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Answer the question based on the following context: Portal hypertension has been reported as a negative prognostic factor and a relative contraindication for liver resection. This study considers a possible role of fibrosis evaluation by transient elastography (FibroScan(®)) and its correlation with portal hypertension in patients with cirrhosis, and discusses the use of this technique in planning therapeutic options in patients with hepatocellular carcinoma (HCC). A total of 77 patients with cirrhosis, 42 (54.5%) of whom had HCC, were enrolled in this study during 2009-2011. The group included 46 (59.7%) men. The mean age of the sample was 65.2 years. The principle aetiology of disease was hepatitis C virus (HCV)-related cirrhosis (66.2%). Liver function was assessed according to Child-Pugh classification. In all patients liver stiffness (LS) was measured using FibroScan(®). The presence of portal hypertension was indirectly defined as: (i) oesophageal varices detectable on endoscopy; (ii) splenomegaly (increased diameter of the spleen to ≥ 12 cm), or (iii) a platelet count of<100,000 platelets/mm(3). Median LS in all patients was 27.9 kPa. Portal hypertension was recorded as present in 37 patients (48.1%) and absent in 40 patients (51.9%). Median LS values in HCC patients with and without portal hypertension were 29.1 kPa and 19.6 kPa, respectively (r = 0.26, P<0.04). Liver stiffness was used to implement the Barcelona Clinic Liver Cancer algorithm in decisions about treatment.

Does transient elastography (FibroScan®) have a role in decision making in hepatocellular carcinoma?

The evaluation of liver fibrosis by transient elastography may be useful in the follow-up of patients with cirrhosis and a direct correlation with portal hypertension may aid in the evaluation of surgical risk in patients with HCC and in the choice of alternative therapies.

Question: Does transient elastography (FibroScan®) have a role in decision making in hepatocellular carcinoma? Answer: The evaluation of liver fibrosis by transient elastography may be useful in the follow-up of patients with cirrhosis and a direct correlation with portal hypertension may aid in the evaluation of surgical risk in patients with HCC and in the choice of alternative therapies.

Answer the question based on the following context: Laparoscopic colectomy is often complicated by adhesions. Studies examining the morbidity of laparoscopic lysis of adhesions (LOA) combined with colectomy are sparse. The goal of this study was to prospectively evaluate the results of using the harmonic scalpel to lyse adhesions in patients undergoing laparoscopic colectomy. Laparoscopic colectomy was performed in 83 patients between November 2003 and April 2007. A total of 20 patients underwent laparoscopic colectomy with LOA and 53 patients underwent laparoscopic colectomy alone. Patients were prospectively followed to determine operative time (OT), blood loss, operative conversion, length of stay (LOS), and 30-day morbidity. Operative conversion was 2%, mean estimated blood loss (EBL) was 95+/-84 mL, and mean OT was 220+/-64 minutes. There were no anastomotic leaks or perioperative mortalities. There were 9 major complications (11%). Patients undergoing laparoscopic colectomy with LOA (n=20) compared with patients undergoing laparoscopic colectomy alone (n=63) had similar conversion rates (5% vs 2%), EBL (115+/-108 vs 88+/-74 mL), and major complications (15% vs 10%), but prolonged minor complications (25% vs 6%) and LOS (6.0+/-3.0 vs 4.6+/-1.5 days).

Is operative conversion necessary for patients diagnosed with dense adhesions during an elective laparoscopic colectomy?

Laparoscopic LOA combined with colectomy leads to similar conversion rates and major morbidity compared to laparoscopic colectomy alone.

Question: Is operative conversion necessary for patients diagnosed with dense adhesions during an elective laparoscopic colectomy? Answer: Laparoscopic LOA combined with colectomy leads to similar conversion rates and major morbidity compared to laparoscopic colectomy alone.

Answer the question based on the following context: Chronic pain is common in persons with multiple sclerosis (MS), but the co-morbidity of fibromyalgia (FM) has yet to be investigated in MS. Objectives of the study were to evaluate, among the various types of chronic pain, the frequency of FM in MS and its impact on MS patients' health-related quality of life (HRQoL). 133 MS patients were investigated for the presence and characterization of chronic pain within 1 month of assessment. A rheumatologist assessed the presence FM according to the 1990 ACR diagnostic criteria. Depression, fatigue, and HRQoL were also assessed by means of specific scales. Chronic pain was present in 66.2% of patients (musculoskeletal in 86.3%; neuropathic in 13.7%; absent in 33.8% [called NoP]). Pain was diagnosed with FM (PFM+) in 17.3% of our MS patients, while 48.9% of them had chronic pain not FM type (PFM-); the prevalence of neuropathic pain in these 2 sub-groups was the same. PFM+ patients were prevalently females and had a higher EDSS than NoP. The PFM+ patients had a more pronounced depression than in the NoP group, and scored the worst in both physical and mental QoL.

Chronic pain in multiple sclerosis: is there also fibromyalgia?

In our sample of MS patients we found a high prevalence of chronic pain, with those patients displaying a higher disability and a more severe depression. Moreover, FM frequency, significantly higher than that observed in the general population, was detected among the MS patients with chronic pain. FM occurrence was associated with a stronger impact on patients' QoL.

Question: Chronic pain in multiple sclerosis: is there also fibromyalgia? Answer: In our sample of MS patients we found a high prevalence of chronic pain, with those patients displaying a higher disability and a more severe depression. Moreover, FM frequency, significantly higher than that observed in the general population, was detected among the MS patients with chronic pain. FM occurrence was associated with a stronger impact on patients' QoL.

Answer the question based on the following context: To evaluate the efficacy and side effects of concentrated versus dilute botulinum toxin A in treating benign essential blepharospasm. The authors performed a prospective randomized clinical trial of 16 patients with an established diagnosis of benign essential blepharospasm. Patients were randomized to receive low concentration (control, 10 U/ml) injections on one side and high concentration (experimental, 100 U/ml) injections on the other. They were surveyed on a scale of 1 to 10 regarding pain, bruising, and redness immediately after the injection. During their return visit, at an established interval of 1 to 3 months, patients were questioned regarding complications (ptosis, diplopia, tearing, and dry eye), duration of relief, and side preferred. Patients were followed over 8 months for 1 to 6 repeat injections, with the side given the higher concentration alternated at each visit. With 16 patients, there were a total of 42 visits and 84 observations (eyes) documented. Using the Wilcoxon rank sum test, there was a statistically significant reduction in pain scores (1.94 vs. 4.59, p<0.001) on the experimental side versus the control side. Patient assessment revealed no significant difference in bruising, redness, complications of injection, side preference, or length of relief of symptoms.

High versus low concentration botulinum toxin A for benign essential blepharospasm: does dilution make a difference?

Compared with the control, the high concentration botulinum toxin A demonstrated a 58% reduction in perceived pain. Patients did not report a significant difference in efficacy or complications with either dilution.

Question: High versus low concentration botulinum toxin A for benign essential blepharospasm: does dilution make a difference? Answer: Compared with the control, the high concentration botulinum toxin A demonstrated a 58% reduction in perceived pain. Patients did not report a significant difference in efficacy or complications with either dilution.

Answer the question based on the following context: To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones. We retrospectively reviewed paired MRI scans obtained before and after PAE for 25 patients and evaluated changes in volumes of the median lobe (ML), central gland (CG), peripheral zone (PZ) and whole prostate gland (WPV) following PAE. We used manual segmentation to calculate volume on axial view T2-weighted images for ML, CG and WPV. We calculated PZ volume by subtracting CG volume from WPV. Enhanced phase on dynamic contrasted-enhanced MRI was used to evaluate the infarction areas after PAE. Clinical results of International Prostate Symptom Score and International Index of Erectile Function questionnaires and the urodynamic study were evaluated before and after PAE. Significant reductions in volume were observed after PAE for ML (26.2 % decrease), CG (18.8 %), PZ (16.4 %) and WPV (19.1 %; p < 0.001 for all these volumes). Patients with clinical failure had smaller volume reductions for WPV, ML and CG (all p < 0.05). Patients with significant CG infarction after PAE displayed larger WPV, ML and CG volume reductions (all p < 0.01).

Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone?

PAE can significantly decrease WPV, ML, CG and PZ volumes, and poor clinical outcomes are associated with smaller volume reductions.

Question: Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? Answer: PAE can significantly decrease WPV, ML, CG and PZ volumes, and poor clinical outcomes are associated with smaller volume reductions.

Answer the question based on the following context: Retrospective review of records of late preterm infants with complex CHD infants that were cared for in a single tertiary perinatal center between 2002 and 2009. Multivariate logistic regression analysis was performed to determine which of the risk factors commonly associated with death prior to discharge from the hospital predict the outcome (hospital death). Of the 106 late preterm infants with complex CHD, 31(29%) died and 15 (14%) received PNS. Endotracheal intubation in the delivery room (42% vs 15%), necrotizing enterocolitis (10% vs 0%) and hypoplastic left heart syndrome (52% vs 25%) were statistically more frequent in non-surviving infants. Non-surviving infants were more frequently treated with PNS (23% vs 11%) but this difference was not statistically significant (p = 0.131). Using logistic regression analysis, delivery room intubation (OR 4.91; 95% CI 1.78 - 13.51) and the hypoplastic left heart syndrome (OR 3.29; 95% CI 1.28 - 8.48), but not prenatal steroids were independently associated with increased risk of hospital death.

Do prenatal steroids improve the survival of late preterm infants with complex congenital heart defects?

In a selected population of late preterm infants with complex CHD, prenatal steroid treatment did not independently influence survival.

Question: Do prenatal steroids improve the survival of late preterm infants with complex congenital heart defects? Answer: In a selected population of late preterm infants with complex CHD, prenatal steroid treatment did not independently influence survival.

Answer the question based on the following context: To examine associations between sexual behaviour, sexual function and sexual health service use of individuals with depression in the British general population, to inform primary care and specialist services. British general population. 15,162 men and women aged 16-74 years were interviewed for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), undertaken in 2010-2012. Using age-adjusted ORs (aAOR), relative to a comparator group reporting no treatment or symptoms, we compared the sexual health of those reporting treatment for depression in the past year. Sexual risk behaviour, sexual function, sexual satisfaction and sexual health service use. 1331 participants reported treatment for depression (5.2% men; 11.8% women). Relative to the comparator group, treatment for depression was associated with reporting 2 or more sexual partners without condoms (men aAOR 2.07 (95% CI 1.38 to 3.10); women 2.22 (1.68 to 2.92)), and concurrent partnerships (men 1.80 (1.18 to 2.76); women 2.06 (1.48 to 2.88)), in the past year. Those reporting depression treatment were more likely to be dissatisfied with their sex lives (men 2.32 (1.74 to 3.11); women 2.30 (1.89 to 2.79)), and to score in the lowest quintile on the Natsal-sexual function measure. They were also more likely to report a recent chlamydia test (men 1.92 (1.15 to 3.20)); women (1.27 (1.01 to 1.60)), and to have sought help regarding their sex life from a healthcare professional (men 2.92 (1.98 to 4.30); women (2.36 (1.83 to 3.04)), most commonly from a family doctor. Women only were more likely to report attending a sexual health clinic (1.91 (1.42 to 2.58)) and use of emergency contraception (1.98 (1.23 to 3.19)). Associations were broadly similar for individuals with depressive symptoms but not reporting treatment.

Are depression and poor sexual health neglected comorbidities?

Depression, measured by reported treatment, was strongly associated with sexual risk behaviours, reduced sexual function and increased use of sexual health services, with many people reporting help doing so from a family doctor. The sexual health of depressed people needs consideration in primary care, and mental health assessment might benefit people attending sexual health services.

Question: Are depression and poor sexual health neglected comorbidities? Answer: Depression, measured by reported treatment, was strongly associated with sexual risk behaviours, reduced sexual function and increased use of sexual health services, with many people reporting help doing so from a family doctor. The sexual health of depressed people needs consideration in primary care, and mental health assessment might benefit people attending sexual health services.

Answer the question based on the following context: Some single photon emission computed tomography (SPECT) methods to detect percent myocardial wall thickening (%WT) assume a linear relationship to changes in maximum myocardial counts, predicated on myocardial walls never exceeding the SPECT camera's partial volume limit. Recent studies have challenged such assumptions, reporting that systolic count changes underestimate wall thickening as measured by echocardiography and magnetic resonance imaging. To test whether clinical data ever are observed to exceed the partial volume limit, we examined gated tomograms of 75 patients selected at random and of an additional 25 patients known to have hypertension with electrocardiographic evidence of left ventricular hypertrophy. Image transformations were performed such that for every cinematic frame, radial counts at every angle were automatically normalized to the same maximum count. If no patient's myocardium ever exceeded the partial volume limit, thickness quantified from transformed images would always be the same throughout the cardiac cycle and would just correspond to the camera's line spread function. Thickness was measured by Gaussian fitting of transformed myocardial counts in the epicardial direction only to exclude cavitary count contamination. % WT was computed from thickness differences from diastole to systole. % WT values were assessed from clinical data at lateral, inferior, septal, anterior, and apical territories. Resulting %WT distributions were tested against the null hypothesis of %WT = 0 by the Z-test. Although some distributions were not actually Gaussian, the maximum mean %WT was only +3% +/-5% for the septal wall, in agreement with an observer's impressions of no detectable wall thickening. Thus mean %WT values were trivial compared with expected physiologic normal values of 30% to 50%.

Do patient data ever exceed the partial volume limit in gated SPECT studies?

No convincing evidence was found of thickness above the partial volume limit in this large sample of 75 normotensive and 25 hypertensive patients. Therefore it is likely that relations between myocardial count increases and wall thickening are similar throughout the cardiac cycle, even in patients with left ventricular hypertrophy.

Question: Do patient data ever exceed the partial volume limit in gated SPECT studies? Answer: No convincing evidence was found of thickness above the partial volume limit in this large sample of 75 normotensive and 25 hypertensive patients. Therefore it is likely that relations between myocardial count increases and wall thickening are similar throughout the cardiac cycle, even in patients with left ventricular hypertrophy.

Answer the question based on the following context: Chlamydia prevalence in the general population is a potential outcome measure for the evaluation of chlamydia control programmes. We carried out a pilot study to determine the feasibility of using a postal survey for population-based chlamydia prevalence monitoring. Postal invitations were sent to a random sample of 2000 17-year-old to 18-year-old women registered with a general practitioner in two pilot areas in England. Recipients were randomised to receive either a self-sampling kit (n=1000), a self-sampling kit and offer of £5 voucher on return of sample (n=500) or a self-sampling kit on request (n=500). Participants returned a questionnaire and self-taken vulvovaginal swab sample for unlinked anonymous Chlamydia trachomatis testing. Non-responders were sent a reminder letter 3 weeks after initial invitation. We calculated the participation rate (number of samples returned/number of invitations sent) and cost per sample returned (including cost of consumables and postage) in each group. A total of 155/2000 (7.8%) samples were returned with consent for testing. Participation rates varied by invitation group: 7.8% in the group who were provided with a self-sampling kit, 14% in the group who were also offered a voucher and 1.0% in the group who were not sent a kit. The cost per sample received was lowest (£36) in the group who were offered both a kit and a voucher.

Can we use postal surveys with anonymous testing to monitor chlamydia prevalence in young women in England?

The piloted survey methodology achieved low participation rates. This approach is not suitable for population-based monitoring of chlamydia prevalence among young women in England.

Question: Can we use postal surveys with anonymous testing to monitor chlamydia prevalence in young women in England? Answer: The piloted survey methodology achieved low participation rates. This approach is not suitable for population-based monitoring of chlamydia prevalence among young women in England.

Answer the question based on the following context: In a recent study, the authors demonstrated the beneficial effect of proton-pump inhibitors (PPI) on fat malabsorption and bone mineral content in children with cystic fibrosis (CF). Prolonged use of PPI could result in vitamin B(12) deficiency as a consequence of impaired release of vitamin B(12) from food in a nonacid environment. The aim of this study was to evaluate the vitamin B 12 status of CF patients either treated with a PPI or not by measuring vitamin B(12) and homocysteine blood levels, the latter being a sensitive indicator of vitamin B(12) deficiency. The study population consisted of 20 CF patients, 11 patients treated with a PPI for at least 2 years and 9 patients not treated with a PPI, and 10 healthy, age-matched control participants. Homocysteine blood levels were measured by high-performance liquid chromatography, and vitamin B(12) levels were measured by a competitive protein-binding assay. Vitamin B(12) levels were significantly higher in both CF groups compared with the control participants (PPI+, P = 0.02; PPI-, P = 0.009). There was no significant difference in vitamin B(12) levels between both CF groups. Homocysteine levels were normal and similar in all groups.

Are children with cystic fibrosis who are treated with a proton-pump inhibitor at risk for vitamin B(12) deficiency?

Cystic fibrosis patients treated with a PPI for at least 2 years show no signs of vitamin B(12) deficiency.

Question: Are children with cystic fibrosis who are treated with a proton-pump inhibitor at risk for vitamin B(12) deficiency? Answer: Cystic fibrosis patients treated with a PPI for at least 2 years show no signs of vitamin B(12) deficiency.

Answer the question based on the following context: Genetic modification of donor dendritic cells (DC) is a potential therapy for allograft rejection. We hypothesized that in vitro interleukin-10 (IL)-10-transfected DC (DC-IL-10) may induce allogeneic T-cell apoptosis, resulting in prolonged allograft survival rat small intestine. Myeloid DC from Wistar-Furth rats (RT-1u) were propagated with rrGM-CSFand rrIL-4,then genetically modified to express the hIL-10 gene. Secretion of IL-10 was quantitated by enzyme-linked immunosorbent assay (ELISA). Allogeneic T cells from Lewis (LEW; RT-1(l)) at proliferative responses were determined by MTT assay in primary mixed leukocyte reactions. We then used a combination of DNA agarose gel electrophoresis, acridine orange staining, and Annexin V/propridium iodide assays to examine apoptosis of allogeneic T cells exposed to DC-IL-10. Then 5 x 10(6) donor-derived DC-IL-10 or untransduced DC were injected intravenously 7 days before small intestine transplantation (WF-->LEW). DC-IL-10 showed pronounced impairment of T-cell allostimulatory activity. Apoptotic T cells were detected in the DC-IL-10 group. Flow cytometry counting at 72 hours showed 45.1% apoptotic T cells in response to DC-IL-10, whereas the untransduced group did not undergo significant apoptosis (P<.01). DC-IL-10 pretreated recipients showed moderate prolongation of allograft survival compared with controls (20.7 +/- 6.0 days vs 7.5 +/- 2.2 days, P<.01).

Allogeneic T-cell apoptosis induced by interleukin-10-modified dendritic cells: a mechanism of prolongation of intestine allograft survival?

DC-IL-10 induced allogeneic T-cell hyporesponsiveness in vitro, possibly due to apoptosis. DC-IL-10 pretreated recipients displayed prolonged intestinal allograft survival rates.

Question: Allogeneic T-cell apoptosis induced by interleukin-10-modified dendritic cells: a mechanism of prolongation of intestine allograft survival? Answer: DC-IL-10 induced allogeneic T-cell hyporesponsiveness in vitro, possibly due to apoptosis. DC-IL-10 pretreated recipients displayed prolonged intestinal allograft survival rates.

Answer the question based on the following context: The relationships between fasting plasma levels of retinol, ascorbic acid, alpha-tochopherol, and beta-carotene and age-related macular degeneration (AMD) were studied in a population enrolled in the Baltimore Longitudinal Study of Aging (BLSA), in which most of the data were collected 2 or more years before assessment of macular status. A total of 976 participants in the study were scheduled for a biennial examination from January 1988 through January 1, 1990, which included taking lens and macular photographs. A total of 827 (85%) of the participants had fundus photographs taken, and most plasma data were available for 82% of those subjects with fundus photographs. Age-related macular degeneration was defined as neovascular changes, geographic and nongeographic atrophy, large or confluent drusen, or hyperpigmentation. A total of 226 cases of AMD were available for analysis. Logistic regression analyses suggested that alpha-tocopherol was associated with a protective effect for AMD, adjusted for age, sex, and nuclear opacity. An antioxidant index, including ascorbic acid, alpha-tocopherol, and beta-carotene, was also protective for AMD. Our conclusions must be tempered with the knowledge that the population under study was basically well nourished, and few individuals had any clinically deficient status. The study cannot exclude the possibility that quite low levels of micronutrients, lower than those observed in this study, might be risk factors for AMD.

Are antioxidants or supplements protective for age-related macular degeneration?

The data suggest a protective effect for AMD of high plasma values of alpha-tocopherol. An antioxidant index, composed of plasma ascorbic acid, alpha-tocopherol, and beta-carotene, was also protective. The use of vitamin supplements to prevent AMD is not supported by these data, which showed no protective effect of vitamin use.

Question: Are antioxidants or supplements protective for age-related macular degeneration? Answer: The data suggest a protective effect for AMD of high plasma values of alpha-tocopherol. An antioxidant index, composed of plasma ascorbic acid, alpha-tocopherol, and beta-carotene, was also protective. The use of vitamin supplements to prevent AMD is not supported by these data, which showed no protective effect of vitamin use.

