent disease), were alive and with no evidence of disease at the completion of the study.

Does fluid hysteroscopy increase the stage or worsen the prognosis in patients with endometrial cancer?

Fluid hysteroscopy and directed biopsies may have a small risk of upstaging early endometrial cancers, but does not seem to influence prognosis.

Question: Does fluid hysteroscopy increase the stage or worsen the prognosis in patients with endometrial cancer? Answer: Fluid hysteroscopy and directed biopsies may have a small risk of upstaging early endometrial cancers, but does not seem to influence prognosis.

Answer the question based on the following context: According to previous reports, the lifetime risk of developing ovarian carcinoma is 1.4%. This figure varies with age from 6.6 per 100,000 among women aged 35 to 39 years up to 55.1 per 100,000 among women aged 75 to 79 years. Prophylactic oophorectomy remains a modality to decrease the incidence of ovarian cancer. What proportion of women diagnosed with an ovarian malignancy had a preceding laparotomy at which time a prophylactic oophorectomy could have been performed? We reviewed the new ovarian cancer diagnoses seen in patients between August 1988 and August 1993 at the Ottawa Regional Cancer Foundation. Four hundred and four patients were identified. These patients were analyzed for preceding abdominal surgery, age, time to disease progression, time to death, time to death from other causes, and average follow-up. The previous abdominal surgeries were divided into: (1) major gynecological surgery; and (2) general surgery procedures, which were further divided into laparotomy and pelvic surgery (group A surgeries) and general surgery that included other abdominal surgeries (ie, appendectomy, cholecystectomy) where access to the pelvis could be more difficult (group B surgeries). A total of 270 abdominal surgeries was performed, prior to the diagnosis of ovarian cancer. The group was stratified according to the timing of the surgery (<or =40 years, 41 to 45 years, 46 to 50 years,>50 years). Based on these data, and on the grouping of general gynecologic surgeries plus the general surgical procedures of group A, 10.9% of ovarian cancers would have been prevented if prophylactic oophorectomy had been performed in patients who had surgery over 40 years of age; over 45 years this was 6.7%, over 50 years it was 4%. If one adds all major surgeries, including general surgery groups A and B, the results were 26.9% over 40 years of age, 20% over 45, and 16.6% over 50.

Is incidental prophylactic oophorectomy an acceptable means to reduce the incidence of ovarian cancer?

We found that, depending on the age of the patient, prophylactic oophorectomy results in a 4% to 10.9% reduction in the incidence of ovarian carcinoma. This increases to 16.6% to 26.9% if one considers general surgery procedures in which access could be more difficult. Although we are not advocating the frequent use of this procedure, we recommend that surgeons routinely discuss this option before surgery with their postmenopausal female patients over 49 years of age. Given that the decision for prophylactic oophorectomy is multifaceted, we feel that a risk scoring for ovarian cancer and a discussion of the risk and benefit ratio should be undertaken. The ultimate goal is to heighten patient awareness of the risk factors to ensure that an informed decision is made concerning this consistently lethal disease.

Question: Is incidental prophylactic oophorectomy an acceptable means to reduce the incidence of ovarian cancer? Answer: We found that, depending on the age of the patient, prophylactic oophorectomy results in a 4% to 10.9% reduction in the incidence of ovarian carcinoma. This increases to 16.6% to 26.9% if one considers general surgery procedures in which access could be more difficult. Although we are not advocating the frequent use of this procedure, we recommend that surgeons routinely discuss this option before surgery with their postmenopausal female patients over 49 years of age. Given that the decision for prophylactic oophorectomy is multifaceted, we feel that a risk scoring for ovarian cancer and a discussion of the risk and benefit ratio should be undertaken. The ultimate goal is to heighten patient awareness of the risk factors to ensure that an informed decision is made concerning this consistently lethal disease.

Answer the question based on the following context: Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV.PATIENTS/ A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4+ count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone.

Are specific antiretrovirals associated with an increased risk of discontinuation due to toxicities or patient/physician choice in patients with hepatitis C virus coinfection?

Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.

Question: Are specific antiretrovirals associated with an increased risk of discontinuation due to toxicities or patient/physician choice in patients with hepatitis C virus coinfection? Answer: Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.

Answer the question based on the following context: To evaluate the impact of follicle rupture on pregnancy rate in intrauterine insemination. Retrospective cohort study. Evidence of follicle rupture was assessed by transvaginal ultrasonography following IUI. Two hundred ninety-six couples with unexplained infertility and 121 couples with male factor subfertility were included. Results of 578 cycles were analyzed here. Clinical pregnancy rate was 23.5% (64/272) in the group when follicle rupture was evident by transvaginal ultrasonography, while it was only 8.8% (27/306) when follicle rupture was not evident (p<0.001).

Intrauterine insemination: is the timing correct?

Postponing IUI until observation of follicle rupture may yield a higher pregnancy rate.

Question: Intrauterine insemination: is the timing correct? Answer: Postponing IUI until observation of follicle rupture may yield a higher pregnancy rate.

Answer the question based on the following context: We have recently shown that brief behavioral counseling based on the stage of change (SOC) model stimulates greater increases in fruit and vegetable intake over 12 months than nutritional education in adults living in a low-income urban area. We tested the hypothesis that behavioral counseling would overcome the greater obstacles to change in precontemplators and contemplators compared with those initially in the preparation stage. Two hundred and seventy-one adults took part in a parallel group randomised controlled trial comparing behavioral counseling and nutritional education. Counseling was delivered in two 15-min sessions and accompanied by written material. Self-report changes in fruit and vegetable consumption over 12 months were analysed on an intention-to-treat basis and related to baseline stage of change. At baseline, 148 (54.6%) of participants were in preparation, 54 (19.9%) in contemplation and 69 (25.5%) in precontemplation. Preparers were younger, more educated and more likely to be female than were precontemplators and contemplators. In the nutritional education group, baseline stage predicted changes over 12 months, with larger increases in fruits and vegetables in the preparation than in the precontemplation or contemplation groups. This was not the case with behavioral counseling, in which increases in consumption were unrelated to baseline stage.

Does the effect of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change?

Tailored behavioral counseling helped to overcome the barriers to increasing fruit and vegetable intake present among participants in contemplation stage but not the precontemplation or preparation stages.

Question: Does the effect of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change? Answer: Tailored behavioral counseling helped to overcome the barriers to increasing fruit and vegetable intake present among participants in contemplation stage but not the precontemplation or preparation stages.

Answer the question based on the following context: To examine the level of involvement in pre-hospital care for children by faculty and fellows of teaching hospitals with a Pediatric Emergency Medicine (PEM) fellowship. In addition, we hypothesized that a divisional faculty member's involvement as principal investigator (PI) on an EMSC grant would not impact divisional involvement in on or off-line medical direction. Cross-sectional national survey. PEM fellowship directors. Self-administered questionnaire. Descriptive and Chi-square analysis to study null hypothesis. The response rate to the survey was 62% (53/85). Of the programs responding, 53 % provided on-line pediatric medical direction for pre-hospital providers, 77% were involved with paramedic education other than PALS, and 58% of systems had pediatric specific protocols. In 87 % of the programs, a designated faculty member functioned as an EMSC liaison. A division faculty member was or had been the PI on an EMSC grant in 18 programs (34%). There was no significant difference in the provision of on or off-line medical direction comparing programs with or without involvement in an EMSC grant. Only 34% of the responding program directors felt that the current level of exposure to EMS was adequate for PEM fellow training.

Are pediatric emergency medicine training programs adequately preparing graduates for involvement in EMS?

The current level of involvement in EMS of PEM faculty and fellows has significant room for improvement. It does not appear that grant support translates into increased local involvement in EMS. Current PEM fellowship curriculum guidelines for training in EMS are not being met by the majority of responding training programs.

Question: Are pediatric emergency medicine training programs adequately preparing graduates for involvement in EMS? Answer: The current level of involvement in EMS of PEM faculty and fellows has significant room for improvement. It does not appear that grant support translates into increased local involvement in EMS. Current PEM fellowship curriculum guidelines for training in EMS are not being met by the majority of responding training programs.

Answer the question based on the following context: Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early.

Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa?

The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.

Question: Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Answer: The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.

Answer the question based on the following context: HBV/HCV coinfection is a common finding among hemodialysis patients. However, there is scarce information concerning the impact of HBV coinfection on the response to treatment of HCV-infected patients on hemodialysis.AIM: We aimed to compare the rate of sustained virologic response (SVR) to treatment with interferon-alfa (IFN) between hemodialysis patients with HBV/HCV coinfection and those with HCV-monoinfection. HCV-infected patients on hemodialysis treated with IFN were included. Patients coinfected by HBV/HCV were compared to HCV-monoinfected patients, regarding clinical and biochemical features and rates of SVR. One hundred and eleven patients were treated. HBV/HCV coinfection was observed in 18/111 patients (16%). Coinfected patients were younger (p = 002), had more time on dialysis (p = 0.05) and showed a tendency to present a higher prevalence of septal fibrosis (p = 0.06). The analysis by intention to treat showed SVR of 56% among coinfected patients and 18% in HCV-monoinfected patients (p = 0.004).

Does hepatitis B virus coinfection have any impact on treatment outcome in hepatitis C patients on hemodialysis?

In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.

Question: Does hepatitis B virus coinfection have any impact on treatment outcome in hepatitis C patients on hemodialysis? Answer: In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.

Answer the question based on the following context: Atrial fibrillation (AF) is an independent risk factor for stroke. Recent studies have demonstrated that the CHA(2)DS(2)-VASc scheme is useful for selecting patients who are truly at low risk. The goal of the present study was to compare the risk of ischemic stroke among AF patients with a CHA(2)DS(2)-VASc score of 0 (male) or 1 (female) with those without AF. The study enrolled 509 males (CHA(2)DS(2)-VASc score=0) and 320 females (CHA(2)DS(2)-VASc score=1) with AF who did not receive any antithrombotic therapy. Patients were selected from the National Health Insurance Research Database in Taiwan. For each study patient, 10 age-matched and sex-matched subjects without AF and without any comorbidity from the CHA(2)DS(2)-VASc scheme were selected as controls. The clinical end point was the occurrence of ischemic stroke. During a follow-up of 57.4 ± 35.7 months, 128 patients (1.4%) experienced ischemic stroke. The event rate did not differ between groups with and without AF for male patients (1.6% vs 1.6%; P=0.920). In contrast, AF was a significant risk factor for ischemic stroke among females (hazard ratio, 7.77), with event rates of 4.4% and 0.7% for female patients with and without AF (P<0.001).

Atrial fibrillation and the risk of ischemic stroke: does it still matter in patients with a CHA2DS2-VASc score of 0 or 1?

AF males with a CHA(2)DS(2)-VASc score of 0 were at true low risk for stroke, which was similar to that of non-AF patients. However, AF females with a score of 1 were still at higher risk for ischemic events than non-AF patients.

Question: Atrial fibrillation and the risk of ischemic stroke: does it still matter in patients with a CHA2DS2-VASc score of 0 or 1? Answer: AF males with a CHA(2)DS(2)-VASc score of 0 were at true low risk for stroke, which was similar to that of non-AF patients. However, AF females with a score of 1 were still at higher risk for ischemic events than non-AF patients.

