Anterior Cruciate Ligament Fixation Devices: Expected Imaging Appearance and Common Complications

Publication date: Available online 9 December 2017
Source:European Journal of Radiology
Author(s): Jake W. Sharp, Kimia K. Kani, Albert Gee, Hyojeong Mulcahy, Felix S. Chew, Jack Porrino
Anterior cruciate ligament reconstruction is a commonly performed orthopaedic procedure which has increased in frequency over the past decade. There are a variety of fixation devices used to secure grafts within the femoral and tibial tunnels during the reconstruction procedure. An understanding of the expected appearance of the varied hardware utilized for reconstruction graft fixation, and their potential complications is important in the review of post-operative imaging. We describe the most common anterior cruciate ligament reconstruction fixation devices and illustrate their more frequently documented abnormalities.



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Comparison of radiation therapy modalities for hepatocellular carcinoma with portal vein thrombosis: A meta-analysis and systematic review

We performed a meta-analysis and systematic review to compare the radiotherapy (RT) modalities for hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT).

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Temporal and spatial variations of 134Cs and 137Cs levels in the Sea of Japan and Pacific coastal region: Implications for dispersion of FDNPP-derived radiocesium

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): M. Inoue, Y. Shirotani, S. Yamashita, H. Takata, H. Kofuji, D. Ambe, N. Honda, Y. Yagi, S. Nagao
To investigate the dispersion of Fukushima Dai-ichi Nuclear Power Plant (FDNPP)-derived radiocesium in the Sea of Japan and western Pacific coastal region and determine the sources of radiocesium in these areas, we examined the temporal and spatial variations of ¹³⁴Cs and ¹³⁷Cs concentrations (activities) during 2011–2016 in seawaters around the western Japanese Archipelago, particularly in the Sea of Japan. In May 2013, the surface concentration of ¹³⁴Cs was ∼0.5 mBq/L (decay-corrected to March 11, 2011), and that of ¹³⁷Cs exceeded the pre-accident level in this study area, where the effects of radiocesium depositions just after the FDNPP accident disappeared in surface waters in October 2011. Subsequently, radiocesium concentrations gradually increased during 2013–2016 (∼0.5–1 mBq/L for ¹³⁴Cs), exhibiting approximately homogeneous distributions in each year. The temporal and spatial variations of ¹³⁴Cs and ¹³⁷Cs concentrations indicated that FDNPP-derived radiocesium around the western Japanese Archipelago, including the Sea of Japan, has been supported by the Kuroshio Current and its branch, Tsushima Warm Current, during 2013–2016. However, in the Sea of Japan, the penetration of ¹³⁴Cs was limited to depths of less than ∼200 m during three years following the re-delivery of FDNPP-derived radiocesium.

Graphical abstract

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Spatial variations of 226Ra, 228Ra, 134Cs, and 137Cs concentrations in western and southern waters off the Korean Peninsula in July 2014

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): M. Inoue, Y. Shirotani, S. Nagao, T. Aramaki, Y.I. Kim, K. Hayakawa
We examined the spatial distributions of ²²⁶Ra, ²²⁸Ra, ¹³⁴Cs, and ¹³⁷Cs concentrations (activities) in seawater off the western and southern Korean Peninsula in July 2014. Radium-228 (and ²²⁶Ra) concentrations in water samples varied widely from 5 to 14 mBq/L (2–4 mBq/L), showing a negative correlation with salinity, particularly at the surface off the western Korean Peninsula. This indicates that the seawaters in this area are fundamentally comprised of ²²⁸Ra-poor and high-saline Kuroshio Current water and ²²⁸Ra-rich and low-saline water (e.g., continental shelf water), with various mixing ratios. Although Fukushima Dai-ichi Nuclear Power Plant (FDNPP)-derived ¹³⁴Cs was below the detection limit (<0.08 mBq/L) in waters off the western Korean Peninsula, low level ¹³⁴Cs (0.1–0.2 mBq/L) was detected in waters off the southern Korean Peninsula accompanied by higher ¹³⁷Cs concentrations (1.6–1.9 mBq/L) relative to that off the western Korean Peninsula. Combined with the lower radium concentrations, the detection of ¹³⁴Cs is explained by mixing of FDNPP-derived radiocesium-contaminated Kuroshio Current water.



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Gongylonema pulchrum infection in the human oral cavity – a case report and literature review

Publication date: Available online 8 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Xiaodan Liu, Zhensheng Wang, Ying Han, Hongwei Liu, Jianqiu Jin, Peiru Zhou, Sha Su, Zhimin Yan
Gongylonema infection is a zoonotic disease occurring throughout the world and is mainly caused by consumption of contaminated water and raw food. Adult Gongylonema worms can exist as parasites in the human body for up to 10 years and cause symptoms of local irritation in the oral cavity, oesophagus, and pharynx. Herein, we report a rare case in which live Gongylonema pulchrum was detected and extracted from the oral cavity of a woman. The pathogen was confirmed as G. pulchrum on the basis of microscopic examination and morphological analysis. The patient's symptoms resolved immediately after surgical removal of the parasite, and the patient has been advised not to drink water that has not been boiled and to avoid consuming unwashed raw vegetables.



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Quality and readability of internet-based information on halitosis

Publication date: Available online 8 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jung Hwan Jo, Eui Joo Kim, Ji Rak Kim, Moon Jong Kim, Jin Woo Chung, Ji Woon Park
ObjectiveTo evaluate quality and readability of Internet-based information on halitosis.Study DesignAn Internet search through three engines (Google, Yahoo and Bing) was done with the terms ("bad breath", "halitosis", "oral malodor", "foul breath", "mouth malodor", "breath malodor", "fetor ex ore", "fetor oris", "ozostomia", and "stomatodysodia"). The first 50 websites from each engine resulting from each search term were screened. Included websites were evaluated using Health on the Net(HON) criteria, Journal of American Medical Association(JAMA) benchmarks, DISCERN, Ensuring Quality Information for Patients(EQIP), Flesch Reading Ease(FRE) score and Flesch-Kincaid Grade level.ResultsOne hundred and one websites were included. HON, DISCERN, EQIP, and FRE score were 42.9%, 37.6%, 37.4%, and 51.9% of the maximum score, respectively. Fewer than 50% of sites displayed attribution, disclosure, and currency according to JAMA benchmarks. HON score, DISCERN score and EQIP score showed significant correlation with each other and were significantly higher in sites displaying the HON seal.ConclusionThe current quality and readability of informative websites on halitosis are generally low and poorly organized. Clinicians should be able to assess the Internet-based information on halitosis, as well as give accurate advice and guide patients concerning this issue.



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Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography.

Related Articles

Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography.

Diagn Interv Radiol. 2017 Dec 07;:

Authors: Clark MS, Diehn FE, Verdoorn JT, Lehman VT, Liebo GB, Morris JM, Thielen KR, Wald JT, Kumar N, Luetmer PH

Abstract
PURPOSE: A recently identified and treatable cause of spontaneous intracranial hypotension (SIH) is cerebrospinal fluid (CSF)-venous fistula, and a recently described computed tomography myelogram (CTM) finding highly compatible with but not diagnostic of this entity is the hyperdense paraspinal vein sign. We aimed to retrospectively measure the prevalence of the hyperdense paraspinal vein sign on CTMs in SIH patients without dural CSF leak, in comparison with control groups.
METHODS: Three CTM groups were identified: 1) SIH study group, which included dural CSF leak-negative standard CTMs performed for SIH, with early and delayed imaging; 2) Early control CTMs, which were performed for indications other than SIH, with imaging shortly after intrathecal contrast administration; 3) Delayed control CTMs, which included delayed imaging. CTMs were retrospectively reviewed for the hyperdense paraspinal vein sign by experienced neuroradiologists, blinded to the group assignment. All CTMs deemed by a single reader to be positive for the hyperdense paraspinal vein sign were independently reviewed by two additional neuroradiologists; findings were considered positive only if consensus was present among all three readers. For positive cases, noncontrast CTs and prior CTMs, if available, were reviewed for the presence of the sign.
RESULTS: Seven of 101 (7%) SIH patients had contrast in a spinal/paraspinal vein consistent with the hyperdense paraspinal vein sign; no patient in either control group (total n=54) demonstrated the hyperdense paraspinal vein sign (P = 0.0463). The finding occurred only at thoracic levels. Each patient had a single level of involvement. Six (86%) occurred on the right. Four occurred in female patients (57%). The sign was seen on early images in 3 of 7 cases (43%) and on both early and delayed images in 4 of 7 cases (57%). In 2 of 7 patients (29%), a noncontrast CT covering the relevant location was available and negative for the sign. A prior CTM was available in 2 of 7 patients (29%), and in both cases the hyperdense paraspinal vein sign was also evident.
CONCLUSION: The prevalence of the hyperdense paraspinal vein sign in SIH patients with dural CSF leak-negative standard CTM was 7%. As the sign was not seen in control groups, this sign is highly compatible with the presence of CSF-venous fistula. Since the CTMs were not specifically dedicated to identifying hyperdense paraspinal veins (i.e., they were not dynamic and were not preceded by digital subtraction myelography), the true prevalence of the sign may be higher. Radiologists should scrutinize conventional CTMs for this sign, especially in patients in whom a traditional dural CSF leak is not identified.

