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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, https://plus.google.com/communities/115462130054650919641?sqinv=VFJWaER0c2NCRl9ERzRjZWhxQmhzY09kVV84cjRn , ,https://plus.google.com/u/0/+AlexandrosGSfakianakis , https://www.youtube.com/channel/UCQH21WX8Qn5YSTKrlJ3OrmQ , https://www.youtube.com/channel/UCTREJHxB6yt4Gaqs4-mLzDA , https://twitter.com/g_orl?lang=el, https://www.instagram.com/alexandrossfakianakis/,

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Σάββατο, 20 Ιανουαρίου 2018

MRI findings in glutamic acid decarboxylase associated autoimmune epilepsy

Abstract

Purpose

Glutamic acid decarboxylase (GAD65) has been implicated in a number of autoimmune-associated neurologic syndromes, including autoimmune epilepsy. This study categorizes the spectrum of MRI findings in patients with a clinical diagnosis of autoimmune epilepsy and elevated serum GAD65 autoantibodies.

Methods

An institutional database search identified patients with elevated serum GAD65 antibodies and a clinical diagnosis of autoimmune epilepsy who had undergone brain MRI. Imaging studies were reviewed by three board-certified neuroradiologists and one neuroradiology fellow. Studies were evaluated for cortical/subcortical and hippocampal signal abnormality, cerebellar and cerebral volume loss, mesial temporal sclerosis, and parenchymal/leptomeningeal enhancement. The electronic medical record was reviewed for relevant clinical information and laboratory markers.

Results

A study cohort of 19 patients was identified. The majority of patients were female (84%), with a mean age of onset of 27 years. Serum GAD65 titers ranged from 33 to 4415 nmol/L (normal < 0.02 nmol/L). The most common presentation was medically intractable, complex partial seizures with temporal lobe onset. Parenchymal atrophy was the most common imaging finding (47%), with a subset of patients demonstrating cortical/subcortical parenchymal T2 hyperintensity (37%) or abnormal hippocampal signal (26%). No patients demonstrated abnormal parenchymal/leptomeningeal enhancement.

Conclusion

The most common MRI finding in GAD65-associated autoimmune epilepsy is disproportionate parenchymal atrophy for age, often associated with abnormal cortical/subcortical T2 hyperintensities. Hippocampal abnormalities are seen in a minority of patients. This constellation of findings in a patient with medically intractable epilepsy should raise the possibility of GAD65 autoimmunity.



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MRI findings in glutamic acid decarboxylase associated autoimmune epilepsy

Abstract

Purpose

Glutamic acid decarboxylase (GAD65) has been implicated in a number of autoimmune-associated neurologic syndromes, including autoimmune epilepsy. This study categorizes the spectrum of MRI findings in patients with a clinical diagnosis of autoimmune epilepsy and elevated serum GAD65 autoantibodies.

Methods

An institutional database search identified patients with elevated serum GAD65 antibodies and a clinical diagnosis of autoimmune epilepsy who had undergone brain MRI. Imaging studies were reviewed by three board-certified neuroradiologists and one neuroradiology fellow. Studies were evaluated for cortical/subcortical and hippocampal signal abnormality, cerebellar and cerebral volume loss, mesial temporal sclerosis, and parenchymal/leptomeningeal enhancement. The electronic medical record was reviewed for relevant clinical information and laboratory markers.

Results

A study cohort of 19 patients was identified. The majority of patients were female (84%), with a mean age of onset of 27 years. Serum GAD65 titers ranged from 33 to 4415 nmol/L (normal < 0.02 nmol/L). The most common presentation was medically intractable, complex partial seizures with temporal lobe onset. Parenchymal atrophy was the most common imaging finding (47%), with a subset of patients demonstrating cortical/subcortical parenchymal T2 hyperintensity (37%) or abnormal hippocampal signal (26%). No patients demonstrated abnormal parenchymal/leptomeningeal enhancement.

Conclusion

The most common MRI finding in GAD65-associated autoimmune epilepsy is disproportionate parenchymal atrophy for age, often associated with abnormal cortical/subcortical T2 hyperintensities. Hippocampal abnormalities are seen in a minority of patients. This constellation of findings in a patient with medically intractable epilepsy should raise the possibility of GAD65 autoimmunity.



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Differences in signal intensities of temporomandibular joint (TMJ) effusion on fluid-attenuated inversion recovery (FLAIR) images

Abstract

Objectives

Joint effusion is demonstrated by high signal intensity in the upper and lower temporomandibular joint (TMJ) spaces on T2-weighted images. The fluid-attenuated inversion recovery (FLAIR) technique can be applied to analyze joint effusion in the TMJ. FLAIR signal intensity can be more sensitively influenced by the contents of joint effusion than T2-weighted signal intensity. The purpose of this study was to analyze the signal intensity of joint effusion on FLAIR images and to investigate the changes in joint effusion contents according to the status of TMJ disorders.

Methods

A total of 48 joints (45 patients) with joint effusion were investigated by magnetic resonance (MR) imaging. Regions of interest were placed over the joint effusion and gray matter on FLAIR images. The joints were categorized as normal disk position (NL), disk displacement with reduction (DWR), disk displacement without reduction (DWOR), and osteoarthritis (OA). The signal intensity ratio of joint effusion was calculated using gray matter as the reference point. The Kruskal–Wallis test and Steel test were applied. A probability of less than 0.05 was considered statistically significant.

Results

The median signal intensity ratios of joint effusion differed significantly among the four joint categories (p = 0.02, Kruskal–Wallis test). The median signal intensity ratio of joint effusion in the OA category was significantly higher than that in the NL category (p = 0.04, Steel test).

Conclusions

The present findings suggest that FLAIR images can demonstrate the changes in joint effusion contents according to the status of TMJ disorders.



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Tertiary Care Experience of Sorafenib in the Treatment of Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma: A Korean Multicenter Study.

Tertiary Care Experience of Sorafenib in the Treatment of Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma: A Korean Multicenter Study.

Thyroid. 2018 Jan 19;:

Authors: Kim M, Kim TH, Shin DY, Lim DJ, Kim EY, Kim WB, Chung JH, Shong Y, Kim BH, Kim WG

Abstract
BACKGROUND: Sorafenib, a multi-kinase inhibitor, is approved for the treatment of patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC). In this study, we evaluated the efficacy and safety of sorafenib in real-world clinical practice and compared the results with those of the DECISION trial. We also evaluated the clinical features associated with better clinical outcomes after sorafenib treatment.
METHODS: This multicenter, retrospective cohort study evaluated 98 patients with progressive RAI-refractory DTC who were treated with sorafenib in six tertiary hospitals in Korea. The primary objective was the progression-free survival (PFS) according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. Overall survival (OS), response rate (defined as the best objective response according to RECIST), and safety were also evaluated.
RESULTS: The median PFS was 9.7 months; median OS was not reached during follow-up. Partial responses and stable disease (SD) were achieved in 25 (25%) and 64 (65%) patients, respectively. A SD more than 6 months was achieved by 41 patients (42%). In subgroup analysis, we identified several prognostic indicators of a better PFS: absence of disease-related symptoms (hazard ratio [HR]=0.5, p=0.041), lung-only metastasis (HR=0.4, p =0.048); a daily maintenance dose ≥ 600 mg (HR=0.3, p=0.005), and a thyroglobulin (Tg) reduction ≥ 60% (HR=0.4, p=0.012). The mean daily dose of sorafenib was 666 ± 114 mg and drug withdrawals due to adverse events (AEs) occurred in 13% of patients. AEs and serious AEs were reported in 93 (95%) and 40 (41%) patients, respectively. The most frequent AE was hand-foot skin reaction (76%).
CONCLUSIONS: The PFS of progressive RAI-refractory DTC patients treated with sorafenib was consistent with the findings of the DECISION trial. Disease-related symptom, lung-only metastasis, a daily maintenance dose, and Tg reduction were significantly associated with PFS. These results suggest that sorafenib is an effective treatment option for patients with progressive RAI-refractory DTC.