Answer the question based on the following context: Previous research has indicated a relation between obsessive-compulsive disorder (OCD), childhood traumatic experiences and higher levels of dissociation that appears to relate to negative treatment outcome for OCD. The aim of the present study is to investigate whether childhood trauma and dissociation are related to severity of OCD in adulthood. We also intend to examine the association between treatment resistance, dissociation, and each form of trauma. Participants included 120 individuals diagnosed with OCD; 58 (48.3 %) of them met the criteria for treatment-resistant OCD (resistant group), whereas the other 62 (51.7 %) were labeled as responder group. The intensity of obsessions and compulsions was evaluated using Yale-brown obsessive-compulsive scale (Y-BOCS). All patients were assessed with the traumatic experiences checklist, dissociative experiences scale, beck depression inventory, and beck anxiety inventory. Controlling for clinical variables, resistant group had significantly higher general OCD severity, anxiety, depression, trauma, and dissociation scores than the responders. Correlation analyses indicated that Y-BOCS scores were significantly related to severity of dissociation, anxiety, depression, and traumatic experiences. In a logistic regression analysis with treatment resistance as a dependent variable, high dissociation levels, long duration of illness, and poor insight emerged as relevant predictors, but gender, levels of anxiety, depression, and traumatic experiences did not.

Are trauma and dissociation related to treatment resistance in patients with obsessive-compulsive disorder?

Our results suggest that dissociation may be a predictor of poorer treatment outcome in patients with OCD; therefore, a better understanding of the mechanisms that underlie this phenomenon may be useful. Future longitudinal studies are warranted to verify if this variable represents predictive factors of treatment non-response.

Question: Are trauma and dissociation related to treatment resistance in patients with obsessive-compulsive disorder? Answer: Our results suggest that dissociation may be a predictor of poorer treatment outcome in patients with OCD; therefore, a better understanding of the mechanisms that underlie this phenomenon may be useful. Future longitudinal studies are warranted to verify if this variable represents predictive factors of treatment non-response.

Answer the question based on the following context: We report bronchoscopic changes observed in children with recurrent lower airways infections (RLAI) and findings in control children undergoing bronchoscopy for causes other than RLAI. Retrospective case-control cohorts study. The clinical records of children who had fiberoptic bronchoscopy (FB) for a history of RLAI without any known underlying disorder between 2007 and 2013 and of control children who required FB for other causes were reviewed. Clinical features, bronchospic findings and bronchoalveolar lavage (BAL) results were assessed. Cases were 62 (32 female) children aged 5 years (1-12) and controls 29 children aged 4.5 years (0.5-14). Airway malacia was observed in 32 (52%) vs. 4 (13%) (p = 0.001), profuse respiratory secretions in 34(55%) vs. 6 (20%) (p = 0.007). Endobronchial obstruction: 4 (6.4%) and tracheobronchomegaly were observed only in cases. In cases with profuse respiratory secretions there was a higher prevalence of airways malacia: 64.7% vs. 35.7% (p = 0.04) and of positive BAL cultures: 45.5% vs. 13.3% (p = 0.04). Isolated organisms in cases were non-typable Haemophilus influenzae and Streptococcus pneumoniae most frequently. Pneumocystiis jirovecii, Staphylococcus aureus, and Streptococcus mitis were isolated in controls.

Are airways structural abnormalities more frequent in children with recurrent lower respiratory tract infections?

Half of the children with RLAI had tracheo and/or bronchomalacia, their frequency being in keeping with previous reports and far higher than that observed in controls. It was associated with profuse respiratory secretions and with a higher frequency of positive BAL cultures mostly for non typable H. influenzae and S. pneumoniae which were not isolated in controls.

Question: Are airways structural abnormalities more frequent in children with recurrent lower respiratory tract infections? Answer: Half of the children with RLAI had tracheo and/or bronchomalacia, their frequency being in keeping with previous reports and far higher than that observed in controls. It was associated with profuse respiratory secretions and with a higher frequency of positive BAL cultures mostly for non typable H. influenzae and S. pneumoniae which were not isolated in controls.

Answer the question based on the following context: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. Randomised equivalence trial. 39 general practices in West London and North West England. 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. Unscheduled need for healthcare. Patient satisfaction and need for courses of oral steroids. 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups.

Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?

It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses.

Question: Can lay people deliver asthma self-management education as effectively as primary care based practice nurses? Answer: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses.

Answer the question based on the following context: There have been no definite indications for additional surgical resection after endoscopic submucosal dissection (ESD) of submucosal invasive colorectal cancer (SICC). The aims of this study were to evaluate the feasibility of ESD for nonpedunculated SICC and to determine the need for subsequent surgery after ESD. A total of 150 patients with nonpedunculated SICC in resected specimens after ESD were analyzed. Among them, 75 patients underwent subsequent surgery after ESD. Clinical outcomes of ESD and histopathological risk factors for lymph node (LN) metastasis were evaluated. The en-bloc resection and complete resection (R0) rates of ESD were 98% (147/150) and 95.3% (143/150), respectively. None of the patients had delayed bleeding after ESD. Perforations occurred in seven patients (4.7%), which were successfully treated by endoscopic clipping. After subsequent surgery for 75 patients, LN metastases were found in 10 cases (13.3%). The incidence of LN metastasis was significantly higher in tumors featuring submucosal invasion of at least 1500 μm, lymphovascular invasion, and tumor budding. Multivariate analysis showed that lymphovascular invasion (P=0.034) and tumor budding (P=0.015) were significantly associated with LN metastasis. Among the 150 patients, no local recurrence or distant metastasis was detected, except one patient with risk factors and who refused subsequent surgery, during the overall median follow-up of 34 months (range, 5-63 months).

Endoscopic submucosal dissection for nonpedunculated submucosal invasive colorectal cancer: is it feasible?

ESD is feasible and may be considered as an alternative treatment option for carefully selected cases of nonpedunculated SICC, provided that the appropriate histopathological curative criteria are fulfilled in completely resectable ESD specimens.

Question: Endoscopic submucosal dissection for nonpedunculated submucosal invasive colorectal cancer: is it feasible? Answer: ESD is feasible and may be considered as an alternative treatment option for carefully selected cases of nonpedunculated SICC, provided that the appropriate histopathological curative criteria are fulfilled in completely resectable ESD specimens.

Answer the question based on the following context: To estimate the prevalence of self-reported osteoporotic fractures and use of bone-sparing agents, and to examine if region of residence is associated with fracture or treatment prevalence. A census of persons aged>or = 55 years residing in 2 regions of Ontario, Canada (East York, a region within Toronto, and Oxford County), was completed between 1995 and 1998. Region was coded by record linkage of residential postal codes to 1996 Canadian Census data into 4 groups: East York (urban core), and Oxford County subdivided into: urban core, small urban, and rural. Respondents were excluded if they resided outside the regions of interest or were missing fracture data (5%). A total of 26,839 persons (15,541 women) were studied. Nearly 3 times as many women as men reported having had an osteoporotic fracture (14% vs 5%), with 31% and 8%, respectively, taking bone-sparing agents. Controlling for age, a diagnosis of osteoporosis, number of osteoporotic fractures, and height loss, women residing in East York were more likely (OR 1.2, 95% CI 1.0-1.4) to be taking a bone-sparing agent other than estrogen, but less likely to be taking estrogen (OR 0.8, 95% CI 0.7-0.9) compared to those living in rural areas. No regional differences were observed in fracture prevalence, treatment among those with an osteoporotic fracture, or use of a bone-sparing agent among men.

Fracture prevalence and treatment with bone-sparing agents: are there urban-rural differences?

Further research into regional differences in osteoporosis screening, treatment, and fractures is warranted. This should examine the appropriateness of possible differences, and separate physician practice patterns from patient characteristics, such as willingness to begin treatment with bone-sparing agents.

Question: Fracture prevalence and treatment with bone-sparing agents: are there urban-rural differences? Answer: Further research into regional differences in osteoporosis screening, treatment, and fractures is warranted. This should examine the appropriateness of possible differences, and separate physician practice patterns from patient characteristics, such as willingness to begin treatment with bone-sparing agents.

Answer the question based on the following context: Diagnostic abdominal imaging is frequently performed in hospitalized patients to assess the cause of abnormal liver function tests (LFTs). We undertook this study to assess whether the extent and severity of LFTs abnormalities predicted the yield of inpatient imaging. We retrospectively reviewed inpatients' abdominal imaging studies performed for abnormal LFTs during a 27 month period. Imaging results were matched to LFTs performed during a 5 day collection window surrounding the image request date. Five LFTs were categorized by severity of abnormality and were then collapsed into three classes based on pathophysiology. Among 759 imaging studies completed for the indication of abnormal LFTs, 196 (26%) were positive (abnormal and explained the abnormal LFTs). Among the LFT classes, severity of laboratory test abnormality correlated with positive imaging examinations yield only for the transaminases: 18% for the normal-mildly abnormal transaminases compared with 31% for moderately-severely abnormal transaminases. The number of abnormal LFT classes per study correlated only slightly better: 21% of patients with none or one abnormal LFT class had a positive imaging study compared with 35% of patients with all three abnormal LFT classes.

Do abnormal liver function tests predict inpatient imaging yield?

The yield of inpatient abdominal imaging for abnormal LFTs correlates only weakly with both the severity and the extent of different abnormal LFTs. Further research is needed to define the optimal imaging strategies for evaluating inpatients with suspected hepatobiliary disease.

Question: Do abnormal liver function tests predict inpatient imaging yield? Answer: The yield of inpatient abdominal imaging for abnormal LFTs correlates only weakly with both the severity and the extent of different abnormal LFTs. Further research is needed to define the optimal imaging strategies for evaluating inpatients with suspected hepatobiliary disease.

Answer the question based on the following context: Few surgeons worldwide currently perform video-assisted thoracoscopic (VAT) lobectomy. We conducted a questionnaire survey of this selected group of surgeons to gain insight into their current practice. A survey with 25 questions on VAT lobectomy including operative approaches, techniques, its role in their practice, and limitations were mailed to 45 thoracic surgeons worldwide who are believed to perform this operation. Thirty-three completed questionnaires were analyzed. Among those surgeons practicing VAT lobectomy, the vast majority work in an academic or government institution and have at least 5 years of practice experience. Two thirds reported that at least 40% of all their thoracic procedures are currently performed using VAT techniques. However, considerable variations exist regarding preference for VAT lobectomy (one third uses VAT techniques in less than 10% of all lobectomies performed, whereas another third uses it in more than 40% of lobectomies), their approaches to mediastinal and hilar lymph nodes, and their operative techniques. The latter range from a purely endoscopic technique to one that is more appropriately termed minithoracotomy with video-assistance when the surgeons operate primarily by looking through the utility thoracotomy. There were no significant differences in the practices of surgeons working in different continents, except that Asian surgeons were more likely to use suture ligation as opposed to a staple-cutter on pulmonary vessels.

Is video-assisted thoracoscopic lobectomy a unified approach?