PMID: 29217497 [PubMed - as supplied by publisher]

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Image-guided adaptive radiotherapy improves acute toxicity during intensity-modulated radiation therapy for head and neck cancer

Abstract

Purpose

The purpose of this study was to evaluate the impact of an image-guided adaptive re-planning strategy on patients treated by intensity-modulated radiotherapy (IMRT) for head and neck cancer.

Methods and materials

Among 198 patients with head and neck cancer comprising the primary study population, 79 (40%) underwent adaptive radiotherapy with modification of the original IMRT midway during treatment.

Results

The incidence of grade 3+ acute skin toxicity was 15 and 35% among patients treated with and without adaptive radiotherapy, respectively (p = 0.01). The incidence of grade 3+ oral mucositis was 15 and 29%, respectively (p = 0.03). There was no significant difference in the 2-year rates of local-regional control or overall survival between the two cohorts (p > 0.05, for both).

Conclusion

The use of an image-guided adaptive radiotherapy strategy reduced the incidence of high-grade skin toxicity and oral mucositis in the acute setting. Further studies are needed to better define which subset of patients may benefit the most.

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Myelin extracellular leaflet compaction requires apolipoprotein D membrane management to optimize lysosomal-dependent recycling and glycocalyx removal

Abstract

To compact the extracellular sides of myelin, an important transition must take place: from membrane sliding, while building the wraps, to membrane adhesion and water exclusion. Removal of the negatively charged glycocalyx becomes the limiting factor in such transition. What is required to initiate this membrane-zipping process? Knocking-out the Lipocalin Apolipoprotein D (ApoD), essential for lysosomal functional integrity in glial cells, results in a specific defect in myelin extracellular leaflet compaction in peripheral and central nervous system, which results in reduced conduction velocity and suboptimal behavioral outputs: motor learning is compromised. Myelination initiation, growth, intracellular leaflet compaction, myelin thickness or internodal length remain unaltered. Lack of ApoD specifically modifies Plp and P0 protein expression, but not Mbp or Mag. Late in myelin maturation period, ApoD affects lipogenic and growth-related, but not stress-responsive, signaling pathways. Without ApoD, the sialylated glycocalyx is maintained and ganglioside content remains high. In peripheral nervous system, Neu3 membrane sialidase and lysosomal Neu1 are coordinately expressed with ApoD in subsets of Schwann cells. ApoD-KO myelin becomes depleted of Neu3 and enriched in Fyn, a kinase with pivotal roles in transducing axon-derived signals into myelin properties. In the absence of ApoD, partial permeabilization of lysosomes alters Neu1 location as well. Exogenous ApoD rescues ApoD-KO hypersialylated glycocalyx in astrocytes, demonstrating that ApoD is necessary and sufficient to control glycocalyx composition in glial cells. By ensuring lysosomal functional integrity and adequate subcellular location of effector and regulatory proteins, ApoD guarantees the glycolipid recycling and glycocalyx removal required to complete myelin compaction.

Main Points

• Apolipoprotein D is required for myelin extracellular leaflet compaction.
• Lack of ApoD halts glycocalyx removal by altering sialidases activity and traffic.
• Targeting ApoD to lysosomes is sufficient for glial cells to control their glycocalyx.

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Origin, History, and Meanings of the Word Transmission.

Origin, History, and Meanings of the Word Transmission.

Microbiol Spectr. 2017 Dec;5(6):

Authors: Villalba J, Navarro FA, Cortés F

Abstract
The origin of the words transmit and transmission and their derivatives can be traced to the Latin transmittere, in turn formed by prefixing the preposition trans ("across or beyond") to the verb mittere ("to let go or to send"). From the times of Ancient Rome in the 3rd century b.c.e., the Latin word transmissio has been "transmitted" (through Romance languages such as French, Italian, Spanish, and Portuguese) to all the major languages of culture, English among them. And through English, the international language of biomedical science in the 21st century, the term transmission is increasingly present today in some of the most dynamic disciplines of modern natural science, including genomics, molecular microbiology, hospital epidemiology, molecular genetics, biotechnology, evolutionary biology, and systems biology.

PMID: 29219108 [PubMed - in process]

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Differences between osteoradionecrosis and medication-related osteonecrosis of the jaw

Abstract

Purpose

The appearance of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) is similar, but clinically important differences between ORN and MRONJ exist. The aim of this study was to compare the clinical data between ORN and MRONJ and to reveal the critical differences between these diseases.

Methods

We retrospectively reviewed the epidemiological data, clinical findings, and treatment in 27 ORN and 61 MRONJ patients. Radiographic signs before the initiation of treatment were also assessed.

Results

The median age (P = 0.0474) and the ratio of female to male patients (P < 0.0001) were significantly higher in MRONJ patients. There were significantly more MRONJ patients who reported a history of pain when compared with ORN patients (P = 0.0263). As an aetiological factor, tooth extraction was significantly more relevant to MRONJ than ORN (P = 0.0352). When assessing the radiographic signs on computed tomographic images, periosteal reaction was found only in MRONJ patients (P = 0.0158). Minimal debridement was performed significantly more frequently for MRONJ (P = 0.0093), and by contrast, surgical resection was performed more frequently for ORN (P = 0.0002).

Conclusions

Understanding the clinical and underlying pathological differences between ORN and MRONJ probably contributes to the selection of appropriate treatment for each patient.

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From weeds to wheat: a diachronic approach to ancient biocultural diversity in the Santa María valley, northwest Argentina

Abstract

The aim of this paper is to analyse continuities and changes in plant diversity and use in the southern part of the Santa María valley in northwest Argentina, from the 1st millennium ad up to the Spanish Conquest in the 16th century. Variable degrees of association between people and plants (wild, weedy and domesticated), as well as various management practices (gathering, cultivation, tolerance, eradication, protection and encouragement) were studied to investigate the biocultural history of this region through the analysis of plant macroremains from archaeological sites. Samples were obtained from four archaeological sites located in the valley, Rincón Chico 1, Rincón Chico 15, Soria 2 and El Colorado. As a result, we identified 628 macroremains belonging to 20 taxa and determined whether they were either wild plants, weeds or crops, related to strategies of gathering and cultivation. The results suggest that there were changes through time, with a dominance of ruderal weeds in the earliest of the archaeological sites along with a diversity of association degrees, while a division was found between wild and domesticated plants, represented by maize and Prosopis (algarrobo), in the sites of the Late period. This last scenario suggests that the growing of trees and shrubs together with crops and pasture (agroforestry), or woodland management together with grazing (silvopasture), could have been part of the past land management practices in the area. Chenopodium remains indicate past complexes of wild plants, weeds and crops growing together in the cultivated plots; the newly introduced crops brought from Spain, such as wheat and barley, did not replace the local plants, mainly Prosopis (algarrobo) and Zea mays (maize), which were still grown during early colonial times. This paper offers a diachronic perspective on plant management in a particular region, considering a plant record that is still limited, but which allows us to get a first glimpse of how plant management strategies may have changed in this part of South America.

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“Think horizontally, act vertically”: the centenary (1916–2016) of pollen analysis and the legacy of Lennart von Post

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Long and attenuated: comparative trends in the domestication of tree fruits

Abstract

This paper asks whether we can identify a recurrent domestication syndrome for tree crops (fruits, nuts) and track archaeologically the evolution of domestication of fruits from woody perennials. While archaeobotany has made major contributions to documenting the domestication process in cereals and other annual grains, long-lived perennials have received less comparative attention. Drawing on examples from across Eurasia, comparisons suggest a tendency for the larger domesticated fruits to contain seeds that are proportionally longer, thinner and with more pointed (acute to attenuated) apices. Therefore, although changes in flavour, such as increased sweetness, are not recoverable, seed metrics and shape provide an archaeological basis for tracking domestication episodes in fruits from woody perennials. Where available, metrical data suggest length increases, as well as size diversification over time, with examples drawn from the Jomon of Japan (Castanea crenata), Neolithic China (Prunus persica) and the later Neolithic of the Near East (Olea europaea, Phoenix dactylifera) to estimate rates of change. More limited data allow us to also compare Mesoamerica avocado (Persea americana) and western Pacific Canarium sp. nuts and Spondias sp. fruits. Data from modern Indian jujube (Ziziphus mauritiana) are also considered in relation to seed length:width trends in relation to fruit contents (flesh proportion, sugar content). Despite the long generation time in tree fruits, rates of change in their seeds are generally comparable to rates of phenotypic evolution in annual grain crops, suggesting that gradual evolution via unconscious selection played a key role in initial processes of tree domestication, and that this had begun in the later Neolithic once annual crops had been domesticated, in both west and east Asia.