PMID: 29350109 [PubMed - as supplied by publisher]



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Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy.

Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Gramegna LL, Pisano A, Testa C, Manners DN, D'Angelo R, Boschetti E, Giancola F, Pironi L, Caporali L, Capristo M, Valentino ML, Plazzi G, Casali C, Dotti MT, Cenacchi G, Hirano M, Giordano C, Parchi P, Rinaldi R, De Giorgio R, Lodi R, Carelli V, Tonon C

Abstract
BACKGROUND AND PURPOSE: Mitochondrial neurogastrointestinal encephalopathy is a rare disorder due to recessive mutations in the thymidine phosphorylase gene, encoding thymidine phosphorylase protein required for mitochondrial DNA replication. Clinical manifestations include gastrointestinal dysmotility and diffuse asymptomatic leukoencephalopathy. This study aimed to elucidate the mechanisms underlying brain leukoencephalopathy in patients with mitochondrial neurogastrointestinal encephalopathy by correlating multimodal neuroradiologic features to postmortem pathology.
MATERIALS AND METHODS: Seven patients underwent brain MR imaging, including single-voxel proton MR spectroscopy and diffusion imaging. Absolute concentrations of metabolites calculated by acquiring unsuppressed water spectra at multiple TEs, along with diffusion metrics based on the tensor model, were compared with those of healthy controls using unpaired t tests in multiple white matters regions. Brain postmortem histologic, immunohistochemical, and molecular analyses were performed in 1 patient.
RESULTS: All patients showed bilateral and nearly symmetric cerebral white matter hyperintensities on T2-weighted images, extending to the cerebellar white matter and brain stem in 4. White matter, N-acetylaspartate, creatine, and choline concentrations were significantly reduced compared with those in controls, with a prominent increase in the radial water diffusivity component. At postmortem examination, severe fibrosis of brain vessel smooth muscle was evident, along with mitochondrial DNA replication depletion in brain and vascular smooth-muscle and endothelial cells, without neuronal loss, myelin damage, or gliosis. Prominent periependymal cytochrome C oxidase deficiency was also observed.
CONCLUSIONS: Vascular functional and histologic alterations account for leukoencephalopathy in mitochondrial neurogastrointestinal encephalopathy. Thymidine toxicity and mitochondrial DNA replication depletion may induce microangiopathy and blood-brain-barrier dysfunction, leading to increased water content in the white matter. Periependymal cytochrome C oxidase deficiency could explain prominent periventricular impairment.

PMID: 29348134 [PubMed - as supplied by publisher]



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Accuracy of the Compressed Sensing Accelerated 3D-FLAIR Sequence for the Detection of MS Plaques at 3T.

Accuracy of the Compressed Sensing Accelerated 3D-FLAIR Sequence for the Detection of MS Plaques at 3T.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Toledano-Massiah S, Sayadi A, de Boer R, Gelderblom J, Mahdjoub R, Gerber S, Zuber M, Zins M, Hodel J

Abstract
BACKGROUND AND PURPOSE: The use of 3D FLAIR improves the detection of brain lesions in MS patients, but requires long acquisition times. Compressed sensing reduces acquisition time by using the sparsity of MR images to randomly undersample the k-space. Our aim was to compare the image quality and diagnostic performance of 3D-FLAIR with and without compressed sensing for the detection of multiple sclerosis lesions at 3T.
MATERIALS AND METHODS: Twenty-three patients with relapsing-remitting MS underwent both conventional 3D-FLAIR and compressed sensing 3D-FLAIR on a 3T scanner (reduction in scan time 1 minute 25 seconds, 27%; compressed sensing factor of 1.3). Two blinded readers independently evaluated both conventional and compressed sensing FLAIR for image quality (SNR and contrast-to-noise ratio) and the number of MS lesions visible in the periventricular, intra-juxtacortical, infratentorial, and optic nerve regions. The volume of white matter lesions was measured with automatic postprocessing segmentation software for each FLAIR sequence.
RESULTS: Image quality and the number of MS lesions detected by the readers were similar between the 2 FLAIR acquisitions (P = .74 and P = .094, respectively). Almost perfect agreement was found between both FLAIR acquisitions for total MS lesion count (Lin concordance correlation coefficient = 0.99). Agreement between conventional and compressed sensing FLAIR was almost perfect for periventricular and infratentorial lesions and substantial for intrajuxtacortical and optic nerve lesions. Postprocessing with the segmentation software did not reveal a significant difference between conventional and compressed sensing FLAIR in total MS lesion volume (P = .63) or the number of MS lesions (P = .15).
CONCLUSIONS: With a compressed sensing factor of 1.3, 3D-FLAIR is 27% faster and preserves diagnostic performance for the detection of MS plaques at 3T.

PMID: 29348137 [PubMed - as supplied by publisher]



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Development of High Signal Intensity within the Globus Pallidus and Dentate Nucleus following Multiple Administrations of Gadobenate Dimeglumine.

Development of High Signal Intensity within the Globus Pallidus and Dentate Nucleus following Multiple Administrations of Gadobenate Dimeglumine.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Bolles GM, Yazdani M, Stalcup ST, Creeden SG, Collins HR, Nietert PJ, Roberts DR

Abstract
BACKGROUND AND PURPOSE: Previous studies have evaluated various gadolinium based contrast agents and their association with gadolinium retention, however, there is a discrepancy in the literature concerning the linear agent gadobenate dimeglumine. Our aim was to determine whether an association exists between the administration of gadobenate dimeglumine and the development of intrinsic T1-weighted signal in the dentate nucleus and globus pallidus.
MATERIALS AND METHODS: In this single-center, retrospective study, the signal intensity of the globus pallidus, dentate nucleus, thalamus, and middle cerebellar peduncle was measured on unenhanced T1-weighted images in 29 adult patients who had undergone multiple contrast MRIs using exclusively gadobenate dimeglumine (mean, 10.1 ± 3.23 doses; range, 6-18 doses). Two neuroradiologists, blinded to the number of prior gadolinium-based contrast agent administrations, separately placed ROIs within the globi pallidi, thalami, dentate nuclei, and middle cerebellar peduncles on the last MR imaging examinations. The correlations between the globus pallidus:thalamus and the dentate nucleus:middle cerebellar peduncle signal intensity ratios with the number of gadolinium-based contrast agent administrations and cumulative dose were tested with either 1-tailed Pearson or Spearman correlations. A priori, P < .05 was considered statistically significant.
RESULTS: Both the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the number of gadolinium-based contrast agent administrations (r = 0.39, P = .017, and r = 0.58, P = .001, respectively). Additionally, the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the cumulative dose of gadobenate dimeglumine (r = 0.48, P = .004, and r = 0.43, P = .009, respectively). Dentate nucleus hyperintensity was qualitatively present on the last MR imaging in 79.3%-86.2% of patients and in all patients who had received >10 doses.
CONCLUSIONS: At high cumulative doses (commonly experienced by patients, for example, with neoplastic disease), gadobenate dimeglumine is associated with an increase in the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncles signal intensity ratios.

PMID: 29348135 [PubMed - as supplied by publisher]



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Resting-State Functional MRI: Everything That Nonexperts Have Always Wanted to Know.

Resting-State Functional MRI: Everything That Nonexperts Have Always Wanted to Know.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Lv H, Wang Z, Tong E, Williams LM, Zaharchuk G, Zeineh M, Goldstein-Piekarski AN, Ball TM, Liao C, Wintermark M

Abstract
Resting-state fMRI was first described by Biswal et al in 1995 and has since then been widely used in both healthy subjects and patients with various neurologic, neurosurgical, and psychiatric disorders. As opposed to paradigm- or task-based functional MR imaging, resting-state fMRI does not require subjects to perform any specific task. The low-frequency oscillations of the resting-state fMRI signal have been shown to relate to the spontaneous neural activity. There are many ways to analyze resting-state fMRI data. In this review article, we will briefly describe a few of these and highlight the advantages and limitations of each. This description is to facilitate the adoption and use of resting-state fMRI in the clinical setting, helping neuroradiologists become familiar with these techniques and applying them for the care of patients with neurologic and psychiatric diseases.