Video-assisted thoracoscopic lobectomy is not a unified approach. Considerable variations exist among the small group of surgeons performing this procedure, in their approach to surgical oncology as well as the operative technique. Distinctions in these different operative approaches must be made before one can make a meaningful comparison of results. Different terms should probably be introduced to further clarify the exact techniques used.

Question: Is video-assisted thoracoscopic lobectomy a unified approach? Answer: Video-assisted thoracoscopic lobectomy is not a unified approach. Considerable variations exist among the small group of surgeons performing this procedure, in their approach to surgical oncology as well as the operative technique. Distinctions in these different operative approaches must be made before one can make a meaningful comparison of results. Different terms should probably be introduced to further clarify the exact techniques used.

Answer the question based on the following context: Although the use of alternative medicine in the United States is increasing, no published studies have documented the effectiveness of naturopathy for treatment of menopausal symptoms compared to women receiving conventional therapy in the clinical setting. To compare naturopathic therapy with conventional medical therapy for treatment of selected menopausal symptoms. A retrospective cohort study, using abstracted data from medical charts. One natural medicine and six conventional medical clinics at Community Health Centers of King County, Washington, from November 1, 1996, through July 31, 1998. Women aged 40 years of age or more with a diagnosis of menopausal symptoms documented by a naturopathic or conventional physician. Improvement in selected menopausal symptoms. In univariate analyses, patients treated with naturopathy for menopausal symptoms reported higher monthly incomes ($1848.00 versus $853.60), were less likely to be smokers (11.4% versus 41.9%), exercised more frequently, and reported higher frequencies of decreased energy (41.8% versus 24.4%), insomnia (57.0% versus 33.1%), and hot flashes (69.6% versus 55.6%) at baseline than those who received conventional treatment. In multivariate analyses, patients treated with naturopathy were approximately seven times more likely than conventionally treated patients to report improvement for insomnia (odds ratio [OR], 6.77; 95% confidence interval [CI], 1.71, 26.63) and decreased energy (OR, 6.55; 95% CI, 0.96, 44.74). Naturopathy patients reported improvement for anxiety (OR, 1.27; 95% CI, 0.63, 2.56), hot flashes (OR, 1.40; 95% CI, 0.68, 2.88), menstrual changes (OR, 0.98; 95% CI, 0.43, 2.24), and vaginal dryness (OR, 0.91; 95% CI, 0.21, 3.96) about as frequently as patients who were treated conventionally.

Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms?

Naturopathy appears to be an effective alternative for relief of specific menopausal symptoms compared to conventional therapy.

Question: Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms? Answer: Naturopathy appears to be an effective alternative for relief of specific menopausal symptoms compared to conventional therapy.

Answer the question based on the following context: To develop a preliminary characterization of the urological personality. Thirty-four urology residents (29 male) from all eleven Canadian training programs anonymously completed the Revised NEO personality inventory (NEO-PI-R(c)), a commercially available validated personality assessment tool in which participants agree or disagree with a compilation of 240 statements. A score is generated in each of five character traits according to the five factor theory of personality: extraversion (E), openness (O), conscientiousness (C), agreeableness (A) and neuroticism (N). The group mean on each scale was compared to the normative mean for the general adult population using one-sample, two-tailed t tests. Urology residents scored significantly higher than the general population on three of the five personality factors: extraversion (E) (p<.001), openness (O) (p<.02) and conscientiousness (C) (p<.05). There was no significant difference from norms in agreeableness (A) or neuroticism (N).

The urological personality: is it unique?

The high scores in 'extraversion' reflect the social, warm, active and talkative nature of urology residents. As well, urology residents tend to be willing to entertain new ideas and are purposeful and determined based on their high scores on 'openness' and 'conscientiousness' respectively. Canadian urology residents possess a distinct personality in comparison to the general population. These provocative findings should be interpreted with caution. If confirmed on a wider basis, the data may be helpful in career counseling and resident selection. Future studies examining differences between the urological personality and other surgical subspecialties may further refine applications of the data.

Question: The urological personality: is it unique? Answer: The high scores in 'extraversion' reflect the social, warm, active and talkative nature of urology residents. As well, urology residents tend to be willing to entertain new ideas and are purposeful and determined based on their high scores on 'openness' and 'conscientiousness' respectively. Canadian urology residents possess a distinct personality in comparison to the general population. These provocative findings should be interpreted with caution. If confirmed on a wider basis, the data may be helpful in career counseling and resident selection. Future studies examining differences between the urological personality and other surgical subspecialties may further refine applications of the data.

Answer the question based on the following context: To characterize the clinical, demographic and epidemiological features of MS patients from the only specialised MS centre in Iraq. Data for consecutive Iraqi MS patients attending the Baghdad Multidiscipline MS Clinic between 2000 and 2002 who fulfilled Poser et al. criteria for clinically definite (CD) and clinically probable (CP) MS were reviewed. We identified a total of 300 MS patients (164 females, 54.7%; 136 males, 45.3%) with a mean age of onset being 29.2+/-7.8 years and the duration being 8.6+/-5.9 years. According to the year of clinical onset of MS, a progressive increase in cases in the last two decades and a trend towards more females was noted. Initial symptom was reported as motor in 31.7%, sensory in 28.3%, optic nerve in 24% and brainstem or cerebellar in 22.3% of patients. The course was relapsing-remitting in 199 (66.3%) patients, secondary progressive in 56 (18.7%) and primary progressive (PP) in 45 (15%) patients.

Multiple sclerosis in Iraq: does it have the same features encountered in Western countries?

MS is not rare in Iraq; its demographic and clinical data were, in general, similar to those reported in Caucasian populations. There was some evidence for North-South gradient and a possible increasing incidence characterized by an increase in female preponderance during the last 2 decades.

Question: Multiple sclerosis in Iraq: does it have the same features encountered in Western countries? Answer: MS is not rare in Iraq; its demographic and clinical data were, in general, similar to those reported in Caucasian populations. There was some evidence for North-South gradient and a possible increasing incidence characterized by an increase in female preponderance during the last 2 decades.

Answer the question based on the following context: Cervical biopsy is the gold standard method used for diagnosing cervical intraepithelial neoplasia, however, it has being stated a very low diagnostic agreement. Klaes demonstrates that p16 immunohistochemical marker increases from 40 to 97% the diagnostic agreement in cervical intraepithelial neoplasia; due to it, its reliability, sensitivity and specificity to detect any neoplasia variant is 100%. To know the diagnostic agreement between Mexican pathologists during the study of two cervical intraepithelial neoplasia specimens stained with hematoxylin and eosin, and with p16, respectively. Two cervical biopsies, one stained with hematoxylin and eosin, and the other with p16, where shown to Mexican pathologists in order to express them diagnosis within the four neoplasia variants. When using hematoxylin and eosin, 52.5% of fragment 1 cases has a CIN 1 diagnosis agreement, and 17.8% of fragment 2 has a CIN 2 diagnosis agreement. In both fragments, almost 100% of biopsies processed with p16 has an agreement.

Cervical biopsy: is the histological diagnosis reliable and reproducible?

It is clear that in daily practice the diagnostic criteria are in theory known but not correctly applied among pathologists; p16 is a useful, reliable and reproducible technique to establish the right diagnosis.

Question: Cervical biopsy: is the histological diagnosis reliable and reproducible? Answer: It is clear that in daily practice the diagnostic criteria are in theory known but not correctly applied among pathologists; p16 is a useful, reliable and reproducible technique to establish the right diagnosis.

Answer the question based on the following context: To investigate the relationship between physical impairment and brain-computer interface (BCI) performance. We present a meta-analysis of 29 patients with amyotrophic lateral sclerosis and six patients with other severe neurological diseases in different stages of physical impairment who were trained with a BCI. In most cases voluntary regulation of slow cortical potentials has been used as input signal for BCI-control. More recently sensorimotor rhythms and the P300 event-related brain potential were recorded. A strong correlation has been found between physical impairment and BCI performance, indicating that performance worsens as impairment increases. Seven patients were in the complete locked-in state (CLIS) with no communication possible. After removal of these patients from the analysis, the relationship between physical impairment and BCI performance disappeared. The lack of a relation between physical impairment and BCI performance was confirmed when adding BCI data of patients from other BCI research groups.

Brain-computer interfaces and communication in paralysis: extinction of goal directed thinking in completely paralysed patients?

Basic communication (yes/no) was not restored in any of the CLIS patients with a BCI. Whether locked-in patients can transfer learned brain control to the CLIS remains an open empirical question.

Question: Brain-computer interfaces and communication in paralysis: extinction of goal directed thinking in completely paralysed patients? Answer: Basic communication (yes/no) was not restored in any of the CLIS patients with a BCI. Whether locked-in patients can transfer learned brain control to the CLIS remains an open empirical question.

Answer the question based on the following context: Prophylactic lateral neck dissection (PLND) is generally not performed for papillary thyroid carcinoma(PTC). When performed, occult metastases are found in upto 50 % of patients, although the incidence of occult level II nodes seems low. Our aim was to evaluate frozen section analysis-oriented elective level II PLND in patients with clinically node-negative (cN0) PTC. This retrospective study included patients with cN0 PTC treated with total thyroidectomy and prophylactic bilateral central and lateral neck dissection of ipsilateral levels III and IV. Frozen section analysis of PLND III and IV was performed. If positive, the PLND was extended to level II. We measured the accuracy of frozen section analysis, the incidence of occult level II metastasis, and oncologic outcomes. A total of 295 patients were included. For frozen section analysis, the sensitivity was 71.0 %, specificity 99.6 %, positive predictive value 97.8 %, negative predictive value 92.4 %, overall accuracy 93.2 %. Definitive analysis found lateral node metastases in 63 of the 295(21 %) patients. Extension to level II was performed in 27 of 46 cases (59 %). Level II contained metastatic nodes in 12 of 27 (44 %) patients. There was no difference in total doses of 131I administered to patients with or without level II disease. Even when extension of PLND to level II was not performed, no cases of recurrent or persistent disease in level II occurred.

Prophylactic level II neck dissection guided by frozen section for clinically node-negative papillary thyroid carcinoma: is it useful?

Frozen section analysis was highly accurate.The rate of occult metastases in level II was low. Detection of additional metastases in level II did not modify subsequent treatment or the rate of recurrence and is not useful for routine application.

Question: Prophylactic level II neck dissection guided by frozen section for clinically node-negative papillary thyroid carcinoma: is it useful? Answer: Frozen section analysis was highly accurate.The rate of occult metastases in level II was low. Detection of additional metastases in level II did not modify subsequent treatment or the rate of recurrence and is not useful for routine application.