Answer the question based on the following context: To test the hypothesis that there is no significant difference in the rate of prostate cancer (PCa) detection rate between the transrectal and transperineal approach in men undergoing a saturation (24-core) prostate rebiopsy. We evaluated 472 consecutive men who underwent a 24-core prostate rebiopsy at 2 tertiary referral centers. Of these, 70% (332) underwent a transrectal biopsy, and 30% (140) underwent a transperineal biopsy. Propensity score was used to match 280 patients with homogeneous characteristics; those represented the final study cohort. Univariable and multivariable logistic regression analyses were used to address the relationship between biopsy approach and PCa detection rate. Covariates consisted of age at biopsy, prostate-specific antigen, total prostate volume, digital rectal examination findings, histologic findings on previous biopsy, and the number of previous negative biopsy sets. Overall, PCa detection rate was 28.6%. There was no statistically significant difference in PCa detection rate between the transrectal and transperineal approach (31.4% vs 25.7%, respectively; P = .3). The type of approach was not an independent predictor of PCa detection rate at multivariable analyses (odds ratio = 0.61, P = .1).

Trans-rectal versus trans-perineal saturation rebiopsy of the prostate: is there a difference in cancer detection rate?

Transrectal and transperineal prostate saturation biopsies have a similar PCa detection rate in men undergoing a saturation rebiopsy. Both approaches can be offered to men undergoing a prostate rebiopsy without undermining the rate of PCa detection.

Question: Trans-rectal versus trans-perineal saturation rebiopsy of the prostate: is there a difference in cancer detection rate? Answer: Transrectal and transperineal prostate saturation biopsies have a similar PCa detection rate in men undergoing a saturation rebiopsy. Both approaches can be offered to men undergoing a prostate rebiopsy without undermining the rate of PCa detection.

Answer the question based on the following context: The aim of study was to evaluate the relationship between serum cystatin C and insulin resistance (IR) in type 1 diabetic patients being the participants of Poznan Prospective Study. The study was performed on 71 Caucasian patients (46 men); with type 1 diabetes, who were recruited into the Poznan Prospective Study, at the age of 39±6.1 meanly, and treated with intensive insulin therapy since the onset of the disease. The follow-up period and diabetes duration were 15±1.6 years. Insulin resistance (IR) was assessed by estimated glucose disposal rate (eGDR) calculation with cut-off point 7.5 mg/kg/min. Patients were divided into two groups, according to the presence or absence of IR. From among 71 patients, 31 patients (43.7%) presented decreased sensitive to insulin with eGDR below 7.5 mg/kg/min. Patients who had eGDR<7.5 mg/kg/min (insulin resistant), compared with subjects with eGDR>7.5 mg/kg/min (insulin sensitive), had higher level of serum cystatin C [0.59 (IQR:0.44-0.84) vs 0.46 (IQR:0.37-0.55) mg/L, p=0.009]. A significant negative correlation between cystatin C and eGDR was revealed (Rs=-0.39, p=0.001). In regression model cystatin C was related to insulin resistance, adjusted for sex, BMI, eGFR and duration of diabetes [OR 0.03 (0.001-0.56), p=0.01].

Does serum cystatin C level reflect insulin resistance in patients with type 1 diabetes?

Higher level of serum cystatin C is related to decreased insulin sensitivity in patients with type 1 diabetes. This relationship seems to have an important clinical implication.

Question: Does serum cystatin C level reflect insulin resistance in patients with type 1 diabetes? Answer: Higher level of serum cystatin C is related to decreased insulin sensitivity in patients with type 1 diabetes. This relationship seems to have an important clinical implication.

Answer the question based on the following context: Tissue that is resected for the treatment of oral tumors often includes salivary gland ducts. At their institution, the authors conserve and transfer as much of the salivary duct as possible during these procedures to avoid obstructive complications. Differentiating these obstructive complications from a metastatic node can be challenging and can confound subsequent oncologic management. This study compared and examined the effectiveness of salivary duct repositioning in decreasing the incidence of obstructive complications. Cases of oromandibular disease treated with salivary duct resection at Kobe University Graduate School of Medicine from 2008 to 2013 were retrospectively analyzed. Thirty-two cases (25 patients) of Wharton duct resection and 31 cases (31 patients) of Stensen duct resection were included. The incidence of complications after salivary duct repositioning, duct ligation, and retention of the sublingual gland around the Wharton duct was compared. Wharton ducts were repositioned in 30 cases and ligated in 2 cases. Complications, including oral swelling at the Wharton duct, were observed in 5 cases of repositioning and 2 cases of ligation. Stensen ducts were repositioned in 9 cases and ligated in 22 cases. The only complication reported was a single case of salivary fistula after ligation.

Does salivary duct repositioning prevent complications after tumor resection or salivary gland surgery?

Salivary duct repositioning is performed to prevent blockage of physiologic salivary discharge. Complications were more frequently associated with Wharton ducts than with Stensen ducts because of the unique physiologic and anatomic characteristics of the Wharton duct. Repositioning of the salivary duct is a suitable method for preventing complications associated with the Wharton duct.

Question: Does salivary duct repositioning prevent complications after tumor resection or salivary gland surgery? Answer: Salivary duct repositioning is performed to prevent blockage of physiologic salivary discharge. Complications were more frequently associated with Wharton ducts than with Stensen ducts because of the unique physiologic and anatomic characteristics of the Wharton duct. Repositioning of the salivary duct is a suitable method for preventing complications associated with the Wharton duct.

Answer the question based on the following context: Patellofemoral pain (PFP) has often been attributed to abnormal hip and knee mechanics in females. To date, there have been few investigations of the hip and knee mechanics of males with PFP. The purpose of this study was to compare the lower extremity mechanics and alignment of male runners with PFP with healthy male runners and female runners with PFP. We hypothesized that males with PFP would move with greater varus knee mechanics compared with male controls and compared with females with PFP. Furthermore, it was hypothesized that males with PFP would demonstrate greater varus alignment. A gait and single-leg squat analysis was conducted on each group (18 runners per group). Measurement of each runner's tibial mechanical axis was also recorded. Motion data were processed using Visual 3D (C-Motion, Bethesda, MD). ANOVAs were used to analyze the data. Males with PFP ran and squatted in greater peak knee adduction and demonstrated greater peak knee external adduction moment compared with healthy male controls. In addition, males with PFP ran and squatted with less peak hip adduction and greater peak knee adduction compared with females with PFP. The static measure of mechanical axis of the tibial was not different between groups. However, a post hoc analysis revealed that males with PFP ran with greater peak tibial segmental adduction.

Are mechanics different between male and female runners with patellofemoral pain?

Males with PFP demonstrated different mechanics during running and during a single-leg squat compared with females with PFP and with healthy males. Based upon the results of this study, therapies for PFP may need to be sex specific.

Question: Are mechanics different between male and female runners with patellofemoral pain? Answer: Males with PFP demonstrated different mechanics during running and during a single-leg squat compared with females with PFP and with healthy males. Based upon the results of this study, therapies for PFP may need to be sex specific.

Answer the question based on the following context: Controversy still exists regarding the position of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis of colorectal carcinoma. The goal of the current study was to evaluate the opinions about this treatment among Dutch oncologic surgeons and medical oncologists. An online survey was sent to all known Dutch oncologic surgeons (n = 459) and medical oncologists (n = 363) representing the respective departments of 84 hospitals. A comparison was made between surgeons and oncologists. 185 eligible responses were received from 71 hospitals, resulting in a response rate of 23 % for individuals and a response rate of 85 % for hospitals. Overall, 65 % of respondents regarded CRS+HIPEC as effective with sufficient evidence, 29 % responded that CRS+HIPEC is probably effective without sufficient evidence, and 7 % of respondents regards HIPEC as probably ineffective. Medical oncologists were less convinced of the effectiveness of CRS+HIPEC than surgeons (P = 0.006). Of all the respondents, 68 % indicated that they regard CRS+HIPEC as a standard treatment for patients with peritoneal dissemination of colorectal carcinoma (77 % of surgeons vs 54 % of oncologists, P = 0.001). Additionally, 68 % of respondents regard CRS+HIPEC as potentially curative (77 % of surgeons vs 54 % of oncologists, P = 0.001).

Cytoreductive surgery and HIPEC in treatment of colorectal peritoneal carcinomatosis: experiment or standard care?

Approximately 30 % of physicians who treat colorectal carcinoma do not regard CRS+HIPEC as standard care. Surgeons appear to be significantly more in favor of this treatment than medical oncologists. This study shows that efforts should be made to improve knowledge and increase acceptance of CRS and HIPEC in colorectal cancer treatment among medical oncologists and surgeons.

Question: Cytoreductive surgery and HIPEC in treatment of colorectal peritoneal carcinomatosis: experiment or standard care? Answer: Approximately 30 % of physicians who treat colorectal carcinoma do not regard CRS+HIPEC as standard care. Surgeons appear to be significantly more in favor of this treatment than medical oncologists. This study shows that efforts should be made to improve knowledge and increase acceptance of CRS and HIPEC in colorectal cancer treatment among medical oncologists and surgeons.

Answer the question based on the following context: The use of the laparoscopic approach in colorectal surgery (LCS) is the subject of active debate. Studies demonstrating its safety and feasibility in tertiary care centres are now available. The aim of this study was to examine the results of LCS performed in a community hospital setting. We prospectively studied 100 patients who underwent an LCS at the North Bay District Hospital (a 200-bed community hospital located 350 km away from the nearest tertiary care centre). All operations were performed by 2 community surgeons who transitioned themselves from an open to a laparoscopic approach. Between October 2000 and December 2003, 100 patients (56 women and 44 men, mean age 64 yr) underwent an LCS for benign (n = 54) and malignant (n = 46) disease. Median operating time was 165 minutes (range 70350 min), and the conversion rate was 10%. The intraoperative complication rate was 3%. There were 10 major postoperative complications and 14 minor postoperative complications. There was no intraoperative mortality and one 30-day mortality secondary to cardiogenic shock. The median length of stay was 4.5 days (range 245 d). At a mean follow-up of 18 months, no trocar site or wound recurrences were noted. The mean number of resected lymphnodes was 10.6.

Can community surgeons perform laparoscopic colorectal surgery with outcomes similar to tertiary care centres?

Our study suggests that it is possible for community surgeons to transition themselves from an open to a laparoscopic approach and to perform LCS with outcomes similar to those of tertiary care centres.

Question: Can community surgeons perform laparoscopic colorectal surgery with outcomes similar to tertiary care centres? Answer: Our study suggests that it is possible for community surgeons to transition themselves from an open to a laparoscopic approach and to perform LCS with outcomes similar to those of tertiary care centres.

Answer the question based on the following context: Wine glass size can influence both perceptions of portion size and the amount poured, but its impact upon purchasing and consumption is unknown. This study aimed to examine the impact of wine glass size on wine sales for on-site consumption, keeping portion size constant. In one establishment (with separate bar and restaurant areas) in Cambridge, England, wine glass size (Standard; Larger; Smaller) was changed over eight fortnightly periods. The bar and restaurant differ in wine sales by the glass vs. by the bottle (93 % vs. 63 % by the glass respectively). Daily wine volume purchased was 9.4 % (95 % CI: 1.9, 17.5) higher when sold in larger compared to standard-sized glasses. This effect seemed principally driven by sales in the bar area (bar: 14.4 % [3.3, 26.7]; restaurant: 8.2 % [-2.5, 20.1]). Findings were inconclusive as to whether sales were different with smaller vs. standard-sized glasses.

Does wine glass size influence sales for on-site consumption?

The size of glasses in which wine is sold, keeping the portion size constant, can affect consumption, with larger glasses increasing consumption. The hypothesised mechanisms for these differential effects need to be tested in a replication study. If replicated, policy implications could include considering glass size amongst alcohol licensing requirements.

Question: Does wine glass size influence sales for on-site consumption? Answer: The size of glasses in which wine is sold, keeping the portion size constant, can affect consumption, with larger glasses increasing consumption. The hypothesised mechanisms for these differential effects need to be tested in a replication study. If replicated, policy implications could include considering glass size amongst alcohol licensing requirements.

Answer the question based on the following context: The Department of Health in KwaZulu-Natal (KZN) has run a surgical outreach programme for over a decade.Objective. To quantify the impact of the outreach programme by analysing its effect on the operative capacity of a single rural health district. During 2012, investigators visited each district hospital in Sisonke Health District (SHD), KZN to quantify surgery undertaken by resident staff between 1998 and 2013. Investigators also reviewed the operative registers of the four district hospitals in SHD for a 6-month period (March - August 2012) to document the surgery performed at each hospital. The number of staff who attended specialist-based teaching was recorded in an attempt to measure the impact of each visit. From 1998 to 2013, 35 385 patients were seen at 1 453 clinics, 5 199 operations were performed and 1 357 patients were referred to regional hospitals. A total of 3 027 staff attended teaching ward rounds and teaching sessions. In the four district hospitals, 2 160 operations were performed in the 6-month period. There were 653 non-obstetrical operations and the obstetric cases comprised 1 094 caesarean sections, 55 sterilisations and 370 evacuations of the uterus.

Surgical outreach in rural South Africa: are we managing to impart surgical skills?

The infrastructure is well established and the outreach programme is well run and reliable. The clinical outputs of the programme are significant. However, the impact of this programme on specific outcomes is less certain. This raises the question of the future strategic choices that need to be made in our attempts to improve access to surgical care.

Question: Surgical outreach in rural South Africa: are we managing to impart surgical skills? Answer: The infrastructure is well established and the outreach programme is well run and reliable. The clinical outputs of the programme are significant. However, the impact of this programme on specific outcomes is less certain. This raises the question of the future strategic choices that need to be made in our attempts to improve access to surgical care.

Answer the question based on the following context: To assess nongeneticist physicians' knowledge and experience with BRCA1/2 testing. In 1998, 2250 internists, obstetrician-gynecologists (Ob-Gyns), and oncologists practicing in Pennsylvania, Maryland, Massachusetts, New York, or New Jersey were surveyed. Forty percent responded. Only 13% of internists, 21% of Ob-Gyns, and 40% of oncologists correctly answered all four knowledge questions about genetic aspects of breast cancer and testing for it. Knowledge was associated with discussing or ordering only among oncologists.

Does knowledge about the genetics of breast cancer differ between nongeneticist physicians who do or do not discuss or order BRCA testing?

Despite deficiencies in their knowledge about the genetic aspects of breast cancer, many nongeneticist physicians have discussed testing and some have ordered testing.

Question: Does knowledge about the genetics of breast cancer differ between nongeneticist physicians who do or do not discuss or order BRCA testing? Answer: Despite deficiencies in their knowledge about the genetic aspects of breast cancer, many nongeneticist physicians have discussed testing and some have ordered testing.

Answer the question based on the following context: To determine whether hospital discharge diagnoses can be used for intensive care unit (ICU)-related activities. Comparison between the diagnoses coded by physicians at the time of ICU admission and those diagnoses coded by medical records personnel. University hospital adult surgical ICU. Consecutive ICU admissions (n = 622). None. The ICU admission and hospital discharge codes were compared in two ways. Initially, each discharge code was subtracted from the corresponding ICU admission code. There was no difference in 150 (24%) cases. In 216 (35%) patients, the codes differed by +/-10. In 221 (36%) instances, the codes differed by>200. The secondary discharge diagnoses were also compared with the ICU admission diagnoses. In 56 patients, the ICU admission diagnosis was one of the secondary diagnoses. The second comparison involved having two physicians not associated with the study examine each pair of codes to determine if the two diagnoses were medically different. Review of the codes by physicians not involved in the study found that in 318 (48%) patients, the two diagnoses were not different, i.e., the codes were either the same or the codes were so similar as not to functionally change the actual diagnosis.

Can hospital discharge diagnoses be used for intensive care unit administrative and quality management functions?

The primary discharge diagnosis often failed to reflect the reason for ICU admission, making it impossible to consistently establish the reason for ICU admission from the discharge data. The reason for ICU admission was also frequently not included among the secondary discharge diagnoses. Administrative data are therefore not useful for ICU quality management and other functions. Intensivists need to establish their own databases.

Question: Can hospital discharge diagnoses be used for intensive care unit administrative and quality management functions? Answer: The primary discharge diagnosis often failed to reflect the reason for ICU admission, making it impossible to consistently establish the reason for ICU admission from the discharge data. The reason for ICU admission was also frequently not included among the secondary discharge diagnoses. Administrative data are therefore not useful for ICU quality management and other functions. Intensivists need to establish their own databases.

Answer the question based on the following context: The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample. Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency. The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p<.0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p<.05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers.

Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital: direct or disguised assessment?

Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

Question: Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital: direct or disguised assessment? Answer: Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

Answer the question based on the following context: Currently, anaplastic thyroid carcinoma has a very poor prognosis and there is an unmet need for new therapeutic options. Therefore, this study aims to identify upregulated genes in anaplastic thyroid carcinoma with known drug interactions that could serve as new therapeutic targets. Publicly available microarray expression profiles of anaplastic thyroid carcinoma and normal thyroid tissue were collected. FGmRNA-profiling was applied, which is a recently developed method that enhances the ability to capture the downstream effects of genomic alterations on gene expression levels. Next, a comparison between FGmRNA-profiles of anaplastic thyroid carcinoma and normal thyroid samples was performed. Significantly upregulated genes in ATC were prioritized based on: 1) known interaction with antineoplastic drugs, 2) current drug development status in human, and 3) association with biologic pathways known to be involved in anaplastic thyroid carcinoma carcinogenesis. In the study, 25 anaplastic thyroid carcinoma and 80 normal thyroid samples were included for FGmRNA-profiling. Class comparison identified 301 significantly upregulated genes. Following prioritization, MTOR, MET, WEE1, PSMD1, MERTK, FGFR3, RARG, and ESR2 were identified as potential therapeutic targets.

Identification of novel therapeutic targets in anaplastic thyroid carcinoma using functional genomic mRNA-profiling: Paving the way for new avenues?

We prioritized 8 potential therapeutic druggable targets in anaplastic thyroid carcinoma. Ultimately, inhibition of these therapeutic targets might improve patient outcome in anaplastic thyroid carcinoma by reducing locoregional disease and distant metastases.

Question: Identification of novel therapeutic targets in anaplastic thyroid carcinoma using functional genomic mRNA-profiling: Paving the way for new avenues? Answer: We prioritized 8 potential therapeutic druggable targets in anaplastic thyroid carcinoma. Ultimately, inhibition of these therapeutic targets might improve patient outcome in anaplastic thyroid carcinoma by reducing locoregional disease and distant metastases.

Answer the question based on the following context: Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P<0.01]. Similar findings were noted for financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P<0.05; chi2 test). After controlling for covariates, publicly-insured families of CSHCN had significantly lower likelihood of financial burden of>10% or 20% of family income than privately-insured families.

Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

Question: Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs? Answer: Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

Answer the question based on the following context: To update trends in mortality by ethnic group from the New Zealand Census-Mortality Study (NZCMS), by additionally linking 2004-06 mortality records to the 2001 Census. To investigate possible bias from this extended linkage, especially for Pacific and Asian people who emigrate more frequently. Anonymous and probabilistic record linkage of 2004-06 mortality records with the 2001 Census was undertaken. Age-standardised 1-74 year old mortality rates by sex and age group, and for all-cause and selected causes of death, were calculated using the direct method for first 30 months post 2001 Census (2001-03) and second 30 months (2003-06). Observed all-cause mortality rates continued to fall in 2003-06 compared to previous periods, but more so for Pacific (18.3% and 21.7% for males and females for 2003-06 compared to 2001-04, respectively) and Asian (22.2%, 16.7%), than for Maori (13.2%, 14.2%) and European/Other (13.0%, 10.4%). Observed rate ratios for Maori, compared to European/Other were 2.43 (95% CI 2.31-2.57) for males and 2.72 (2.56-2.89) for females, the same (males) and slightly less (7%, females) than in 2001-03. Declines in cardiovascular disease (CVD) and injury mortality were the main drivers of all-cause mortality rate reductions for all ethnic groups. Relative inequalities in CVD between Maori and European/Other remain high (three to four-fold relative risks), but reduced by 8% for both males and females from 2001-03 to 2003-06, which in turn means that absolute inequalities closed by as much as 20%.

Mortality by ethnic group to 2006: is extending census-mortality linkage robust?

We suspect that analyses comparing mortality rates over time within one of the closed NZCMS cohorts (e.g. 2001-03 compared to 2003-06) is prone to bias due to our inability to censor people when they migrate out of New Zealand. This limitation means mortality rates in the NZCMS are increasingly underestimated with time since census night, particularly for Pacific and Asian people. However, previously published NZCMS trends remain valid as the duration of follow-up (3 years) is short, and cohorts were not split by time since census. Nevertheless, it is safe to conclude that mortality rates continued to decline from 2001-03 to 2003-04 for all four ethnic groups. All-cause mortality inequalities for Maori compared to European/Other over this time were probably stable in relative terms and decreasing in absolute terms, but cardiovascular disease (CVD) inequalities probably decreased in both absolute and relative terms.

Question: Mortality by ethnic group to 2006: is extending census-mortality linkage robust? Answer: We suspect that analyses comparing mortality rates over time within one of the closed NZCMS cohorts (e.g. 2001-03 compared to 2003-06) is prone to bias due to our inability to censor people when they migrate out of New Zealand. This limitation means mortality rates in the NZCMS are increasingly underestimated with time since census night, particularly for Pacific and Asian people. However, previously published NZCMS trends remain valid as the duration of follow-up (3 years) is short, and cohorts were not split by time since census. Nevertheless, it is safe to conclude that mortality rates continued to decline from 2001-03 to 2003-04 for all four ethnic groups. All-cause mortality inequalities for Maori compared to European/Other over this time were probably stable in relative terms and decreasing in absolute terms, but cardiovascular disease (CVD) inequalities probably decreased in both absolute and relative terms.