PMID: 29348136 [PubMed - as supplied by publisher]



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Review of the Imaging Features of Benign Osteoporotic and Malignant Vertebral Compression Fractures.

Review of the Imaging Features of Benign Osteoporotic and Malignant Vertebral Compression Fractures.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Mauch JT, Carr CM, Cloft H, Diehn FE

Abstract
Vertebral compression fractures are very common, especially in the elderly. Benign osteoporotic and malignant vertebral compression fractures have extremely different management and prognostic implications. Although there is an overlap in appearances, characteristic imaging features can aid in the distinction between these 2 types of compression fractures. The aim of this review is to characterize the imaging features of benign and malignant vertebral compression fractures seen with CT, PET, SPECT, and MR imaging.

PMID: 29348133 [PubMed - as supplied by publisher]



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T2 Relaxometry MRI Predicts Cerebral Palsy in Preterm Infants.

T2 Relaxometry MRI Predicts Cerebral Palsy in Preterm Infants.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Chen LW, Wang ST, Huang CC, Tu YF, Tsai YS

Abstract
BACKGROUND AND PURPOSE: T2-relaxometry brain MR imaging enables objective measurement of brain maturation based on the water-macromolecule ratio in white matter, but the outcome correlation is not established in preterm infants. Our study aimed to predict neurodevelopment with T2-relaxation values of brain MR imaging among preterm infants.
MATERIALS AND METHODS: From January 1, 2012, to May 31, 2015, preterm infants who underwent both T2-relaxometry brain MR imaging and neurodevelopmental follow-up were retrospectively reviewed. T2-relaxation values were measured over the periventricular white matter, including sections through the frontal horns, midbody of the lateral ventricles, and centrum semiovale. Periventricular T2 relaxometry in relation to corrected age was analyzed with restricted cubic spline regression. Prediction of cerebral palsy was examined with the receiver operating characteristic curve.
RESULTS: Thirty-eight preterm infants were enrolled for analysis. Twenty patients (52.6%) had neurodevelopmental abnormalities, including 8 (21%) with developmental delay without cerebral palsy and 12 (31.6%) with cerebral palsy. The periventricular T2-relaxation values in relation to age were curvilinear in preterm infants with normal development, linear in those with developmental delay without cerebral palsy, and flat in those with cerebral palsy. When MR imaging was performed at >1 month corrected age, cerebral palsy could be predicted with T2 relaxometry of the periventricular white matter on sections through the midbody of the lateral ventricles (area under the receiver operating characteristic curve = 0.738; cutoff value of >217.4 with 63.6% sensitivity and 100.0% specificity).
CONCLUSIONS: T2-relaxometry brain MR imaging could provide prognostic prediction of neurodevelopmental outcomes in premature infants. Age-dependent and area-selective interpretation in preterm brains should be emphasized.

PMID: 29348132 [PubMed - as supplied by publisher]



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Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications.

Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications.

AJNR Am J Neuroradiol. 2018 Jan 18;:

Authors: Bonatti M, Lombardo F, Zamboni GA, Vittadello F, Currò Dossi R, Bonetti B, Pozzi Mucelli R, Bonatti G

Abstract
BACKGROUND AND PURPOSE: Intracerebral hemorrhage represents a potentially severe complication of revascularization of acute ischemic stroke. The aim of our study was to assess the capability of iodine extravasation quantification on dual-energy CT performed immediately after mechanical thrombectomy to predict hemorrhagic complications.
MATERIALS AND METHODS: Because this was a retrospective study, the need for informed consent was waived. Eighty-five consecutive patients who underwent brain dual-energy CT immediately after mechanical thrombectomy for acute ischemic stroke between August 2013 and January 2017 were included. Two radiologists independently evaluated dual-energy CT images for the presence of parenchymal hyperdensity, iodine extravasation, and hemorrhage. Maximum iodine concentration was measured. Follow-up CT examinations performed until patient discharge were reviewed for intracerebral hemorrhage development. The correlation between dual-energy CT parameters and intracerebral hemorrhage development was analyzed by the Mann-Whitney U test and Fisher exact test. Receiver operating characteristic curves were generated for continuous variables.
RESULTS: Thirteen of 85 patients (15.3%) developed hemorrhage. On postoperative dual-energy CT, parenchymal hyperdensities and iodine extravasation were present in 100% of the patients who developed intracerebral hemorrhage and in 56.3% of the patients who did not (P = .002 for both). Signs of bleeding were present in 35.7% of the patients who developed intracerebral hemorrhage and in none of the patients who did not (P < .001). Median maximum iodine concentration was 2.63 mg/mL in the patients who developed intracerebral hemorrhage and 1.4 mg/mL in the patients who did not (P < .001). Maximum iodine concentration showed an area under the curve of 0.89 for identifying patients developing intracerebral hemorrhage.
CONCLUSIONS: The presence of parenchymal hyperdensity with a maximum iodine concentration of >1.35 mg/mL may identify patients developing intracerebral hemorrhage with 100% sensitivity and 67.6% specificity.

PMID: 29348131 [PubMed - as supplied by publisher]



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Cancer patients need better care, not just more technology.

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Cancer patients need better care, not just more technology.

Nature. 2017 09 19;549(7672):325-328

Authors: Sullivan R, Pramesh CS, Booth CM

PMID: 28933447 [PubMed - indexed for MEDLINE]



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Chinese version of the Constant-Murley questionnaire for shoulder pain and disability: a reliability and validation study.

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Chinese version of the Constant-Murley questionnaire for shoulder pain and disability: a reliability and validation study.

Health Qual Life Outcomes. 2017 Sep 18;15(1):178

Authors: Yao M, Yang L, Cao ZY, Cheng SD, Tian SL, Sun YL, Wang J, Xu BP, Hu XC, Wang YJ, Zhang Y, Cui XJ

Abstract
BACKGROUND: Shoulder pain is a common musculoskeletal disorder in Chinese population, which affects more than 1,3 billion individuals. To the best of our knowledge, there has been no available Chinese-language version of measurements of shoulder pain and disability so far. Moreover, the Constant-Murley score (CMS) questionnaire is a universally recognized patient-reported questionnaire for clinical practice and research. The present study was designed to evaluate a Chinese translational version of CMS and subsequently assess its reliability and validity.
METHODS: The Chinese translational version of CMS was formulated by means of forward-backward translation. Meanwhile, a final review was carried out by an expert committee, followed by conducting a test of the pre-final version. Therefore, the reliability and validity of the Chinese translational version of CMS could be assessed using the internal consistency, construct validity, factor analysis, reliability and floor and ceiling effects. Specifically, the reliability was assessed by testing the internal consistency (Cronbach's α) and test-retest reliability (intraclass coefficient correlation [ICC]), while the construct validity was evaluated via comparison between the Chinese translational version of CMS with visual analog scale (VAS) score and the 36-Item Short Form Health Survey (SF-36, Spearman correlation).
RESULTS: The questionnaire was verified to be acceptable after distribution among 120 subjects with unilateral shoulder pain. Factor analysis had revealed a two-factor and 10-item solution. Moreover, the assessment results indicated that the Chinese translational version of CMS questionnaire harbored good internal consistency (Cronbach's α = 0.739) and test-retest reliability (ICC = 0.827). In addition, the Chinese translational version of CMS was moderately correlated with VAS score (r = 0.497) and SF-36 (r = 0.135). No obvious floor and ceiling effects were observed in the Chinese translational version of CMS questionnaire.
CONCLUSION: Chinese translational version of CMS exhibited good reliability, which is relatively acceptable and is likely to be widely used in this population.

PMID: 28923113 [PubMed - indexed for MEDLINE]



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Reflective practice and social responsibility in family medicine: Effect of performing an international rotation in a developing country.

http:--highwire.stanford.edu-icons-exter Related Articles

Reflective practice and social responsibility in family medicine: Effect of performing an international rotation in a developing country.