Answer the question based on the following context: Thermal ablation techniques (radiofrequency-ablation/cryotherapy) can be indicated with a curative intent. The success rate and prognostic factors for complete treatment were analysed.MATERIAL/ The medical records of all patients who had undergone curatively intended thermal ablation of bone metastases between September 2001 and February 2012 were retrospectively analysed. The goal was to achieve complete treatment of all bone metastases in patients with oligometastatic disease (group 1) or only of bone metastases that could potentially lead to skeletal-related events in patients with a long life expectancy (group 2). We report the rate of complete treatment according to patient characteristics, primary tumour site, bone metastasis characteristics, radiofrequency ablation/cryotherapy and the treatment group (group 1/group 2). Eighty-nine consecutive patients had undergone curatively intended thermal ablation of 122 bone metastases. The median follow-up was 22.8 months [IQR = 12.2-44.4]. In the intent-to-treat analysis, the 1-year complete treatment rate was 67% (95%CI: 50%-76%). In the multivariate analysis the favourable prognostic factors for complete local treatment were oligometastatic status (p = 0.02), metachronous (p = 0.004) and small-sized (p = 0.001) bone metastases, without cortical bone erosion (p = 0.01) or neurological structures in the vicinity (p = 0.002).

Thermal ablation techniques: a curative treatment of bone metastases in selected patients?

Thermal ablation should be included in the therapeutic arsenal for the cure of bone metastases.

Question: Thermal ablation techniques: a curative treatment of bone metastases in selected patients? Answer: Thermal ablation should be included in the therapeutic arsenal for the cure of bone metastases.

Answer the question based on the following context: To characterise the nature and impact of World Youth Day (WYD) 2008 on emergency department (ED) presentations at key hospitals. Retrospective analysis of WYD pilgrims presenting to the EDs of St Vincent's Hospital and Sydney Hospital, 9-23 July 2008. Frequency of pilgrim ED presentations; presenting complaint, Australasian Triage Scale category, diagnosis, admission to hospital and demographic characteristics. 191 pilgrims presented at the two EDs during the study period, comprising 7.8% of all visits to these EDs. Pilgrims had a median age of 22 years, and most were international visitors. The female-to-male ratio was 1.7 : 1. The most common diagnoses were lower limb strain or sprain, infections, and acute asthma. Pilgrims presented with less severe illnesses (with lower triage scores), and were less likely to be admitted to hospital than other patients.

World Youth Day 2008: did it stress Sydney hospitals?

The pilgrim caseload was small, and these presentations were less acute and less likely to result in admission than non-pilgrim presentations. Thus, the overall impact on the hospitals was very small.

Question: World Youth Day 2008: did it stress Sydney hospitals? Answer: The pilgrim caseload was small, and these presentations were less acute and less likely to result in admission than non-pilgrim presentations. Thus, the overall impact on the hospitals was very small.

Answer the question based on the following context: To verify the hypothesis that in most patients bowel segmental resection to treat endometriosis can be safely performed without creation of a stoma and to discuss the limitations of this statement. Retrospective study (Canadian Task Force classification III). Tertiary referral center. Forty-one women with sigmoid and rectal endometriotic lesions who underwent segmental resection. Segmental resection procedures performed between 2004 and 2011. Patient demographic, operative, and postoperative data were compared. Sigmoid resection was performed in 6 patients (15%), and rectal anterior resection in 35 patients (high in 21 patients [51%], and low, i.e.,<10 cm from the anal verge, in 14 [34%]). In 4 patients a temporary ileostomy was created. There was 1 anastomotic leak (2.4%), in a patient with an unprotected anastomosis, which was treated via laparoscopic surgery and creation of a temporary ileostomy. Other postoperative complications included hemoperitoneum, pelvic abscess, pelvic collection, and a ureteral vaginal fistula, in 1 patient each (all 2.4%).

Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis?

A protective stoma may be averted in low anastomosis if it is>5 cm from the anal verge and there are no adverse intraoperative events.

Question: Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? Answer: A protective stoma may be averted in low anastomosis if it is>5 cm from the anal verge and there are no adverse intraoperative events.

Answer the question based on the following context: To validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. Subjects Children visiting any of 96 CHCs (N = 69 189) from 2011 to 2012. Analysis The authors measured correspondence (whether or not the visit was covered by Medicaid) between EHR coverage data and (i) reimbursement data and (ii) coverage data from Medicaid. Compared to reimbursement data and Medicaid coverage data, EHR coverage data had high agreement (87% and 95%, respectively), sensitivity (0.97 and 0.96), positive predictive value (0.88 and 0.98), but lower kappa statistics (0.32 and 0.49), specificity (0.27 and 0.60), and negative predictive value (0.66 and 0.45). These varied among clinics.DISCUSSION/

Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?

EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients. Future work should attempt to replicate these analyses in other settings.

Question: Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data? Answer: EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients. Future work should attempt to replicate these analyses in other settings.

Answer the question based on the following context: The role of left ventricular (LV) diastolic dysfunction in recurrent atrial fibrillation (AF) after catheter ablation remains unknown. We investigated LV diastolic function using the ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (e') and evaluated its predictive value for AF recurrence. One hundred three AF patients underwent transthoracic echocardiography before ablation and during 3 months of follow-up. Clinical and echocardiographic parameters of patients with maintained sinus rhythm were compared with those with recurrent AF. Of 103 patients, 26 had recurrent AF during follow-up. The E/e' index was the best independent predictor of AF recurrence in a multivariate logistic regression model. A cutoff value of 11.2 for the E/e' measured before ablation was associated with a sensitivity of 80.8% and specificity of 81.8% (area under ROC curve, 0.840; 95% CI, 0.754-0.926) for AF recurrence. E/e' measured in sinus rhythm after ablation had an even better predictive power (area under ROC curve, 0.917; 95% CI, 0.850-0.983).

Does the E/e' index predict the maintenance of sinus rhythm after catheter ablation of atrial fibrillation?

LV diastolic function was closely associated with AF recurrence after catheter ablation. The E/e' index can be used as an incremental predictor for AF recurrence after catheter ablation.

Question: Does the E/e' index predict the maintenance of sinus rhythm after catheter ablation of atrial fibrillation? Answer: LV diastolic function was closely associated with AF recurrence after catheter ablation. The E/e' index can be used as an incremental predictor for AF recurrence after catheter ablation.

Answer the question based on the following context: When consultations for all reasons are combined, women are seen to consult their general practitioners more than men through most of adult life. It is, therefore, often assumed that women are more likely to consult for every condition. To examine whether women report being more likely to consult a general practitioner than men when taking account of the underlying condition and various aspects of the experience of the condition consulted for. Home-based nurse-interviews with 852 people in early middle age (39 years) and 858 in late middle age (58 years) sampled from the general population in the West of Scotland. Detailed information about current chronic conditions included general practitioner consultation and reported experience of pain frequency, pain severity, limitation to normal activities and restricted activity in the previous four weeks. Women were no more likely than men to consult a general practitioner in the previous year when experiencing the five most common groups of conditions; in addition, women were no more likely than men to consult at a given level of severity for a given condition type, except in the case of one aspect of reported experience of mental health problems.

Are women more ready to consult than men?

The results argue against the most widely accepted explanation for gender differences in consulting, namely, that women are simply more likely to consult a general practitioner than men irrespective of underlying morbidity. Reasons for the higher rates of women consulting observed in general practice-based studies are discussed in relation to these data.

Question: Are women more ready to consult than men? Answer: The results argue against the most widely accepted explanation for gender differences in consulting, namely, that women are simply more likely to consult a general practitioner than men irrespective of underlying morbidity. Reasons for the higher rates of women consulting observed in general practice-based studies are discussed in relation to these data.

Answer the question based on the following context: Aetiology of idiopathic form of gynecomastia is unknown and it has not been established if it is related to factors present at the prenatal period or if it is caused by yet unidentified environmental conditions. The aim of this study is to compare digit ratio (2D:4D) in men with idiopathic gynecomastia and unaffected male and female controls from the general population. The study involved 250 subjects (50 men with idiopathic gynecomastia, 100 control men and 100 control women). Eight measurements were taken: body height, waist and hip circumferences, II and IV digits' lengths (right and left), and body weight, and 4 indices were calculated: BMI, WHR, and 2D:4D for the right and left hand. 2D:4D in men with gynecomastia ([median (I-III quartiles)]: 1.03 (1.01-1.04) for right hand and 1.03 (1.01-1.03) for left hand) was significantly different than the ratio in control men [0.97 (0.95-0.99)]for right and left hand) (p<0.0001) and similar to the ratio found in control women [1.02 (1-1.03)] for right and left hand) (p=1). Men with gynecomastia were characterized with higher values of the following variables: weight, waist and hip circumferences, BMI and WHR. Their body height was significantly greater than in women (p<0.0001) but similar to the values observed in control men (p=0.2687).

Can digit ratio (2D:4D) studies be helpful in explaining the aetiology of idiopathic gynecomastia?

The findings presented in this study may influence the aetiology-related classification of gynecomastia and justify introducing the new group: "gynecomastia related to the prenatal sex hormones disturbances".

Question: Can digit ratio (2D:4D) studies be helpful in explaining the aetiology of idiopathic gynecomastia? Answer: The findings presented in this study may influence the aetiology-related classification of gynecomastia and justify introducing the new group: "gynecomastia related to the prenatal sex hormones disturbances".

Answer the question based on the following context: To test the hypothesis that economic recessions lead to reduced global development assistance for health (DAH). Data obtained from the Creditor Reporting System of the Organisation for Economic Co-operation and Development (OECD) for 15 OECD countries were used to model the percentage change (relative difference) in commitments and disbursements for DAH as a function of three measures of economic recession: recessionary year (as a dummy variable with 0 for no recession and 1 for recession), percentage change in per capita gross domestic product and percentage point change in unemployment rate for recessionary cycles from 1975 through 2007. We looked for an association both during the concurrent recessionary year and one and two years later. No statistically significant association was found in the short or long run between measures of economic recession and the amount of official DAH committed or disbursed.

Does recession reduce global health aid?

Any important decrease in overall DAH following the current economic recession would have little historical precedent and claims of inevitability would be unjustifiable.

Question: Does recession reduce global health aid? Answer: Any important decrease in overall DAH following the current economic recession would have little historical precedent and claims of inevitability would be unjustifiable.

Answer the question based on the following context: Due to their relative scarcity and to limit single-center bias, multi-center data are needed to study femoral hernias. The aim of this study was to evaluate outcomes and quality of life (QOL) following laparoscopic vs. open repair of femoral hernias. The International Hernia Mesh Registry was queried for femoral hernia repairs. Laparoscopic vs. open techniques were assessed for outcomes and QOL, as quantified by the Carolinas Comfort Scale (CCS), preoperatively and at 1, 6, 12, and 24 months postoperatively. Outcomes were evaluated using the standard statistical analysis. A total of 80 femoral hernia repairs were performed in 73 patients: 37 laparoscopic and 43 open. There was no difference in mean age (54.7 ± 14.6 years), body mass index (24.2 ± 3.8 kg/m2), gender (60.3 % female), or comorbidities (p > 0.05). The hernias were recurrent in 21 % of the cases with an average of 1.23 ± 0.6 prior repairs (p > 0.1). Preoperative CCS scores were similar for both groups and indicated that 59.7 % of patients reported pain and 46.4 % had movement limitations (p > 0.05). Operative time was equivalent (47.2 ± 21.2 vs. 45.9 ± 14.8 min, p = 0.82). There was no difference in postoperative complications, with an overall 8.2 % abdominal wall complications rate (p > 0.05). The length of stay was shorter in the laparoscopic group (0.5 ± 0.6 vs. 1.3 ± 1.6 days, p = 0.02). Follow-up was somewhat longer in the open group (23.8 ± 10.2 vs. 17.3 ± 10.9 months, p = 0.02). There was one recurrence, which was in the laparoscopic group (3.1 vs. 0 %, p = 0.4). QOL outcomes at all time points demonstrated no difference for pain, movement limitation, or mesh sensation. Postoperative QOL scores improved for both groups when compared to preoperative scores.

Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage?

In this prospective international multi-institution study of 80 femoral hernia repairs, no difference was found for operative times, long-term outcomes, or QOL in the treatment of femoral hernias when comparing laparoscopic vs. open techniques. After repair, QOL at all time-points postoperatively improved compared to QOL scores preoperatively for laparoscopic and open femoral hernia repair. While international data supports improved outcomes with laparoscopic approach for femoral hernia repair, no data had existed prior to this study on the difference of approach impacting QOL. In the setting where recurrence and complication rates are equal after femoral hernia repair for either approach, surgeons should perform the technique with which they are most confident, as the operative approach does not appear to change QOL outcomes after femoral hernia repair.

Question: Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage? Answer: In this prospective international multi-institution study of 80 femoral hernia repairs, no difference was found for operative times, long-term outcomes, or QOL in the treatment of femoral hernias when comparing laparoscopic vs. open techniques. After repair, QOL at all time-points postoperatively improved compared to QOL scores preoperatively for laparoscopic and open femoral hernia repair. While international data supports improved outcomes with laparoscopic approach for femoral hernia repair, no data had existed prior to this study on the difference of approach impacting QOL. In the setting where recurrence and complication rates are equal after femoral hernia repair for either approach, surgeons should perform the technique with which they are most confident, as the operative approach does not appear to change QOL outcomes after femoral hernia repair.

Answer the question based on the following context: To determine how successful two large academic radiology departments have been in responding to market-driven pressures to reduce costs and improve productivity by downsizing their technical and support staffs while maintaining or increasing volume. A longitudinal study was performed in which benchmarking techniques were used to assess the changes in cost and productivity of the two departments for 5 years (fiscal years 1992-1996). Cost per relative value unit and relative value units per full-time equivalent employee were tracked. Substantial cost reduction and productivity enhancement were realized as linear improvements in two key metrics, namely, cost per relative value unit (decline of 19.0% [decline of $7.60 on a base year cost of $40.00] to 28.8% [$12.18 of $42.21]; P<or = .001) and relative value unit per full-time equivalent employee (increase of 46.0% [increase of 759.55 units over a base year productivity of 1,651.45 units] to 55.8% [968.28 of 1,733.97 units]; P<.001), during the 5 years of study.

Can academic radiology departments become more efficient and cost less?

Academic radiology departments have proved that they can "do more with less" over a sustained period.

Question: Can academic radiology departments become more efficient and cost less? Answer: Academic radiology departments have proved that they can "do more with less" over a sustained period.

Answer the question based on the following context: To comprehensively assess brain iron levels in typically developing control subjects and patients with attention deficit hyperactivity disorder (ADHD) when psychostimulant medication history is accounted for. This prospective study was approved by the institutional review board, and informed consent was obtained. Brain iron was indexed noninvasively by using magnetic resonance (MR) imaging relaxation rates (R2, R2*, R2') and magnetic field correlation (MFC) in the globus pallidus, putamen, caudate nucleus, and thalamus for 22 patients with ADHD (12 medication-naïve patients and 10 with a history of psychostimulant treatment) and 27 control subjects (age range, 8-18 years). Serum iron measures were also collected. Subgroup differences were analyzed with data-appropriate omnibus tests followed by post hoc pairwise comparisons; false discovery rate correction was conducted to control for multiple comparisons. Medication-naïve ADHD patients had significantly lower striatal and thalamic MFC indexes of brain iron than did control subjects (putamen, P = .012; caudate nucleus, P = .008; thalamus, P = .012) and psychostimulant-medicated ADHD patients (putamen, P = .006; caudate nucleus, P = .010; thalamus, P = .021). Conversely, the MFC indexes in medicated patients were comparable to those in control subjects. No significant differences were detected with R2, R2*, R2', or serum measures.

Multimodal MR imaging of brain iron in attention deficit hyperactivity disorder: a noninvasive biomarker that responds to psychostimulant treatment?

Lower MFC indexes of striatal and thalamic brain iron in medication-naïve ADHD patients and lack of differences in psychostimulant-medicated patients suggest that MFC indexes of brain iron may represent a noninvasive diagnostic biomarker that responds to psychostimulant treatment.

Question: Multimodal MR imaging of brain iron in attention deficit hyperactivity disorder: a noninvasive biomarker that responds to psychostimulant treatment? Answer: Lower MFC indexes of striatal and thalamic brain iron in medication-naïve ADHD patients and lack of differences in psychostimulant-medicated patients suggest that MFC indexes of brain iron may represent a noninvasive diagnostic biomarker that responds to psychostimulant treatment.

Answer the question based on the following context: During its use in pain management the patient-controlled analgesia (PCA) devices are capable of registering the course of treatment at patient request, the condition of drug delivery and total amount of drug being given. The patients could determine the need of medication to their own satisfaction while forced treatment by the bias of the health care personnel is avoided and the safety of patients is further warranted. In pain relief with this device, the number of requests for analgesia and the dose of analgesic used can be easily measured. Therefore, it is more objective to compare the pain intensity among different types of operation when PCA device is used. Using PCA morphine consumption as a parameter, we attempted to elucidate the difference of intensity of pain associated with total hip and total knee replacements by comparing their morphine requirement. In this prospective cohort study, 50 patients who underwent either total hip replacement (THR, n = 24) or total knee replacement (TKR, n = 26) were enrolled. After recovery from general anesthesia when the patients first complained intense pain in the recovery room, morphine was given intravenously in titration with a calculated loading dose in 30 min to achieve an acceptable analgesia (VAS<or = 3) followed by morphine PCA at 1 mg bolus with a lockout interval of 6 min. The patients were then followed for 48 h. During and at the end of the course the data relevant to pain score, total dose, demand, delivery, and adverse effects were recorded for assessment. With the use of PCA, the pain scores were similar in both surgical groups in the 48 h observation. Total consumption of morphine in THR was 13.2 +/- 8.1 mg as against 19.7 +/- 5.7 mg in TKR in postoperative day 1 and 25.2 +/- 12.7 mg as against 34.1 +/- 13.9 mg in postoperative day 2 (P<0.05, t-test). Demand/delivery ratio was not statistically significant between the 2 groups at 24 and 48 h (t-test). Minor adverse effects were seen in both groups but the differences were not significant.

Is total knee replacement more painful than total hip replacement?

Using PCA morphine consumption as parameter, we can distinguish the magnitude of pain intensity between 2 major orthopedic surgeries. The deeper and more extensive operation would in total hip replacement does not mean that it is a more painful procedure than total knee replacement. Several speculations are proposed.

Question: Is total knee replacement more painful than total hip replacement? Answer: Using PCA morphine consumption as parameter, we can distinguish the magnitude of pain intensity between 2 major orthopedic surgeries. The deeper and more extensive operation would in total hip replacement does not mean that it is a more painful procedure than total knee replacement. Several speculations are proposed.

Answer the question based on the following context: Heart transplantation remains the last treatment option for patients with end-stage cardiac disease. Such diseases include ischemic cardiomyopathy, nonischemic cardiomyopathy and other conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and cardiac amyloidosis. To review the changes that have occurred over time in the etiology of heart disease in patients requiring heart transplantation, and to compare the clinical and histological diagnoses of explanted hearts from patients with progressive cardiac disease. The pathological findings of 296 surgically excised hearts over a 20-year period (January 1987 to July 2006) at one institution were examined. Patients were separated into groups based on year of heart transplantation. The tissue was examined to determine the underlying cardiac pathology leading to congestive heart failure. Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. A shift in the underlying etiology was found in patients who underwent heart transplantation from 1992 to 1996, and 1997 to 2001. Between 1987 and 1997, the majority of transplant cases consisted of ischemic cardiomyopathies. From 1997 to 2001, the majority of patients had nonischemic cardiomyopathies, and this trend continued to 2006. A majority of patients with ischemic and hypertrophic cardiomyopathy were diagnosed correctly (96.5% and 82%, respectively) before transplantation. Most patients diagnosed post-transplant with lymphocytic (viral, 15%), hypersensitive/ eosinophilic (25%) and giant cell (100%) myocarditis, arrhythmogenic right ventricle dysplasia (100%), cardiac sarcoidosis (83%) and iron overload toxicity- associated cardiomyopathy (100%) had been misdiagnosed in pretransplantation investigations. Investigations before transplantation did not include an EMB. Of all 296 patients, 51 patients (17%) were misdiagnosed. Excluding the patients with ischemic cardiomyopathy, 46 of 152 patients (30%) were misdiagnosed before transplantation.

Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients?

Although cardiac transplantation is a viable treatment option for patients with a variety of cardiac diseases, accurate diagnosis of patients before transplantation remains a priority. Accurate diagnosis of particular diseases (sarcoidosis, myocarditis, iron toxicity-associated cardiomyopathy and others) allows for proper treatment before transplantation, which may slow down disease progression and improve patient outcomes. Furthermore, it is important to accurately diagnose patients with diseases such as sarcoidosis, amyloidosis and particular types of myocarditis because these can readily recur in the grafted heart. The risk for recurrence must be known to practitioners and, most importantly, to the patient. We strongly recommend the use of EMB if a nonischemic cardiomyopathy is suspected, because the results may alter the diagnosis and modify the treatment strategy.

Question: Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? Answer: Although cardiac transplantation is a viable treatment option for patients with a variety of cardiac diseases, accurate diagnosis of patients before transplantation remains a priority. Accurate diagnosis of particular diseases (sarcoidosis, myocarditis, iron toxicity-associated cardiomyopathy and others) allows for proper treatment before transplantation, which may slow down disease progression and improve patient outcomes. Furthermore, it is important to accurately diagnose patients with diseases such as sarcoidosis, amyloidosis and particular types of myocarditis because these can readily recur in the grafted heart. The risk for recurrence must be known to practitioners and, most importantly, to the patient. We strongly recommend the use of EMB if a nonischemic cardiomyopathy is suspected, because the results may alter the diagnosis and modify the treatment strategy.