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Trajectories of change in Mediterranean Holocene vegetation through classification of pollen data

Abstract

Quantification of vegetation cover from pollen analysis has been a goal of palynologists since the advent of the method in 1916 by the great Lennart von Post. Pollen-based research projects are becoming increasingly ambitious in scale, and the emergence of spatially extensive open-access datasets, advanced methods and computer power has facilitated sub-continental analysis of Holocene pollen data. This paper presents results of one such study, focussing on the Mediterranean basin. Pollen data from 105 fossil sequences have been extracted from the European Pollen database, harmonised by both taxonomy and chronologies, and subjected to a hierarchical agglomerative clustering method to synthesise the dataset into 16 main groupings. A particular focus of analysis was to describe the common transitions from one group to another to understand pathways of Holocene vegetation change in the Mediterranean. Two pollen-based indices of human impact (OJC: Oleaceae, Juglans, Castanea; API: anthropogenic pollen indicators) have been used to infer the degree of human modification of vegetation within each pollen grouping. Pollen-inferred cluster groups that are interpreted as representing more natural vegetation states show a restricted number of pathways of change. A set of cluster groups were identified that closely resemble anthropogenically-disturbed vegetation, and might be considered anthromes (anthopogenic biomes). These clusters show a very wide set of potential pathways, implying that all potential vegetation communities identified through this analysis have been altered in response to land exploitation and transformation by human societies in combination with other factors, such as climatic change. Future work to explain these ecosystem pathways will require developing complementary datasets from the social sciences and humanities (archaeology and historical sources), along with synthesis of the climatic records from the region.

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Lower Arterial Cross-Sectional Area of Carotid and Vertebral Arteries and Higher Frequency of Secondary Neck Vessels Are Associated with Multiple Sclerosis.

Related Articles

Lower Arterial Cross-Sectional Area of Carotid and Vertebral Arteries and Higher Frequency of Secondary Neck Vessels Are Associated with Multiple Sclerosis.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Belov P, Jakimovski D, Krawiecki J, Magnano C, Hagemeier J, Pelizzari L, Weinstock-Guttman B, Zivadinov R

Abstract
BACKGROUND AND PURPOSE: Arterial and neck vessel system characteristics of patients with multiple sclerosis have not been previously investigated. Therefore, the aim of this study was to examine the frequency of neck vessels and their cross-sectional areas (in square millimeters) between patients with MS and healthy controls.
MATERIALS AND METHODS: In this study, 193 patients with MS and 193 age- and sex-matched healthy controls underwent 2D TOF venography at 3T. The main arterial (carotid and vertebral), venous (internal jugular), and secondary neck vessels were examined at 4 separate cervical levels (C2/3, C4, C5/6, and C7/T1). The ANCOVA adjusted for age, body mass index, smoking status, hypertension, and heart disease was used to compare the differences between patients with MS and healthy controls.
RESULTS: After controlling for all confounding factors, patients with MS had significantly lower cross-sectional areas of the carotid arteries at the C2/3 (P = .03), C5/6 (P = .026), and C7/T1 (P = .005) levels as well as of the vertebral arteries at the C2/3 (P = .02), C4 (P = .012), and C7/T1 (P = .006) levels, compared with healthy controls. A higher frequency of secondary neck vessels was found at all 4 levels in patients with MS: C2/3 (12.9 versus 10, P < .001), C4 (9.1 versus 7.5, P < .001), C5/6 (7.8 versus 6.8, P = .012), and C7/T1 (8.8 versus 6, P < .001). The total cross-sectional areas of secondary neck vessels were also significantly higher at all 4 levels (P < .03). No significant differences in the cross-sectional areas of jugular veins were found between patients with MS and healthy controls.
CONCLUSIONS: Patients with MS showed lower cross-sectional areas of the carotid and vertebral arteries and a higher frequency of secondary neck vessels and their cross-sectional areas compared with healthy controls.

PMID: 29217748 [PubMed - as supplied by publisher]

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MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps.

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MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Nael K, Doshi A, De Leacy R, Puig J, Castellanos M, Bederson J, Naidich TP, Mocco J, Wintermark M

Abstract
BACKGROUND AND PURPOSE: Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA.
MATERIALS AND METHODS: Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2-6 seconds (ATD2-6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed.
RESULTS: Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2-6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2-6 seconds × relative CBV2-6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%.
CONCLUSIONS: The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.

PMID: 29217747 [PubMed - as supplied by publisher]

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Semiautomated Middle Ear Volume Measurement as a Predictor of Postsurgical Outcomes for Congenital Aural Atresia.

Related Articles

Semiautomated Middle Ear Volume Measurement as a Predictor of Postsurgical Outcomes for Congenital Aural Atresia.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Kabadi SJ, Ruhl DS, Mukherjee S, Kesser BW

Abstract
BACKGROUND AND PURPOSE: Middle ear space is one of the most important components of the Jahrsdoerfer grading system (J-score), which is used to determine surgical candidacy for congenital aural atresia. The purpose of this study was to introduce a semiautomated method for measuring middle ear volume and determine whether middle ear volume, either alone or in combination with the J-score, can be used to predict early postoperative audiometric outcomes.
MATERIALS AND METHODS: A retrospective analysis was conducted of 18 patients who underwent an operation for unilateral congenital aural atresia at our institution. Using the Livewire Segmentation tool in the Carestream Vue PACS, we segmented middle ear volumes using a semiautomated method for all atretic and contralateral normal ears on preoperative high-resolution CT imaging. Postsurgical audiometric outcome data were then analyzed in the context of these middle ear volumes.
RESULTS: Atretic middle ear volumes were significantly smaller than those in contralateral normal ears (P < .001). Patients with atretic middle ear volumes of >305 mm3 had significantly better postoperative pure tone average and speech reception thresholds than those with atretic ears below this threshold volume (P = .01 and P = .006, respectively). Atretic middle ear volume incorporated into the J-score offered the best association with normal postoperative hearing (speech reception threshold ≤ 30 dB; OR = 37.8, P = .01).
CONCLUSIONS: Middle ear volume, calculated in a semiautomated fashion, is predictive of postsurgical audiometric outcomes, both independently and in combination with the conventional J-score.

PMID: 29217746 [PubMed - as supplied by publisher]

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Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy.

Related Articles

Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Peckham ME, Wiggins RH, Orlandi RR, Anzai Y, Finke W, Harnsberger HR

Abstract
BACKGROUND AND PURPOSE: Esthesioneuroblastoma is a neuroectodermal tumor that commonly arises in the nasal cavity olfactory recess and, when isolated to the intranasal cavity, can be indistinguishable from benign processes. Because lesional aggressiveness requires a more invasive operation for resection than polypectomy, patients with isolated intranasal lesions were studied to define distinguishing CT characteristics.
MATERIALS AND METHODS: Patients with intranasal esthesioneuroblastoma and controls without esthesioneuroblastoma with olfactory recess involvement were identified by using a report search tool. Studies demonstrating skull base invasion and/or intracranial extension were excluded. The imaging spectrum of these lesions was reviewed on both CT and MR imaging, and CT findings were compared with those of controls without esthesioneuroblastoma. Two blinded readers assessed subjects with esthesioneuroblastomas and controls without esthesioneuroblastoma and, using only CT criteria, rated their level of suspicion for esthesioneuroblastoma in each case.
RESULTS: Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma.
CONCLUSIONS: Esthesioneuroblastoma can present as a well-marginated intranasal lesion that unilaterally widens the olfactory recess. CT patterns can help predict esthesioneuroblastoma, potentially preventing multiple operations by instigating the correct initial operative management.

PMID: 29217745 [PubMed - as supplied by publisher]

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The CT Swirl Sign Is Associated with Hematoma Expansion in Intracerebral Hemorrhage.

Related Articles

The CT Swirl Sign Is Associated with Hematoma Expansion in Intracerebral Hemorrhage.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Ng D, Churilov L, Mitchell P, Dowling R, Yan B

Abstract
BACKGROUND AND PURPOSE: Hematoma expansion is an independent determinant of poor clinical outcome in intracerebral hemorrhage. Although the "spot sign" predicts hematoma expansion, the identification requires CT angiography, which limits its general accessibility in some hospital settings. Noncontrast CT, without the need for CT angiography, may identify sites of active extravasation, termed the "swirl sign." We aimed to determine the association of the swirl sign with hematoma expansion.
MATERIALS AND METHODS: Patients with spontaneous intracerebral hemorrhage between 2007 and 2014 who underwent an initial and subsequent noncontrast CT at a single center were retrospectively identified. The swirl sign, on noncontrast CT, was defined as iso- or hypodensity within a hyperdense region that extended across 2 contiguous 5-mm axial CT sections.
RESULTS: A total of 212 patients met the inclusion criteria. The swirl sign was identified in 91 patients with excellent interobserver agreement (κ = 0.87). The swirl sign was associated with larger initial hematoma (P < .001) and earlier initial CT (P < .001) and hematoma expansion (P = .028). Multivariable regression modeling demonstrated that if one assumed similar initial hematoma volume, onset-to-first scan, and time between CT scans, the median absolute hematoma growth was 5.77 mL (95% CI, 2.37-9.18 mL; P = .001) and relative growth was 35.6% (95% CI, 18.5%-52.6%; P < .001) higher in patients with the swirl sign compared with those without.
CONCLUSIONS: The NCCT swirl sign was reliably identified and is associated with hematoma expansion. We propose that the swirl sign be included in risk stratification of intracerebral hemorrhage and considered for inclusion in clinical trials.