Can Fam Physician. 2016 Nov;62(11):e699-e704

Authors: Loignon C, Gottin T, Valois C, Couturier F, Williams R, Roy PM

Abstract
OBJECTIVE: To explore the perceived effect of an elective international health rotation on family medicine resident learning.
DESIGN: Qualitative, collaborative study based on semistructured interviews.
SETTING: Quebec.
PARTICIPANTS: A sample of 12 family medicine residents and 9 rotation supervisors (N = 21).
METHODS: Semistructured interviews of residents and rotation supervisors.
MAIN FINDINGS: Residents and supervisors alike reported that their technical skills and relationship skills had benefited. All increased their knowledge of tropical pathologies and learned to expand their clinical examinations. They benefited from having very rich interactions in other care settings, working with vulnerable populations. The rotations had their greatest effect on relationship skills (communication, empathy, etc) and the ability to work with vulnerable patients. All of the participants were exposed to local therapies and local interpretations of disease symptoms and pathogenesis.
CONCLUSION: The findings of this study will have a considerable effect on pedagogy. The residents' experiences of their international health rotations and what they learned in terms of medical skills and pedagogic approaches in working with patients are described. Using a collaborative approach with the rotation supervisors, the data were triangulated and the benefits of an international rotation on academic training were more accurately defined. The findings can now be used to enrich academic programs in social and preventive medicine and more adequately prepare future family physicians for work in various social and cultural settings.

PMID: 28661890 [PubMed - indexed for MEDLINE]



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Approaching a global definition of family medicine: The Besrour Papers: a series on the state of family medicine in the world.

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Approaching a global definition of family medicine: The Besrour Papers: a series on the state of family medicine in the world.

Can Fam Physician. 2016 Nov;62(11):891-896

Authors: Gibson C, Arya N, Ponka D, Rouleau K, Woollard R

Abstract
OBJECTIVE: To find a common global definition of family medicine.
COMPOSITION OF THE COMMITTEE: Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences.
METHODS: Searching both definition of family medicine and history of family medicine yields a variety of defining features. Visiting family medicine training programs worldwide highlights this discrepancy.
REPORT: It is not an easy task to define family medicine-one of its key attributes is its adaptability to a local context, but this makes aggregation of data challenging. There is a lack of clarity regarding whether family medicine is the same discipline globally and what the core features are that define it. Unifying components of the definition have always included comprehensive care at all life stages and the management of the common illnesses of a particular community. The emerging global emphasis on competency and social accountability demonstrates commitment to the principle that family doctors provide health care for all in the context of the community. Although the competencies are not universal, the fact that family physicians fill in primary care "gaps" and tailor learning strategies to community priorities is a unifying distinction. We argue for a focus on the core competencies that bind us as a discipline.
CONCLUSION: Family medicine can be practised in various forms. The unifying elements are the socially accountable responsiveness to local need, the adaptation of existing health infrastructure, and the ongoing development of the skills required to succeed in that role-always grounded in relationships of care. In this way, family medicine will continue to evolve to suit the health needs of communities and health systems.

PMID: 28661866 [PubMed - indexed for MEDLINE]



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A systematic review and narrative synthesis of group self-management interventions for adults with epilepsy.

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A systematic review and narrative synthesis of group self-management interventions for adults with epilepsy.

BMC Neurol. 2017 Jun 17;17(1):114

Authors: Smith A, McKinlay A, Wojewodka G, Ridsdale L

Abstract
BACKGROUND: Epilepsy is a serious and costly long-term condition that negatively affects quality of life, especially if seizures persist on medication. Studies show that people with epilepsy (PWE) want to learn more about the condition and some educational self-management courses have been trialled internationally. The objectives of this review were to evaluate research and summarise results on group self-management interventions for PWE.
METHODS: We searched Medline and PsycINFO for results published in English between 1995 and 2015. Only studies evaluating face-to-face, group interventions for adults with epilepsy were included. Heterogeneity in study outcomes prevented the carrying out of a meta-analysis; however, a Cochrane style review was undertaken.
RESULTS: We found eleven studies, nine of which were randomised controlled trials. There were variable standards of methodological reporting with some risk of bias. Seven of the studies used quality of life as an outcome, with four finding statistically significant improvements in mean total score. Two found an improvement in outcome subscales. One study included some additional semi-qualitative data.
CONCLUSIONS: We identified promising trends in the trials reviewed. In particular, there were significant improvements in quality of life scales and seizure frequency in many of the interventions. However, considerable heterogeneity of interventions and outcomes made comparison between the studies difficult. Courses that included psychological interventions and others that had a high number of sessions showed more effect than short educational courses. Furthermore, the evidence was predominantly from pilot studies with small sample sizes and short follow-up duration. Further research is needed to better evaluate the role of group self-management interventions in outpatient epilepsy management.

PMID: 28623909 [PubMed - indexed for MEDLINE]



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Improving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol.

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Improving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol.

BMC Neurol. 2017 Jun 17;17(1):115

Authors: Reeves MJ, Hughes AK, Woodward AT, Freddolino PP, Coursaris CK, Swierenga SJ, Schwamm LH, Fritz MC

Abstract
BACKGROUND: For some stroke patients and caregivers, navigating the transition between hospital discharge and returning home is associated with substantial psychosocial and health-related challenges. Currently, no evidence-based standard of care exists that addresses the concerns of stroke patients and caregivers during the transition period. Objectives of the Michigan Stroke Transitions Trial (MISTT) are to test the impact of a social worker home-based case management program, as well as an online information and support resource, on patient and caregiver outcomes after returning home.
METHODS: The Michigan Stroke Transitions Trial is a randomized, pragmatic, open (un-blinded), 3-group parallel designed superiority trial conducted in 3 Michigan hospitals. Eligible participants are adult acute stroke patients discharged home directly or within 4 weeks of being discharged to a rehabilitation facility. The patient's primary caregiver is also invited to participate. Patients are randomized on the day they return home using a randomized block design. Consented patients discharged to a rehabilitation facility who do not go home within 4 weeks are dropped from the study. The 2 study interventions begin within a week of returning home and conclude 3 months later. The 3-group design compares usual care to either a home-based social worker stroke case management (SWSCM) program, or a combination of the SWSCM program plus access to an online information and support resource (MISTT website). Outcomes data are collected at 7-days and 90-days by trained telephone interviewers. Primary patient outcomes include the PROMIS global 10 score (a generic Quality of Life scale), and the Patient Activation Measure (PAM). Caregiver outcomes include the Bakas Caregiving Outcomes Scale. Final analysis will be based on 214 randomized acute stroke patients. To accommodate subjects excluded due to prolonged rehabilitation stays, as well as those lost-to-follow-up, up to 315 patients will be consented.
DISCUSSION: The MISTT study will determine if a home-based case management program designed around the needs and preferences of stroke patients and caregivers, alone or in combination with a patient-centered online information and support resource can improve stroke survivor and caregiver outcomes 3 months after returning home.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT02653170 (Protocol ID: 135457). Registered April 9, 2015.

PMID: 28623892 [PubMed - indexed for MEDLINE]



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Long-term diabetes complications after pancreas transplantation.

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Long-term diabetes complications after pancreas transplantation.

Curr Opin Organ Transplant. 2017 Aug;22(4):382-388

Authors: Jenssen T, Hartmann A, Birkeland KI

Abstract
PURPOSE OF REVIEW: The intention of this study is to summarize present knowledge about adverse effects of hyperglycemia in diabetes, and in this context review more recent data concerning the effects of pancreas transplantation on a wide range of diabetic complications.
RECENT FINDINGS: Effective blood glucose control by insulin delays progression of microvascular complications and probably improves survival in type 1 diabetes. A successful pancreas transplantation combined with a kidney graft has recently been found to prevent diabetic kidney lesions, and registry data support improved long-term patient survival. Cardiovascular mortality was reduced in one study, even though coronary heart disease was not significantly altered. Advanced coronary lesions may be too advanced in these patients at baseline. However, with a successful single pancreas transplant, which is generally performed in patients with near-normal kidney function, pancreas transplantation may improve left ventricular function. Development of retinopathy and neuropathy is delayed with functioning pancreas grafts, and both quality of life and certain skin lesions may improve after pancreas transplantation.
SUMMARY: In patients with type 1 diabetes, pancreas transplantation may improve cardiac outcomes and ameliorate diabetic lesions in the kidney transplant. Also quality of life, neuropathy, retinopathy, and healing of certain skin lesions may be improved.