Answer the question based on the following context: Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted.QUESTIONS/ We reviewed our minimum 9-year results of 70 patients who underwent one-stage exchange arthroplasty with a rotating hinge design to determine: (1) What was the proportion of patients free of infection? (2) What was the patient rate of survival free of any reoperation? (3) What were the clinical outcomes as measured by Hospital for Special Surgery scores? (4) What proportion of patients developed radiographic evidence of loosening? All one-stage revision TKAs for infection between January 1 and December 31, 2002, with a minimum 9-year followup (mean, 10 years; range, 9-11 years), in which patients had been seen within the last 1 year, were included in this retrospective review. During that period, 11 patients with infected TKAs were treated with other approaches (including two-stage approaches in eight); the general indication for one-stage revision was the diagnosis of PJI with a known causative organism. Exclusion criteria were culture-negative preoperative aspiration, known allergy to local antibiotics or bone cement, or cases in which radical débridement was impossible as a result of the involvement of important anatomical structures. Eighty-one patients with PJI were seen during this period; 70 underwent one-stage exchange using our strict protocol and were reimplanted with a rotating hinge TKA. Eleven patients (15.7%) were lost to followup. Hospital for Special Surgery scores were recorded and all radiographs were evaluated for prosthetic loosening. Failure was defined as revision surgery for infection or any other cause. Our 10-year infection-free survival was 93% (mean, 4.1; 95% confidence interval [CI], 89%-96%; p<0.007); and the patient 10-year survival rate free of revision for other causes was 91% (mean, 5.2; 95% CI, 86%-95%; p<0.002). Mean Hospital for Special Surgery knee score at last followup was 69.6 (± 22.5 SD; range, 22-100) and the mean improvement in Hospital for Special Surgery knee score from preoperative to most recent followup was 35 (± 24.2 SD; range, 13-99). Evidence of radiographic loosening was seen in 11 patients at last followup, whereby in six patients, there was need for revision surgery.

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design?

Our study results showed an overall infection control rate of 93% and good clinical results using our one-stage approach, which combines aggressive débridement of the collateral ligaments and posterior capsule with a rotating hinge implant. These results are comparable with two-stage techniques at a followup of 10 years; further research into one-stage exchange techniques for PJI in TKA appears warranted.

Question: Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? Answer: Our study results showed an overall infection control rate of 93% and good clinical results using our one-stage approach, which combines aggressive débridement of the collateral ligaments and posterior capsule with a rotating hinge implant. These results are comparable with two-stage techniques at a followup of 10 years; further research into one-stage exchange techniques for PJI in TKA appears warranted.

Answer the question based on the following context: Medical schools worldwide are playing a role in addressing the shortage of rural health practitioners. Selection of rural-origin students and long-term rural undergraduate placements have been shown to have a positive influence on a subsequent career choice of rural health. Evidence for the impact of short-term rural placements is less clear. In New Zealand, the Otago University Faculty of Medicine introduced a 7 week rural undergraduate placement at the Dunedin School Of Medicine, one of its three clinical schools, in 2000. A study of the first two annual cohorts showed a positive influence of the course on student attitudes to rural health and their intention to practise in a rural setting. The purpose of this study was to test whether or not these effects persisted into postgraduate years. The original study cohorts were posted a questionnaire (questions worded identically to the original survey) in 2009 (5th and 6th postgraduate years). Non-responders were followed up after 2 months. Graduates from the same year cohort at the two other Otago clinical schools (Christchurch and Wellington) were also surveyed. In addition to analysis by question, principal component analysis (PCA) identified 3 questions which represented the influence of the medical undergraduate program on students' attitudes towards rural general practice. This was used as an index of influence of the undergraduate curriculum. There was a statistically significant difference among graduates from Dunedin and the other two schools in reporting a positive influence towards rural practice from the undergraduate course.When asked how the medical undergraduate program influenced their attitude towards a career in rural practice, 56% of respondents from Dunedin reported a positive influence compared with 24% from Christchurch and 15% Wellington. This effect was less strong than that obtained immediately after the rural placement where 70% of Dunedin based students reported a positive influence. The index value for positive effect on attitudes was significantly higher for respondents who studied at Dunedin than at Wellington (mean index value 0.552 for Dunedin, -0.374 for Wellington t=4.172, p=0.000) or Christchurch (mean index value -0.083 for Christchurch t=2.606, p=0.011). There was no significant difference between Christchurch and Wellington (t=1.420, p=0.160). There was no significant difference among schools in the proportion of graduates who had worked or intended to work in rural general practice at any point in their career (24% Dunedin, 31% Christchurch, 16% Wellington (Phi=0.160, p=0.178).

Does the positive influence of an undergraduate rural placement persist into postgraduate years?

Most of the literature on the influence of rural undergraduate placements, especially short term placements, examines immediate changes. This study adds to the evidence by showing that positive effects from a rural undergraduate placement persist into the postgraduate years, although that in isolation is unlikely to result in a significant workforce effect. Further investigation is warranted into which features of the undergraduate placement result in an extended positive effect on student attitudes.

Question: Does the positive influence of an undergraduate rural placement persist into postgraduate years? Answer: Most of the literature on the influence of rural undergraduate placements, especially short term placements, examines immediate changes. This study adds to the evidence by showing that positive effects from a rural undergraduate placement persist into the postgraduate years, although that in isolation is unlikely to result in a significant workforce effect. Further investigation is warranted into which features of the undergraduate placement result in an extended positive effect on student attitudes.

Answer the question based on the following context: To determine if column agglutination technology (CAT) for titration of anti-D and anti-c concentrations produces comparable results to those obtained by continuous flow analyser (CFA). Anti-D and anti-c are the two commonest antibodies that contribute to serious haemolytic disease of the foetus and neonate (HDFN). Current practice in the UK is to monitor these antibodies by CFA quantification, which is considered more reproducible and less subjective than manual titration by tube IAT (indirect antiglobulin test). CAT is widely used in transfusion laboratory practice and provides a more objective endpoint than tube technique. Antenatal samples were (i) quantified using CFA and (ii) titrated using CAT with the reaction strength recorded by a card reader and expressed as a titre score (TS). The TS rose in accordance with levels measured by quantification and was able to distinguish antibody levels above and below the threshold of clinical significance.

Antenatal monitoring of anti-D and anti-c: could titre scores determined by column agglutination technology replace continuous flow analyser quantification?

CAT titre scores provided a simple and reproducible method to monitor anti-D and anti-c levels. The method was sensitive to a wide range of antibody levels as determined by quantification. This technique may have the potential to replace CFA quantification by identifying those cases that require closer monitoring for potential HDFN.

Question: Antenatal monitoring of anti-D and anti-c: could titre scores determined by column agglutination technology replace continuous flow analyser quantification? Answer: CAT titre scores provided a simple and reproducible method to monitor anti-D and anti-c levels. The method was sensitive to a wide range of antibody levels as determined by quantification. This technique may have the potential to replace CFA quantification by identifying those cases that require closer monitoring for potential HDFN.

Answer the question based on the following context: The validity of the National Adult Reading Test (NART) as a predictor of premorbid IQ when used with patients who have sustained a traumatic brain injury (TBI) has been questioned in recent years. This study examined whether performance on the Wechsler Test of Adult Reading (WTAR) is similarly affected by TBI in the first year after an injury. The WTAR scores of participants who had sustained a mild TBI (N=82), moderate TBI (N=73), severe TBI (N=61) or an orthopaedic injury (N=95) were compared (cross-sectional study). A subset of 21 mild TBI, 31 moderate TBI, 26 severe TBI and 21 control group participants were additionally reassessed 6 months later to assess the impact of recovery on WTAR scores (longitudinal study). The severe TBI group had significantly lower scores on the WTAR than the mild TBI, moderate TBI and control groups in the cross-sectional study, despite being matched demographically. The findings from the longitudinal study revealed a significant group difference and a small improvement in performance over time but the interaction between group and time was not significant, suggesting that the improvements in WTAR performance over time were not restricted to more severely injured individuals whose performance was temporarily suppressed.

Is performance on the Wechsler test of adult reading affected by traumatic brain injury?

These findings suggest that reading performance may be affected by severe TBI and that the WTAR may underestimate premorbid IQ when used in this context, which may cause clinicians to underestimate the cognitive deficits experienced by these patients.

Question: Is performance on the Wechsler test of adult reading affected by traumatic brain injury? Answer: These findings suggest that reading performance may be affected by severe TBI and that the WTAR may underestimate premorbid IQ when used in this context, which may cause clinicians to underestimate the cognitive deficits experienced by these patients.

Answer the question based on the following context: A pharmacoinvasive (PI) strategy for early presenting ST-segment elevation myocardial infarction nominally reduced 30-day cardiogenic shock and congestive heart failure compared with primary percutaneous coronary intervention (PPCI). We evaluated whether infarct size (IS) was related to this finding. Using the peak cardiac biomarker in patients randomized to PI versus PPCI within the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, IS was divided into 3 groups: small (≤2 times the upper limit normal [ULN]), medium (>2 to ≤5 times the upper limit normal) and large (>5 times the upper limit normal). The association between IS and 30-day shock and congestive heart failure was subsequently examined. Data on 1701 of 1892 (89.9%) patients randomized to PI (n=853, 50.1%) versus PPCI (n=848, 49.9%) within STREAM were evaluated. A higher proportion of PPCI patients had a large IS (PI versus PPCI: small, 49.8% versus 50.2%; medium, 56.9% versus 43.1%; large, 48.4% versus 51.6%; P=0.035), despite comparable intergroup ischemic times for each reperfusion strategy. As IS increased, a parallel increment in shock and congestive heart failure occurred in both treatment arms, except for the small IS group. The difference in shock and congestive heart failure in the small IS group (4.4% versus 11.6%, P=0.026) in favor of PI likely relates to higher rates of aborted myocardial infarction with the PI strategy (72.7% versus 54.3%, P=0.005). After adjustment, a trend favoring PI persisted in this subgroup (relative risk 0.40, 95% CI 0.15 to 1.06, P=0.064); no difference in treatment-related outcomes was evident in the other 2 groups.

Infarct Size, Shock, and Heart Failure: Does Reperfusion Strategy Matter in Early Presenting Patients With ST-Segment Elevation Myocardial Infarction?

A PI strategy appears to alter the pattern of IS after ST-segment elevation myocardial infarction, resulting in more medium and fewer large infarcts compared with PPCI. Despite a comparable number of small infarcts, PI patients in this group had more aborted myocardial infarctions and less 30-day shock and congestive heart failure.

Question: Infarct Size, Shock, and Heart Failure: Does Reperfusion Strategy Matter in Early Presenting Patients With ST-Segment Elevation Myocardial Infarction? Answer: A PI strategy appears to alter the pattern of IS after ST-segment elevation myocardial infarction, resulting in more medium and fewer large infarcts compared with PPCI. Despite a comparable number of small infarcts, PI patients in this group had more aborted myocardial infarctions and less 30-day shock and congestive heart failure.

Answer the question based on the following context: Current recommendations are that young children with a skull fracture following head injury undergo computed tomography (CT) examination of their head to exclude significant intracranial injury. Recent reports, however, have raised concern that radiation exposure from CT scanning may cause malignancies. To estimate the proportion of children with nondisplaced linear skull fractures who have clinically significant intracranial injury. Retrospective review of patients younger than 2 years who presented to an emergency department and received a diagnosis of skull fracture. Ninety-two patients met the criteria for inclusion in the study; all had a head CT scan performed. None suffered a clinically significant intracranial injury.

Nondepressed linear skull fractures in children younger than 2 years: is computed tomography always necessary?