Answer the question based on the following context: Data on bone mineral density (BMD) in Klinefelter syndrome (KS) are scarce and contradictory. The aim of the present study was to investigate BMD in patients with KS and in healthy controls with special attention to gonadal status. We investigated 26 patients with KS (30±9 yr) who had never been treated with testosterone. Thirty-nine age-matched healthy males served as controls. We assessed BMD by performing dual energy X-ray absorptiometry and measured serum hormone levels, including total testosterone (T), free testosterone, estradiol (E2), leptin. The estrogen to androgen ratio (E2/T) was used as an indirect measure for aromatase activity. No difference was found in BMD at femoral neck (1.06 ± 0.16 vs 1.04 ± 0.14 g/cm²), or at lumbar spine (1.00 ± 0.09 vs 1.03 ± 0.11) between patients and controls. Two patients and one control were classified as osteoporotic (T-score ≤ -2.5). Compared with controls, patients had lower levels of T and free testosterone, similar E2 levels, and increased E2/T (P<0.05). In KS patients, leptin was significantly higher and correlated positively with E2/T (r = 0.484, P = 0.02). E2/T correlated with femoral neck BMD (r = 0.566, p = 0.02), T and free T correlated with lumbar spine BMD (r = 0.433, P = 0.05 and r = 0.534, P = 0.05).

Klinefelter's syndrome and bone mineral density: is osteoporosis a constant feature?

Osteoporosis is not a constant feature in young patients with KS, even without testosterone substitution. The aromatisation of T into E2, related to adiposity, may contribute to the achievement and maintenance of normal BMD in some KS patients.

Question: Klinefelter's syndrome and bone mineral density: is osteoporosis a constant feature? Answer: Osteoporosis is not a constant feature in young patients with KS, even without testosterone substitution. The aromatisation of T into E2, related to adiposity, may contribute to the achievement and maintenance of normal BMD in some KS patients.

Answer the question based on the following context: Our objectives were threefold: to evaluate the sensitivity and specificity of laryngeal computed tomography (CT) in the evaluation of laryngeal cancer, to determine the positive and negative predictive values of CT in assessing laryngeal cancer with respect to patient outcome, and to compare the CT staging of laryngeal cancer with endoscopy. We reviewed the records of 77 consecutive patients with endoscopically proven laryngeal cancer. All patients underwent nonhelical CT evaluation of the larynx, with 23 subsequently undergoing surgery and 54 undergoing radiotherapy. The CT findings in the surgical cohort were compared with the pathologic analysis of resected specimens and with endoscopic data using a predetermined checklist of 14 regions of surgical interest. All the CT data in the radiotherapy cohort were compared with patient outcome in an attempt to define regions of tumour involvement that may predict disease recurrence after radiotherapy. CT evaluation of laryngeal cancer had an overall sensitivity of 74% and a specificity of 93%. In the radiotherapy cohort, CT had an overall positive predictive value of 51% and a negative predictive value of 62% for disease recurrence after radiotherapy. Compared with endoscopic examination, CT resulted in upgrading of clinical staging in 43% of patients in the surgical cohort and 33% of patients in the radiotherapy cohort.

Laryngeal cancer: is computed tomography a valuable imaging technique?

Our findings suggest that, despite the superiority of CT over endoscopy in the assessment of laryngeal cancer, this imaging technique is weak in staging advanced laryngeal cancer and is poor in predicting clinical outcome following radiotherapy.

Question: Laryngeal cancer: is computed tomography a valuable imaging technique? Answer: Our findings suggest that, despite the superiority of CT over endoscopy in the assessment of laryngeal cancer, this imaging technique is weak in staging advanced laryngeal cancer and is poor in predicting clinical outcome following radiotherapy.

Answer the question based on the following context: The choice of surgical repair or conservative treatment for iatrogenic tracheobronchial rupture (ITBR) remains controversial. However, thoracic surgeons consider that surgical repair is an important treatment modality. The purpose of this study was to evaluate the clinical results from the perspective of the surgery-preferred group. We treated 11 patients (8 women and 3 men; age: 52.6 ± 22.9 years) with ITBR from January 2011 to January 2016. A posterolateral thoracotomy or a trans-tracheal approach was performed according to the mechanism of injury. Nine patients underwent surgery, and all patients received primary repair. Five patients received a right posterolateral thoracotomy, whereas one patient received a left posterolateral thoracotomy. No mortality or morbidity related to the surgery was observed. The mechanical ventilation time was 65.9 ± 99.2 hours. The intensive care unit duration was 19.7 ± 33.3 days. Two patients received conservative treatment, and all patients died of another disease that was not related to the conservative treatment.

Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture?

Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.

Question: Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Answer: Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.

Answer the question based on the following context: Congenital cytomegalovirus (CMV) infection and mutation of the gap junction β-2 (GJB2) gene are important causes of sensorineural hearing loss (SNHL). This study aims to determine if congenital CMV infection leads to deafness by inducing GJB2 mutation. GJB2 gene sequencing and auditory brainstem response testing were performed in 159 neonates (63 with and 96 without CMV infection) from August 2008 to August 2011. For neonates with GJB2 mutation, their parents were further screened for GJB2 sequence. The incidence of SNHL was 12.7% in CMV-infected but 0% in uninfected children aged 1-1.5 y (P = 0.000). Similar mutation rates of the GJB2 gene were observed in neonates with or without CMV infection (34.9 vs. 32.3%, respectively, P = 0.734). No significant difference in the mutation rate of GJB2 was found among neonates with CMV infection and SNHL, those with CMV infection and normal hearing, and uninfected newborns with normal hearing (P = 0.438). Mutations 79G>A, 109G>A, 341A>G, and 608T>C were found in neonates with and without CMV infection. All of the above mutations were also found in both or one of the corresponding parents.

Does congenital cytomegalovirus infection lead to hearing loss by inducing mutation of the GJB2 gene?

Congenital CMV infections may cause deafness in neonates, but this might be independent of GJB2 gene mutation.

Question: Does congenital cytomegalovirus infection lead to hearing loss by inducing mutation of the GJB2 gene? Answer: Congenital CMV infections may cause deafness in neonates, but this might be independent of GJB2 gene mutation.

Answer the question based on the following context: Gastric polyps, such as adenomas and hyperplastic polyps, can be found in various colonic polyposis syndromes. Unlike in sporadic gastric adenomas, in which the increased risk of colorectal neoplasia has been well characterized, information in sporadic gastric hyperplastic polyps was limited.AIM: To evaluate the association of sporadic gastric hyperplastic polyps with synchronous colorectal neoplasia in a large cohort. Patients with sporadic gastric hyperplastic polyps who underwent colonoscopy simultaneously or within six months were consecutively enrolled. Each patient was compared with two randomly selected age and sex matched controls without gastric polyps who also underwent colonoscopy in the same period. Data of patients' demographics and characteristics of the gastrointestinal polyps were documented. A total of 261 cases in 118,576 patients who underwent esophagogastroduodenoscopy were diagnosed as sporadic gastric hyperplastic polyps, and 192 of 261 (73.6%) patients underwent colonoscopy. Colorectal neoplasias were identified in 46 (24.0%) of 192 cases and in 40 (10.4%) of 384 controls (P＜0.001). The mean size and distribution of colorectal neoplasias were not significantly different between the two groups. There was a significantly higher rate of colorectal adenoma (odds ratio [OR] 3.2, 95% confidence interval [CI]1.9-5.3) in the gastric hyperplastic polyps group than in the control group, while the prevalence of colorectal cancer was similar in the two groups. Logistic regression analysis also suggested that the presence of gastric hyperplastic polyps (OR 2.5, 95% CI 1.5-4.0) was an independent risk factor for colorectal neoplasias.

Is surveillance colonoscopy necessary for patients with sporadic gastric hyperplastic polyps?

The risk of colorectal adenoma increases in patients with sporadic gastric hyperplastic polyps, and surveillance colonoscopy for these patients should be considered.

Question: Is surveillance colonoscopy necessary for patients with sporadic gastric hyperplastic polyps? Answer: The risk of colorectal adenoma increases in patients with sporadic gastric hyperplastic polyps, and surveillance colonoscopy for these patients should be considered.

Answer the question based on the following context: Up to one-third of the children with epilepsy are diagnosed with cryptogenic localization related epilepsy (CLRE). As yet, there is a lack of studies that specify the short- and long-term prognosis for this group. In this study, we systematically established neurological outcome (represented by seizure frequency) as well as neuropsychological outcome in a cohort of 68 children with CLRE who had been referred to our tertiary outpatient clinic. Also, we analysed correlations with risk and prognostic factors. A systematic cross-sectional open clinical and non-randomized design was used including 68 children admitted to our epilepsy centre in a child neurological programme between January 1999 and December 2004. A model was defined, distinguishing risk factors with a potential effect on epileptogenesis (history of febrile seizures, family history of epilepsy, history of early mild development delay and serious diagnostic delay) and prognostic factors, with a potential effect on the course of the epilepsy (neurological symptoms or soft signs, age at onset, duration of epilepsy, seizure type, percentage of time with epileptiform activity, localization of epileptiform activity, treatment history and treatment duration). Seizure frequency was used as the primary outcome variable, whereas three neuropsychological outcomes (IQ, psychomotor delay and educational delay) were used as secondary outcome variables. The children experienced a broad range of seizure types with the 'absence-like' complex partial seizure as the most commonly occurring seizure type. Almost half of the children of the study sample had a high seizure frequency. They experienced several seizures per month, week or even daily seizures. Also a substantial impact on neuropsychological outcome was observed. Mean full scale IQ was 87.7, mean academic delay was almost 1 school year and 27 children showed psychomotor delay on the Movement ABC. Only 'having more than one seizure type' showed a prognostic value for seizure frequency, and no factors were found to be correlated with the secondary outcome measures. None of the risk factors show a differential impact on seizure outcome.

Cryptogenic localization related epilepsy in children from a tertiary outpatient clinic: is neurological and neuropsychological outcome predictable?

CLRE has a non-predictable course; clinical variability is high and prognosis in many children with CLRE is obscure. Having more than one seizure type was the only factor correlated to seizure frequency. Further longitudinal studies are needed.

Question: Cryptogenic localization related epilepsy in children from a tertiary outpatient clinic: is neurological and neuropsychological outcome predictable? Answer: CLRE has a non-predictable course; clinical variability is high and prognosis in many children with CLRE is obscure. Having more than one seizure type was the only factor correlated to seizure frequency. Further longitudinal studies are needed.

Answer the question based on the following context: A prospective cross-sectional study was conducted. Consecutive women who visited at 11-13 + 6 weeks' gestation were enrolled. Subjects were divided into two groups by maternal hemoglobin concentration. Cases with maternal anemia were defined as a hemoglobin level less than 11 g/dl on a blood test (cases), and the others were defined as controls. An ultrasound examination was performed to measure the placental volume and the uterine arterial blood flow. The three-dimensional volume of the placenta using virtual organ computer-aided analysis (VOCAL) technique was acquired by transabdominal ultrasonography. Placental volumes were compared in women with and without anemia. 31 cases and 486 controls were analyzed. Maternal characteristics were not different between two groups except anemia. Placental volumes were 63.6 ± 22.2 and 60.9 ± 22.8 cm(3) (ns), uterine arterial RIs were 0.7 ± 0.1 and 0.8 ± 0.1 (ns), and PIs were 1.7 ± 0.5 and 1.8 ± 0.6 (ns) in cases and controls, respectively.

Is maternal anemia associated with small placental volume in the first trimester?

Maternal anemia was not associated with reduced placental volume and uterine arterial Doppler wave form at 11-13 weeks' gestation.

Question: Is maternal anemia associated with small placental volume in the first trimester? Answer: Maternal anemia was not associated with reduced placental volume and uterine arterial Doppler wave form at 11-13 weeks' gestation.

Answer the question based on the following context: The relationship between volume and outcome in many complex surgical procedures is well established. No published data has examined this relationship in pediatric cardiac transplantation, but low-volume adult heart transplant programs seem to have higher early mortality. The United Network for Organ Sharing (UNOS) provided center-specific data for the 4647 transplants performed on patients younger than 19 years old, 1992 to 2007. Patients were stratified into 3 groups based on the volume of transplants performed in the previous 5 years at that center: low [<19 transplants, n = 1135 (24.4%)], medium [19–62 transplants, n = 2321(50.0%)], and high [≥63 transplants, n= 1191 (25.6%)]. A logistic regression model for postoperative mortality was developed and observed-to-expected (O:E) mortality rates calculated for each group. Unadjusted long-term survival decreased with decreasing center volume (P<0.0001). Observed postoperative mortality was higher than expected at low-volume centers [O:E ratio 1.39, 95% confidence interval (CI) 1.05–1.83]. At low volume centers, high-risk patients (1.34, 0.85–2.12)--especially patients 1 year old or younger (1.60, 1.07–2.40) or those with congenital heart disease (1.36, 0.94–1.96)--did poorly, but those at high-volume centers did well (congenital heart disease: 0.90, 0.36–1.26; age<1 year: 0.75, 0.51–1.09). Similar results were obtained in the subset of patients transplanted after 1996. In multivariate logistic regression modeling, transplantation at a low-volume center was associated with an odds ratio for postoperative mortality of 1.60 (95% CI, 1.14–2.24); transplantation at a medium volume center had an odds ratio of 1.24 (95% CI, 0.92–1.66).

Increased short- and long-term mortality at low-volume pediatric heart transplant centers: should minimum standards be set?

The volume of transplants performed at any one center has a significant impact on outcomes. Regionalization of care is one option for improving outcomes in pediatric cardiac transplantation.

Question: Increased short- and long-term mortality at low-volume pediatric heart transplant centers: should minimum standards be set? Answer: The volume of transplants performed at any one center has a significant impact on outcomes. Regionalization of care is one option for improving outcomes in pediatric cardiac transplantation.

Answer the question based on the following context: To determine if oral bacteria colonize the cleft nasal floor in patients with unilateral oronasal fistula when compared with the unaffected nasal floor and whether the results obtained would be of benefit in assessing oronasal fistulae in the clinic. Prospective study of 26 patients with cleft palate and unilateral oronasal fistula. Microbiological culture swabs were taken from the mouth and nasal floors of patients. The unaffected nasal floor was used as a control. Bacterial isolates were identified and compared in the laboratory by a senior microbiologist. A significant growth of oral bacteria from the cleft nasal floor when compared with the unaffected nasal floor. Four patients were excluded because no growth was found on any culture plate. In the remaining 22 cases, a light growth of oral flora was found in the cleft nasal floor in only 3 patients. No statistical correlation between culture of oral bacteria and the cleft nasal floor could be found (p =.12).

Do oral flora colonize the nasal floor of patients with oronasal fistulae?

The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.

Question: Do oral flora colonize the nasal floor of patients with oronasal fistulae? Answer: The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.

Answer the question based on the following context: To ascertain the prevalence of premedication before intubation and the choice of drugs used in UK neonatal units in 2007 and assess changes in practice since 1998. A structured telephone survey of 221 eligible units was performed. 214 of the units surveyed completed the telephone questionnaire. The units were subdivided into those that routinely intubated and ventilated neonates (routine group) and those that intubated neonates prior to transfer to a regional unit (transfer group). A similar study was performed by one of the authors in 1998. The same telephone methodology was used in both studies. Premedication for newborn intubations was provided by 93% (198/214) of all UK units and 76% (162/214) had a written policy or guideline concerning premedication prior to elective intubation. Of those 198 units which premedicate, morphine was the most widely used sedative for newborn intubations with 80% (158/198) using either morphine alone or in combination with other drugs. The most widely used combination was morphine and suxamethonium+/-atropine, which was used by 21% (41/198) of all units. 78% (154/198) of all units administered a paralytic agent.

Premedication before intubation in UK neonatal units: a decade of change?

There has been substantial growth over the last decade in the number of UK neonatal units that provide some premedication for non-emergent newborn intubation, increasing from 37% in 1998 to 93% in 2007. This includes a concomitant increase in the use of paralytic drugs from 22% to 78%. However, the variety of drugs used merits further research.

Question: Premedication before intubation in UK neonatal units: a decade of change? Answer: There has been substantial growth over the last decade in the number of UK neonatal units that provide some premedication for non-emergent newborn intubation, increasing from 37% in 1998 to 93% in 2007. This includes a concomitant increase in the use of paralytic drugs from 22% to 78%. However, the variety of drugs used merits further research.

Answer the question based on the following context: Few healthcare economic evaluations, and none in cardiac rehabilitation, report results based on both community and patient preferences for health outcomes. We published the results of a randomized trial of cardiac rehabilitation after myocardial infarction in 1994 in which preferences were measured using both perspectives but only patient preferences were reported. This secondary analysis uses both types of preference measurements. We collected community Quality of Well-Being (QWB) and patient Time Trade-off (TTO) preference scores from 188 patients (rehabilitation, n=93; usual care, n=95) on entry into the trial, at 2 months (end of the intervention) and again at 4, 8, and 12 months. Mean preference scores over the 12-month follow-up study period, estimates of quality-adjusted life years (QALYs) gained per patient, incremental cost-effectiveness ratios [costs inflated to 2006 US dollars] and probabilities of the cost-effectiveness of rehabilitation for costs per QALY up to USD100,000 are reported. Mean QWB preference scores were lower (P<0.01) than the corresponding mean TTO preference scores at each assessment point. The 12-month changes in mean QWB and TTO preference scores were large and positive (P<0.001) with rehabilitation patients gaining a mean of 0.011 (95% confidence interval, -0.030 to +0.052) more QWB-derived QALYs, and 0.040 (-0.026, 0.107) more TTO-derived QALYs, per patient than usual care patients. The incremental cost-effectiveness ratio for QWB-derived QALYs was estimated at $60 270/QALY (about euro50 600/QALY) and at $16 580/QALY (about euro13 900/QALY) with TTO-derived QALYs. With a willingness to spend $100 000/QALY, the probability of rehabilitation being cost-effective is 0.58 for QWB-derived QALYs and 0.83 for TTO-derived QALYs.

Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter?

This secondary analysis of data from a randomized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients.

Question: Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter? Answer: This secondary analysis of data from a randomized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients.

Answer the question based on the following context: To assess whether the Framingham and PROCAM risk functions were applicable to men in Belfast and France. We performed an external validation study within the PRIME (Prospective Epidemiological Study of Myocardial Infarction) cohort study. It comprised men recruited in Belfast (2399) and France (7359) who were aged 50 to 59 years, free of CHD at baseline (1991 to 1993) and followed over 5 years for CHD events (coronary death, myocardial infarction, angina pectoris). We compared the relative risks of CHD associated with the classic risk factors in PRIME with those in Framingham and PROCAM cohorts. We then compared the number of predicted and observed 5-year CHD events (calibration). Finally, we estimated the ability of the risk functions to separate high risk from low risk subjects (discrimination). The relative risk of CHD calculated for the various factors in the PRIME population were not statistically different from those published in the Framingham and PROCAM risk functions. The number of CHD events predicted by these risk functions however clearly overestimated those observed in Belfast and France. The two risk functions had a similar ability to separate high risk from low risk subjects in Belfast and France (c-statistic range: 0.61-0.68).

Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations?

The Framingham and PROCAM risk functions should not be used to estimate the absolute CHD risk of middle-aged men in Belfast and France without any CHD history because of a clear overestimation. Specific population risk functions are needed.

Question: Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? Answer: The Framingham and PROCAM risk functions should not be used to estimate the absolute CHD risk of middle-aged men in Belfast and France without any CHD history because of a clear overestimation. Specific population risk functions are needed.

Answer the question based on the following context: Children under the age of 2 years admitted to hospital following convulsions, were examined within 48 hours of admission. The convulsions were classified by a paediatric neurologist and detailed ocular examination, including indirect ophthalmoscopy, was performed by an ophthalmologist. Statistical analysis was undertaken using Hanley's rule of three. 32 consecutive children admitted with convulsions were examined; 10 of them were admitted following epileptic seizures and 22 following febrile convulsions. Two of the children with febrile convulsions were admitted in status epilepticus. None of these children had retinal haemorrhages. Therefore, using Hanley's rule of three, the upper limit of 95% confidence interval of retinal haemorrhages following convulsions in children under the age of 2 years, is less than 10/100.

Can convulsions alone cause retinal haemorrhages in infants?

In children under the age of 2 years convulsions alone are unlikely to cause retinal haemorrhages. By combining the results of this study with those previously reported from this unit in older children, the upper limit of 95% confidence interval of retinal haemorrhages, following convulsions in children under the age of 14 years, is less than 5/100. Therefore, the finding of retinal haemorrhages in a child admitted with a history of convulsion should trigger a meticulous search for other causes of these haemorrhages, particularly non-accidental injury.