PMID: 28598888 [PubMed - indexed for MEDLINE]



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Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis.

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Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis.

BMC Neurol. 2017 Jun 08;17(1):109

Authors: Gauthier LV, Kane C, Borstad A, Strahl N, Uswatte G, Taub E, Morris D, Hall A, Arakelian M, Mark V

Abstract
BACKGROUND: Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined.
METHODS: This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL).
DISCUSSION: This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation.
TRIAL REGISTRATION: Clinicaltrials.gov, NCT02631850 .

PMID: 28595611 [PubMed - indexed for MEDLINE]



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Paolo Macchiarini's academic afterlife in Russia ends.

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Paolo Macchiarini's academic afterlife in Russia ends.

Science. 2017 May 19;356(6339):672-673

Authors: Astakhova A

PMID: 28522475 [PubMed - indexed for MEDLINE]



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Understanding sex differences in health status: A frontier in the field of vascular medicine.

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Understanding sex differences in health status: A frontier in the field of vascular medicine.

Vasc Med. 2017 04;22(2):110-111

Authors: Mays RJ, Regensteiner JG

PMID: 28429661 [PubMed - indexed for MEDLINE]



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The factors related to early-onset depression after first stroke.

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The factors related to early-onset depression after first stroke.

Psychogeriatrics. 2017 Nov;17(6):414-422

Authors: Karakus K, Kunt R, Memis CO, Kunt DA, Dogan B, Ozdemiroglu F, Sevincok L

Abstract
BACKGROUND: The biological and psychological aspects of post-stroke depression (PSD) may vary based on the time since stroke onset. The sociodemographic and clinical correlates of early-onset PSD are not yet well understood. In the present study, we aimed to investigate the clinical correlates of early-onset depression following first stroke. We hypothesized that the severity of a stroke or disability (other than lesion characteristics) would likely be related to PSD in a sample of first stroke patients with single and unilateral lesions.
METHODS: Post-stroke patients with (n = 40) and without (n = 51) early-onset depression were compared with respect to several demographic and clinical variables.
RESULTS: There were no significant differences between the groups with respect to lesion location, lateralization, or volume. Scores on the Brief Disability Questionnaire, National Institutes of Health Stroke Scale, and Modified Rankin Scale were significantly higher in depressed post-stroke patients than in non-depressed patients. The anxiety, depression, and total scores of the Hospital Anxiety and Depression Scale were positively correlated with the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Brief Disability Questionnaire scores. A previous history of depression and Brief Disability Questionnaire score were strongly associated with the occurrence of early-onset PSD.
CONCLUSION: Our findings suggest that early-onset PSD is likely to be correlated with the severity of stroke and functional disability.

PMID: 28387015 [PubMed - indexed for MEDLINE]



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Evaluation of nursing interventions using minimally invasive assessments methods for patients in a persistent vegetative state.

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Evaluation of nursing interventions using minimally invasive assessments methods for patients in a persistent vegetative state.

Psychogeriatrics. 2017 Nov;17(6):406-413

Authors: Sato M, Sugimoto M, Yamaguchi K, Kawaguchi T

Abstract
AIM: This study aimed to evaluate the effects of nursing interventions using minimally invasive or non-invasive methods conducive to frequent use in order to assess patients in a persistent vegetative state (PVS).
METHODS: We provided three nursing interventions-sitting the patient in an upright position, footbath care, and oral care-to PVS patients (n = 11) and elderly bedridden subjects with consciousness (n = 6) for 3 weeks in addition to ordinary nursing treatments. The Kohnan Score, plasma cortisol and adrenaline levels, General Well-Being Schedule score, and facial expression assessments were used as evaluation methods.
RESULTS: The Kohnan Score of PVS patients declined significantly, indicating that the interventions increased patients' consciousness levels, but none of the other parameters showed significant change in either group. The change in Kohnan Score showed dependent trends for facial expression at baseline, cortisol change during the intervention, and the term of PVS.
CONCLUSIONS: The data suggest three indices for predicting intervention efficacy in individuals and for assessing an intervention's contribution to quality of life improvement. Among the multiple evaluation methods, Konan Scores was the most effective. Ultimately, the three nursing interventions used in this study and Konan Score led to the optimization of nursing home care and rehabilitation for PVS patients.

PMID: 28378507 [PubMed - indexed for MEDLINE]



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Systematic review of the effectiveness of health-related behavioral interventions using portable activity sensing devices (PASDs).

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Systematic review of the effectiveness of health-related behavioral interventions using portable activity sensing devices (PASDs).

J Am Med Inform Assoc. 2017 Sep 01;24(5):1002-1013

Authors: Abedtash H, Holden RJ

Abstract
Background: Portable activity sensing devices (PASDs) have received significant interest as tools for objectively measuring activity-related parameters and promoting health-related outcomes. Studies of PASDs suggest the potential value of integrating them with behavioral interventions to improve intermediate and downstream clinical outcomes.
Objectives: This systematic review describes and evaluates evidence from controlled studies of interventions using PASDs on their effectiveness in health-related outcomes. Study quality was also assessed.
Methods: A systematic literature search was performed of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, and CINAHL databases. We included English-language papers of controlled trials through 2015 reporting the effectiveness of PASDs in improving health-related outcomes in any population. We extracted and analyzed data on study characteristics including design, target population, interventions, and findings.
Results: Seventeen trials met the inclusion criteria from a total of 9553 unique records. Study objectives varied greatly, but most sought to increase physical activity. Studies with a "passive" intervention arm using a PASD with minimal behavioral support generally did not demonstrate effectiveness in improving health-related outcomes. Interventions integrating PASDs with multiple behavioral change techniques were more likely to be effective, particularly for intermediate outcomes such as physical activity and weight loss. Trials had small sample sizes but were generally free of bias, except for blinding and selection bias.
Conclusion: There is insufficient evidence to draw a conclusion about the general health-related benefits of PASD interventions. PASD interventions may improve intermediate outcomes when coupled with multiple behavioral change techniques. Devices alone or with minimal behavioral change support are insufficient to change health-related outcomes.

PMID: 28339620 [PubMed - indexed for MEDLINE]



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Epilepsy in transition from child care to adult service: a missing link in sub-Saharan Africa.

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Epilepsy in transition from child care to adult service: a missing link in sub-Saharan Africa.

Trop Doct. 2017 Jul;47(3):273-275

Authors: Adebiyi A, Lagunju I, Ogunniyi A

Abstract
Epilepsy is a common chronic neurological disease which predominantly affects children and young adults. The disease is highly stigmatised and transition from child care to adult services is not routine in many low- and middle-income countries. Where a treatment system follows routines which cannot be sustained in such countries because of specialised manpower challenges, it becomes imperative that appropriate care models be sought for patients whose seizures fail to remit in childhood. In teaching hospitals, well-organised, multidisciplinary meetings and a planned transfer between paediatric and adult neurologists will be feasible. However, an alternative model is advocated at the community level where the majority of the patients reside which involves task shifting to general practitioners and community healthcare workers. The latter can organise home visits to ensure management compliance. This will ensure better seizure outcomes and a good quality of life for epileptic patients.

PMID: 27578858 [PubMed - indexed for MEDLINE]



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Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies.

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Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies.