PMID: 29217744 [PubMed - as supplied by publisher]

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Dural Arteriovenous Fistulas: A Characteristic Pattern of Edema and Enhancement of the Medulla on MRI.

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Dural Arteriovenous Fistulas: A Characteristic Pattern of Edema and Enhancement of the Medulla on MRI.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Copelan AZ, Krishnan A, Marin H, Silbergleit R

Abstract
Medullary edema with enhancement is rarely reported at initial MR imaging in intracranial dural arteriovenous fistulas. We report a series of 5 patients with dural arteriovenous fistulas, all of whom demonstrated a characteristic pattern of central medullary edema and medullary enhancement at initial MR imaging. Cognard type V dural arteriovenous fistula, defined by drainage into the perimedullary veins and the veins surrounding the brain stem, is a rare yet well-described pathologic entity. Even more rarely reported, however, is its clinical presentation with predominantly bulbar symptoms and MR imaging findings of central medullary edema with enhancement. This constellation of findings frequently leads to a convoluted clinical picture, prompting work-up for alternative disease processes and delaying diagnosis. Because an expedited diagnosis is critical in preventing poor outcomes, it is paramount to make the referring physician and neuroradiologist more cognizant of this rare-yet-characteristic imaging manifestation of dural arteriovenous fistula.

PMID: 29217743 [PubMed - as supplied by publisher]

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Diagnostic Accuracy of Centrally Restricted Diffusion in the Differentiation of Treatment-Related Necrosis from Tumor Recurrence in High-Grade Gliomas.

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Diagnostic Accuracy of Centrally Restricted Diffusion in the Differentiation of Treatment-Related Necrosis from Tumor Recurrence in High-Grade Gliomas.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Zakhari N, Taccone MS, Torres C, Chakraborty S, Sinclair J, Woulfe J, Jansen GH, Nguyen TB

Abstract
BACKGROUND AND PURPOSE: Centrally restricted diffusion has been demonstrated in recurrent high-grade gliomas treated with bevacizumab. Our purpose was to assess the accuracy of centrally restricted diffusion in the diagnosis of radiation necrosis in high-grade gliomas not treated with bevacizumab.
MATERIALS AND METHODS: In this prospective study, we enrolled patients with high-grade gliomas who developed a new ring-enhancing necrotic lesion and who underwent re-resection. The presence of a centrally restricted diffusion within the ring-enhancing lesion was assessed visually on diffusion trace images and by ADC measurements on 3T preoperative diffusion tensor examination. The percentage of tumor recurrence and radiation necrosis in each surgical specimen was defined histopathologically. The association between centrally restricted diffusion and radiation necrosis was assessed using the Fisher exact test. Differences in ADC and the ADC ratio between the groups were assessed via the Mann-Whitney U test, and receiver operating characteristic curve analysis was performed.
RESULTS: Seventeen patients had re-resected ring-enhancing lesions: 8 cases of radiation necrosis and 9 cases of tumor recurrence. There was significant association between centrally restricted diffusion by visual assessment and radiation necrosis (P = .015) with a sensitivity of 75% and a specificity of 88.9%, a positive predictive value 85.7%, and a negative predictive value of 80% for the diagnosis of radiation necrosis. There was a statistically significant difference in the ADC and ADC ratio between radiation necrosis and tumor recurrence (P = .027).
CONCLUSIONS: The presence of centrally restricted diffusion in a new ring-enhancing lesion might indicate radiation necrosis rather than tumor recurrence in high-grade gliomas previously treated with standard chemoradiation without bevacizumab.

PMID: 29217742 [PubMed - as supplied by publisher]

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On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease.

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On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Wong SM, Backes WH, Zhang CE, Staals J, van Oostenbrugge RJ, Jeukens CRLPN, Jansen JFA

Abstract
BACKGROUND AND PURPOSE: Intravoxel incoherent motion imaging can measure both microvascular and parenchymal abnormalities simultaneously. The contamination of CSF signal can be suppressed using inversion recovery preparation. The clinical feasibility of inversion recovery-intravoxel incoherent motion imaging was investigated in patients with cerebrovascular disease by studying its reproducibility.
MATERIALS AND METHODS: Sixteen patients with cerebrovascular disease (66 ± 8 years of age) underwent inversion recovery-intravoxel incoherent motion imaging twice. The reproducibility of the perfusion volume fraction and parenchymal diffusivity was calculated with the coefficient of variation, intraclass correlation coefficient, and the repeatability coefficient. ROIs included the normal-appearing white matter, cortex, deep gray matter, white matter hyperintensities, and vascular lesions.
RESULTS: Values for the perfusion volume fraction ranged from 2.42 to 3.97 ×10-2 and for parenchymal diffusivity from 7.20 to 9.11 × 10-4 mm2/s, with higher values found in the white matter hyperintensities and vascular lesions. Coefficients of variation were <3.70% in normal-appearing tissue and <9.15% for lesions. Intraclass correlation coefficients were good to excellent, showing values ranging from 0.82 to 0.99 in all ROIs, except the deep gray matter and cortex, with intraclass correlation coefficients of 0.66 and 0.54, respectively. The repeatability coefficients ranged from 0.15 to 0.96 × 10-2 and 0.10 to 0.37 × 10-4 mm2/s for perfusion volume fraction and parenchymal diffusivity, respectively.
CONCLUSIONS: Good reproducibility of inversion recovery-intravoxel incoherent motion imaging was observed with low coefficients of variation and high intraclass correlation coefficients in normal-appearing tissue and lesion areas in cerebrovascular disease. Good reproducibility of inversion recovery-intravoxel incoherent motion imaging in cerebrovascular disease is feasible in monitoring disease progression or treatment responses in the clinic.

PMID: 29217741 [PubMed - as supplied by publisher]

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Optic Nerve Measurement on MRI in the Pediatric Population: Normative Values and Correlations.

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Optic Nerve Measurement on MRI in the Pediatric Population: Normative Values and Correlations.

AJNR Am J Neuroradiol. 2017 Dec 07;:

Authors: Al-Haddad CE, Sebaaly MG, Tutunji RN, Mehanna CJ, Saaybi SR, Khamis AM, Hourani RG

Abstract
BACKGROUND AND PURPOSE: Few articles in the literature have looked at the diameter of the optic nerve on MR imaging, especially in children, in whom observations are subjective and no normative data exist. The aim of this study was to establish a data base for optic nerve diameter measurements on MR imaging in the pediatric population.
MATERIALS AND METHODS: This was a retrospective study on the MR imaging of pediatric subjects (younger than 18 years of age) at the Department of Diagnostic Radiology at the American University of Beirut Medical Center, Beirut, Lebanon. The optic nerve measurements were obtained by 3 raters on axial and coronal sections at 3 mm (retrobulbar) and 7 mm (intraorbital) posterior to the lamina cribrosa.
RESULTS: Of 211 scans of patients (422 optic nerves), 377 optic nerves were measured and included. Ninety-four patients were female (45%) and the median age at MR imaging was 8.6 years (interquartile range, 3.9-13.3 years). Optic nerves were divided into 5 age groups: 0-6 months (n = 18), 6 months-2 years (n = 44), 2-6 years (n = 86), 6-12 years (n = 120), and 12-18 years (n = 109). An increase in optic nerve diameter was observed with age, especially in the first 2 years of life. Measurements did not differ with eye laterality or sex.
CONCLUSIONS: We report normative values of optic nerve diameter measured on MR imaging in children from birth to 18 years of age. A rapid increase in optic nerve diameter was demonstrated during the first 2 years of life, followed by a slower increase. This was independent of sex or eye laterality.

PMID: 29217740 [PubMed - as supplied by publisher]

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Social support following bereavement: The role of beliefs, expectations, and support intentions

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"Is it Sjogren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral symptoms"-a commentary.

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"Is it Sjogren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral symptoms"-a commentary.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Oct 20;:

Authors: Mortazavi H, Anbari F

PMID: 29217136 [PubMed - as supplied by publisher]

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Magnetic resonance imaging of cardiovascular thrombi in children

Abstract

Cardiovascular thrombosis is rare in children and usually occurs in the presence of predisposing conditions, such as indwelling vascular catheters, tumors, aneurysms, ventricular dysfunction, or after surgery. Clots can occur in the cardiac chambers, arteries or veins, or inside conduits. Detection of thrombi is feasible with a variety of magnetic resonance imaging (MRI) techniques, including unenhanced methods but also contrast-enhanced MR angiography. In this essay we illustrate the MRI appearance of cardiovascular thrombosis in children and suggest an imaging protocol based on our clinical experience.