Question: Can convulsions alone cause retinal haemorrhages in infants? Answer: In children under the age of 2 years convulsions alone are unlikely to cause retinal haemorrhages. By combining the results of this study with those previously reported from this unit in older children, the upper limit of 95% confidence interval of retinal haemorrhages, following convulsions in children under the age of 14 years, is less than 5/100. Therefore, the finding of retinal haemorrhages in a child admitted with a history of convulsion should trigger a meticulous search for other causes of these haemorrhages, particularly non-accidental injury.

Answer the question based on the following context: To investigate breast cancer outcomes in a group of African American and white patients offered the same access to mammography screening in a health maintenance organization located in suburban Philadelphia, Pennsylvania. We used medical chart reviews and retrospective tumor tissue studies to investigate disparities in the mode of diagnosis and breast cancer outcomes among African American and white patients in a health maintenance organization. African American women were more likely to have detected their breast cancers accidentally and to have breast tumors larger than 2 cm than were whites. Invasive breast cancers with both lymph node involvement and systemic metastases were more prevalent in African American than in white women.

Does access to screening through health maintenance organization membership translate into improved breast cancer outcomes for African American patients?

These results suggest that even in health care settings that provide access to routine screening, African American women are more likely to have their breast cancers diagnosed accidentally and at more advanced stages than their white counterparts.

Question: Does access to screening through health maintenance organization membership translate into improved breast cancer outcomes for African American patients? Answer: These results suggest that even in health care settings that provide access to routine screening, African American women are more likely to have their breast cancers diagnosed accidentally and at more advanced stages than their white counterparts.

Answer the question based on the following context: Although the 'test-and-treat' strategy is suggested as first-line therapy for uninvestigated dyspepsia, no large-scale studies in a real-life setting are available. 1552 dyspeptic patients aged between 25 and 60 with no alarm symptoms were recruited to the study. After screening with a 13C-urea breath test, they were randomized into three treatment arms: Helicobacter pylori-positive either to eradication therapy with OAM (omeprazole, amoxycillin and metronidazole) (Hp+/erad) or omeprazole 20 mg daily (Hp+/ome) for 10 days, whereas H. pylori-negative patients (Hp-/ome) were treated with 20 mg omeprazole for 10 days. Gastrointestinal symptoms were registered at baseline at 1 and 2 years on the Gastrointestinal Symptom Rating Scale (GSRS) and quality of life with the Psychological General Well-Being index (PGWB). Additional visits, referrals for and number of endoscopies and their findings were registered during the 2 years' follow-up. Of the 1552 patients, 583 were H. pylori-positive (37.6%), and 288 of these were randomized for omeprazole and 295 to OAM. The Hp-/ome group had fewer general practitioner (GP) contacts (P<0.0001) than the H. pylori-positive groups. Eradication therapy significantly improved general well-being and reduced upper gastrointestinal symptoms: abdominal pain (P=0.0001), heartburn (P=0.0061), acid regurgitation (P=0.003), hunger pain (P=0.009), especially in Hp+/erad. Peptic ulcer was found in 6.2%, 1.0%, 0.2% in Hp+/ome, Hp-+/erad and Hp-/ome, respectively (P=0.0007). Only 3 patients (1.0%) developed peptic ulcers in Hp-+/erad, all eradication failures.

Does the 'test-and-treat' strategy work in primary health care for management of uninvestigated dyspepsia?

In uninvestigated dyspepsia, a negative test result for H. pylori reduces the number of GP contacts and endoscopy referrals compared to H. pylori-positive regardless of eradication therapy. Applied in real life, the test-and-treat strategy failed to reduce the number of endoscopies, but significantly reduced peptic ulcer disease and improved dyspeptic symptoms and quality of life.

Question: Does the 'test-and-treat' strategy work in primary health care for management of uninvestigated dyspepsia? Answer: In uninvestigated dyspepsia, a negative test result for H. pylori reduces the number of GP contacts and endoscopy referrals compared to H. pylori-positive regardless of eradication therapy. Applied in real life, the test-and-treat strategy failed to reduce the number of endoscopies, but significantly reduced peptic ulcer disease and improved dyspeptic symptoms and quality of life.

Answer the question based on the following context: Although vaccination can be a useful tool for control of avian influenza epidemics, it might engender emergence of a vaccine-resistant strain. Field and experimental studies show that some avian influenza strains acquire resistance ability against vaccination. We investigated, in the context of the emergence of a vaccine-resistant strain, whether a vaccination program can prevent the spread of infectious disease. We also investigated how losses from immunization by vaccination imposed by the resistant strain affect the spread of the disease. We designed and analyzed a deterministic compartment model illustrating transmission of vaccine-sensitive and vaccine-resistant strains during a vaccination program. We investigated how the loss of protection effectiveness impacts the program. Results show that a vaccination to prevent the spread of disease can instead spread the disease when the resistant strain is less virulent than the sensitive strain. If the loss is high, the program does not prevent the spread of the resistant strain despite a large prevalence rate of the program. The epidemic's final size can be larger than that before the vaccination program. We propose how to use poor vaccines, which have a large loss, to maximize program effects and describe various program risks, which can be estimated using available epidemiological data.

Paradox of vaccination: is vaccination really effective against avian flu epidemics?

We presented clear and simple concepts to elucidate vaccination program guidelines to avoid negative program effects. Using our theory, monitoring the virulence of the resistant strain and investigating the loss caused by the resistant strain better development of vaccination strategies is possible.

Question: Paradox of vaccination: is vaccination really effective against avian flu epidemics? Answer: We presented clear and simple concepts to elucidate vaccination program guidelines to avoid negative program effects. Using our theory, monitoring the virulence of the resistant strain and investigating the loss caused by the resistant strain better development of vaccination strategies is possible.

Answer the question based on the following context: To compare regional body fat distribution and sex hormone status of postmenopausal women with NIDDM with those of age- and BMI-matched normoglycemic women. The regional body fat distribution and sex hormone status of 42 postmenopausal women with NIDDM were compared with those of 42 normoglycemic women matched for age and BMI, who served as control subjects. Body composition was measured by dual-energy X-ray absorptiometry, and sex hormone-binding globulin (SHBG) and testosterone were measured in serum. Although the levels of total body fat were similar between the two groups, the women with NIDDM had significantly less lower-body fat (LBF) (P<0.01) than the control subjects matched for age and BMI. This pattern of fat deposition in women with NIDDM was accompanied by an androgenic hormone profile, with decreased SHBG concentration and an increased free androgen index (P<0.05 and P<0.01, respectively).

Do postmenopausal women with NIDDM have a reduced capacity to deposit and conserve lower-body fat?

A reduced capacity to deposit and/or conserve LBF may be an independent factor associated with (or may be a marker of) the metabolic manifestations of the insulin resistance syndrome in women with NIDDM. The possibility that the smaller relative accumulation of LBF is a consequence of the androgenic hormonal profile should be investigated in future studies.

Question: Do postmenopausal women with NIDDM have a reduced capacity to deposit and conserve lower-body fat? Answer: A reduced capacity to deposit and/or conserve LBF may be an independent factor associated with (or may be a marker of) the metabolic manifestations of the insulin resistance syndrome in women with NIDDM. The possibility that the smaller relative accumulation of LBF is a consequence of the androgenic hormonal profile should be investigated in future studies.

Answer the question based on the following context: To determine if omission of the Center for Epidemiologic Studies Depression Scale (CES-D) items that assess the somatic symptoms of depression improves the psychometric properties of the scale and utility of the CES-D diagnosis of depression for predicting four adverse obstetrical outcomes that have been tentatively linked to maternal depression. A cohort of 1684 13-21-year-old participants in an adolescent-oriented maternity program completed the CES-D at enrollment. Chi-square analyses were used to compare the predictive capacity of depression diagnosed by the full CES-D and the 14-item non-somatic subscale of the CES-D. The reliability and construct validity of the two scales were also compared. Removing the somatic component of the CES-D decreased the proportion of adolescents who met screening criteria for depression. However, it did not improve the psychometric properties of the scale. The reliability (Cronbach alpha: 0.87) and construct validity (depressed adolescents were significantly more psychologically stressed and had poorer social support) of the two scales were equivalent. Regardless of the scale used, adolescent mothers who were depressed in the second and third trimesters were at increased risk for inadequate weight gain and both small for gestational age fetuses and preterm delivery (ORs 1.6-1.8). The differences in case definition and predictive capacity were most evident when the CES-D was administered during the first trimester. However, overall effect sizes were nearly identical with the two scales.

Depression, weight gain, and low birth weight adolescent delivery: do somatic symptoms strengthen or weaken the relationship?

Removing the somatic component does not improve the psychometric properties of the CES-D or the predictive capacity of the CES-D diagnosis of depression for three sentinel obstetrical outcomes. This information should be reassuring to researchers and clinicians as most studies of the causes and consequences of maternal depression during and after pregnancy use the full CES-D scale.

Question: Depression, weight gain, and low birth weight adolescent delivery: do somatic symptoms strengthen or weaken the relationship? Answer: Removing the somatic component does not improve the psychometric properties of the CES-D or the predictive capacity of the CES-D diagnosis of depression for three sentinel obstetrical outcomes. This information should be reassuring to researchers and clinicians as most studies of the causes and consequences of maternal depression during and after pregnancy use the full CES-D scale.

Answer the question based on the following context: In critically ill patients, a decrease in whole body oxygen consumption under hyperoxia has been reported and this could be related to hyperoxia-induced arterial changes. We investigated changes in brachial artery circulation and tone during short-term hyperoxic ventilation in septic patients. Prospective clinical study in the intensive care unit of a university hospital. Fourteen patients (severe sepsis n=3 and septic shock n=11) requiring mechanically controlled ventilation due to sepsis syndrome were investigated under stable clinical conditions. After a 20-min period of hyperoxic ventilation (inspired oxygen fraction = 100%), two-dimensional images of brachial artery cross-sectional area and brachial blood flow velocities were recorded using conventional ultrasonography and pulsed Doppler simultaneously with invasive arterial pressure measurements. Hyperoxia did not affect heart rate, but increased mean arterial pressure and decreased cross-sectional areas both at the end of diastole and at the end of systole. Haemodynamic study showed an increase in resistance index, and a decrease in distensibility and compliance coefficients. Furthermore, a decrease in brachial artery blood flow and arterial oxygen delivery was observed during hyperoxic exposure.

Could hyperoxic ventilation impair oxygen delivery in septic patients?

Hyperoxia was paradoxically demonstrated to decrease oxygen delivery in upper limbs during septic shock.

Question: Could hyperoxic ventilation impair oxygen delivery in septic patients? Answer: Hyperoxia was paradoxically demonstrated to decrease oxygen delivery in upper limbs during septic shock.

Answer the question based on the following context: Gestational diabetes affects approximately 7 percent of all pregnancies in the United States; its prevalence may have increased among all ethnic groups since the early 1990 s. Our study examined whether physical activity during pregnancy reduced the risk of gestational diabetes among women who were physically inactive before pregnancy. We used data from the 1988 National Maternal and Infant Health Survey (NMIHS), a nationally representative sample of mothers with live births. The NMIHS obtained mothers' gestational diabetes diagnoses from care providers and mothers reported their physical activity before and during pregnancy, including the number of months with physical activity and types of physical activity. We developed a physical activity index, the product of the number of months with physical activity, and average metabolic equivalents for specific activities. The analysis included 4,813 women who reported being physically inactive before pregnancy, with singleton births and no previous diabetes diagnosis. Gestational diabetes was diagnosed in 3.5 percent of the weighted sample in 1988. About 11.8 percent of these previously inactive women began physical activity during pregnancy. Women who became physically active had 57 percent lower adjusted odds of developing gestational diabetes than those who remained inactive (OR 0.43, 95% CI 0.20-0.93). Women who had done brisk walking during pregnancy had a lower adjusted risk of gestational diabetes (OR 0.44, CI 0.19-1.02) and women with a physical activity index score above the median had 62 percent lower odds of developing gestational diabetes than the inactive women (CI 0.15-0.96).

Does physical activity during pregnancy reduce the risk of gestational diabetes among previously inactive women?

Results suggest that physical activity during pregnancy is associated with lower risk for gestational diabetes among previously inactive women.

Question: Does physical activity during pregnancy reduce the risk of gestational diabetes among previously inactive women? Answer: Results suggest that physical activity during pregnancy is associated with lower risk for gestational diabetes among previously inactive women.

Answer the question based on the following context: To detect the incidence of metastases in regional nodes (inguinal and external iliac) in patients with carcinoma of the penis and to determine whether nodal involvement was predictable pre-operatively by clinical and histological parameters. Seventy-eight patients who in total had undergone 135 groin dissections were studied. The incidence of inguinal and iliac node metastases was correlated with factors such as the size of the nodes, the histological degree of differentiation, the extent of penile involvement by the primary tumour and the clinical palpability of the iliac nodes. The incidence of metastases to the inguinal and iliac nodes was 74% and 32% of patients respectively. The risk of involvement was equal on both sides irrespective of whether the nodes were palpable. Inguinal nodes larger than 2 cm in diameter and poor histological differentiation of the primary tumour were significant predictors of inguinal node involvement. The palpability of the iliac nodes, inguinal nodes larger than 2 cm and the fixity of the inguinal nodes were important indicators of metastases to iliac nodes. Extension of the primary tumour to the proximal shaft of the penis was associated with a significantly higher incidence of inguinal node but not iliac node metastases. None of the parameters studied identified all the patients with nodal metastases.

Can regional lymph node involvement be predicted in patients with carcinoma of the penis?

In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow-up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow-up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.

Question: Can regional lymph node involvement be predicted in patients with carcinoma of the penis? Answer: In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow-up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow-up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.

Answer the question based on the following context: The question of whether patients presenting for inguinal hernia repair require pre-operative assessment for colon cancer has remained unanswered. A case-control study is necessary to assess whether the prevalence of premalignant or malignant colonic lesions is higher in patients presenting with inguinal hernia compared to the general population. Between 1990-2000, 614 inguinal herniorrhaphies were performed at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). We retrospectively studied the 149 (24%) patients from this group with no prior history of colonic polyps, malignancy, or gastrointestinal bleeding who had flexible sigmoidoscopy or colonoscopy performed during the peri-operative period. Comparison was made to 149 controls undergoing colonoscopy or sigmoidoscopy during the same time period for colon cancer (CRC) screening. The mean (+/-SEM) patient age was 67 +/- 0.7 (range 31-92) yr in the hernia patients and 66 +/- 0.8 (range 46-93) in the control group (p = 0.7). Eighty-two of the inguinal hernia patients had screening procedures performed preoperatively with a mean time (+/-SEM) of 1.4 +/- 0.14 yr, while endoscopy was performed in the post-operative period for the remaining 67 patients (average time 2.7 +/- 0.2 yr, p<0.001). More patients underwent colonoscopy in the control group compared to the hernia cohort (p = 0.004). Seven (5%) patients in the hernia group were found to have colorectal cancer compared to six (4%) in the control group (p = 0.8).

Is colorectal cancer screening necessary in the preoperative assessment of inguinal herniorrhaphy?

This study does not support previously published findings that patients with inguinal hernias are more likely to have premalignant colonic lesions. Patients with inguinal hernias should undergo screening for colon cancer at the same rate as the general population.

Question: Is colorectal cancer screening necessary in the preoperative assessment of inguinal herniorrhaphy? Answer: This study does not support previously published findings that patients with inguinal hernias are more likely to have premalignant colonic lesions. Patients with inguinal hernias should undergo screening for colon cancer at the same rate as the general population.

Answer the question based on the following context: Computerized tomography (CT) is considered as the imaging study of choice for blunt abdominal trauma in children. Nevertheless, recent investigations clearly indicate an increased risk of cancer in children exposed to radiation during abdominal spiral CT. Therefore, alternative strategies should be used for the diagnosis and surgical decision making in blunt abdominal trauma in children. Retrospective analysis included all children with intraabdominal organ rupture after blunt abdominal trauma. Patients were diagnosed by a standardized emergency protocol that included primary clinical assessment and repeated ultrasound but not routine CT. Efficacy of abdominal ultrasound was evaluated in regard to safe diagnosis and appropriate surgical decision making. The study included 35 children with intraabdominal organ rupture diagnosed by ultrasound. One fifth (7/35) of the patients were polytraumatized, whereas 28 of 35 had an isolated blunt abdominal trauma. All patients underwent immediate ultrasound scanning of the abdomen and retroperitoneal space. Two patients were immediately operated because of hemodynamically instability. Four of 7 polytraumatized patients and 7 of 28 patients with isolated blunt abdominal trauma were additionally diagnosed by spiral CT. Only 1 patient underwent subsequent surgery because of the findings in the CT. Ultrasound was effective in more than 97% (34/35) of the patients for diagnosis and appropriate surgical decision making.

Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma?

Ultrasound combined with clinical assessment presents an effective method for safe diagnosis and appropriate surgical decision making in pediatric blunt abdominal trauma. Selected cases with polytrauma and/or unequivocal findings in the ultrasound should undergo abdominal CT. Patients requiring abdominal CT should have an anticipated benefit that exceeds the radiation risk. The importance of repeated clinical assessment cannot be overstated.

Question: Is sonography reliable for the diagnosis of pediatric blunt abdominal trauma? Answer: Ultrasound combined with clinical assessment presents an effective method for safe diagnosis and appropriate surgical decision making in pediatric blunt abdominal trauma. Selected cases with polytrauma and/or unequivocal findings in the ultrasound should undergo abdominal CT. Patients requiring abdominal CT should have an anticipated benefit that exceeds the radiation risk. The importance of repeated clinical assessment cannot be overstated.

Answer the question based on the following context: Recurrent complete ulnar nerve dislocation has been perceived as a risk factor for development of ulnar neuropathy at the elbow (UNE). However, the role of dislocation in the pathogenesis of UNE remains uncertain. We studied 133 patients with complete ulnar nerve dislocation to determine whether this condition is a risk factor for UNE. In all, the nerve was palpated as it rolled over the medial epicondyle during elbow flexion. Of 56 elbows with unilateral dislocation, UNE localized contralaterally in 17 elbows (30.4%) and ipsilaterally in 10 elbows (17.9%). Of 154 elbows with bilateral dislocation, 26 had UNE (16.9%). Complete dislocation decreased the odds of having UNE by 44% (odds ratio = 0.475; P =  0.028), and was associated with less severe UNE (P = 0.045).

Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy?

UNE occurs less frequently and is less severe on the side of complete dislocation. Complete dislocation may have a protective effect on the ulnar nerve. Muscle Nerve 56: 242-246, 2017.

Question: Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy? Answer: UNE occurs less frequently and is less severe on the side of complete dislocation. Complete dislocation may have a protective effect on the ulnar nerve. Muscle Nerve 56: 242-246, 2017.

Answer the question based on the following context: Obesity remains a major public health problem, associated with a cluster of metabolic abnormalities. However, individuals exist who are very obese but have normal metabolic parameters. The aim of this study was to determine to what extent differences in metabolic health in very obese women are explained by differences in body fat distribution, insulin resistance and level of physical activity. This was a cross-sectional pilot study of 39 obese women (age: 28-64 yrs, BMI: 31-67 kg/m2) recruited from community settings. Women were defined as 'metabolically normal' on the basis of blood glucose, lipids and blood pressure. Magnetic Resonance Imaging was used to determine body fat distribution. Detailed lifestyle and metabolic profiles of participants were obtained. Women with a healthy metabolic profile had lower intra-abdominal fat volume (geometric mean 4.78 l [95% CIs 3.99-5.73] vs 6.96 l [5.82-8.32]) and less insulin resistance (HOMA 3.41 [2.62-4.44] vs 6.67 [5.02-8.86]) than those with an abnormality. The groups did not differ in abdominal subcutaneous fat volume (19.6 l [16.9-22.7] vs 20.6 [17.6-23.9]). A higher proportion of those with a healthy compared to a less healthy metabolic profile met current physical activity guidelines (70% [95% CIs 55.8-84.2] vs 25% [11.6-38.4]). Intra-abdominal fat, insulin resistance and physical activity make independent contributions to metabolic status in very obese women, but explain only around a third of the variance.

Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities?

A sub-group of women exists who are metabolically normal despite being very obese. Differences in fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these women, but account only partially for these differences. Future work should focus on strategies to identify those obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors that contribute to metabolic status in obese individuals.

Question: Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? Answer: A sub-group of women exists who are metabolically normal despite being very obese. Differences in fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these women, but account only partially for these differences. Future work should focus on strategies to identify those obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors that contribute to metabolic status in obese individuals.

Answer the question based on the following context: The American Thoracic Society/European Respiratory Society International Consensus Classification panel identified the clinical entity idiopathic nonspecific interstitial pneumonia (NSIP) as a provisional diagnosis and recommended further study. We hypothesized that idiopathic NSIP is an autoimmune disease and the lung manifestation of undifferentiated connective tissue disease (UCTD), a recently described, distinct entity. We studied 28 consecutive patients with idiopathic interstitial pneumonia (IIP) enrolled in the University of California, San Francisco Interstitial Lung Disease Center who met prespecified criteria for UCTD, as follows: at least one clinical manifestation of connective tissue disease, serologic evidence of systemic inflammation in the absence of clinical infection, and absence of sufficient American College of Rheumatology criteria for another connective tissue disease. Medical record reviews, evaluation of radiographs, and scoring of lung biopsies were performed. The control group consisted of all other patients (n = 47) with IIP who did not meet the UCTD criteria. The patients with UCTD were more likely to be women, younger, and nonsmokers than the IIP control subjects. Compared with the control group, patients with UCTD-ILD were significantly more likely to have ground-glass opacity on high-resolution computed tomography (HRCT) and NSIP pattern on biopsy, and less likely to have honeycombing on HRCT or usual interstitial pneumonia on biopsy. At our center, the majority of patients classified as idiopathic NSIP (88%) met the criteria for UCTD.