Observation, rather than CT, may be a reasonable management option for head-injured children younger than 2 years who have a nondisplaced linear skull fracture on plain radiography but no clinical signs of intracranial injury.

Question: Nondepressed linear skull fractures in children younger than 2 years: is computed tomography always necessary? Answer: Observation, rather than CT, may be a reasonable management option for head-injured children younger than 2 years who have a nondisplaced linear skull fracture on plain radiography but no clinical signs of intracranial injury.

Answer the question based on the following context: Hand-held flushing of radial arterial lines at 0.5 ml/s in neonates can result in retrograde embolization of flush solution into the central arterial circulation. We studied flush flow velocities during intermittent arterial line purging using a flow regulating device with an infusion bag pump and a syringe pump system. In this in vitro experiment we simulated flushing of a 24- and a 22-G cannula against a mean arterial pressure of 45 mmHg. Fluid flow velocities were gravimetrically measured during flushing from an infusion bag system pressurized to 100, 200, and 300 mmHg and from a syringe pump flush system after initialization of boluses of 0.5, 1.0, 1.5, 2.0, and 2.5 ml. The flow regulating device was opened for 1, 2, and 5 s. Both flush systems tested allowed delivery of flush flow velocities exceeding 0.5 ml/s (e.g., 22-G cannula; bag system, pressure 300 mmHg up to 0.64+/-0.08 ml/s; syringe pump, 2 ml bolus up to 0.74+/-0.05 ml/s). In syringe pump systems the main determinant of flow velocity was bolus size, in bag pump systems flushing time and bag pressure.

Pressurized bag pump and syringe pump arterial flushing systems: an unrecognized hazard in neonates?

Based on data about critical flow velocities through an radial arterial cannula in neonates, both tested flushing systems carry the risk of exceeding the critical value of 0.5 ml/s. They are likely to cause retrograde embolization of flushing solution into the central arterial circulation with the associated risk of clot and air embolization. In vivo studies should identify margins of safety to minimize the risk of retrograde flushing into the central arterial circulation.

Question: Pressurized bag pump and syringe pump arterial flushing systems: an unrecognized hazard in neonates? Answer: Based on data about critical flow velocities through an radial arterial cannula in neonates, both tested flushing systems carry the risk of exceeding the critical value of 0.5 ml/s. They are likely to cause retrograde embolization of flushing solution into the central arterial circulation with the associated risk of clot and air embolization. In vivo studies should identify margins of safety to minimize the risk of retrograde flushing into the central arterial circulation.

Answer the question based on the following context: To determine the effectiveness and direct of two protective devices-a shielded 3 ml safety syringe (Safety-Lok; Becton Dickinson and Co., Becton Dickinson Division, Franklin Lakes, N.J.) and the components of a needleless IV system (InterLink; Baxter Healthcare Corp., Deerfield, Ill.)--in preventing needlestick injuries to health care workers. Twelve-month prospective, controlled, before-and-after trial with a standardized questionnaire to monitor needlestick injury rates. Six hospital inpatient units, consisting of three medical units, two surgical units (all of which were similar in patient census, acuity, and frequency of needlesticks), and a surgical-trauma intensive care unit, at a 900-bed urban university medical center. All nursing personnel, including registered nurses, licensed practical nurses, nursing aides, and students, as well as medical teams consisting of an attending physician, resident physician, interns, and medical students on the study units. After a 6-month prospective surveillance period, the protective devices were randomly introduced to four of the chosen study units and to the surgical-trauma intensive care unit. Forty-seven needlesticks were reported throughout the entire study period, 33 in the 6 months before and 14 in the 6 months after the introduction of the protective devices. Nursing staff members who were using hollow-bore needles and manipulating intravenous lines accounted for the greatest number of needlestick injuries in the pre-intervention period. The overall rate of needlestick injury was reduced by 61%, from 0.785 to 0.303 needlestick injuries per 1000 health care worker-days after the introduction of the protective devices (relative risk = 1.958; 95% confidence interval, 1.012 to 3.790; p = 0.046). Needlestick injury rates associated with intravenous line manipulation, procedures with 3 ml syringes, and sharps disposal were reduced by 50%; however, reductions in these subcategories were not statistically significant. No seroconversions to HIV-1 or hepatitis B virus seropositivity occurred among those with needlestick injuries. The direct cost for each needlestick prevented was $789.

Do protective devices prevent needlestick injuries among health care workers?

Despite an overall reduction in needlestick injury rates, no statistically significant reductions could be directly attributed to the protective devices. These devices are associated with a significant increase in cost compared with conventional devices. Further studies must be concurrently controlled to establish the effectiveness of these devices.

Question: Do protective devices prevent needlestick injuries among health care workers? Answer: Despite an overall reduction in needlestick injury rates, no statistically significant reductions could be directly attributed to the protective devices. These devices are associated with a significant increase in cost compared with conventional devices. Further studies must be concurrently controlled to establish the effectiveness of these devices.

Answer the question based on the following context: The aim of this study was to examine the impact of a telemedical robot on trauma intensive care unit (TICU) clinician teamwork (i.e., team attitudes, behaviors, and cognitions) during patient rounds. Thirty-two healthcare providers who conduct rounds volunteered to take surveys assessing teamwork attitudes and cognitions at three time periods: (1) the onset of the study, (2) the end of the 30-day control period, and (3) the end of the 30-day experimental period, which immediately followed the control period. Rounds were recorded throughout the 30-day control period and 30-day experimental period to observe provider behaviors. For the initial 30 days, there was no access to telemedicine. For the final 30 days, the rounding healthcare providers had access to the RP-7 robot (Intouch Health Inc., Santa Barbara, CA), a telemedical tool that can facilitate patient rounds conducted away from bedside. Using a one-tailed, one-way repeated-measures analysis of variance (ANOVA) to compare trust at Times 1, 2, and 3, there was no significant effect on trust: F(2, 14)=1.20, p=0.16. When a one-tailed, one-way repeated-measures ANOVA to compare transactive memory systems (TMS) at Times 1, 2, and 3 was conducted, there was no significant effect on TMS: F(2, 15)=1.33, p=0.15. We conducted a one-tailed, one-way repeated-measures ANOVA to compare team psychological safety at Times 1, 2, and 3, and there was no significant effect on team psychological safety: F(2,15)=1.53, p=0.12. There was a significant difference in communication between rounds with and without telemedicine [t(25)=-1.76, p<0.05], such that there was more task-based communication during telerounds. Telemedicine increased task-based communication and did not negatively impact team trust, psychological safety, or TMS during rounds.

Utilizing Telemedicine in the Trauma Intensive Care Unit: Does It Impact Teamwork?

Telemedicine may offer advantages for some teamwork competencies without sacrificing the efficacy of others and may be adopted by intact rounding teams without hindering teamwork.

Question: Utilizing Telemedicine in the Trauma Intensive Care Unit: Does It Impact Teamwork? Answer: Telemedicine may offer advantages for some teamwork competencies without sacrificing the efficacy of others and may be adopted by intact rounding teams without hindering teamwork.

Answer the question based on the following context: Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbar-pelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.QUESTIONS/ We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-to-ankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90° of apparent hip flexion. After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5° more posterior pelvic tilt (95% CI, -2° to -8° lower sacral slope angles; p<0.01) and 7° less lumbar lordosis (95% CI, -10° to -3°; p<0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4° less posterior pelvic tilt (95% CI, 1°-7° higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD spines experienced 10° less spine flexion (95% CI, -14° to -7°; p<0.01) and 10° more femoroacetabular flexion (95% CI, 6° to 14°; p<0.01).

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Most patients undergoing THA sit in a similar range of pelvic tilt, with a small mean difference in pelvic tilt between patients with DDD spines and those without radiographic arthrosis. However, in general, the mechanism by which patients with DDD of the lumbar spine achieve sitting differs from those without spine arthrosis with less spine flexion and more femoroacetabular flexion.

Question: Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty? Answer: Most patients undergoing THA sit in a similar range of pelvic tilt, with a small mean difference in pelvic tilt between patients with DDD spines and those without radiographic arthrosis. However, in general, the mechanism by which patients with DDD of the lumbar spine achieve sitting differs from those without spine arthrosis with less spine flexion and more femoroacetabular flexion.

Answer the question based on the following context: To evaluate the predictive ability of ROTEM thromboelastometry (Pentapharm, Basel, Switzerland) to identify patients bleeding more than 200 mL/h in the early postoperative period after cardiac surgery. A prospective observational study. A single university hospital. Fifty-eight adult male and female patients undergoing primary coronary artery revascularization. Blood samples taken preoperatively and at 1, 2, and 3 hours after surgery. Eight patients bled at least 200 mL/h in the study period. All (100%) had at least 1 abnormal ROTEM result in the study period. Of the 49 patients not found to be bleeding more than 200 mL/h in any of the first 4 postoperative hours, 46 (94%) had at least 1 abnormal ROTEM result. The positive and negative predictive values were 14.8% and 100%, respectively.

Can ROTEM thromboelastometry predict postoperative bleeding after cardiac surgery?

ROTEM thromboelastometry has poor predictive utility to identify patients who bleed more than 200 mL/h in the early postoperative period after cardiac surgery. However, its negative predictive value was good.

Question: Can ROTEM thromboelastometry predict postoperative bleeding after cardiac surgery? Answer: ROTEM thromboelastometry has poor predictive utility to identify patients who bleed more than 200 mL/h in the early postoperative period after cardiac surgery. However, its negative predictive value was good.

Answer the question based on the following context: To investigate the effect of patient age on the stone-free rate (SFR) in patients with urinary calculi treated by extracorporeal shockwave lithotripsy (ESWL). In all, 2192 solitary radio-opaque urinary stones of 5-15 mm were identified in adult patients receiving primary ESWL. Patients were divided into three age groups, i.e.<or = 40, 41-60 and>60 years (579, 1026 and 587 patients, respectively). Multiple logistic regression was used to assess the effect of age and other possible predicting factors (gender, stone characteristics, e.g. side, site and size, and the type of lithotripter used) on the SFR at 3 months after treatment. The overall adjusted odds ratios (95% confidence interval) for the SFR for those aged 41-60 and>60 years (taking those aged<or= 40 years as the reference) were 0.708 (0.573-0.875; P = 0.001) and 0.643 (0.506-0.818; P<0.001). However, if the patients were divided into those with renal or ureteric stones, only the SFR of the former was affected by age, and the adjusted odds ratios were 0.665 (0.512-0.864; P = 0.002) and 0.629 (0.470-0.841; P = 0.002), respectively. Ageing had no effect on the SFR for ureteric stones.

Is extracorporeal shock wave lithotripsy the preferred treatment option for elderly patients with urinary stone?

The SFR after ESWL for renal stones, but not ureteric stones, was significantly lower in older patients. Further studies on the effects of ageing on renal stone clearance after ESWL are needed to improve stone management in the elderly population.

Question: Is extracorporeal shock wave lithotripsy the preferred treatment option for elderly patients with urinary stone? Answer: The SFR after ESWL for renal stones, but not ureteric stones, was significantly lower in older patients. Further studies on the effects of ageing on renal stone clearance after ESWL are needed to improve stone management in the elderly population.