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RT @ICR_London : Our big news from last night: Professor Nicholas Turner (ICR + @royalmarsdenNHS ) has been presented with the @AACR 'Outstan…

RT @ICR_London : Our big news from last night: Professor Nicholas Turner (ICR + @royalmarsdenNHS ) has been presented with the @AACR 'Outstan…

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Anatomic parameters of the sacral lamina for osteosynthesis in transverse sacral fractures.

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Anatomic parameters of the sacral lamina for osteosynthesis in transverse sacral fractures.

Surg Radiol Anat. 2017 Dec 08;:

Authors: Katsuura Y, Lorenz E, Gardner W

Abstract
PURPOSE: To analyze the morphometric parameters of the dorsal sacral lamina and pedicles to determine if there is adequate bony architecture to support plate osteosynthesis.
METHODS: Two reviewers performed measurements on 98 randomly selected high-resolution CT scans of the pelvis to quantify the bony anatomy of the sacral lamina. Measurements included the depths of the lamina at each sacral level, the trajectory and depth of the sacral pedicles from the sacral lamina, and the width of the sacral canal. A bone mineral density analysis was performed on the sacral lamina using Hounsfield units (HU) and compared to the L1 and S1 vertebral bodies.
RESULTS: The sacral lamina were found to form peaks and troughs which we refered to as major and minor sections. On average, the thickness was > 4 mm at all major screw starting points, indicating adequate geometry for screw fixation. The sacral pedicle depths were 27, 18, 16, and 14 mm at S2-S5, respectively. The average angulation from midline of this screw path directed laterally to avoid the sacral canal was 20°, 17°, 8°, and - 8° for the S2-5 pedicles, respectively. Average sacral canal diameter was 11 mm for S2 and 8 mm for S3-5. The sacral lamina had an average bone mineral density of 635 HU, which was significantly different from the density of the L5 (220 HU) and S1 (165 HU) vertebral bodies (p < 0.005). This morphometric data was used to pilot a new plating technique.
CONCLUSIONS: The sacral lamina offers a novel target for screw fixation and meets the basic geometric and compositional criteria for screw purchase. To our knowledge, this study represents the first morphometric analysis performed on the sacral lamina and pedicles for plate application.

PMID: 29218387 [PubMed - as supplied by publisher]

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Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery.

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Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery.

Surg Radiol Anat. 2017 Dec 07;:

Authors: Basnet LM, Ghosh SK, Shrestha S, Dhungel S

Abstract
OBJECTIVE: The present study was undertaken to know the anatomical basis of medial sural artery (MSA) and its perforators in Nepalese.
METHODS: The popliteal arteries of 16 preserved cadaveric lower limbs were injected with a mixture of red ink and glycerine. The number, location, diameter of perforators; length and intramuscular course of pedicle; the branching pattern of MSA were observed and measured.
RESULTS: The mean of 2.2 ± 1.2 perforators (range 0-4) was observed. The perforators were clustered between 8.6 and 25.7 cm from the popliteal crease and 0.3-7.5 cm from posterior midline of leg. The dominant perforators were observed in middle 1/3rd of the leg. The average pedicle length was 12.04 ± 3.27 cm. The intramuscular courses of pedicles were observed in deep and superficial strata in 65.7 and 34.3%, respectively. The MSA originated from popliteal artery in 62.5% and common sural artery in 37.5%. An accessory MSA was found in 12.5%. Type I and Type III branching patterns of MSA were observed in 31.2% each whereas Type II was found in 37.5%. The mean external diameter of perforators and MSA were 0.85 ± 0.27 mm and 2.2 ± 0.43 mm, respectively.
CONCLUSIONS: The metrical presentation of this study provides an easy access to know about the distribution of perforators and branching pattern of MSA which will help the surgeons to make a convenient plan to harvest the MSA perforator flap in Nepalese population.

PMID: 29218386 [PubMed - as supplied by publisher]

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Bilateral carotid-anterior cerebral artery anastomoses associated with bilateral ophthalmic arteries arising from the anastomotic arteries diagnosed by magnetic resonance angiography: a case report.

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Bilateral carotid-anterior cerebral artery anastomoses associated with bilateral ophthalmic arteries arising from the anastomotic arteries diagnosed by magnetic resonance angiography: a case report.

Surg Radiol Anat. 2017 Dec 07;:

Authors: Uchino A, Saito N, Tanahashi N

Abstract
Rarely, the anterior cerebral artery (ACA) arises from the ophthalmic segment of the internal carotid artery, a condition described as carotid-ACA anastomosis or infraoptic course of the ACA that generally demonstrates right-sided predominance. We diagnosed a case of bilateral anastomoses of the carotid and ACA vessels in which bilateral ophthalmic arteries arose from the origins of the anastomotic vessels using magnetic resonance (MR) angiography. Identification of rare arterial variations on MR angiography requires careful scrutiny of source images, and creation of partial volume-rendering images can aid visualization of detailed anatomic structures.

PMID: 29218385 [PubMed - as supplied by publisher]

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Is it possible to give a single definition of the rectosigmoid junction?

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Is it possible to give a single definition of the rectosigmoid junction?

Surg Radiol Anat. 2017 Dec 07;:

Authors: Massalou D, Moszkowicz D, Mariage D, Baqué P, Camuzard O, Bronsard N

Abstract
AIM: The rectosigmoid junction is the limit separating the sigmoid colon and rectum. This transition zone has different definitions. We want to highlight different landmarks of the rectosigmoid junction (RSJ), to help the clinicians to adopt a consensual definition.
METHOD: We reviewed anatomical, endoscopic, physiological and surgical points of view concerning the rectosigmoid junction (RSJ).
RESULTS: The rectosigmoid junction has a different definition depending on who is studying it. Nevertheless, it is a high pressure location, a place connecting different muscles organizations, neurological systems or vascular anastomosis. The clear pathophysiology of the RSJ is not yet determined with certainty, but its resection is essential for the therapeutic care of patients and also for the improvement of surgical skills. From a surgical point of view, anatomical landmarks has to be chosen: easily reproducible and identifiable. The disappearance of taenia coli (belonging to the colon) and the peritoneal reflection (recto-genital pouch), located below the upper rectum, seem the most reliable. The level of rectal section must, in any case, be below the promontory.
CONCLUSION: There is not a single definition, but rather several definitions of the RSJ. Each one of them reflects one appearance of this region: embryological and anatomical evolution or clinical entity. From a surgical point of view, the criterion which seems to be the most reliable is the disappearance of taenia coli and the peritoneal reflection (recto-genital pouch).

PMID: 29218384 [PubMed - as supplied by publisher]

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Linburg-Comstock variation and syndrome. A meta-analysis.

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Linburg-Comstock variation and syndrome. A meta-analysis.

Surg Radiol Anat. 2017 Dec 07;:

Authors: Yammine K, Erić M

Abstract
INTRODUCTION: Linburg-Comstock variation often connecting the flexor pollicis longus and flexor digitorum profundus of the index finger at a different level with significant discrepancy between clinical and cadaveric frequencies reported in the literature. Although this variation is quite prevalent, it is yet frequently unrecognized. The aim of this meta-analysis is to generate more accurate weighted frequency values of the Linburg-Comstock variation and to look for possible association with ethnicity, laterality, gender and side.
METHODS: A systematic literature search identified 14 studies, including 4132 forearms/hands, which met the inclusion criteria.
RESULTS: While no significant difference was found for laterality, we found significantly higher Linburg-Comstock variation rate in females compared to males. Turkish population demonstrated a significantly higher crude frequency when compared to Europeans (22.2 vs. 15.2%). Hispanic population showed the highest crude frequency (34.5%), whereas the African ancestry showed the least one (8.8%).
CONCLUSIONS: Linburg-Comstock variation could cause career-threatening disabilities and could complicate some hand injuries as well. This review invites future researchers to use a single nomenclature; the term "Linburg-Comstock variation" is to be used when no symptoms are present, and the term "Linburg-Comstock syndrome" in cases where the variation is symptomatic.