Idiopathic nonspecific interstitial pneumonia: lung manifestation of undifferentiated connective tissue disease?

Most patients diagnosed with idiopathic NSIP meet the case definition of UCTD. Furthermore, these results show that the clinical entity idiopathic NSIP is different from idiopathic pulmonary fibrosis and appears to be an autoimmune disease.

Question: Idiopathic nonspecific interstitial pneumonia: lung manifestation of undifferentiated connective tissue disease? Answer: Most patients diagnosed with idiopathic NSIP meet the case definition of UCTD. Furthermore, these results show that the clinical entity idiopathic NSIP is different from idiopathic pulmonary fibrosis and appears to be an autoimmune disease.

Answer the question based on the following context: To analyze the incidence of tumors in renal graft recipients, the course, treatment and its effect on the graft and patient. We conducted a retrospective and prospective study on 477 renal transplants performed at our hospital from 1980 to 1996. The tumor type, course and possible tumor-related factors (immunosuppression, age, sex, graft rejection, virus) were analyzed. 57 tumors were found; 41 patients had at least one tumor. The most common were skin, renal and lung cancer. Age, sex and immunosuppression were found to be tumor-related factors in renal transplant recipients.

Incidence of tumors in renal transplant patients. Is there a changing tumor pattern in these patients?

Patients undergoing renal transplantation are at a higher risk for developing a tumor, above all in the older male patients. A relationship was found for immunosuppression, the number of drugs received and the number of rejection episodes. Furthermore, the tumor pattern in these patients is different from the usual pattern.

Question: Incidence of tumors in renal transplant patients. Is there a changing tumor pattern in these patients? Answer: Patients undergoing renal transplantation are at a higher risk for developing a tumor, above all in the older male patients. A relationship was found for immunosuppression, the number of drugs received and the number of rejection episodes. Furthermore, the tumor pattern in these patients is different from the usual pattern.

Answer the question based on the following context: To explore experiences and consequences of the process of being diagnosed with fibromyalgia. Qualitative focus-group study. Two local self-help groups. Eleven women diagnosed with fibromyalgia. Descriptions of experiences and consequences of the process of being diagnosed with fibromyalgia. Many participants had been suffering for years, and initial response of relief was common. For some, the diagnosis legitimized the symptoms as a disease, for others it felt better to suffer from fibromyalgia rather than more serious conditions. Nevertheless sadness and despair emerged when they discovered limitations in treatment options, respect, and understanding. Some patients keep the diagnosis to themselves since people seem to pay no attention to the name, or blatantly regard them as too cheerful or healthy looking. The initial blessing of the fibromyalgia diagnosis seems to be limited in the long run. The process of adapting to this diagnosis can be lonely and strenuous.

The fibromyalgia diagnosis: hardly helpful for the patients?

A diagnosis may be significant when it provides the road to relief or legitimizes the patient's problems. The social and medical meaning of the fibromyalgia diagnosis appears to be more complex. Our findings propose that the diagnosis was hardly helpful for these patients.

Question: The fibromyalgia diagnosis: hardly helpful for the patients? Answer: A diagnosis may be significant when it provides the road to relief or legitimizes the patient's problems. The social and medical meaning of the fibromyalgia diagnosis appears to be more complex. Our findings propose that the diagnosis was hardly helpful for these patients.

Answer the question based on the following context: Outcome prediction models are widely used to evaluate trauma care. External benchmarking provides individual institutions with a tool to compare survival with a reference dataset. However, these models do have limitations. In this study, the hypothesis was tested whether specific injuries are associated with increased mortality and whether differences in case-mix of these injuries influence outcome comparison. A retrospective study was conducted in a Dutch trauma region. Injury profiles, based on injuries most frequently endured by unexpected death, were determined. The association between these injury profiles and mortality was studied in patients with a low Injury Severity Score by logistic regression. The standardized survival of our population (Ws statistic) was compared with North-American and British reference databases, with and without patients suffering from previously defined injury profiles. In total, 14,811 patients were included. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic injuries were significantly associated with mortality corrected for age, sex, and physiologic derangement in patients with a low injury severity. Odds ratios ranged from 2.42 to 2.92. The Ws statistic for comparison with North-American databases significantly improved after exclusion of patients with these injuries. The Ws statistic for comparison with a British reference database remained unchanged.

Injury profiles related to mortality in patients with a low Injury Severity Score: a case-mix issue?

Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic wall injuries are associated with increased mortality. Comparative outcome analysis of a population with a reference database that differs in case-mix with respect to these injuries should be interpreted cautiously.

Question: Injury profiles related to mortality in patients with a low Injury Severity Score: a case-mix issue? Answer: Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic wall injuries are associated with increased mortality. Comparative outcome analysis of a population with a reference database that differs in case-mix with respect to these injuries should be interpreted cautiously.

Answer the question based on the following context: Percutaneous core-needle biopsy is widely accepted for preoperative histologic assessment of suspicious breast lesions. The purpose of this study was to asses the impact of continuous sonographic guidance on diagnostic accuracy of large core needle biopsy of palpable breast lesions. We analysed 170 breast lesions in a retrospective study. Percutaneous breast biopsies were performed by using a biopsy gun with 14-gauge needles. Eighty-eight biopsies were performed under continuous ultrasound guidance (group II) and 82 biopsies without ultrasound documentation of the procedure (group I). Core needle diagnoses were compared with the patients final tissue diagnosis as based on surgical excisional biopsy. In patient group I, 17 lesions were categorized as core breast biopsy cancer misses (sensitivity 79 %). The sensitivity in this group showed an obvious dependency on tumor size. Among the 17 false negative lesions, 13 lesions were 3 cm in mean diameter or smaller. Two false negative findings occurred in group II (sensitivity 98 %), with a tumor size of 0.5 and 1.0 cm.

Percutaneous core-needle biopsy of palpable breast tumors. Do we need ultrasound guidance?

Sonographic guidance is indispensable to ensure adequate diagnostic accuracy for core-needle biopsy of palpable breast lesions.

Question: Percutaneous core-needle biopsy of palpable breast tumors. Do we need ultrasound guidance? Answer: Sonographic guidance is indispensable to ensure adequate diagnostic accuracy for core-needle biopsy of palpable breast lesions.

Answer the question based on the following context: There are no guidelines that exist to direct the management of incidental adrenal masses (IAM) in children. The aim of this study was to determine if there is a subset of IAMs that could be safely observed. A retrospective analysis was conducted of all adrenal masses that were either resected or biopsied between 1990 and 2002 (n = 91) at the Hospital for Sick Children, Toronto. IAM was defined as a solitary adrenal mass discovered by either physical examination (n = 6; 23.1%) or diagnostic imaging for other indications (n = 20; 76.9%), without metastases or biochemical activity. Twenty-six (28.6%) IAMs were detected (mean age, 4.6 years [range, antenatal to 17 years]; 11 boys, 15 girls). Pathologic diagnoses included neuroblastoma (n = 7), ganglioneuroma (n = 6), adrenocortical adenoma (n = 4), adrenal cyst/pseudocyst (n = 3), adrenal hemorrhage (n = 3), ganglioneuroblastoma (n = 1), nodular cortical hyperplasia (n = 1), and teratoma (n = 1). Eight masses were malignant (30.8%). Two of the 5 masses discovered on antenatal ultrasound scan were neuroblastoma. In comparing the benign with malignant lesions, there was no significant difference in mean size (4.8 cm v 4.3 cm; P =.57), radiologic characteristics, or mode of presentation. Benign lesions occurred more frequently in older children (mean age, 6.5 years v 1.3 years; P =.03).

Is surgery necessary for incidentally discovered adrenal masses in children?

Clear guidelines cannot be established to predict benign IAM in children. Given the high proportion of malignant lesions, we recommend that all pediatric IAMs should be resected.

Question: Is surgery necessary for incidentally discovered adrenal masses in children? Answer: Clear guidelines cannot be established to predict benign IAM in children. Given the high proportion of malignant lesions, we recommend that all pediatric IAMs should be resected.

Answer the question based on the following context: The "athletic triad" of amenorrhea, osteopenia, and eating disorders (EDs) has received increasing attention in the past decade. Adolescents may seek care for amenorrhea or other menstrual irregularity before disclosure of an eating disorder to a primary care clinician. The purpose of this study was to determine the prevalence of abnormal eating attitudes and behaviors in adolescent girls going to a clinic for reproductive endocrinology (RE) visits versus the prevalence in girls going for health maintenance (HM) visits. All patients aged 8-22 years going to RE or HM clinics were given a 26-item modified eating attitudes test (EAT) and two pages of questions on other eating issues and demographics. Informed consent was obtained from all participants, and also from the parents of those less than 18 years of age. All subjects were seen at a hospital-based ambulatory (HM) or subspecialty (RE) clinic, with both clinics located on the same floor. The study included 53 girls from the RE clinic and 108 girls from the HM clinic. All demographics were similar except that the RE patients were slightly older and had significantly more parents with masters or doctorate degrees. Study variables were compared between RE and HM groups using either the Student's t test or the Chi-square test, with statistical significance defined as p<0.05. A score of 20 or higher on the modified EAT was correlated with a high risk of EDs and was used as a measure of prevalence of abnormal eating attitudes and behaviors. Modified EAT scores were 11.8 +/- 8.9 in RE patients vs 7.0 +/- 7.2 in HM patients (p<0.001), with 10 (18.9%) RE patients and 7 (6.5%) HM patients having scores of at least 20 (p = 0.016). No differences in daily exercise, dairy consumption, or use of vomiting or laxatives to control weight were found. As expected, RE patients were significantly more likely to experience menstrual irregularities than the HM patients (p<0.001).

Prevalence of abnormal eating attitudes and behaviors in hospital-based primary and tertiary care clinics: a window of opportunity?

Adolescents attending a reproductive endocrinology clinic showed a higher prevalence of abnormal eating attitudes and behaviors than did those going to a clinic for HM visits. Early detection of eating disorders may occur both within and outside of the primary care setting through use of a modified EAT.

Question: Prevalence of abnormal eating attitudes and behaviors in hospital-based primary and tertiary care clinics: a window of opportunity? Answer: Adolescents attending a reproductive endocrinology clinic showed a higher prevalence of abnormal eating attitudes and behaviors than did those going to a clinic for HM visits. Early detection of eating disorders may occur both within and outside of the primary care setting through use of a modified EAT.

Answer the question based on the following context: Traffic-related pollution is associated with cardiovascular disease in general, but previous studies suggested that low socioeconomic status (SES) groups might be more susceptible towards a negative impact. We examined whether the association between long-term exposure to high traffic and early signs of coronary artery disease is modified by SES. Individual-level medical and social data from a population-based study were linked with census information on neighbourhood socioeconomic characteristics. Residential exposure to traffic was defined as proximity to major roads using a geographical information system. We studied associations between high traffic and coronary artery calcification (CAC) within strata of SES to examine effect modification. Data stem from an epidemiological study in Germany including 2264 women and 2037 men (45-75 years). High traffic and low SES were both associated with higher amounts of calcification (>or=75th age-specific percentile). More participants with low SES lived close to major roads while stratified analyses did not indicate higher susceptibility in low SES groups. Participants with low SES and simultaneous exposure to high traffic had highest levels of CAC. For example, the prevalence of high calcification was 23.9% in better-educated men with low traffic exposure but 37.7% in lower-educated men with high traffic exposure (women: 22.0% vs 28.1%).

Traffic exposure and subclinical cardiovascular disease: is the association modified by socioeconomic characteristics of individuals and neighbourhoods?

High traffic exposure was associated with coronary calcification in all social groups, but as low SES individuals had higher calcification in general and were also more often exposed to traffic, existing inequalities could be further shaped by traffic exposure.

Question: Traffic exposure and subclinical cardiovascular disease: is the association modified by socioeconomic characteristics of individuals and neighbourhoods? Answer: High traffic exposure was associated with coronary calcification in all social groups, but as low SES individuals had higher calcification in general and were also more often exposed to traffic, existing inequalities could be further shaped by traffic exposure.

Answer the question based on the following context: Social determinants of health may be substantially affected by spatial factors, which together may explain the persistence of health inequities. Clustering of possible sources of negative health and social outcomes points to a spatial focus for future interventions. We analyzed the spatial clustering of sex work businesses in Southern California to examine where and why they cluster. We explored economic and legal factors as possible explanations of clustering. We manually coded data from a website used by paying members to post reviews of female massage parlor workers. We identified clusters of sexually oriented massage parlor businesses using spatial autocorrelation tests. We conducted spatial regression using census tract data to identify predictors of clustering. A total of 889 venues were identified. Clusters of tracts having higher-than-expected numbers of sexually oriented massage parlors ("hot spots") were located outside downtowns. These hot spots were characterized by a higher proportion of adult males, a higher proportion of households below the federal poverty level, and a smaller average household size.

Do Sexually Oriented Massage Parlors Cluster in Specific Neighborhoods?

Sexually oriented massage parlors in Los Angeles and Orange counties cluster in particular neighborhoods. More research is needed to ascertain the causal factors of such clusters and how interventions can be designed to leverage these spatial factors.

Question: Do Sexually Oriented Massage Parlors Cluster in Specific Neighborhoods? Answer: Sexually oriented massage parlors in Los Angeles and Orange counties cluster in particular neighborhoods. More research is needed to ascertain the causal factors of such clusters and how interventions can be designed to leverage these spatial factors.

Answer the question based on the following context: The burden of maternal mortality in sub-Saharan Africa is very high. In Ghana maternal mortality ratio was 380 deaths per 100,000 live births in 2013. Skilled birth attendance has been shown to reduce maternal mortality and morbidity, yet in 2010 only 68 percent of mothers in Ghana gave birth with the assistance of skilled birth attendants. In 2005, the Ghana Health Service piloted a strategy that involved using the integrated Community-based Health Planning and Services (CHPS) program and training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). The study assesses the feasibility of and extent to which the skilled delivery program has been implemented as an integrated component of the existing CHPS, and documents the benefits and challenges of the integrated program. We employed an intrinsic case study design with a qualitative methodology. We conducted 41 in-depth interviews with health professionals and community stakeholders. We used a purposive sampling technique to identify and interview our respondents. The CHO-midwives provide integrated services that include skilled delivery in CHPS zones. The midwives collaborate with District Assemblies, Non-Governmental Organizations (NGOs) and communities to offer skilled delivery services in rural communities. They refer pregnant women with complications to district hospitals and health centers for care, and there has been observed improvement in the referral system. Stakeholders reported community members' access to skilled attendants at birth, health education, antenatal attendance and postnatal care in rural communities. The CHO-midwives are provided with financial and non-financial incentives to motivate them for optimal work performance. The primary challenges that remain include inadequate numbers of CHO-midwives, insufficient transportation, and infrastructure weaknesses.

Can community health officer-midwives effectively integrate skilled birth attendance in the community-based health planning and services program in rural Ghana?

Our study demonstrates that CHOs can successfully be trained as midwives and deployed to provide skilled delivery services at the doorsteps of rural households. The integration of the skilled delivery program with the CHPS program appears to be an effective model for improving access to skilled birth attendance in rural communities of the UER of Ghana.

Question: Can community health officer-midwives effectively integrate skilled birth attendance in the community-based health planning and services program in rural Ghana? Answer: Our study demonstrates that CHOs can successfully be trained as midwives and deployed to provide skilled delivery services at the doorsteps of rural households. The integration of the skilled delivery program with the CHPS program appears to be an effective model for improving access to skilled birth attendance in rural communities of the UER of Ghana.

Answer the question based on the following context: There is controversy regarding the role of high grade prostatic intraepithelial neoplasia (HGPIN) on prostatic needle biopsy (PNB) as a risk factor for prostatic adenocarcinoma. We utilise a large Canadian database to determine whether HGPIN detected on extended PNB is a significant risk factor for prostatic adenocarcinoma. Pathological findings from PNBs from 12 304 men who underwent initial PNB during an 8 year period were analysed. Patients were included in the study if their initial diagnosis was HGPIN alone or a benign diagnosis, if at least one follow-up PNB was performed, and if both the initial and follow-up PNB contained at least 10 prostate cores. In the benign group of 105 patients and the HGPIN group of 120 patients, 14.1% and 20.8% were diagnosed with prostatic adenocarcinoma, respectively. When the HGPIN group was further subdivided into unifocal (1 core) and multifocal (>or=2 cores) groups, 9.4% and 29.9% developed prostatic adenocarcinoma, respectively (p<0.0001). Cox regression analysis adjusting for age and prostate specific antigen (PSA) confirms the significance of HGPIN as a risk factor for prostatic adenocarcinoma (p = 0.0045).

Is high grade prostatic intraepithelial neoplasia still a risk factor for adenocarcinoma in the era of extended biopsy sampling?

Patients with an initial diagnosis of multifocal HGPIN on extended PNB are at a greater risk for subsequent prostatic adenocarcinoma than those with unifocal HGPIN or benign diagnoses.

Question: Is high grade prostatic intraepithelial neoplasia still a risk factor for adenocarcinoma in the era of extended biopsy sampling? Answer: Patients with an initial diagnosis of multifocal HGPIN on extended PNB are at a greater risk for subsequent prostatic adenocarcinoma than those with unifocal HGPIN or benign diagnoses.

Answer the question based on the following context: Cerebral white matter lesions (WML), evident on CT and MRI brain scans, are histopathologically heterogeneous but associated with vascular risk factors and thought mainly to indicate ischemic damage. There has been disagreement over their clinical prognostic value in predicting conversion from mild cognitive impairment (MCI) to dementia. We scrutinised and rated CT and MRI brain scans for degree of WML in a memory clinic cohort of 129 patients with at least 1 year of follow-up. We examined the relationship between WML severity and time until conversion to dementia for all MCI patients and for amnestic (aMCI) and non-amnestic (naMCI) subgroups separately. Five-year outcome data were available for 87 (67%) of the 129 patients. The proportion of patients converting to dementia was 25% at 1 year and 76% at 5 years. Patients with aMCI converted to dementia significantly earlier than those with naMCI. WML severity was not associated with time to conversion to dementia for either MCI patients in general or aMCI patients in particular. Among naMCI patients, there was a tendency for those with a low degree of WML to survive without dementia for longer than those with a high degree of WML. However, this was not statistically significant.

Do cerebral white matter lesions influence the rate of progression from mild cognitive impairment to dementia?

MCI subtype is a significant independent predictor of conversion to dementia, with aMCI patients having higher risk than naMCI for conversion throughout the 5-year follow-up period. WML severity does not influence conversion to dementia for aMCI but might accelerate progression in naMCI.

Question: Do cerebral white matter lesions influence the rate of progression from mild cognitive impairment to dementia? Answer: MCI subtype is a significant independent predictor of conversion to dementia, with aMCI patients having higher risk than naMCI for conversion throughout the 5-year follow-up period. WML severity does not influence conversion to dementia for aMCI but might accelerate progression in naMCI.

Answer the question based on the following context: Silver-Russell syndrome (SRS) is a genetically heterogeneous syndrome characterized by low birth weight, severe short stature, and variable dysmorphic features. GH treatment is a registered growth-promoting therapy for short children born small for gestational age, including SRS, but there are limited data on the GH response in SRS children and on differences in response among the (epi)genetic SRS subtypes (11p15 aberrations, maternal uniparental disomy of chromosome 7 [mUPD7], and idiopathic SRS). To compare growth and adult height between GH-treated small for gestational age children with and without SRS (non-SRS), and to analyze the difference in GH response among SRS genotypes. A longitudinal study. Sixty-two SRS and 227 non-SRS subjects. All subjects received GH treatment (1 mg/m(2)/d). Adult height and total height gain. The SRS group consisted of 31 children with 11p15 aberrations, 11 children with mUPD7, and 20 children with idiopathic SRS. At the start of GH treatment, mean (SD) height standard deviation score [SDS] was significantly lower in SRS (-3.67 [1.0]) than in non-SRS (-2.92 [0.6]; P<.001). Adult height SDS was lower in SRS (-2.17 [0.8]) than in non-SRS (-1.65 [0.8]; P = .002), but the total height gain SDS was similar. There was a trend toward a greater height gain in mUPD7 than in 11p15 (P = .12).

Long-Term Results of GH Treatment in Silver-Russell Syndrome (SRS): Do They Benefit the Same as Non-SRS Short-SGA?

Children with SRS have a similar height gain during GH treatment as non-SRS subjects. All (epi)genetic SRS subtypes benefit from GH treatment, with a trend toward mUPD7 and idiopathic SRS having the greatest height gain.

Question: Long-Term Results of GH Treatment in Silver-Russell Syndrome (SRS): Do They Benefit the Same as Non-SRS Short-SGA? Answer: Children with SRS have a similar height gain during GH treatment as non-SRS subjects. All (epi)genetic SRS subtypes benefit from GH treatment, with a trend toward mUPD7 and idiopathic SRS having the greatest height gain.