Answer the question based on the following context: Our objective was to assess the impact of disruption by a new 2-week vacation break on outcomes of required third-year clerkships. Mean scores on National Board of Medical Examiners (NBME) clerkship specific clinical science subject ("subject") examinations and overall student evaluations were compared for clerkships with the break and those over the previous 3 years without the break. Students were surveyed about the impact of the break on learning and the time spent studying during the break. No significant differences were found in examination scores between clerkships with the break and those without. Overall student clerkship evaluations were significantly different only for the surgery clerkship. The break was regarded more favorably by students on the 8-week than the 6-week clerkships, but student perspectives varied significantly by specialty. The time reported studying varied significantly by specialty and campus. Student comments were predominantly supportive of the break and focused on the advantages of opportunity to relax, spend time with family, and to study. Concerns included forgetting content knowledge, losing skills, and having difficulty regaining momentum on return to the clerkship.

Does a Vacation Break Impact the Outcomes of Required Clinical Clerkships?

Interruption of clerkships by a 2-week break was not associated with any significant change in subject examination scores or overall student evaluation of the clerkship, despite predominantly positive comments. Significant differences were reported by specialty in student perception of benefit and reported time studying during the break.

Question: Does a Vacation Break Impact the Outcomes of Required Clinical Clerkships? Answer: Interruption of clerkships by a 2-week break was not associated with any significant change in subject examination scores or overall student evaluation of the clerkship, despite predominantly positive comments. Significant differences were reported by specialty in student perception of benefit and reported time studying during the break.

Answer the question based on the following context: To report the prospective follow-up of pregnancies exposed to misoprostol during the first trimester and analyse the teratogenic risk depending on the indication for use. Prospective observational study of 265 women exposed to misoprostol during the first 12 weeks of pregnancy and followed until the delivery. Women were included if they or their physician had contacted a French pharmacovigilance centre before 22 weeks of gestation (WG) to obtain information on the risk of misoprostol exposure, and if there had been misoprostol exposure before 13 WG. Data were collected at the time of the first contact, and the pregnancy outcome was recorded at follow-up. Women were prospectively enrolled from January 1988 to December 2013. The main indication for misoprostol was voluntary abortion (60.9%). Ten major malformations (5.5%) (95% CI 2.65-9.82%) were reported and five of them were consistent with the pattern of malformations attributed to misoprostol: Möbius sequence, hydrocephalus, terminal transverse limb reduction associated with a clubfoot, syndactyly, and complete posterior encephalocele. The rate of malformations was higher, but not significantly, in women exposed to misoprostol for voluntary abortion (7.9%) compared with women exposed to misoprostol for other or unknown indications (3.2%).

Misoprostol exposure during the first trimester of pregnancy: Is the malformation risk varying depending on the indication?

Our results confirmed a specific pattern of malformations due to misoprostol use in early pregnancy, even with low dose of misoprostol. Despite the small number of cases, we observed a higher proportion of major malformations in fetuses born to women who continued their pregnancy after a failed voluntary abortion with misoprostol. Further studies should be conducted to evaluate other potential factors, such as combination treatment with mifepristone and the socio-environmental characteristics in this group of women.

Question: Misoprostol exposure during the first trimester of pregnancy: Is the malformation risk varying depending on the indication? Answer: Our results confirmed a specific pattern of malformations due to misoprostol use in early pregnancy, even with low dose of misoprostol. Despite the small number of cases, we observed a higher proportion of major malformations in fetuses born to women who continued their pregnancy after a failed voluntary abortion with misoprostol. Further studies should be conducted to evaluate other potential factors, such as combination treatment with mifepristone and the socio-environmental characteristics in this group of women.

Answer the question based on the following context: To evaluate long-term cure rates and late complication rates after treatment for female stress urinary incontinence (SUI) with transobturator tape (TOT) procedure and to compare the outcomes of 1st year versus 5th year. We analyzed 138 women who underwent TOT procedure for pure SUI and mixed urinary incontinence in two institutions during the time period of June 2005-May 2008 retrospectively. We used two kinds of polypropylene monofilament tapes (Heine Medizinurethral support system, Germany and I-STOPCL Medical, France) for the standard outside-in TOT in similar numbers. All patients were evaluated with pelvic examination including cough stress test and International Consultation on Incontinence Questionnaire-Short Form at 3 and 12 months and annually. Our primary outcome measures were rates of objective cure, subjective cure, patient satisfaction and failure for long-term follow-up. The objective cure, subjective cure and patient satisfaction rates of the 126 women at 1 year were 89.6, 86.5 and 92% respectively. During 5-year follow-up, objective cure rate was stable with 87.3% rate (p = 0.554), whereas subjective cure and patient satisfaction rates were decreased to 65.9 and 73%, respectively (p = 0.001). Complications are reported according to the Clavien-Dindo classification with Gr I 14.3%, Gr II 64.3%, Gr IIIa 7.1% and Gr IIIb 14.3 %.

Are the outcomes of transobturator tape procedure for female stress urinary incontinence durable in long-term follow-up?

TOT procedure is an effective minimal invasive procedure with satisfactory results for female SUI in short term. Although recovery in SUI symptoms was stable during 5-year follow-up, subjective cure and patient satisfaction rates decreased significantly due to urge urinary incontinence symptoms.

Question: Are the outcomes of transobturator tape procedure for female stress urinary incontinence durable in long-term follow-up? Answer: TOT procedure is an effective minimal invasive procedure with satisfactory results for female SUI in short term. Although recovery in SUI symptoms was stable during 5-year follow-up, subjective cure and patient satisfaction rates decreased significantly due to urge urinary incontinence symptoms.

Answer the question based on the following context: Mesh reinforcement in hiatal hernia surgery is debated. Randomized controlled trials have shown that recurrences may be reduced, but there is also the fear of mesh-related complications. Experimental studies on the characteristics of specific mesh types with regard to the risk of such complications are rare. The current study aimed to investigate the properties of a circular heavy-weight polypropylene mesh in terms of stenosis, migration, erosions, and adhesions in a porcine model. A 55 x 55-mm heavy-weight polypropylene mesh with a 16.5-mm eccentric hole for the esophagus corresponding to a calculated mesh area of 2811 mm(2) and a hole area of 214 mm(2) were implanted in nine German Landrace pigs. Six weeks later, the meshes were explanted and investigated for size, shrinkage, migration and adhesions. The total mesh area shrank to a mean of 2,040 +/- 178 mm(2) (p<0.001), and the hole for the esophagus showed a trend toward an increase to 239 +/- 38 mm(2) (p = 0.108). In not a single location did the mesh overhang the hiatal margin. The mean distance of retraction from the hiatal margin was 4.3 +/- 2.8 mm. Therefore, no stenoses, migrations, or erosions occurred.

Is a circular polypropylene mesh appropriate for application at the esophageal hiatus?

A circular heavy-weight polypropylene mesh seems to be appropriate for the application at the esophageal hiatus in terms of safety and stability. This means that it is characterized by a position-stable centered fixation around the esophagus without a tendency toward stenosis, migration, or erosion.

Question: Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Answer: A circular heavy-weight polypropylene mesh seems to be appropriate for the application at the esophageal hiatus in terms of safety and stability. This means that it is characterized by a position-stable centered fixation around the esophagus without a tendency toward stenosis, migration, or erosion.

Answer the question based on the following context: Women with depressive symptoms may use preventive services less frequently and experience poorer health outcomes. We investigated the association of depressive symptoms with breast and colorectal cancer screening rates and stage of cancer among a cohort of postmenopausal women. In The Women's Health Initiative Observational Study, 93,676 women were followed on average for 7.6 years. Depressive symptoms were measured at baseline and at 3 years using the 6-item scale from the Center for Epidemiological Studies Depression scale (CES-D). We calculated a cancer screening rate expressed as a proportion of the years that women were current with recommended cancer screening over the number of follow-up visits in the study. Breast and colorectal cancers were staged based on Surveillance, Epidemiology and End Results (SEER) classification. At baseline, 15.8% (12,621) women were positive for depressive symptoms, and 6.9% (4,777) were positive at both baseline screening and at 3 years. The overall average screening rate was 71% for breast cancer and 53% for colorectal cancer. The breast cancer screening rate was 1.5% (CI 0.9%-2.0%) lower among women who reported depressive symptoms at baseline than among those who did not. Depressive symptoms were not a predictor for colorectal cancer screening. Stage of breast and colorectal cancer was not found to be associated with depressive symptoms after adjusting for covariates.

Are depressive symptoms associated with cancer screening and cancer stage at diagnosis among postmenopausal women?

Among a healthy and self-motivated cohort of women, self-reported depressive symptoms were associated with lower rates of screening mammography but not with colorectal cancer screening.

Question: Are depressive symptoms associated with cancer screening and cancer stage at diagnosis among postmenopausal women? Answer: Among a healthy and self-motivated cohort of women, self-reported depressive symptoms were associated with lower rates of screening mammography but not with colorectal cancer screening.

Answer the question based on the following context: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. This study investigated clinicians' reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups.

An experimental Investigation of the Impact of Personality Disorder Diagnosis on Clinicians: Can We See Past the Borderline?

Diagnostic labels may negatively impact on clinicians' judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

Question: An experimental Investigation of the Impact of Personality Disorder Diagnosis on Clinicians: Can We See Past the Borderline? Answer: Diagnostic labels may negatively impact on clinicians' judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

Answer the question based on the following context: To evaluate the effect of the oral synthetic delta-9-tetrahydrocannabinol dronabinol on central neuropathic pain in patients with multiple sclerosis. Randomised double blind placebo controlled crossover trial. Outpatient clinic, University Hospital of Aarhus, Denmark. 24 patients aged between 23 and 55 years with multiple sclerosis and central pain. Orally administered dronabinol at a maximum dose of 10 mg daily or corresponding placebo for three weeks (15-21 days), separated by a three week washout period. Median spontaneous pain intensity (numerical rating scale) in the last week of treatment. Median spontaneous pain intensity was significantly lower during dronabinol treatment than during placebo treatment (4.0 (25th to 75th centiles 2.3 to 6.0) v 5.0 (4.0 to 6.4), P = 0.02), and median pain relief score (numerical rating scale) was higher (3.0 (0 to 6.7) v>0 (0 to 2.3), P = 0.035). The number needed to treat for 50% pain relief was 3.5 (95% confidence interval 1.9 to 24.8). On the SF-36 quality of life scale, the two items bodily pain and mental health indicated benefits from active treatment compared with placebo. The number of patients with adverse events was higher during active treatment, especially in the first week of treatment. The functional ability of the multiple sclerosis patients did not change.

Does the cannabinoid dronabinol reduce central pain in multiple sclerosis?

Dronabinol has a modest but clinically relevant analgesic effect on central pain in patients with multiple sclerosis. Adverse events, including dizziness, were more frequent with dronabinol than with placebo during the first week of treatment.

Question: Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Answer: Dronabinol has a modest but clinically relevant analgesic effect on central pain in patients with multiple sclerosis. Adverse events, including dizziness, were more frequent with dronabinol than with placebo during the first week of treatment.