PMID: 29218383 [PubMed - as supplied by publisher]

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Consequences of restricted STI testing for young heterosexuals in the Netherlands on test costs and QALY losses

Publication date: Available online 8 December 2017
Source:Health Policy
Author(s): Anita W.M. Suijkerbuijk, Eelco A.B. Over, Fleur van Aar, Hannelore M. Götz, Birgit H.B. van Benthem, Anna K. Lugnér
BackgroundDue to rising costs caused by increasing demand for sexually transmitted infection (STI) care, the Dutch government changed the funding of STI clinics. In 2015, a more restrictive testing policy was introduced with syphilis and HIV tests only on indication for younger, heterosexual clients. We evaluated intended savings and missed syphilis and/or HIV infections and explored efficiency of possible test policies.MethodsUsing surveillance data from 2011 to 2013 with extensive testing for all, we estimated effects of restrictive testing on test costs, number of infections missed, costs per Quality Adjusted Life Year (QALY) lost, and calculated the net monetary benefit from a government perspective.ResultsThe 2015 policy led to estimated savings of €1.1 million, while missing approximately three HIV infections and seven syphilis infections annually. Savings were €435,000/QALY lost. If testing second-generation immigrants for syphilis and HIV, savings rose to €525,000/QALY lost. Offering an HIV test when diagnosed with chlamydia or gonorrhoea savings were €568,000/QALY lost. In a sensitivity analysis, the willingness-to-pay threshold had the highest impact on results.ConclusionsThe 2015 testing policy resulted in a modest decline of detected HIV and syphilis infections, generating substantial savings. Syphilis and HIV tests for both first- and second-generation immigrants and an HIV test in case of positive chlamydia or gonorrhoea diagnosis could reduce missed infections in a cost-effective way.



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IJERPH, Vol. 14, Pages 1544: An Exploration of Intent to Use Telehealth at Home for Patients with Chronic Diseases

IJERPH, Vol. 14, Pages 1544: An Exploration of Intent to Use Telehealth at Home for Patients with Chronic Diseases

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14121544

Authors: Shu-Lin Uei Yu-Ming Kuo Chung-Hung Tsai Yu-Lun Kuo

Telecare is defined as care practiced at a distance. It is an effective strategy for improving the self-health care management of home-patients with chronic diseases. The purpose of this study was to explore the intent to use of telehealth patients. The correlation between the self-care behaviors, the intent to use of telehealth, and the effects on physiological indicators of patients with chronic disease at home were studied. A cross-sectional study design employing purposive sampling was selected. The structured questionnaire ‘Telecare Usage Intention Scale and Self-Care Behavior Scale’ were used, ‘HbA1c, glucose levels and monthly blood pressure measurements’ were analyzed in this thirteen month study. The self-care behaviors of the participants were positively correlated with their intent to use telehealth (p &lt; 0.01). The results also indicated that HbA1c, glucose levels and frequency BP measurement of the participants improved significantly after using telecare (p &lt; 0.005). The results indicated a strong intent to use telehealth and positive perception of telecare services by in-home patients with a chronic disease. Telehealth improves the self-care behavior of in-home chronic disease patients and enhances medical professionals’ ability to deliver quality and effective healthcare.

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CT features for diagnosing acute torsion of uterine subserosal leiomyoma

Abstract

Purpose

To evaluate the usefulness of computed tomographic (CT) features for identifying acute torsion of uterine subserosal leiomyoma (USL).

Subjects and methods

We analyzed contrast-enhanced CT examinations of 7 USLs with torsion and 44 USLs without torsion. Two radiologists evaluated the CT features, which consisted of poor contrast enhancement inside the USL, thin rim enhancement around the USL, calcification within the USL, a beak sign between the uterus and USL, fan-shaped poor contrast enhancement in the uterus area adjacent to the USL (dark fan sign), and ascites. We analyzed the frequencies of these CT features in the USLs with versus without torsion using Fisher's exact test.

Results

The respective frequencies of CT features in USLs with and without torsion were as follows: poor contrast enhancement, 86 and 5% (P = 0.001); thin rim enhancement, 71 and 9% (P = 0.001); calcification, 29 and 18% (P = 0.61); beak sign, 57 and 86% (P = 0.10); dark fan sign, 57 and 0% (P = 0.001); and ascites, 100 and 20% (P = 0.01).

Conclusions

The CT features of poor contrast enhancement, thin rim enhancement, and dark fan sign are valuable for identifying acute torsion of USL.

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Universal etiology, multifactorial diseases and the constitutive model of disease classification.

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Universal etiology, multifactorial diseases and the constitutive model of disease classification.

Stud Hist Philos Biol Biomed Sci. 2017 Dec 04;:

Authors: Fuller J

Abstract
Infectious diseases are often said to have a universal etiology, while chronic and noncommunicable diseases are said to be multifactorial in their etiology. It has been argued that the universal etiology of an infectious disease results from its classification using a monocausal disease model. In this article, I will reconstruct the monocausal model and argue that modern 'multifactorial diseases' are not monocausal by definition. 'Multifactorial diseases' are instead defined according to a constitutive disease model. On closer analysis, infectious diseases are also defined using the constitutive model rather than the monocausal model. As a result, our classification models alone cannot explain why infectious diseases have a universal etiology while chronic and noncommunicable diseases lack one. The explanation is instead provided by the Nineteenth Century germ theorists.

PMID: 29217262 [PubMed - as supplied by publisher]

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Overlapping and Concurrent Surgery: A Professional and Ethical Analysis.

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Overlapping and Concurrent Surgery: A Professional and Ethical Analysis.

J Bone Joint Surg Am. 2017 Dec 06;99(23):2045-2050

Authors: Levin PE, Moon D, Payne DE

Abstract
Overlapping and concurrent surgeries form a continuum of simultaneous surgical practice in which a single surgeon has 2 or more patients in operating rooms at the same time. Undeniably, in an acute life-or-limb-threatening presentation, it may be essential for a surgeon to care for 2 individual patients simultaneously. These situations are different from scheduled elective surgery. Concurrent surgery is defined as the attending surgeon not being present for "critical and key" portions of a procedure. Billing for concurrent surgical procedures is a violation of the U.S. Centers for Medicare & Medicaid Services guidelines. The American College of Surgeons Statement of Principles (April 2016), adopted by the American Academy of Orthopaedic Surgeons, judges the practice of concurrent surgery to be "inappropriate." Overlapping surgery, although permissible under regulatory guidelines in the United States, presents substantial professional, bioethical, and legal concerns, and threatens our obligation as orthopaedic surgeons to respect the primacy of patient welfare and an individual's autonomy.

PMID: 29206796 [PubMed - indexed for MEDLINE]

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Tear osmolarity and subjective dry eye symptoms in migraine sufferers.

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Tear osmolarity and subjective dry eye symptoms in migraine sufferers.

Can J Ophthalmol. 2017 Oct;52(5):513-518

Authors: Wong M, Dodd MM, Masiowski P, Sharma V

Abstract
OBJECTIVE: Previous studies have suggested an association between dry eye and migraine. In a busy ophthalmologist clinic, quick identification of dry eye in migraine sufferers may improve their quality of life. Tear osmolarity is an objective and reliable tool for diagnosing dry eye. It has not been investigated in any population with migraine. Using tear osmolarity and questionnaires, we aimed to explore the relationship between dry eye and clinical symptoms in patients with migraine.
DESIGN: Prospective cross-sectional study.
PARTICIPANTS: Thirty-four adults with migraine sequentially recruited from a single neurologist's practice.
METHODS: Patients were assessed for subjective and objective signs of migraine and dry eye by using the Migraine Disability Assessment Score, the Ocular Surface Disease Index, and tear osmolarity (TearLab). Headache characteristics were compared by using χ2, Fisher's exact, and Mann-Whitney U tests. Osmolarity scores were compared with scores for headache features.
RESULTS: Median age of patients was 38 years, and 76.5% were females. Severe migraine disability was reported in 75.6%, and 34.5% reported moderate to severe dry eye symptoms. Objectively, 49.5% had evidence of dry eye, significantly higher than the 20% recognized in the general population (p < 0.0001). Aura was found to occur more frequently with dry eye (43.8% vs 5.9%; p = 0.02). Those with daily headaches were also more likely to have higher tear osmolarity with marginal significance (median osmolarity 310 mOsm/L vs 299 mOsm/L; p = 0.08).
CONCLUSIONS: Patients with migraine, especially those with aura, appear more likely to have dry eye, as indicated by tear osmolarity. Tear osmolarity may also be greater in those who suffer from daily headaches.

PMID: 28985814 [PubMed - indexed for MEDLINE]

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Association of urinary phenolic compounds, inflammatory bowel disease and chronic diarrheal symptoms: Evidence from the National Health and Nutrition Examination Survey.

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Association of urinary phenolic compounds, inflammatory bowel disease and chronic diarrheal symptoms: Evidence from the National Health and Nutrition Examination Survey.