Answer the question based on the following context: Data of 810 female patients, aged 45 to 60 years, with 819 suspicious breast lesions evaluated by four participating centres between October 1996 and December 1997. Standardised breast ultrasound was performed uniformly using a AU4 IDEA diagnostic ultrasound system by Esaote-Biomedica in addition to a standardised procedure of clinical examination and standard-2view-mammography. Analysis of all aquired data and the correlating histopathological findings was done by means of descriptive statistics on the basis of an access datafile (Version 2.0). The histopathological evaluation showed 435 benign and 384 malignant findings. Overall sensitivity and specificity of the clinical examination were 71.1 % and 88.9 % and for mammography 84.7 % and 76.5 %, respectively. Standard ultrasound with 7,5 MHz reached a sensitivity of 82,6 % and a specificity of 80.8 % high-frequency ultrasound with 13 MHz came to 87.2 % and 78.4 %, respectively. Regarding tumour size, mammography gave the highest sensitivity in detection of pre-invasive cancers (DCIS). High-frequency breast ultrasound (13 MHz) proved to have a higher diagnostic accuracy compared to standard breast ultrasound (7,5 MHz) regardless of tumour size. Sensitivity was especially improved in case of small invasive tumours (pT1a) with 78 % versus 56 %, respectively.

Ultrasound examination of the breast with 7.5 MHz and 13 MHz-transducers: scope for improving diagnostic accuracy in complementary breast diagnostics?

We conclude that high-frequency ultrasound is a valueable additive tool especially in the diagnosis of small tumours, improving diagnostic safety and reducing unnecessary invasive diagnostic procedures.

Question: Ultrasound examination of the breast with 7.5 MHz and 13 MHz-transducers: scope for improving diagnostic accuracy in complementary breast diagnostics? Answer: We conclude that high-frequency ultrasound is a valueable additive tool especially in the diagnosis of small tumours, improving diagnostic safety and reducing unnecessary invasive diagnostic procedures.

Answer the question based on the following context: In non-small cell lung cancer patients (NSCLC), median survival from the time patients develop bone metastasis is classically described being inferior to 6 months. We investigated the subcategory of patients having an inaugural skeletal-related-event revealing NSCLC. The purpose of this study was to assess the impact of bone involvement on overall survival and to determine biological and tumoral prognosis factors on OS and PFS. An analysis of the subgroup of solitary bone metastasis patients was also performed. In a population of 1208 lung cancer patients, 55 consecutive NSCLC patients revealed by inaugural bone metastasis and treated between 2003 and 2010, were retrospectively analysed. Survival was measured with a Kaplan-Meyer curve. Univariate and multivariate analysis were performed using the Stepwise Cox proportional hazard regression model. A p value of less than 0,05 was considered statistically significant. Estimated incidence of revealing bone metastasis is 4,5% among newly diagnosed lung cancer patients. Median duration of skeletal symptoms before diagnosis was 3 months and revealing bone site was located on axial skeleton in 70% of the cases. Histology was adenocarcinoma (78%), with small primary tumors Tx-T1-2 accounting for 71% of patients. Rate of second SRE is 37%.Median overall survival was 8.15 months, IQR [5-16 months], mean survival 13.4 months, and PFS was 3.5 months. In multivariate analysis, variables significantly associated with shortened survival were advanced T stage (HR=2.8; p=0.004), weight loss>10% (HR=3.1; p=0.02), inaugural spinal epidural metastasis (HR 2.5; p=0.0036), elevated C-reactive protein (HR=4.3; p=0.002) and TTF-1 status (HR=2.42; p=0.004). Inaugural spinal epidural metastasis is a very strong adverse pronostic factor in these cases, with a 3 months median survival. Single bone metastasis patients showed prolonged survival of 14.2 months versus 7.6 months, only in univariate analysis (HR=0.42; p=0.0059).

Inaugural bone metastases in non-small cell lung cancer: a specific prognostic entity?

Prognosis of lung cancer patients with inaugural SRE remains pejorative. Accurately estimating the survival of this population is helpful for bone surgical decision-making at diagnosis. The trend for a higher proportion of adenocarcinoma in NSCLC patients should result with an increasing number of patients with inaugural SRE at diagnosis.

Question: Inaugural bone metastases in non-small cell lung cancer: a specific prognostic entity? Answer: Prognosis of lung cancer patients with inaugural SRE remains pejorative. Accurately estimating the survival of this population is helpful for bone surgical decision-making at diagnosis. The trend for a higher proportion of adenocarcinoma in NSCLC patients should result with an increasing number of patients with inaugural SRE at diagnosis.

Answer the question based on the following context: An anti-angiogenesis strategy has been widely recognized as a viable approach to fight cancer and more and more anti-angiogenic factors are continually being identified. Among them, the muscular isoform of Troponin I (TnI) has been described as being a powerful anti-angiogenic agent in vitro as well as in vivo. We investigated the therapeutic efficacy of TnI gene therapy in a human-like orthotopic rat osteosarcoma model. In this tumor model, we evaluated whether the administration of the secreted TnI coding sequence complexed to cationic liposomes (named TnITag cDNA/lCLP) could induce a delay in tumor growth and reduce tumor vasculature. Although TnI specifically inhibited endothelial cell growth in vitro, we were not able to demonstrate any therapeutic efficacy of TnI in the transplantable osteosarcoma model.

Is troponin I gene therapy effective for osteosarcoma treatment?

This lack of efficacy probably resulted from the rapid degradation of recombinant TnI by matrix metalloproteinases, especially MMP2, which are present in large amounts in tumors.

Question: Is troponin I gene therapy effective for osteosarcoma treatment? Answer: This lack of efficacy probably resulted from the rapid degradation of recombinant TnI by matrix metalloproteinases, especially MMP2, which are present in large amounts in tumors.

Answer the question based on the following context: There is limited research on awareness of alcohol warning labels and their effects. The current study examined the awareness of the Australian voluntary warning labels, the 'Get the facts' logo (a component of current warning labels) that directs consumers to an industry-designed informational website, and whether alcohol consumers visited this website. Participants aged 18-45 (unweighted n = 561; mean age = 33.6 years) completed an online survey assessing alcohol consumption patterns, awareness of the 'Get the facts' logo and warning labels, and use of the website. No participants recalled the 'Get the facts' logo, and the recall rate of warning labels was 16% at best. A quarter of participants recognised the 'Get the facts' logo, and awareness of the warning labels ranged from 13.1-37.9%. Overall, only 7.3% of respondents had visited the website. Multivariable logistic regression models indicated that younger drinkers, increased frequency of binge drinking, consuming alcohol directly from the bottle or can, and support for warning labels were significantly, positively associated with awareness of the logo and warning labels. While an increased frequency of binge drinking, consuming alcohol directly from the container, support for warning labels, and recognition of the 'Get the facts' logo increased the odds of visiting the website.

Do consumers 'Get the facts'?

Within this sample, recall of the current, voluntary warning labels on Australian alcohol products was non-existent, overall awareness was low, and few people reported visiting the DrinkWise website. It appears that current warning labels fail to effectively transmit health messages to the general public.

Question: Do consumers 'Get the facts'? Answer: Within this sample, recall of the current, voluntary warning labels on Australian alcohol products was non-existent, overall awareness was low, and few people reported visiting the DrinkWise website. It appears that current warning labels fail to effectively transmit health messages to the general public.

Answer the question based on the following context: The aim was to study the effectiveness of subjective color Doppler evaluation and spectral Doppler parameters in preoperative characterization of endometrial carcinomas. Seventy-six patients with endometrial carcinoma were preoperatively analyzed by color Doppler ultrasound in order to subjectively evaluate the amount of intratumoral blood flow (color score) and to analyze the lowest resistance index (RI), the highest peak systolic velocity (PV), and the highest time averaged maximum velocity (TAMVX). These parameters were analyzed according to clinico-pathological characteristics. In 13 patients no intratumoral arterial vessels were detected by color Doppler examination. No lymph node metastases were found in this group of patients. Positive nodes were found in 24% of patients with detectable arterial vessels, although the difference did not reach the statistical significance. No differences were found in spectral Doppler parameters (RI, PV, TAMVX) according to tumor characteristics or nodal involvement. A higher percentage of cases with a color score of 3 was found in stage>I than in stage I patients (69 vs 42%, P<0.05), and in patients with myometrial invasion greater than 50% than in those with less than 50% invasion (72 vs 38%; P = 0.05).

Intratumoral color Doppler analysis in endometrial carcinoma: is it clinically useful?

Nodal metastases were found in 24% of patients with detectable vessels at color Doppler examination. Subjective analysis of vessel density correlated>50%, myometrial invasion, but spectral Doppler analysis was not predictive of surgical stage, tumor grade, myometrial invasion, or lymph node metastases. These results do not support the use of preoperative intratumoral blood flow analysis as a clinical test in evaluating tumor characteristics or in predicting lymph node metastases.

Question: Intratumoral color Doppler analysis in endometrial carcinoma: is it clinically useful? Answer: Nodal metastases were found in 24% of patients with detectable vessels at color Doppler examination. Subjective analysis of vessel density correlated>50%, myometrial invasion, but spectral Doppler analysis was not predictive of surgical stage, tumor grade, myometrial invasion, or lymph node metastases. These results do not support the use of preoperative intratumoral blood flow analysis as a clinical test in evaluating tumor characteristics or in predicting lymph node metastases.

Answer the question based on the following context: Intracompartmental pressure measurements are frequently used in the diagnosis of compartment syndrome, particularly in patients with equivocal or limited physical examination findings. Little clinical work has been done to validate the clinical use of intracompartmental pressures or identify associated false-positive rates. We hypothesized that diagnosis of compartment syndrome based on one-time pressure measurements alone is associated with a high false-positive rate. Forty-eight consecutive patients with tibial shaft fractures who were not suspected of having compartment syndrome based on physical examinations were prospectively enrolled. Pressure measurements were obtained in all four compartments at a single point in time immediately after induction of anesthesia using a pressure-monitoring device. Preoperative and intraoperative blood pressure measurements were recorded. The same standardized examination was performed by the attending surgeon preoperatively, postoperatively, and during clinical follow-up for 6 months to assess clinical evidence of acute or late compartment syndrome. No clinical evidence of compartment syndrome was observed postoperatively or during follow-up until 6 months after injury. Using the accepted criteria of delta P of 30 mm Hg from preoperative diastolic blood pressure, 35% of cases (n = 16; 95% confidence interval, 21.5-48.5%) met criteria for compartment syndrome. Raising the threshold to delta P of 20 mm Hg reduced the false-positive rate to 24% (n = 11; 95% confidence interval, 11.1-34.9%). Twenty-two percent (n = 10; 95% confidence interval, 9.5-32.5%) exceeded absolute pressure of 45 mm Hg.

Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?

A 35% false-positive rate was found for the diagnosis of compartment syndrome in patients with tibial shaft fractures who were not thought to have compartment syndrome by using currently accepted criteria for diagnosis based solely on one-time compartment pressure measurements. Our data suggest that reliance on one-time intracompartmental pressure measurements can overestimate the rate of compartment syndrome and raise concern regarding unnecessary fasciotomies.

Question: Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome? Answer: A 35% false-positive rate was found for the diagnosis of compartment syndrome in patients with tibial shaft fractures who were not thought to have compartment syndrome by using currently accepted criteria for diagnosis based solely on one-time compartment pressure measurements. Our data suggest that reliance on one-time intracompartmental pressure measurements can overestimate the rate of compartment syndrome and raise concern regarding unnecessary fasciotomies.

Answer the question based on the following context: Some studies have suggested that increased blood pressure has a stronger effect on the risk of cardiovascular disease (CVD) in lean persons than in obese persons, although this is not a universal finding. Given the inconsistency of this result, we tested it using a large population-based cohort data set. Systolic and diastolic blood pressures (BPs) and body mass index were measured in 1 145 758 Swedish men born between 1951 and 1976 who were in young adulthood (median age 18.2 years). During the register-based follow-up, which lasted until the end of 2006, 65 611 new CVD events took place, including 6799 myocardial infarctions and 8827 strokes. Hazard ratios (HRs) per 1-SD increase in systolic and diastolic BP were computed within established body mass index categories (underweight, normal, overweight, or obese) with Cox proportional hazards models. The strongest associations of diastolic BP with CVD (HR 1.18), myocardial infarction (HR 1.22), and stroke (HR 1.13) were observed in the obese category. For systolic BP, the strongest associations were observed in the obese category with CVD (HR 1.16) and stroke (HR 1.29) but in the overweight category with myocardial infarction (HR 1.19). We observed statistically significant interactions (P<0.0001) with body mass index for diastolic BP in relation to CVD and for systolic BP in relation to CVD and stroke.

Does obesity modify the effect of blood pressure on the risk of cardiovascular disease?

In contrast to the findings of previous studies, we observed a general increase in the magnitude of the association between blood pressure and subsequent CVD with increasing body mass index. Hypertension should not be regarded as a less serious risk factor in obese than in lean or normal-weight persons.

Question: Does obesity modify the effect of blood pressure on the risk of cardiovascular disease? Answer: In contrast to the findings of previous studies, we observed a general increase in the magnitude of the association between blood pressure and subsequent CVD with increasing body mass index. Hypertension should not be regarded as a less serious risk factor in obese than in lean or normal-weight persons.

Answer the question based on the following context: The anti-androgen withdrawal syndrome (AAWS) can be seen in one-third of patients after discontinuation of first-generation non-steroidal anti-androgen therapy. With the introduction of new agents for anti-androgen therapy as well as alternate mechanisms of action, new therapeutic options before and after docetaxel chemotherapy have arisen (Ohlmann et al. in World J Urol 30(4):495-503, 2012). The question regarding the occurrence of an enzalutamide withdrawal syndrome (EWS) has not been evaluated yet. In this study, we assess prostate-specific antigen (PSA) response after discontinuation of enzalutamide. In total 31 patients with metastatic castration-resistant prostate cancer (mCRPC) underwent an enzalutamide withdrawal and were evaluated. Data were gathered from 6 centres in Germany. Patients with continuous oral administration of enzalutamide with rising serum PSA levels were evaluated, starting from enzalutamide withdrawal until subsequent therapy was initiated, follow-up ended or death of the patient occurred. Statistical evaluation was performed applying one-sided binomial testing using R-statistical software, version 3.0.1. Mean withdrawal follow-up was 6.5 weeks (range 1-26.1 weeks). None of the 31 patients showed a PSA decline. Mean relative PSA rise over all patients was 73.9 % (range 0.5-440.7 %) with a median of 44.9 %.

Is there an anti-androgen withdrawal syndrome for enzalutamide?

If existent, an AAWS is at least very rare for enzalutamide in patients with mCRPC after taxane-based chemotherapy and does not play a clinical role in this setting. This may be attributed to the different pharmacodynamics of enzalutamide. Longer duration of therapy or a longer withdrawal interval may reveal a rare EWS in the future.

Question: Is there an anti-androgen withdrawal syndrome for enzalutamide? Answer: If existent, an AAWS is at least very rare for enzalutamide in patients with mCRPC after taxane-based chemotherapy and does not play a clinical role in this setting. This may be attributed to the different pharmacodynamics of enzalutamide. Longer duration of therapy or a longer withdrawal interval may reveal a rare EWS in the future.

Answer the question based on the following context: Plain radiography of the paranasal sinuses (Water's view) may fail to demonstrate typical signs of orbital floor fractures. To resolve questionable cases, computed tomography (CT) is performed. B-mode ultra-sonography (US) is investigated concerning its reliability and as a possible alternative to CT. The replacement of standard radiological techniques in primary evaluation will be discussed. A skull was used to assess the visualization of the bony floor in the ultrasound-technique. Fifteen patients with suspected fractures of the orbital floor were investigated with plain radiographs, ultrasound of both orbits in closed-eyelid technique, and CT scans. The findings were compared. Thirteen patients were found to have apparent fractures in CT scans. These fractures were also diagnosed on ultrasound. In three patients, ultrasonographic localization was imprecise. These fractures were located behind the lower orbital rim or far posteriorly. Plain radiographs showed positive fracture signs only in five patients. Localization was not possible. The application of the ultrasound probe was well tolerated.

Ultrasound diagnosis of orbital floor fractures: an alternative to computerized tomography?

B-mode ultrasonography is a valuable and inexpensive technique to visualize orbital floor fractures. It should be employed in primary evaluation patients with suspected isolated orbital floor fractures prior to taking plain radiographs of the paranasal sinuses. Computed tomography should be used in suspected complex fractures and questionable orbital fractures.

Question: Ultrasound diagnosis of orbital floor fractures: an alternative to computerized tomography? Answer: B-mode ultrasonography is a valuable and inexpensive technique to visualize orbital floor fractures. It should be employed in primary evaluation patients with suspected isolated orbital floor fractures prior to taking plain radiographs of the paranasal sinuses. Computed tomography should be used in suspected complex fractures and questionable orbital fractures.

Answer the question based on the following context: To assess the effect of intra-arterial magnesium on the radial artery during transradial cardiac catheterization. Transradial coronary angiography has become popular in the last decade and offers several advantages over transfemoral angiography. Radial artery spasm is a major limitation of this approach, and a vasodilatory cocktail is usually given. The aim of this study was to examine the effect of magnesium sulphate on the radial artery during cardiac catheterization. This was a prospective, double-blind, randomized trial of 86 patients undergoing radial catheterization. Patients were randomized to receive magnesium sulphate (150 mg) or verapamil (1 mg) into the radial sheath. Radial dimensions were assessed using Doppler ultrasound. The primary endpoint of the study was a change in radial artery diameter following administration. Secondary endpoints included operator-defined radial artery spasm and patient pain. Following administration of the study drug, there was an increase in radial artery diameter in both groups (p<0.01), although the increase seen was greater in the group receiving magnesium (magnesium 0.36 +/- 0.03 mm; verapamil 0.27 +/- 0.03 mm; p<0.05). Administration of verapamil resulted in a fall in mean arterial pressure (MAP) (change in MAP -6.6 +/- 1.4 mmHg; p<0.01), whereas magnesium did not have a hemodynamic effect. Severe arm pain (pain score>5) was observed in 14 (30%) patients receiving verapamil and 9 (27%) receiving magnesium (p = NS).

Magnesium sulphate during transradial cardiac catheterization: a new use for an old drug?

This study demonstrates that magnesium is a more effective vasodilator when compared to verapamil, with a reduced hemodynamic effect, and is equally effective at preventing radial artery spasm. As such, the use of this agent offers distinct advantages over verapamil during radial catheterization.

Question: Magnesium sulphate during transradial cardiac catheterization: a new use for an old drug? Answer: This study demonstrates that magnesium is a more effective vasodilator when compared to verapamil, with a reduced hemodynamic effect, and is equally effective at preventing radial artery spasm. As such, the use of this agent offers distinct advantages over verapamil during radial catheterization.

Answer the question based on the following context: The randomized TARGIT trial comparing experimental intra-operative radiotherapy (IORT) to up to 7 weeks of daily conventional external beam radiotherapy (EBRT) recruited participants in Western Australia between 2003 and 2012. We aimed to understand preferences for this evolving radiotherapy treatment for early breast cancer (EBC) in health professionals, and how they changed over time and in response to emerging data. Preferences for single dose IORT or EBRT for EBC were elicited in 2004 and 2011, together with factors that may be associated with these preferences. Western Australian health professionals working with breast cancer patients were invited to complete a validated, self-administered questionnaire. The questionnaire used hypothetical scenarios and trade-off methodology to determine the maximum increase in risk of local recurrence health professionals were willing to accept in order to have a single dose of IORT in the place of EBRT if they were faced with this decision themselves. Health professional characteristics were similar across the two time points although 2011 included a higher number of nurse (49% vs. 36%) and allied health (10% vs. 4%) participants and a lower number of radiation therapists (17% vs. 32% ) compared to 2004.Health professional preferences varied, with 7.5% and 3% judging IORT unacceptable at any risk, 18% and 21% judging IORT acceptable only if offering an equivalent risk, 56% and 59% judging IORT acceptable with a low maximum increase in risk (1-3%) and 19% and 17% judging a high maximum increase in risk acceptable (4-5%), in 2004 and 2011 respectively. A significantly greater number of nurses accepted IORT as a treatment option in 2011.

Intraoperative radiotherapy for early breast cancer: do health professionals choose convenience or risk?

Most Western Australian health professionals working with breast cancer patients are willing to accept an increase in risk of local recurrence in order to replace EBRT with IORT in a hypothetical setting. This finding was consistent over two time points spanning 7 years despite the duration of clinical experience with IORT and the publication of the early clinical results of IORT in 2010. These results need to be compared with preferences elicited from patient groups, and further investigation into the impact of personal preferences on health professionals' advice to patients is warranted.

Question: Intraoperative radiotherapy for early breast cancer: do health professionals choose convenience or risk? Answer: Most Western Australian health professionals working with breast cancer patients are willing to accept an increase in risk of local recurrence in order to replace EBRT with IORT in a hypothetical setting. This finding was consistent over two time points spanning 7 years despite the duration of clinical experience with IORT and the publication of the early clinical results of IORT in 2010. These results need to be compared with preferences elicited from patient groups, and further investigation into the impact of personal preferences on health professionals' advice to patients is warranted.