Cardiology. 2016;135(3):141-150

Authors: Werdan K, Perings S, Köster R, Kelm M, Meinertz T, Stöckl G, Müller-Werdan U

Abstract
OBJECTIVES: The efficacy of ivabradine has been demonstrated in different subpopulations of stable angina patients in randomized clinical trials. This study explored its effectiveness in subpopulations seen in clinical practice as they often differ from those of randomized trials.
METHODS: Data were pooled from three German observational studies with similar inclusion criteria (stable angina and heart rate ≥60 bpm). All patients received 2.5, 5, or 7.5 mg b.i.d. of ivabradine for 4 months, with or without concomitant beta-blocker. Antianginal effectiveness was analyzed in subpopulations defined by gender, age, heart rate, angina severity, use of concomitant beta-blocker, previous percutaneous coronary intervention procedure, and comorbidities (including previous myocardial infarction and diabetes).
RESULTS: Treatment data were available on 8,555 patients, where therapy with ivabradine was associated with a significant reduction in the frequency of angina attacks and consumption of short-acting nitrates of 87%. Effectiveness was maintained in all investigated subpopulations, with a reduction in antianginal parameters of 82-90%. Clinical status (Canadian Cardiovascular Society class) and quality of life were also improved. Ivabradine was well tolerated in all subgroups.
CONCLUSIONS: Ivabradine is effective and safe in all subpopulations of angina patients seen in clinical practice, independent of age, comorbidities, and use of beta-blocker.

PMID: 27333284 [PubMed - indexed for MEDLINE]



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The cost and impact of compulsivity: A research perspective.

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The cost and impact of compulsivity: A research perspective.

Eur Neuropsychopharmacol. 2016 05;26(5):800-9

Authors: Hollander E, Doernberg E, Shavitt R, Waterman RJ, Soreni N, Veltman DJ, Sahakian BJ, Fineberg NA

Abstract
Compulsivity is the defining feature of various psychiatric disorders including Obsessive Compulsive Related Disorders (OCRDs), and other compulsive, impulsive, and addictive disorders. These disorders are disabling, chronic conditions with an early onset and high rates of comorbidity, misdiagnoses, and delay in treatment onset. Disorders of compulsivity are responsible for considerable socioeconomic burden to society. We review the costs and impacts of compulsivity. In order to facilitate earlier diagnosis and targeted treatments, we examine the overlapping mechanisms that underlie compulsivity. We reconceptualize psychiatric disorders based on core features of compulsivity, highlight challenges in harmonizing research in children and adults, describe newer research methodologies, and point to future directions that can impact the costs and impact of disorders of compulsivity.

PMID: 27235690 [PubMed - indexed for MEDLINE]



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Lumbar Spinal Stenosis.

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Lumbar Spinal Stenosis.

J Pain Palliat Care Pharmacother. 2016 Jun;30(2):150-2

Authors: Feeney R

Abstract
Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question, lumbar spinal stenosis, commonly a multifactorial disease that can have profound functional consequences, is considered, along with a discussion of physical and pharmacologic treatments and quality of life.

PMID: 27145444 [PubMed - indexed for MEDLINE]



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Is khat use disorder a valid diagnostic entity?

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Is khat use disorder a valid diagnostic entity?

Addiction. 2016 Sep;111(9):1666-76

Authors: Duresso SW, Matthews AJ, Ferguson SG, Bruno R

Abstract
AIMS: This study aimed to validate the presence of a khat use disorder syndrome using DSM-5 criteria and to examine its relationship with increased experience of harms.
DESIGN: Cross-sectional, purposive sample of current khat-chewers, recruited from khat markets and cafes.
SETTING: Participants were recruited from the general community and from Adama Science and Technology University in Ethiopia.
PARTICIPANTS: A total of 400 current khat consumers aged 16 and above were recruited between September 2014 and January 2015 MEASURES: Survey comprising current clinical symptoms (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), and validated measures of health, psychological distress, quality of life and academic functioning.
FINDINGS: A third [35.5% 95% confidence interval (CI) = 31.0-40.3] of respondents reported daily khat use and a quarter (25.4% 95% CI = 21.4-30.0) using three times or more per week. Using DSM-5 criteria, 10.5% (95% CI = 7.9-13.9) were categorized as experiencing mild, 8.8% (95% CI = 6.4-12.0) moderate and 54.5% (95% CI = 49.6-59.3) severe khat use disorder. Confirmatory factor analysis demonstrated a good fit of symptoms to a single underlying construct, consistent with other substance use disorders. Individuals categorized as experiencing khat use disorder demonstrated significantly greater frequency [odds ratio (OR) = 45.29; 95% CI = 10.97-19.01) and quantity of khat use (OR = 2.35; 95% CI = 1.29-4.29). They also demonstrated increased financial problems associated with use, greater problems with academic functioning and higher rates of self-reported mental health problems, higher psychological distress and poorer quality of life. Treatment access was poor, with only one-third (32.9%) of individuals with khat use disorder reporting life-time access, near-exclusively related to help-seeking from friends and relatives.
CONCLUSION: The construct of a substance use disorder syndrome for khat using DSM-5 criteria appears valid and performs in a manner consistent with other substances of dependence. Individuals with khat use disorder experience substantial problems in association with khat use. Despite this, there are low levels of help-seeking for these problems.

PMID: 27061394 [PubMed - indexed for MEDLINE]



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Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity.

Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity.

Neurosurgery. 2018 Jan 17;:

Authors: Smith JS, Shaffrey CI, Kim HJ, Passias P, Protopsaltis T, Lafage R, Mundis GM, Klineberg E, Lafage V, Schwab FJ, Scheer JK, Miller E, Kelly M, Hamilton DK, Gupta M, Deviren V, Hostin R, Albert T, Riew KD, Hart R, Burton D, Bess S, Ames CP

Abstract
BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates.
OBJECTIVE: To assess all-cause mortality following ACSD surgery.
METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed.
RESULTS: Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006).
CONCLUSION: All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.

PMID: 29351637 [PubMed - as supplied by publisher]



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Impact of HIV Infection on Alpha-1 Antitrypsin in the Lung.

Impact of HIV Infection on Alpha-1 Antitrypsin in the Lung.

Am J Physiol Lung Cell Mol Physiol. 2017 Dec 14;:

Authors: Stephenson SE, Wilson CL, Crothers K, Attia EF, Wongtrakool C, Petrache I, Schnapp LM

Abstract
BACKGROUND: Emphysema is one of the most common lung diseases in HIV+ individuals. The pathogenesis of HIV-associated emphysema remains unclear; however, radiographic distribution and earlier age of presentation of emphysema in the lungs of HIV+ patients are similar to deficiency of alpha-1 antitrypsin (A1AT), a key elastase inhibitor in the lung. Reduced levels of circulating A1AT have been detected in HIV+ patients, suggesting a potential mechanism for emphysema development. In the present study, we asked if A1AT levels and activity in the bronchoalveolar lavage fluid (BALF) differ in patients with and without HIV and emphysema.
METHODS: A1AT levels were measured by ELISA in plasma and BALF from a cohort of 21 HIV+ and 29 HIV- patients with or without emphysematous changes on chest CT scan. To analyze A1AT function, we measured elastase activity in the BALF and assessed oxidation and polymerization of A1AT by western blotting.
RESULTS: Total A1AT was increased in the BALF but not in the plasma of HIV+ compared to HIV- patients, regardless of the presence or absence of emphysema. However, there was decreased anti-elastase activity in BALF from HIV+ patients, suggesting impaired A1AT function. Higher levels of the oxidized form of A1AT were detected in HIV+ BALF as compared to HIV-, which may account for the decreased anti-elastase activity.
CONCLUSION: These findings suggest that in the lungs of HIV+ patients, posttranslational modifications of A1AT produce a "functional deficiency" of this critical elastase inhibitor, which may contribute to emphysema development.

PMID: 29351445 [PubMed - as supplied by publisher]



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The Effect of Melatonin Upon Postacute Withdrawal Among Males in a Residential Treatment Program (M-PAWS): A Randomized, Double-blind, Placebo-controlled Trial.