Environ Pollut. 2017 Oct;229:621-626

Authors: de Silva PS, Yang X, Korzenik JR, Goldman RH, Arheart KL, Caban-Martinez AJ

Abstract
Endocrine disruptors such as phenolic compounds and parabens may be involved in chronic non-infective disease. While products incorporating these compounds are extensively utilized in consumer and personal products, little is known about their effect on bowel health. Inflammatory bowel disease (IBD) - consisting of the diseases ulcerative colitis and Crohn's disease - and irritable bowel syndrome are common chronic non-infectious diarrheal diseases. Despite limited knowledge on the etiology of IBD, these diseases have increased prevalence in industrialized countries and cause significant impairment to quality of life. In the present study we examine relationships between urinary environmental phenolic compounds, chronic diarrhea and inflammatory bowel disease. Data was obtained from the 2005-2010 US National Health and Nutrition Examination Survey (NHANES) including demographics, lifestyle factors, self-reported health conditions, inflammatory markers and urinary phenolic chemical concentrations. Only participants with complete environmental phenols & parabens component were included in our analysis. Chronic diarrheal symptoms were determined by using the 2009-2010 NHANES questionnaire which included questions pertaining to bowel health. We utilized chronic bowel leakage symptoms as a surrogate marker for chronic diarrhea. The presence of IBD was also analyzed from 2009 to 2010 NHANES data, as a sub-analysis for arthropathy directly querying the presence or absence of IBD. Among the subset of 5218 American adults aged 20-80 years in the NHANES study period who completed environmental phenols & parabens component, 25.5% reported chronic diarrheal symptoms. Abnormal markers of inflammation were present in 2200 (42.2%) of respondents. For IBD, 19 individuals with arthropathy confirmed a diagnosis of ulcerative colitis, and 1 person confirmed a Crohn's diagnosis. After adjustment for demographics, inflammatory and subsample weighing; lower paraben levels were associated with chronic bowel leakage (diarrheal) symptoms. Higher 4-tert-octylphenol levels was significantly associated with ulcerative colitis. Further study of underlying mechanisms should be considered.

PMID: 28689150 [PubMed - indexed for MEDLINE]

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Co-occurring Attention Deficit Hyperactivity Disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs.

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Co-occurring Attention Deficit Hyperactivity Disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs.

Psychiatry Res. 2017 Apr;250:210-216

Authors: Lugoboni F, Levin FR, Pieri MC, Manfredini M, Zamboni L, Somaini L, Gerra G, Gruppo InterSert Collaborazione Scientifica Gics

Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a risk for substance use disorders. The aim of this study was to investigate the association between adult ADHD symptoms, opioid use disorder, life dysfunction and co-occurring psychiatric symptoms. 1057 heroin dependent patients on opioid substitution treatment participated in the survey. All patients were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS-v1.1). 19.4% of the patients screened positive for concurrent adult ADHD symptoms status and heroin dependence. Education level was lower among patients with ADHD symptoms, but not significant with respect to non-ADHD patients. Patients with greater ADHD symptoms severity were less likely to be employed. A positive association was observed between ADHD symptoms status and psychiatric symptoms. Patients with ADHD symptoms status were more likely to be smokers. Patients on methadone had a higher rate of ADHD symptoms status compared to buprenorphine. Those individuals prescribed psychoactive drugs were more likely to have ADHD symptoms. In conclusion, high rate of ADHD symptoms was found among heroin dependent patients, particularly those affected by the most severe form of addiction. These individuals had higher rates of unemployment, other co-morbid mental health conditions, heavy tobacco smoking. Additional psychopharmacological interventions targeting ADHD symptoms, other than opioid substitution, is a public health need.

PMID: 28473157 [PubMed - indexed for MEDLINE]

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Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review.

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Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review.

J Womens Health (Larchmt). 2017 Aug;26(8):849-859

Authors: Resurrección DM, Motrico E, Rigabert A, Rubio-Valera M, Conejo-Cerón S, Pastor L, Moreno-Peral P

Abstract
BACKGROUND: Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs.
METHODS: Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method.
RESULTS: A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs.
CONCLUSIONS: Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.

PMID: 28388314 [PubMed - indexed for MEDLINE]

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The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial.

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The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial.

Int J Cardiol. 2017 Jun 01;236:65-70

Authors: Lynggaard V, Nielsen CV, Zwisler AD, Taylor RS, May O

Abstract
BACKGROUND: Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education 'Learning and Coping Strategies' (LC) on patient adherence to an eight-week CR program.
METHODS: 825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression.
RESULTS: More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P=0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P=0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income.
CONCLUSIONS: Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention.
TRIAL REGISTRATION: http://ift.tt/PmpYKN identifier NCT01668394.

PMID: 28259552 [PubMed - indexed for MEDLINE]

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Qualitative Analysis of Parental Observations on Quality of Life in Australian Children with Down Syndrome.

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Qualitative Analysis of Parental Observations on Quality of Life in Australian Children with Down Syndrome.

J Dev Behav Pediatr. 2017 Feb/Mar;38(2):161-168

Authors: Murphy N, Epstein A, Leonard H, Davis E, Reddihough D, Whitehouse A, Jacoby P, Bourke J, Williams K, Downs J

Abstract
OBJECTIVE: There are many challenges to health, functioning, and participation for children with Down syndrome; yet, the quality-of-life (QOL) domains important for this group have never been clearly articulated. This study investigated parental observations to identify QOL domains in children with Down syndrome and determined whether domains differed between children and adolescents.
METHODS: The sample comprised 17 families whose child with Down syndrome was aged 6 to 18 years. Primary caregivers took part in semistructured telephone interviews to explore aspects of their child's life that were satisfying or challenging. Qualitative thematic analysis was implemented using a grounded theory framework to identify domains. The coded data set was divided into 2 groups (childhood and adolescence) at 3 age cut points to observe whether differences existed between the coded domains and domain elements: (1) 6 to 11 years with 12 to 18 years; (2) 6 to 13 years with 14 to 18 years; and (3) 6 to 15 years with 16 to 18 years.
RESULTS: Eleven domains were identified: physical health, behavior and emotion, personal value, communication, movement and physical activity, routines and predictability, independence and autonomy, social connectedness and relationships, variety of activities, nature and outdoors, and access to services. No differences in domains and domain elements were identified across childhood and adolescence.
CONCLUSION: Our data form a preliminary framework from which to design investigations of the child's perspectives on life quality and suggest a range of necessary supports and services.

PMID: 28092296 [PubMed - indexed for MEDLINE]

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Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial.

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Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial.

BMJ Open. 2017 Jan 13;7(1):e013254

Authors: Javanbakht M, Azuara-Blanco A, Burr JM, Ramsay C, Cooper D, Cochran C, Norrie J, Scotland G

Abstract
OBJECTIVE: To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.
DESIGN: Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon.
SETTING: 22 hospital eye services in the UK.
POPULATION: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).
INTERVENTIONS: Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).
OUTCOME MEASURES: Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care.
RESULTS: The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.
CONCLUSIONS: We find that lens extraction has a 67-89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years.
TRIAL REGISTRATION NUMBER: ISRCTN44464607; Results.

PMID: 28087548 [PubMed - indexed for MEDLINE]

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Children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review and meta-ethnography of qualitative studies.

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Children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review and meta-ethnography of qualitative studies.

BMJ Open. 2017 Jan 13;7(1):e012633

Authors: Parslow RM, Harris S, Broughton J, Alattas A, Crawley E, Haywood K, Shaw A

Abstract
OBJECTIVE: To synthesis the qualitative studies of children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).
DESIGN: Systematic review and meta-ethnography.
BACKGROUND: CFS/ME is an important disabling illness, with uncertain cause and prognosis. As a result, children with CFS/ME can find themselves living with greater uncertainty and stigma, exacerbating the impact of the condition. There is a growing body of qualitative research in CFS/ME, yet there has been no attempt to systematically synthesis the studies involving children.
METHODS: Studies exploring the experiences of children diagnosed with CFS/ME, published or unpublished, using qualitative methods were eligible. MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched as well as grey literature, reference lists and contacting authors. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography.
RESULTS: Ten studies involving 82 children with CFS/ME aged 8-18 were included. Our synthesis describes four third-order constructs within children's experiences: (1) disruption and loss: physical, social and the self; (2) barriers to coping: suspension in uncertainty, problems with diagnosis and disbelief; (3) facilitators to coping: reducing uncertainty, credible illness narratives, diagnosis and supportive relationships and (4) hope, personal growth and recovery. CFS/ME introduces profound biographical disruption through its effects on children's ability to socialise, perform school and therefore how they see their future. Unfamiliarity of the condition, problems with diagnosis and felt stigma prevent children from forming a new illness identity. Children adopt coping strategies such as building credible explanations for their illness.
CONCLUSIONS: Physical, social, emotional and self-dimensions of life should be included when treating and measuring outcomes from healthcare in paediatric CFS/ME. There is a need for greater recognition and diagnosis of childhood CFS/ME, specialist advice on activity management and improved communication between health and education providers to help children cope with their condition.

PMID: 28087544 [PubMed - indexed for MEDLINE]

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Perceived Racial Bias and Health-Related Stigma Among Youth with Sickle Cell Disease.

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Perceived Racial Bias and Health-Related Stigma Among Youth with Sickle Cell Disease.