Answer the question based on the following context: To compare the use of the 5-year-olds' index on both dental study casts and intraoral photographs when measuring primary surgical outcome for children born with unilateral cleft lip and palate (UCLP). A cross-sectional study. Models and photographs collected from cleft units across the UK as part of the CCUK (Cleft Care UK) study were scored by two clinicians at the School of Oral and Dental Sciences, Bristol, UK. Five-year-old children born with UCLP as part of the CCUK study. One hundred and ninety-eight had dental study casts available and 49 had intraoral photographs available. The records of both groups, that is study casts (n = 198) and photographs (n = 49) were scored using the 5-year-olds' index on two occasions by two examiners. Reliability of scoring is reduced for intraoral photographs compared with dental study casts. Using weighted Kappa the inter-rater reliability for dental study casts was 0.72 to 0.77 and the inter-rater reliability for intraoral photographs was 0.52 to 0.59. The photographs and study casts were not matched for each individual and were collected by a number of different clinicians in each unit, both of which will have had an effect on the quality and consistency of the final records.

Are photographs a suitable alternative to dental study casts when assessing primary surgical outcome in children born with unilateral cleft lip and palate?

Dental study casts provide more reliable results and thus still represent the gold standard when assessing primary surgical outcome in cleft care using the 5-year-olds' index.

Question: Are photographs a suitable alternative to dental study casts when assessing primary surgical outcome in children born with unilateral cleft lip and palate? Answer: Dental study casts provide more reliable results and thus still represent the gold standard when assessing primary surgical outcome in cleft care using the 5-year-olds' index.

Answer the question based on the following context: Medical oncologists often must deliver bad news. The authors were interested in the extent of formal training in delivering bad news in hematology/oncology fellowships in the United States. An e-mail survey was sent to all hematology/oncology fellowship program directors in the United States. Surveys were e-mailed to 124 program directors and responses were received either via e-mail or regular mail. Program directors were asked the adequacy, the perceived necessity, the quality of this training, and the institutional support provided. It was also intended to elicit responses about the degree of formal training fellows receive in delivering bad news. chi(2) Statistics were used to perform comparisons between items; p values of less than 0.05 were considered statistically significant. Sixty-five surveys were completed and returned (52% response rate). The majority of programs, 82%, are in urban areas and 97% of the primary teaching hospitals are considered tertiary care centers and 46% of programs carry a National Cancer Institute (NCI) designation. Median number of fellows in a training program is 6 with the range being 3 to 46. Eighty-nine percent of program directors reported that they themselves received little to no formal training in delivering bad news, but they report 37% of current fellows receive little to no formal training with 40% receiving some training and additional 23% receiving moderate to extensive training (p<0.001). Sixty-three percent of program directors felt that extensive, formal training is important for skill development in delivering bad news, while an additional 34% felt that some training is useful. Only 3% of respondents did not believe any training is needed. Seventy-six percent of program directors want improvements in how their fellows are trained, but 43% reported little to no institutional support for training (p<0.001).

Are we training our fellows adequately in delivering bad news to patients?

Of the program directors who responded to our survey, a large majority did not have formal training in delivering bad news. Despite this lack of training, most program directors felt that training was useful for skill development in delivering bad news. The majority of today's fellows do receive training in delivering bad news. However, there was still a significant percentage of program directors who reported little or no formal training for fellows. Most program directors would like to see improvements in how fellows are trained. Specific institutional support for training fellows in delivering bad news remains lacking.

Question: Are we training our fellows adequately in delivering bad news to patients? Answer: Of the program directors who responded to our survey, a large majority did not have formal training in delivering bad news. Despite this lack of training, most program directors felt that training was useful for skill development in delivering bad news. The majority of today's fellows do receive training in delivering bad news. However, there was still a significant percentage of program directors who reported little or no formal training for fellows. Most program directors would like to see improvements in how fellows are trained. Specific institutional support for training fellows in delivering bad news remains lacking.

Answer the question based on the following context: It is unknown whether physical activity during pregnancy (PA) has long-term impact on the metabolic profile of the offspring. We investigated associations of PA with markers of the metabolic syndrome (MS) in 20y old offspring. Longitudinal study where 965 pregnant women during 1988-1989 had four dimensions of PA assessed by questionnaires in gestation week 30: PA at work; leisure time PA, daily amount of walking-biking and sport participation. The following MS markers were assessed in the offspring (n=439): body mass index (BMI), waist circumference, blood pressure, homeostasis model assessment insulin resistance as well as fasting plasma glucose, triglycerides, cholesterol (high-density lipoprotein (HDL), low-density lipoprotein and total cholesterol), insulin and leptin levels. Walking-biking PA in pregnancy is associated with unchanged or subtle, adverse changes of distinct MS markers among offspring including lower levels of HDL cholesterol (ratio 0.95 (95% CI 0.92 to 0.98) per 1 h increment in walking-biking), a higher diastolic blood pressure (difference 1.12 (95% CI 0.03 to 2.20) mm Hg/1 h increment) and a higher BMI (ratio 1.03 (95% CI 1.01 to 1.05) per 1 h increment). In separate analyses in males, these associations persisted and additional adverse associations were found for triglycerides, systolic blood pressure, waist circumference and leptin. No associations were detected with other measures of PA.

Does physical activity during pregnancy adversely influence markers of the metabolic syndrome in adult offspring?

The study did not substantiate any protective effects of PA in pregnancy. In contrast, data suggested that high amounts of daily walking-biking in pregnancy may have adverse effects on levels of HDL cholesterol, diastolic blood pressure and BMI in young adult offspring.

Question: Does physical activity during pregnancy adversely influence markers of the metabolic syndrome in adult offspring? Answer: The study did not substantiate any protective effects of PA in pregnancy. In contrast, data suggested that high amounts of daily walking-biking in pregnancy may have adverse effects on levels of HDL cholesterol, diastolic blood pressure and BMI in young adult offspring.

Answer the question based on the following context: To determine (1) whether academic otolaryngologists who have received an American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNSF) Centralized Otolaryngology Research Efforts (CORE) grant are more likely to procure future National Institutes of Health (NIH) funding; (2) whether CORE grants or NIH Career Development (K) awards have a stronger association with scholarly impact. Historical cohort. Scholarly impact, as measured by the h-index, publication experience, and prior grant history, were determined for CORE-funded and non-CORE-funded academic otolaryngologists. All individuals were assessed for NIH funding history. Of 192 academic otolaryngologists with a CORE funding history, 39.6% had active or prior NIH awards versus 15.1% of 1002 non-CORE-funded faculty (P<.0001). Higher proportions of CORE-funded otolaryngologists have received K-series and R-series grants from the NIH (P-values<.05). K-grant recipients had higher h-indices than CORE recipients (12.6 vs 7.1, P<.01). Upon controlling for rank and experience, this difference remained significant among junior faculty.

Do AAO-HNSF CORE Grants Predict Future NIH Funding Success?

A higher proportion of academic otolaryngologists with prior AAO-HNSF CORE funding have received NIH funding relative to their non-CORE-funded peers, suggesting that the CORE program may be successful in its stated goals of preparing individuals for the NIH peer review process, although further prospective study is needed to evaluate a "cause and effect" relationship. Individuals with current or prior NIH K-grants had greater research productivity than those with CORE funding history. Both cohorts had higher scholarly impact values than previously published figures among academic otolaryngologists, highlighting that both CORE grants and NIH K-grants awards are effective career development resources.

Question: Do AAO-HNSF CORE Grants Predict Future NIH Funding Success? Answer: A higher proportion of academic otolaryngologists with prior AAO-HNSF CORE funding have received NIH funding relative to their non-CORE-funded peers, suggesting that the CORE program may be successful in its stated goals of preparing individuals for the NIH peer review process, although further prospective study is needed to evaluate a "cause and effect" relationship. Individuals with current or prior NIH K-grants had greater research productivity than those with CORE funding history. Both cohorts had higher scholarly impact values than previously published figures among academic otolaryngologists, highlighting that both CORE grants and NIH K-grants awards are effective career development resources.

Answer the question based on the following context: To describe the association between labour market status and death by suicide with focus on admission with a psychiatric disorder. Nested case-control study. Data from routine registers. Entire Danish population. 9011 people aged 25-60 years who committed suicide during 1982-1997 and 180 220 matched controls. In the general population, not being fully employed is associated with a twofold to threefold increased relative risk of death by suicide, compared with being fully employed. In contrast, fully employed people who have been first admitted to a psychiatric hospital within the past year are at increased suicide risk. Patients who are unemployed, social benefits recipients, disability pensioners, or otherwise marginalised on the labour market have a suicide risk of 0.60 (95% CI: 0.46 to 0.78), 0.41 (0.23 to 0.74), 0.70 (0.45 to 1.08), and 0.86 (0.53 to 1.41), respectively. Although a similar risk decrease is found in women, men, people younger than 30 years, people older than 45 years, and in people who become unemployed, the reversed effect attenuates with time since admission, and little association is seen when a marginal structural model is applied.

Effect of psychiatric illness and labour market status on suicide: a healthy worker effect?

Although the results show an increased suicide mortality associated with unemployment and labour market marginalisation in the general population, the results suggest little or an inverse association between unemployment and suicide in people with psychiatric illness. The associations seen suggest the need to consider healthy worker selection effects when studying the causal pathway from unemployment and psychiatric illness to suicide.

Question: Effect of psychiatric illness and labour market status on suicide: a healthy worker effect? Answer: Although the results show an increased suicide mortality associated with unemployment and labour market marginalisation in the general population, the results suggest little or an inverse association between unemployment and suicide in people with psychiatric illness. The associations seen suggest the need to consider healthy worker selection effects when studying the causal pathway from unemployment and psychiatric illness to suicide.

Answer the question based on the following context: Syncope in Wolff-Parkinson-White (WPW) syndrome may reveal an arrhythmic event or is not WPW syndrome related. The aim of the study is to evaluate the results of electrophysiological study in WPW syndrome according to the presence or not of syncope and the possible causes of syncope. Among 518 consecutive patients with diagnosis of WPW syndrome, 71 patients, mean age 34.5 +/- 17, presented syncope. Transoesophageal electrophysiological study in control state and after isoproterenol infusion was performed in the out-patient clinic. Atrioventricular re-entrant tachycardia (AVRT) was more frequently induced than in asymptomatic patients (n = 38, 53.5%, P<0.01), less frequently than in those with tachycardia; atrial fibrillation (AF) and/or antidromic tachycardia (ATD) was induced in 28 patients (39%) more frequently (P<0.05) than in asymptomatic patients or those with tachycardia. The incidence of high-risk form [rapid conduction over accessory pathway (AP) and AF or ATD induction] was higher in syncope group (n = 18, 25%, P<0.001) than in asymptomatic subjects (8%) or those with tachycardias (7.5%). Maximal rate conducted over AP was similar in patients with and without syncope, and higher in patients with spontaneous AF, but without syncope. Results were not age-related.

Are the results of electrophysiological study different in patients with a pre-excitation syndrome, with and without syncope?

Tachycardia inducibility was higher in patients with syncope than in the asymptomatic group. The incidence of malignant WPW syndrome was higher in patients with syncope than in asymptomatic or symptomatic population, but the maximal rate conducted over AP was not higher and another mechanism could be also implicated in the mechanism of syncope.

Question: Are the results of electrophysiological study different in patients with a pre-excitation syndrome, with and without syncope? Answer: Tachycardia inducibility was higher in patients with syncope than in the asymptomatic group. The incidence of malignant WPW syndrome was higher in patients with syncope than in asymptomatic or symptomatic population, but the maximal rate conducted over AP was not higher and another mechanism could be also implicated in the mechanism of syncope.

Answer the question based on the following context: Postpartum depression is an important and under-diagnosed problem. The aims of this study were (1) to compare the prevalence of depressive symptomology in Turkish mothers who were 1-3 months postpartum with the prevalence of depressive symptomology in mothers who had not been pregnant for at least 1 year, (2) to identify risk factors associated with depression in both groups, and (3) to examine the effect of postpartum depression on breastfeeding by the mothers. Cross-sectional study Well-baby clinic 326 women enrolled in January 2001; 163 were 1-3 months postpartum, and 163 had not been pregnant in the previous year. The prevalence of depressive symptomology in the postpartum and non-postpartum groups was 17% (28/163) and 24.5% (40/163), respectively; this was not statistically significant (P = 0.102). When we compared mean Beck Depression Inventory (BDI) scores, the difference between the two groups was statistically significant (10.75 +/- 8.06 and 12.63 +/- 8.81, respectively, P = 0.045). Premenstrual tension and a history of depression were risk factors for depressive symptomology in both groups. Three or more births and a history of induced abortion were risk factors for depressive symptomology in the non-postpartum group. In the postpartum group, the effect of depression on breast-feeding was not statistically significant (P = 0.7). The generalisability of the study results to the community is limited.

Is there a role for the family and close community to help reduce the risk of postpartum depression in new mothers?

In this study, the prevalence of depressive symptomology in the postpartum and non-postpartum groups did not show a significant difference, but the prevalence of depressive symptomology was high in both groups. Postpartum depression did not have a negative effect on breast-feeding. Lower BDI scores in the postpartum period may be the result of the protective factors of motherhood which is a respected status for women in populations where the preservations of traditions and customs are valued.

Question: Is there a role for the family and close community to help reduce the risk of postpartum depression in new mothers? Answer: In this study, the prevalence of depressive symptomology in the postpartum and non-postpartum groups did not show a significant difference, but the prevalence of depressive symptomology was high in both groups. Postpartum depression did not have a negative effect on breast-feeding. Lower BDI scores in the postpartum period may be the result of the protective factors of motherhood which is a respected status for women in populations where the preservations of traditions and customs are valued.

Answer the question based on the following context: Octogenarians are at increased risk for perioperative morbidity and mortality after coronary artery bypass. In this study we compared our experience with patients undergoing on-pump coronary artery bypass (CAB) and those undergoing off-pump coronary artery bypass (OPCAB) to assess outcomes. We used hospital database analysis in patients 80 years and older who underwent nonemergent coronary artery bypass with (N = 169) and without (N = 60) cardiopulmonary bypass from January 1999 through June 2001. Both groups were at increased perioperative risk based on the Society of Thoracic Surgeons risk model (7.7% OPCAB vs 5.8% CAB, p = 0.03). There were no operative deaths in the OPCAB group but there were eight (4.7%) in the CAB group (p = NS). Perioperative stroke (0% OPCAB vs 7.1% CAB, p = 0.04), prolonged ventilation (1.7% OPCAB vs 11.8% CAB, p = 0.02), and transfusion rate (33% OPCAB vs 70.4% CAB, p<0.001) were all lower in the OPCAB group. A shorter hospital stay (6.3 days OPCAB vs 11.5 days CAB, p<0.001) resulted in lower hospital cost in the OPCAB group ($9,363 OPCAB vs $12,312 CAB, p<0.001).

Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice?

In this study, off-pump coronary artery bypass grafting in elderly patients was associated with fewer complications, a shorter hospital stay, and lower hospital cost. Off-pump coronary artery bypass grafting may be the operation of choice for octogenarians requiring surgical myocardial revascularization.

Question: Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice? Answer: In this study, off-pump coronary artery bypass grafting in elderly patients was associated with fewer complications, a shorter hospital stay, and lower hospital cost. Off-pump coronary artery bypass grafting may be the operation of choice for octogenarians requiring surgical myocardial revascularization.

Answer the question based on the following context: To test whether three different intensive programs of treatment for neurotic and personality disorders are effective in decreasing neurotic symptoms and traits of neurotic personality and whether there are differences between them in clinical outcome. The sample consisted of 105 patients (83% female, mean age 35) diagnosed with neurosis and personality disorders that were treated in three therapeutic wards under routine inpatient conditions. The therapeutic programs are designed for patients with neurotic and personality disorders. They consist of 6-12 weeks of approximately 5 hours of eclectic group treatment (group psychotherapy, psychodrama, psychoeducation etc.). Participants filled in Symptoms' Questionnaire KS-II, and Neurotic Personality Questionnaire KON-2006 at the beginning and at the end of the course of psychotherapy. The treatment proved to be effective in diminishing neurotic symptoms (d Cohen = 0.56). More detailed analysis revealed that there was a significant interaction between the three analysed therapeutic wards and the effectiveness (12 = 0.09). The treatments offered in two institutions were effective (d Cohen = 0.80) while one of the programs did not lead to significant improvement of the patients. None of the therapeutic wards proved to be effective in changing the neurotic personality traits.

Differences in effectiveness of intensive programs of treatment for neurotic and personality disorders. Is it worth to monitor the effectiveness of the therapeutic team?

There are significant differences in effectiveness of the intensive programs of treatment for neurotic and personality disorders. In the light of the literature, one can assume that the differences are more connected with the characteristics of therapeutic teams than with the methods used. The need for standard methods of effectiveness monitoring is discussed.

Question: Differences in effectiveness of intensive programs of treatment for neurotic and personality disorders. Is it worth to monitor the effectiveness of the therapeutic team? Answer: There are significant differences in effectiveness of the intensive programs of treatment for neurotic and personality disorders. In the light of the literature, one can assume that the differences are more connected with the characteristics of therapeutic teams than with the methods used. The need for standard methods of effectiveness monitoring is discussed.

Answer the question based on the following context: The objective was to determine whether girls were more insulin-resistant than boys. Data from 1009 children (508 males) in 10 elementary schools, between April and September, 2007 were collected. BMI, waist circumference (WC), blood pressure, Tanner stage, lipids, insulin, and glucose were obtained. One hundred and sixty five (16.4%) of the children were obese (>95%ile), and 166 (16.5%) were overweight (85-95%ile). Mean HOMA-IR and insulin were higher among 10.0-13.9-year-old girls than boys. Multiple logistic regression using the 3rd quartile of HOMA-IR as the dependent variable showed that only BMI OR=1.18 (95% CI 1.12-1.24; p<0.001), Tanner OR=1.39 (95% CI 1.12-1.73; p=0.003) and triglycerides 1.005 (95% CI 1.00-1.01; p=0.04) were significantly associated with insulin resistance while sex and HDL-C were not.

Are girls more insulin-resistant than boys?

This study showed that no significant sex-related differences were found, and HOMA-IR was associated with adiposity and pubertal stage suggesting that the higher values of HOMA-IR in girls than in boys could be due to their earlier pubertal development.

Question: Are girls more insulin-resistant than boys? Answer: This study showed that no significant sex-related differences were found, and HOMA-IR was associated with adiposity and pubertal stage suggesting that the higher values of HOMA-IR in girls than in boys could be due to their earlier pubertal development.

Answer the question based on the following context: In bipolar patients, the rate of mortality from cardiovascular diseases is two-fold higher than that in other psychiatric disorders. The risk of cardiovascular diseases was found to be associated with some cellular adhesion molecules: Intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM) and E-selectin. The aim of this study was to compare ICAM, VCAM and E-selectin levels at first manic episode and subsequent remission period, and to investigate the presence of a relationship between adhesion molecules levels and clinical and metabolic variables. In line with this purpose, 50 patients diagnosed with mania according to DSM IV-TR criteria, who had their first episode were evaluated consecutively. The control group consisted of 50 healthy individuals without any history of psychiatric admission and treatment, matched with the manic patients in terms of age, gender, BMI and smoking status. For the confirmation of subsequent remission period (n=40), Young Mania Rating Scale and Hamilton Depression Rating Scale were used. In three groups plasma ICAM, VCAM and E-selectin, fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured and compared. ICAM and VCAM levels were found to be higher in first manic episode than those in subsequent remission and healthy individuals. A weak correlation was found between ICAM levels and YMRS scores in manic patients. In first manic episode, a weak correlation was found between ICAM and total cholesterol and LDL cholesterol levels and a weak correlation was found between ICAM, VCAM and E-selectin levels and BMI.

Are ICAM, VCAM and E-selectin levels different in first manic episode and subsequent remission?

In the present study, which is the first investigation of proinflammatory and prothrombotic state, which is defined as a risk for metabolic syndrome and cardiovascular disease, in bipolar disorder, ICAM and VCAM levels were found to be higher in first episode mania than those in subsequent remission and healthy individuals. As the study group included first episode mani cases, there was no effect of chronic psychotropic use. Probable risk of cardiovascular disease, reflected by increased ICAM and VCAM levels is already present in bipolar patients at the onset of the disease. In addition, ICAM and VCAM levels increasing in manic episode, return to normal in the subsequent remission period.

Question: Are ICAM, VCAM and E-selectin levels different in first manic episode and subsequent remission? Answer: In the present study, which is the first investigation of proinflammatory and prothrombotic state, which is defined as a risk for metabolic syndrome and cardiovascular disease, in bipolar disorder, ICAM and VCAM levels were found to be higher in first episode mania than those in subsequent remission and healthy individuals. As the study group included first episode mani cases, there was no effect of chronic psychotropic use. Probable risk of cardiovascular disease, reflected by increased ICAM and VCAM levels is already present in bipolar patients at the onset of the disease. In addition, ICAM and VCAM levels increasing in manic episode, return to normal in the subsequent remission period.