The Effect of Melatonin Upon Postacute Withdrawal Among Males in a Residential Treatment Program (M-PAWS): A Randomized, Double-blind, Placebo-controlled Trial.

J Addict Med. 2018 Jan 18;:

Authors: Bondi CD, Kamal KM, Johnson DA, Witt-Enderby PA, Giannetti VJ

Abstract
OBJECTIVE: Assess the effect of melatonin (5 mg) compared with placebo as an adjuvant treatment along with current behavioral and pharmacotherapy for 28 days on weekly self-reported severity of anxiety, depression, stress, and sleep complaints, and also how sleep is affecting daily life in males 18 years of age and older in recovery from substance use at a residential program in south-western Pennsylvania.
BACKGROUND: Individuals in recovery experience a variety of symptoms including, but are not limited to, anxiety, depression, sleep difficulties, and stress. In the U.S., melatonin is a readily available nutraceutical that is used to alleviate sleep difficulties. Studies also suggest that melatonin may also have anxiolytic and antidepressive actions alone, as well as in those with co-morbid insomnia. Observation of clinicians treating individuals during and/or post drug cessation indicated that melatonin is commonly provided specifically to alleviate sleep difficulties with little evidence regarding efficacy in this population. The paucity of evidence as well as observation of clinical practices provided the rationale for this randomized clinical trial.
METHODS: A single-center, randomized, double-blind, placebo-controlled, parallel-group trial was conducted. Seventy individuals were enrolled, block-randomized with an allocation ratio of 1:1. Intention-to-treat analysis was performed for all primary outcome measures. Primary outcome measures were assessed with the Generalized Anxiety Disorder Scale (GAD-7), Personal Health Questionnaire Depression Scale (PHQ-8), Perceived Stress Scale (PSS-14), and Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-1). Secondary outcome measures were to acquire participant characteristics, determine adherence, and document adverse events.
RESULTS: No statistically significant between-group differences were detected for baseline characteristics. Even though the proportion of individuals reporting an adverse event between groups was not significantly different, the frequency of reported adverse events was greater in the melatonin group. Intention-to-treat analysis for all the measured outcomes revealed no statistically significant between-group differences for same day comparisons.
CONCLUSIONS: The diversity of medication regimens, and also the services provided by the residential treatment site add to the complexity of assessing the efficacy of melatonin on the measured outcomes. Given these limitations, there exists insufficient evidence to suggest that the effect of melatonin and placebo on the outcomes were significantly different.

PMID: 29351138 [PubMed - as supplied by publisher]



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Circadian Rhythms Disturbances in Alzheimer Disease: Current Concepts, Diagnosis, and Management.

Circadian Rhythms Disturbances in Alzheimer Disease: Current Concepts, Diagnosis, and Management.

Alzheimer Dis Assoc Disord. 2018 Jan 18;:

Authors: Milán-Tomás Á, Shapiro CM

Abstract
The purpose of this review is to provide an overview of the research regarding circadian rhythms in Alzheimer disease (AD). Furthermore, this paper explores the role of melatonin in the pathogenesis of AD and the limitation of trials addressing circadian rhythms disturbances in the AD population. A literature search using Medline with PubMed and Embase was carried out identifying papers focusing on circadian rhythms in AD. Sleep disorders and especially circadian rhythm disturbances are very common in the elderly population but definitely more pronounced in patients with AD. The lack of trials evaluating the management of circadian rhythms disorders in the elderly population and especially in AD should be considered of the utmost importance. Although there is a better understanding about the pathophysiology of AD and its relationship with circadian disorders, further studies in human models need to be conducted.

PMID: 29351091 [PubMed - as supplied by publisher]



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Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate.

Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate.

Cleft Palate Craniofac J. 2018 Feb;55(2):287-291

Authors: Sobral DS, Faller GJ, Collares MVM

Abstract
Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

PMID: 29351040 [PubMed - in process]



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Age Effects on Cerebral Oxygenation and Behavior in Children with Sleep Disordered Breathing.

Age Effects on Cerebral Oxygenation and Behavior in Children with Sleep Disordered Breathing.

Am J Respir Crit Care Med. 2018 Jan 19;:

Authors: Tamanyan K, Walter LM, Weichard A, Davey MJ, Nixon GM, Biggs SN, Horne RS

Abstract
RATIONALE: Childhood sleep disordered breathing ranges in severity from primary snoring to obstructive sleep apnea and is associated with behavioral and neurocognitive deficits. It remains unknown why children with primary snoring, who do not experience peripheral oxygen desaturation or sleep fragmentation, experience similar daytime deficits as those with obstructive sleep apnea or why effects are age dependent.
OBJECTIVE: To examine cerebral tissue oxygenation and oxygen extraction as an explanation for daytime deficits in children with primary snoring.
METHODS: Children referred for suspected sleep disordered breathing and non-snoring controls underwent overnight polysomnography with Near Infrared Spectroscopy. Children were categorized into 3-6y (N=87) and 7-12y (N=72) groups, and according to the obstructive apnea hypopnea index into primary snoring (≤1 event/h), mild (>1-5 events/h) and moderate/severe obstructive sleep apnea (>5 events/h). Cognitive and behavioral performance were assessed.
MEASUREMENTS AND MAIN RESULTS: In 3-6y, there were no differences in cerebral oxygenation or oxygen extraction between severity groups. In 7-12y, cerebral oxygenation was significantly lower in controls versus primary snoring during Wake, N1 and REM. Oxygen extraction was significantly higher in controls versus primary snoring during N1 sleep, with no differences between primary snoring and obstructive sleep apnea groups. Cerebral oxygenation was not associated with cognitive performance in either age group or behavior in the 3-6y; however it was associated with behavior in the school-aged children.
CONCLUSIONS: Children with sleep disordered breathing are able to maintain cerebral oxygenation and the small changes observed are not related to cognitive deficits. However, in older children these differences were related to behavioral measures.

PMID: 29351000 [PubMed - as supplied by publisher]



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Reliability and Validity of the Atopic Dermatitis Symptom Score.

Reliability and Validity of the Atopic Dermatitis Symptom Score.

Pediatr Allergy Immunol. 2018 Jan 19;:

Authors: Lee JY, Kim M, Yang HK, Kim HM, Cho J, Kim YM, Lim IS, Cheong HK, Kim HS, Sohn I, Kim J, Ahn K

Abstract
BACKGROUND: We have developed the Atopic Dermatitis Symptom Score (ADSS) by which patients or parents can easily assess and record AD symptoms on a daily basis in a smartphone application. The aim of the present study was to evaluate the reliability and validity of the ADSS.
METHODS: We enrolled 307 children and adolescents with AD. Parents or caregivers were asked to record daily symptoms of the patients (itching, sleep disturbance, erythema, dryness, oozing, and oedema) using a scale of 0 to 4. Statistical analyses consisted of the test-retest reliability, concurrent validity, minimal clinically important difference (MCID), responsiveness, floor or ceiling effects, and screening accuracy. Receiver-operating characteristic analyses were conducted to evaluate the ADSS cut-off point for predicting severe AD (SCORing AD [SCORAD] ≥40).
RESULTS: Test-retest reliability between daytime and nighttime ADSS was good (intraclass correlation coefficient, 0.82 [95% CI: 0.70-0.90]). An increase in ADSS was significantly associated with an increase in SCORAD (r = 0.64, P < 0.0001) (concurrent validity). The MCID was 4.1 points for the ADSS. There was a significant association between changes in ADSS and SCORAD (r = 0.56, P < 0.0001), indicating good responsiveness. At the optimal ADSS cut-off value of 7.0, sensitivity, specificity, and positive and negative predictive values were 88.4%, 78.6%, 21.1%, and 99.1%, respectively (screening accuracy).
CONCLUSIONS: The ADSS can be a useful tool for self-assessment of skin symptoms in children with AD. This article is protected by copyright. All rights reserved.

PMID: 29350788 [PubMed - as supplied by publisher]



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Randomized trial of transcranial DC stimulation for post-stroke dysphagia.