J Dev Behav Pediatr. 2017 Feb/Mar;38(2):129-134

Authors: Wakefield EO, Popp JM, Dale LP, Santanelli JP, Pantaleao A, Zempsky WT

Abstract
OBJECTIVE: Little is known about the role of perceived racial bias and health-related stigma on the health of youth with sickle cell disease (SCD). The purpose of this study was to investigate the occurrence of perceived racial bias and health-related stigma among youth with SCD and its relationship with psychological and physical well-being.
METHODS: Twenty-eight youth with SCD, ages 13 to 21, were recruited from outpatient and inpatient settings at an urban children's medical center. Participants completed measures of perceived racial bias, perceived health-related stigma, depression, quality of life, and pain burden.
RESULTS: Most participants endorsed occurrences of racial bias and health-related stigma. The findings indicate that greater perceived racial bias was associated with greater pain burden, and greater perceived health-related stigma was related to lower quality of life.
CONCLUSION: Perceived racial bias and health-related stigma may be important to consider for future research investigating the psychological and physiological features of SCD for youth.

PMID: 28059954 [PubMed - indexed for MEDLINE]

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Motivation and mortality in older women with early stage breast cancer: A longitudinal study with ten years of follow-up.

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Motivation and mortality in older women with early stage breast cancer: A longitudinal study with ten years of follow-up.

J Geriatr Oncol. 2017 Mar;8(2):133-139

Authors: Dumontier C, Clough-Gorr KM, Silliman RA, Stuck AE, Moser A

Abstract
OBJECTIVES: The Getting Out of Bed Scale (GOB) was validated as a health-related quality of life (HRQoL) variable in older women with early stage breast cancer, suggesting its potential as a concise yet powerful measure of motivation. The aim of our project was to assess the association between GOB and mortality over 10years of follow-up.
MATERIALS AND METHODS: We studied 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer. Data were collected over 10years of follow-up from interviews, medical records, and death indexes.
RESULTS: Compared to women with lower GOB scores, women with higher GOB had an unadjusted hazard ratio (HR) of all-cause mortality of 0.78 at 5years, 95% confidence interval (CI) (0.52, 1.19) and 0.77 at 10years, 95%CI (0.59, 1.00). These associations diminished after adjusting for age and stage of breast cancer, and further after adjusting for other HRQoL variables including physical function, mental health, emotional health, psychosocial function, and social support. Unadjusted HRs of breast cancer-specific mortality were 0.92, 95%CI (0.49, 1.74), at 5years, and 0.82, 95%CI (0.52, 1.32), at 10years. These associations also decreased in adjusted models.
CONCLUSION: Women with higher GOB scores had a lower hazard of all-cause mortality in unadjusted analysis. This effect diminished after adjusting for confounding clinical and HRQoL variables. GOB is a measure of motivation that may not be independently associated with cancer mortality, but reflects other HRQoL variables making it a potential outcome to monitor in older patients with cancer.

PMID: 27986501 [PubMed - indexed for MEDLINE]

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Long-Term Medical and Psychosocial Outcomes in Living Liver Donors.

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Long-Term Medical and Psychosocial Outcomes in Living Liver Donors.

Am J Transplant. 2017 Apr;17(4):880-892

Authors: Dew MA, Butt Z, Humar A, DiMartini AF

Abstract
Due to the enduring organ shortage, living donor liver transplantation has been a valuable treatment strategy for advanced liver disease patients for over 20 years. A variety of reviews have summarized the extensive data now available on medical and psychosocial risks to living donors in the aftermath of donation. However, evidence on donor medical and psychosocial outcomes beyond the first year postdonation has not been synthesized in any previous review. The evidence base on such "long-term" outcomes has been growing in recent years. A review of this evidence would therefore be timely and could serve as an important resource to assist transplant centers in their efforts to fully educate prospective donors and gain informed consent, as well as develop appropriate postdonation clinical care and surveillance plans. We reviewed recent literature on long-term donor outcomes, considering (a) medical outcomes, including mortality risk, rates of complications, abnormalities detected in laboratory testing, and the progress of liver regeneration; and (b) donor-reported psychosocial outcomes reflecting physical, emotional, and interpersonal/socioeconomic well-being, as well as overall health-related quality of life. We summarize limitations and gaps in available evidence, and we provide recommendations for future research and clinical care activities focused on long-term outcomes in liver donors.

PMID: 27862972 [PubMed - indexed for MEDLINE]

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Is my older cancer patient on too many medications?

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Is my older cancer patient on too many medications?

J Geriatr Oncol. 2017 Mar;8(2):77-81

Authors: Turner JP, Shakib S, Bell JS

Abstract
"Is my older cancer patient on too many medications?" is a question that confronts many physicians. Increasing age is associated with an increase in comorbidity, and consequently an increase in the number of medications prescribed to provide symptomatic relief and prevent disease related sequelae. The use of multiple medications, often termed polypharmacy, is highly prevalent in older people with cancer. Polypharmacy is not necessarily inappropriate but has been associated with drug-drug interactions, use of potentially inappropriate medications and a range of adverse events. Specific medications for which the risks outweigh the benefits are considered inappropriate, particularly when safer alternatives exist. Additionally, the appropriateness of medication therapy for both cancer and non-cancer indications is dependent on a patient's life expectancy and treatment goals. A range of implicit and explicit tools are available to assist clinicians work as part of a multidisciplinary team to identify inappropriate or unnecessary medications. Inappropriate or unnecessary medications can be targeted for cessation. Deprescribing is the patient-centered process of reducing medications after consideration of treatment goals, benefits and risks, and medical ethics. A six step process for deprescribing in older patients with cancer is presented; 1) determine life expectancy and treatment goals, 2) review medications, 3) evaluate medication appropriateness, 4) identify medications to cease, 5) create a deprescribing plan, and 6) monitor and review. Although further research is required, there is an increasing body of research demonstrating that deprescribing inappropriate or unnecessary medications is feasible, can be done safely, and can improve patient quality of life.

PMID: 27840102 [PubMed - indexed for MEDLINE]

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The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome.

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The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome.

Gen Hosp Psychiatry. 2016 Nov - Dec;43:17-22

Authors: Millstein RA, Celano CM, Beale EE, Beach SR, Suarez L, Belcher AM, Januzzi JL, Huffman JC

Abstract
OBJECTIVE: This study examined the effects of optimism and gratitude on self-reported health behavior adherence, physical functioning and emotional well-being after an acute coronary syndrome (ACS).
METHODS: Among 156 patients, we examined associations between optimism and gratitude measured 2 weeks post-ACS and 6-month outcomes: adherence to medical recommendations, mental and physical health-related quality of life (HRQoL), physical functioning, depressive symptoms and anxiety. Multivariable linear regression models were used, controlling for increasing levels of adjustment.
RESULTS: Optimism [β=.11, standard error (S.E.)=.05, P=.038] and gratitude (β=.10, S.E.=.05, P=.027) at 2 weeks were associated with subsequent self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) at 6 months in fully adjusted models. Two-week optimism and gratitude were associated with improvements in mental HRQoL (optimism: β=.44, S.E.=.13, P=.001; gratitude: β=.33, S.E.=.12, P=.005) and reductions in symptoms of depression (optimism: β=-.11, S.E.=.05, P=.039; gratitude: β=-.10, S.E.=.05, P=.028) and anxiety (optimism: β=-.15, S.E.=.05, P=.004; gratitude: β=-.10, S.E.=.05, P=.034) at 6 months.
CONCLUSION: Optimism and gratitude at 2 weeks post-ACS were associated with higher self-reported adherence and improved emotional well-being 6 months later, independent of negative emotional states. Optimism and gratitude may help recovery from an ACS. Interventions promoting these positive constructs could help improve adherence and well-being.

PMID: 27796252 [PubMed - indexed for MEDLINE]

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Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2).

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Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2).

Am J Transplant. 2017 Apr;17(4):1081-1096

Authors: DiMartini A, Dew MA, Liu Q, Simpson MA, Ladner DP, Smith AR, Zee J, Abbey S, Gillespie BW, Weinrieb R, Mandell MS, Fisher RA, Emond JC, Freise CE, Sherker AH, Butt Z

Abstract
Because results from single-center (mostly kidney) donor studies demonstrate interpersonal relationship and financial strains for some donors, we conducted a liver donor study involving nine centers within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2) consortium. Among other initiatives, A2ALL-2 examined the nature of these outcomes following donation. Using validated measures, donors were prospectively surveyed before donation and at 3, 6, 12, and 24 mo after donation. Repeated-measures regression models were used to examine social relationship and financial outcomes over time and to identify relevant predictors. Of 297 eligible donors, 271 (91%) consented and were interviewed at least once. Relationship changes were positive overall across postdonation time points, with nearly one-third reporting improved donor family and spousal or partner relationships and >50% reporting improved recipient relationships. The majority of donors, however, reported cumulative out-of-pocket medical and nonmedical expenses, which were judged burdensome by 44% of donors. Lower income predicted burdensome donation costs. Those who anticipated financial concerns and who held nonprofessional positions before donation were more likely to experience adverse financial outcomes. These data support the need for initiatives to reduce financial burden.

PMID: 27647626 [PubMed - indexed for MEDLINE]

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