Answer the question based on the following context: Urinary density (UD) has been routinely used for decades as a surrogate marker for urine osmolality (Uosm). We asked if UD can accurately estimate Uosm both in healthy subjects and in different clinical scenarios of kidney disease. UD was assessed by refractometry. Uosm was measured by freezing point depression in spot urines obtained from healthy volunteers (N = 97) and in 319 inpatients with acute kidney injury (N = 95), primary glomerulophaties (N = 118) or chronic kidney disease (N = 106). UD and Uosm correlated in all groups (p < 0.05). However, a wide range of Uosm values was associated with each UD value. When UD was ≤ 1.010, 28.4% of samples had Uosm above 350 mOsm/kg. Conversely, in 61.6% of samples with UD above 1.020, Uosm was below 600 mOsm/kg. As expected, Uosm exhibited a strong relationship with serum creatinine (Screat), whereas a much weaker correlation was found between UD and Screat.

Is urinary density an adequate predictor of urinary osmolality?

We found that UD is not a substitute for Uosm. Although UD was significantly correlated with Uosm, the wide dispersion makes it impossible to use UD as a dependable clinical estimate of Uosm. Evaluation of the renal concentrating ability should be based on direct determination of Uosm.

Question: Is urinary density an adequate predictor of urinary osmolality? Answer: We found that UD is not a substitute for Uosm. Although UD was significantly correlated with Uosm, the wide dispersion makes it impossible to use UD as a dependable clinical estimate of Uosm. Evaluation of the renal concentrating ability should be based on direct determination of Uosm.

Answer the question based on the following context: Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear.QUESTIONS/ We asked if posterior radiocapitellar synovial plica excision made any additional improvement in pain or function after arthroscopic ECRB release. We retrospectively reviewed 38 patients who had arthroscopic treatment for refractory lateral epicondylitis between November 2003 and October 2009. Twenty patients (Group A) underwent the Baker technique and 18 patients (Group B) underwent a combination of the Baker technique and posterior synovial plica excision. The minimum followup was 36 months (mean, 46 months; range, 36-72 months) for Group A and 25 months (mean, 30 months; range, 25-36 months) for Group B. Postoperatively we obtained VAS pain and DASH scores for each group. Two years postoperatively, we found no differences in the VAS pain score or DASH: the mean VAS pain scores were 0.3 points in Group A and 0.4 points in Group B, and the DASH scores were 5.1 points and 6.1 points respectively.

Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow?

The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication.

Question: Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Answer: The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication.

Answer the question based on the following context: This retrospective study included patients with chronic liver disease who underwent hepatocellular carcinoma screening with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 30 November 2014. For each case, HBP was graded as adequate or suboptimal, based on Liver Image Reporting and Data System (LI-RADS) criteria. The following laboratory data obtained within 3 months of the MRI date was extracted: total bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, activated partial thromboplastin time (aPTT), and International normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver operating characteristic (ROC) curve analysis was used to establish cut-off values for predicting suboptimal HBP. Of 284 patients, 242 (85.2%) patients (91; 57.6% male) had an adequate HBP and 42 (14.8%) patients (13; 61.9% male) had suboptimal HBP, with mean ages of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC curve for predicting suboptimal HBP were 0.85 (95%CI 0.79-0.91) for the MELD score, 0.88 (95%CI 0.82-0.93) for TB, and 0.91 (95%CI 0.86-0.95) for DB. Accuracy, positive likelihood ratios and cut-off values for predicting suboptimal HBP were, respectively: 86.7% and 11.2 for the MELD score ≥16.7, 88.2% and 28.7 for TB ≥4.3 mg/dl, and 91.1% and 36.4 for DB ≥1.3 mg/dl. SGOT, SGPT, and ALP were not statistically significantly different between the groups.

Limitations of GD-EOB-DTPA-enhanced MRI: can clinical parameters predict suboptimal hepatobiliary phase?

Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.

Question: Limitations of GD-EOB-DTPA-enhanced MRI: can clinical parameters predict suboptimal hepatobiliary phase? Answer: Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.

Answer the question based on the following context: The purpose of this study was to compare outcomes and complications after total knee arthroplasty (TKA) between end-stage renal disease (ESRD) patients and patients without renal insufficiency. A retrospective case-control study with prospectively collected data was carried out to compare 15 ESRD patients with a matched cohort of 30 nonrenal patients. Clinical evaluation was performed by the Knee Society Scores (KSS) and reduced Western Ontario MacMasters University (WOMAC) questionnaire. Radiologic evaluation was also performed. The mean postoperative follow-up was 3.4 years (range, 2-6). In the ESRD, the mean hospital stay and transfusion rate were significantly higher than control group. Preoperatively and postoperatively, there were no significant differences in KSS-knee or WOMAC-pain scores, but KSS-function and WOMAC-function were significantly lower in the ESRD group. There was no significant difference between groups in mean gain of KSS-function (45.1 vs 43.2, P = .071), but there was a significant lower mean gain for WOMAC-function in the ESRD group (37.0 vs 44.0, P = .003). In the ESRD group, 3 patients presented medical complications which were treated successfully. There were 2 superficial infections and no deep infection. One patient died at 30 postoperative months. In the control group, there were no medical complications, infections, or deaths during the follow-up period. In ESRD group, there were 2 knees with radiolucent lines. In either group, there was no loosening or revision.

Elective Total Knee Arthroplasty in Patients With End-Stage Renal Disease: Is It a Safe Procedure?

TKA was a successful procedure for knee osteoarthritis in most ESRD patients. Dialysis patients may expect improvement in function after TKA, but the patients need to be informed of the possible risk of postoperative severe medical complications due to nature of their renal disease.

Question: Elective Total Knee Arthroplasty in Patients With End-Stage Renal Disease: Is It a Safe Procedure? Answer: TKA was a successful procedure for knee osteoarthritis in most ESRD patients. Dialysis patients may expect improvement in function after TKA, but the patients need to be informed of the possible risk of postoperative severe medical complications due to nature of their renal disease.

Answer the question based on the following context: The incidence and management of antitumoral compound extravasation that occurred in our medical day hospital unit were registered in a 10-year period. A total of 114 episodes were consecutively recorded out of an estimated number of 211,948 administrations performed (0.05%). Type of compound, localization, timing, symptoms, treatment, resolution, or sequelae were documented. Extravasations after anthracyclines (17/114), platinum compounds (34/114), vinca alkaloids (7/114), and taxanes (34/114) were more frequently associated with edema and erythema ± pain. Five cases of monoclonal antibodies extravasation were observed without sequelae. With the involvement of an interdisciplinary task force and the use of dedicated guidelines, conservative management was successful in all patients. In the great majority of cases, recovery was complete within 48 hours after antidote administration. The support of our pharmacy was crucial. Physiatric evaluation was considered in several cases. No patients required surgery.

Cytotoxic extravasation: an issue disappearing or a problem without solution?

We confirm that the adopted standardized approach to this event resulted in a satisfactory outcome and could be suggested as appropriate for managing extravasation in a large clinical context.

Question: Cytotoxic extravasation: an issue disappearing or a problem without solution? Answer: We confirm that the adopted standardized approach to this event resulted in a satisfactory outcome and could be suggested as appropriate for managing extravasation in a large clinical context.

Answer the question based on the following context: Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period.

Initial abstinence status and contingency management treatment outcomes: does race matter?

CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed.

Question: Initial abstinence status and contingency management treatment outcomes: does race matter? Answer: CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed.

Answer the question based on the following context: The objective of this report is to conduct short- and long-term evaluation of a large panel of antiphospholipid (aPL) autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in primary antiphospholipid syndrome (PAPS) patients and healthy controls. Forty-five PAPS and 33 healthy controls were immunized with H1N1 vaccine. They were prospectively assessed at pre-vaccination, and three weeks and six months after vaccination. aPL autoantibodies were determined by an enzyme-linked immunosorbent assay (ELISA) and included IgG/IgM: anticardiolipin (aCL), anti-beta2glycoprotein I (anti-β2GPI); anti-annexin V, anti-phosphatidyl serine and anti-prothrombin antibodies. Anti-Sm was determined by ELISA and anti-double-stranded DNA (anti-dsDNA) by indirect immunofluorescence. Arterial and venous thrombosis were also clinically assessed. Pre-vaccination frequency of at least one aPL antibody was significantly higher in PAPS patients versus controls (58% vs. 24%, p = 0.0052). The overall frequencies of aPL antibody at pre-vaccination, and three weeks and six months after immunization remained unchanged in patients (p = 0.89) and controls (p = 0.83). The frequency of each antibody specificity for patients and controls remained stable in the three evaluated periods (p>0.05). At three weeks, two PAPS patients developed a new but transient aPL antibody (aCL IgG and IgM), whereas at six months new aPL antibodies were observed in six PAPS patients and none had high titer. Anti-Sm and anti-dsDNA autoantibodies were uniformly negative and no new arterial or venous thrombosis were observed throughout the study.

Pandemic influenza immunization in primary antiphospholipid syndrome (PAPS): a trigger to thrombosis and autoantibody production?

This is the first study to demonstrate that pandemic influenza vaccine in PAPS patients does not trigger short- and long-term thrombosis or a significant production of aPL-related antibodies (ClinicalTrials.gov, #NCT01151644).

Question: Pandemic influenza immunization in primary antiphospholipid syndrome (PAPS): a trigger to thrombosis and autoantibody production? Answer: This is the first study to demonstrate that pandemic influenza vaccine in PAPS patients does not trigger short- and long-term thrombosis or a significant production of aPL-related antibodies (ClinicalTrials.gov, #NCT01151644).

Answer the question based on the following context: Artemisinin combination therapy (ACT) is first-line treatment for malaria in most endemic countries and is increasingly available in the private sector. Most studies on ACT adherence have been conducted in the public sector, with minimal data from private retailers. Parallel studies were conducted in Tanzania, in which patients obtaining artemether-lumefantrine (AL) at 40 randomly selected public health facilities and 37 accredited drug dispensing outlets (ADDOs) were visited at home and questioned about doses taken. The effect of sector on adherence, controlling for potential confounders was assessed using logistic regression with a random effect for outlet. Of 572 health facility patients and 450 ADDO patients, 74.5% (95% CI: 69.8, 78.8) and 69.8% (95% CI: 64.6, 74.5), respectively, completed treatment and 46.0% (95% CI: 40.9, 51.2) and 34.8% (95% CI: 30.1, 39.8) took each dose at the correct time ('timely completion'). ADDO patients were wealthier, more educated, older, sought care later in the day, and were less likely to test positive for malaria than health facility patients. Controlling for patient characteristics, the adjusted odds of completed treatment and of timely completion for ADDO patients were 0.65 (95% CI: 0.43, 1.00) and 0.69 (95% CI: 0.47, 1.01) times that of health facility patients. Higher socio-economic status was associated with both adherence measures. Higher education was associated with completed treatment (adjusted OR = 1.68, 95% CI: 1.20, 2.36); obtaining AL in the evening was associated with timely completion (adjusted OR = 0.35, 95% CI: 0.19, 0.64). Factors associated with adherence in each sector were examined separately. In both sectors, recalling correct instructions was positively associated with both adherence measures. In health facility patients, but not ADDO patients, taking the first dose of AL at the outlet was associated with timely completion (adjusted OR = 2.11, 95% CI: 1.46, 3.04).

Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?

When controlling for patient characteristics, there was some evidence that the adjusted odds of adherence for ADDO patients was lower than that for public health facility patients. Better understanding is needed of which patient care aspects are most important for adherence, including the role of effective provision of advice.

Question: Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy? Answer: When controlling for patient characteristics, there was some evidence that the adjusted odds of adherence for ADDO patients was lower than that for public health facility patients. Better understanding is needed of which patient care aspects are most important for adherence, including the role of effective provision of advice.

Answer the question based on the following context: Several randomized controlled trials and observational studies have compared outcomes for coronary artery bypass graft (CABG) surgery and drug-eluting stents (DES), but these studies have not thoroughly investigated the relative difference in outcomes by sex. We aimed to compare 3-year outcomes (mortality, mortality/myocardial infarction/stroke, and repeat revascularization) for CABG surgery and percutaneous coronary interventions with DES by sex. A total of 4,532 women (2,266 pairs of CABG and DES patients) and 11,768 men (5,884 pairs) were propensity matched separately using multiple patient risk factors and were compared with respect to 3-year outcomes. Both women and men receiving DES had significantly higher mortality rates (adjusted hazard ratio, 1.28; 95% confidence interval, 1.06 to 1.54 and adjusted hazard ratio, 1.22; 95% confidence interval, 1.06 to 1.41, respectively) and myocardial infarction/mortality/stroke rates (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19 to 1.64 and adjusted hazard ratio, 1.36; 95% confidence interval, 1.20 to 1.54, respectively) with DES. The advantage for CABG surgery was also present for several preselected patient subgroups. Men had consistently lower adverse outcome rates than women for both procedures. For example, the mortality rates for CABG and DES for men were 8.0% and 9.1%, compared with respective rates of 11.8% and 13.7% for women.

Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter?

For women, the advantage of CABG surgery over DES is very similar to what was found for men, and this advantage persisted for patients with and without high-risk characteristics.

Question: Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter? Answer: For women, the advantage of CABG surgery over DES is very similar to what was found for men, and this advantage persisted for patients with and without high-risk characteristics.

Answer the question based on the following context: Almost every country in the Western world has great difficulties allocating enough financial resources to meet the needs in the care of the increasing elderly population. The main problem is common to all countries and concerns the efforts to meet elderly persons' needs on an individual level while still maintaining society's responsibility for distributing justice. The aim of this study is to elaborate an instrument for measuring the quality of individual care and staff's working time in order to allocate public resources fairly. The present study gives an account of a new classification system named TiC (Time in Care), indicating how it can be used most effectively and also investigating the validity and reliability of the system. All recipients in 13 sheltered homes for elderly care (n = 505) in a Swedish municipality were surveyed regarding the care they needed, in dimensions of General Care, Medical Care, Cognitive Dysfunction and Rehabilitation, and the time required. Construct validity was assessed by means of factor analysis. The inter-rater agreement of two raters concerning 79 recipients was measured using weighted Kappa. The stability of the instrument and its sensitivity to change were investigated through test-retest reliability measurements, conducted once a month during a six-month period. The content validity of the instrument was also assessed. Factor analysis resulted in a reduction of the number of items from 25 to 16 in three dimensions: General Care, Medical Care and Cognitive Dysfunction. The Kappa analysis showed satisfactory to excellent inter-rater agreement. The care need scores were basically stable but showed sensitivity to change in health status.

Can care of elderly be measured?

The instrument was found to be useful and reliable for assessing individual needs in community health care.

Question: Can care of elderly be measured? Answer: The instrument was found to be useful and reliable for assessing individual needs in community health care.

Answer the question based on the following context: Selection interviews for GP training places are high-stakes interviews that demand fair and robust assessment methods. The aim of this study was to evaluate whether the results of standardised patient assessments on consecutive days of the week using the same scenarios were equivalent. We were concerned that candidates later in the week may receive information from their colleagues and potentially gain an unfair advantage by discovering the content of the exercise. Anonymised data were obtained from 221 candidates who undertook the standardised patient assessment at the West Midlands Deanery, resulting in an interactive skills score, on five consecutive days in October 2005. The relationship between interactive skills scores and screening test score, country of graduation, gender and day of assessment was analysed using a linear model with identity link and normal error. The presence of statistical outliers was assessed. Analysis of the relationship between interactive skills score and screening test score, country of graduation, gender and day of assessment showed a significant association between overall score with gender and country of graduation only. The results indicated that females and those candidates who graduated in the UK on average achieved higher scores. There was no significant association between interactive skills score and day of assessment and there were no statistical outliers.

Standardised patient assessments on consecutive days during high-stakes GP training interviews: is there any evidence of candidates sharing information?

On average candidate performance in the simulated patient exercise of GP training interviews was not influenced by the day of the assessment, indicating that, overall, candidates later in the week did not gain any advantage.

Question: Standardised patient assessments on consecutive days during high-stakes GP training interviews: is there any evidence of candidates sharing information? Answer: On average candidate performance in the simulated patient exercise of GP training interviews was not influenced by the day of the assessment, indicating that, overall, candidates later in the week did not gain any advantage.

Answer the question based on the following context: The pace of implementation of a laparoscopic nephrectomy programme is affected by factors including surgical expertise, case load, learning curves and outcome audits. We report our experience in introducing a laparoscopic nephrectomy programme over a 3-year period. From January 2001 to December 2003, 187 nephrectomies were performed (105 by conventional surgery, 82 by laparoscopy). Hand-assisted laparoscopy was used predominantly. The indications for surgery, factors affecting the approach and outcome parameters were studied. A cost comparison was made between patients with similar-sized renal tumours undergoing laparoscopic versus open surgery. Most operations were performed for malignancy in both the open (70%) and laparoscopic (67%) surgery groups. The laparoscopic approach was most commonly used in upper tract transitional cell cancers (TCCs; 70% of 30 patients) and benign pathologies (49% of 35 patients), followed by radical nephrectomies (34% of 99 patients) and donor nephrectomies (44% of 23 patients). There was a rapid rise in laparoscopic surgeries, from 30% in 2001 to 58% in 2002. The median hospital stay was 5.8 days in the laparoscopic group and 8.1 days in the open surgery group. The procedure cost for laparoscopic surgery was 4,943 dollars compared with 4,479 dollars for open surgery. However, due to a shorter hospital stay, the total hospital cost was slightly lower in the laparoscopic group (7,500 dollars versus 7,907 dollars).

Laparoscopic nephrectomy: new standard of care?

The laparoscopic approach for various renal pathologies was quickly established with a rapid increase in the number of laparoscopic procedures.

Question: Laparoscopic nephrectomy: new standard of care? Answer: The laparoscopic approach for various renal pathologies was quickly established with a rapid increase in the number of laparoscopic procedures.

Answer the question based on the following context: The root exit zone (REZ) of the seventh cranial nerve has been the target of microvascular decompression surgery (MVD) while searching the neurovascular conflict for treatment of hemifacial spasm for long time. Recently, increasing cases regarding the offending vessel beyond the REZ have been reported. To verify whether a thorough dissection of the nerve may give rise to a better postoperative result without enhancing complications, we conducted a parallel investigation. 112 Connective entire-nerve-exposed MVDs were performed and compared to 186 REZ-exposed MVDs performed by the same group of surgeons in 2009. The surgical findings, postoperative outcomes and complications as well as microscopic operating time were examined. Immediately after the surgery, the outcomes were excellent in 98.2%, good in 1.8% and poor in 0% in the entire-nerve-exposed group, compared to excellent in 92.5%, good in 1.6% and poor in 5.9% in the REZ-exposed group. The difference of outcomes between the two groups were statistically significant (χ(2)=4.6845, P=0.0304), but not the complications and microscopic operating time. Nine of the 11 poor-outcome patients from the REZ-exposed group were then reoperated on within a few days, and their symptoms disappeared in eight patients. The main reason for the failed surgeries was that the offending vessels beyond REZ were missed.

Is entire nerve root decompression necessary for hemifacial spasm?

These findings suggested that the entire-root-decompression technique is recommended while performing MVDs in patients with hemifacial spasm.

Question: Is entire nerve root decompression necessary for hemifacial spasm? Answer: These findings suggested that the entire-root-decompression technique is recommended while performing MVDs in patients with hemifacial spasm.

Answer the question based on the following context: The measurement of cardiac markers is still the gold standard for diagnosing myocardial infarction (MI), but there is always a transition period between the time of infarction and when a marker can be measured in the blood. Therefore, clinicians are shifting their focus to the identification of potential new analytes capable of predicting MIs before the standard cardiac markers increase. In this study, we tested whether measurement of the concentration of soluble intercellular adhesion molecule 1 (sICAM-1) in plasma can be used for this purpose. In this prospective study, we included 60 male patients who had a left main coronary artery lesion or a left main equivalent and who underwent elective (group I, n = 20), urgent (group II, n = 20), or emergent (group III, n = 20) coronary artery bypass grafting (CABG). We excluded patients who had increased cardiac markers at admission, and drew blood samples for sICAM-1 measurements from other patients immediately after coronary angiography evaluations. We divided the patients into 3 groups according to their clinical characteristics and cardiac marker levels. Only patients with increased cardiac markers underwent emergent CABG (group III). We measured sICAM-1 concentrations immediately after coronary angiography and measured creatine kinase MB (CK-MB) and cardiac troponin I (cTnI) just before CABG. We then evaluated the results for correlations. CK-MB, cTnI, and sICAM-1 levels were significantly higher in group III than in groups I and II (P<.05 for all). Our analysis for correlations between the sICAM-1 level and cardiac marker levels revealed no significant correlations in group I (CK-MB, r = 0.241 [P = .15]; cTnI, r = -0.107 [P = .32]) and group II (CK-MB, r = -0.202 [P = .19]; cTnI, r = 0.606 [P = .002]), but our analysis did reveal highly significant correlations in group III (CK-MB, r = 0.584 [P = .003]; cTnI, r = 0.605 [P = .002]).

Does the level of soluble intercellular adhesion molecule 1 predict myocardial injury before cardiac markers increase?

Measuring the plasma concentration of sICAM-1 before the concentrations of cardiac markers increase in patients with MI may provide clinicians with faster and reliable data for deciding on and administering the most appropriate procedures and/or therapies.

Question: Does the level of soluble intercellular adhesion molecule 1 predict myocardial injury before cardiac markers increase? Answer: Measuring the plasma concentration of sICAM-1 before the concentrations of cardiac markers increase in patients with MI may provide clinicians with faster and reliable data for deciding on and administering the most appropriate procedures and/or therapies.