Randomized trial of transcranial DC stimulation for post-stroke dysphagia.

Ann Neurol. 2018 Jan 19;:

Authors: Suntrup-Krueger S, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U, Claus I, Warnecke T, Teismann I, Pantev C, Dziewas R

Abstract
OBJECTIVE: We evaluated whether transcranial direct current stimulation (tDCS) is able to enhance dysphagia rehabilitation following stroke. Besides relating clinical effects with neuroplastic changes in cortical swallowing processing we aimed to identify factors influencing treatment success.
METHODS: In this double-blind, randomized study 60 acute dysphagic stroke patients received contralesional anodal (1 mA, 20 min) or sham tDCS on four consecutive days. Swallowing function was thoroughly assessed before and after the intervention using the validated Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and clinical assessment. In 10 patients, swallowing-related brain activation was recorded applying magnetoencephalography (MEG) before and after the intervention. Voxel-based statistical lesion pattern analysis was also performed.
RESULTS: Study groups did not differ according to demographic data, stroke characteristics, or baseline dysphagia severity. Patients treated with tDCS showed greater improvement in FEDSS than the sham group (1.3 vs 0.4 points, mean difference: 0.9 [95%CI 0.4-1.4], p<0.0005). Functional recovery was accompanied by a significant increase of activation (p<0.05) in the contralesional swallowing network after real but not sham tDCS. Looking for predictors of treatment success every hour of earlier treatment initiation was associated with greater improvement of FEDSS (adjusted OR 0.99 [0.98-1.00], p<0.05) in multivariable analysis. Stroke location in the right insula and operculum was indicative of worse response to tDCS (p<0.05).
INTERPRETATION: Application of tDCS over the contralesional swallowing motor cortex supports swallowing network reorganization, thereby leading to faster rehabilitation of acute post-stroke dysphagia. Early treatment initiation seems beneficial. TDCS may be less effective in right-hemispheric insulo-opercular stroke. This article is protected by copyright. All rights reserved.

PMID: 29350775 [PubMed - as supplied by publisher]



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Sleep-Wake Disturbance: A Systematic Review of Evidence-Based Interventions for Management in Patients With Cancer.

Sleep-Wake Disturbance: A Systematic Review of Evidence-Based Interventions for Management in Patients With Cancer.

Clin J Oncol Nurs. 2018 Feb 01;22(1):37-52

Authors: Matthews E, Carter P, Page M, Dean G, Berger A

Abstract
BACKGROUND: New or worsening sleep-wake disturbance (SWD) can occur throughout the cancer trajectory.
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OBJECTIVES: The purpose of this article is to critically review available empirical evidence supporting the efficacy of interventions for SWD, highlighting new evidence since the 2006 and 2009 Putting Evidence Into Practice (PEP) SWD publications.
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METHODS: A systematic review of studies published from 2009-2017 was conducted to identify effective interventions for cancer-related SWD. The PEP weight of evidence classification schema was used to categorize the strength of evidence.
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FINDINGS: Cognitive behavioral intervention/approach is the only intervention that is recommended for practice. Mindfulness-based stress reduction and exercise interventions are likely to be effective but require more evidence. Pharmacologic interventions, relaxation, imagery, meditation, acupuncture, yoga, massage, and psychoeducation have insufficient evidence.

PMID: 29350708 [PubMed - in process]



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Symptom Burden and Self-Advocacy: Exploring the Relationship Among Female Cancer Survivors
.

Symptom Burden and Self-Advocacy: Exploring the Relationship Among Female Cancer Survivors
.

Clin J Oncol Nurs. 2018 Feb 01;22(1):E23-E30

Authors: Hagan TL, Gilbertson-White S, Cohen SM, Temel JS, Greer JA, Donovan HS

Abstract
BACKGROUND: Although patient self-advocacy is a critical component of patient-centered care, the association between symptom burden and self-
advocacy has received little attention. 
.
OBJECTIVES: This analysis evaluates the degree to which self-advocacy is associated with symptom burden among women with a history of cancer. 
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METHODS: Participants completed online or paper questionnaires. Descriptive statistics and ordinary least squares regression models were used to analyze the association between the three dimensions of self-advocacy and two dimensions of symptom burden.
FINDINGS: Participants reported moderate levels of symptom burden. Fatigue, disturbed sleep, and memory problems were most common. Informed decision making was positively associated with symptom burden and participants' burden across the three most severe symptoms. Effective communication was negatively associated with total symptom burden and the degree to which symptoms interfered with daily life.

PMID: 29350706 [PubMed - in process]



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Radiofrequency ablation of osteoid osteoma.

Radiofrequency ablation of osteoid osteoma.

Acta Biomed. 2018 Jan 19;89(1-S):175-185

Authors: De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E, Piccolo C, Capasso R, Sica A, Cioce F, Carbone M, Bruno F, Masciocchi C, Miele V

Abstract
Osteoid osteoma is a benign bone neoplasm with a reported incidence of 2-3% among all bone primary tumors. Although it is a small and benign lesion, it is often cause of patient complaint and discomfort. It is generally characterized by a long lasting, unremitting pain that typically exacerbates at night, often leading to sleep deprivation and functional limitation of the skeletal segment involved, with a significant reduction of patient daily life activities and consequent worsening of the overall quality of life. Over decades, complete surgical resection has represented the only curative treatment for symptomatic patients. In the last years, new percutaneous ablation techniques, especially radiofrequency ablation, have been reported to be a safe and effective alternative to classical surgery, with a low complication and recurrence rate, and a significant reduction in hospitalization cost and duration. The aim of this article is to provide an overview about the radiofrequency thermal ablation procedure in the treatment of osteoid osteoma.

PMID: 29350646 [PubMed - in process]



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Sleep disruption in caregivers of pediatric stem cell recipients.

Sleep disruption in caregivers of pediatric stem cell recipients.

Pediatr Blood Cancer. 2018 Jan 19;:

Authors: Coleman K, Flesch L, Petiniot L, Pate A, Lin L, Crosby L, Beebe DW, Nelson A, Alonso PB, Davies SM, Baker RB, Dandoy CE

Abstract
Parents/caregivers of hospitalized patients are at risk of sleep disruption. We performed a cross-sectional quantitative and qualitative evaluation of sleep in parents/caregivers of children undergoing hematopoietic stem cell transplant (HSCT; n = 17). Additionally, we explored the frequency of room entries for hospitalized patients undergoing HSCT (n = 189 nights). Twelve caregivers (71%) demonstrated significant sleep disturbance, 12 (71%) described sleep quality as poor, 15 (88%) averaged < 6 hours of sleep per night, 14 (82%) awakened at least four times per night. Patient rooms were entered a median of 12 times per night (interquartile range 10-15). Intervention studies to improve caregiver sleep during hospitalization are needed.

PMID: 29350494 [PubMed - as supplied by publisher]



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Three-generation family with novel contiguous gene deletion on chromosome 2p22 associated with thoracic aortic aneurysm syndrome.

Three-generation family with novel contiguous gene deletion on chromosome 2p22 associated with thoracic aortic aneurysm syndrome.

Am J Med Genet A. 2018 Jan 19;:

Authors: Quiñones-Pérez B, VanNoy GE, Towne MC, Shen Y, Singh MN, Agrawal PB, Smith SE

Abstract
Latent transforming growth factor binding proteins (LTBP) are a family of extracellular matrix glycoproteins that play an important role in the regulation of transforming growth factor beta (TGF-ß) activation. Dysregulation of the TGF-ß pathway has been implicated in the pathogenesis of inherited disorders predisposing to thoracic aortic aneurysms syndromes (TAAS) including Marfan syndrome (MFS; FBN1) and Loeys-Dietz syndrome (LDS; TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD2, SMAD3). While these syndromes have distinct clinical criteria, they share clinical features including aortic root dilation and musculoskeletal findings. LTBP1 is a component of the TGF-ß pathway that binds to fibrillin-1 in the extracellular matrix rendering TGF-ß inactive. We describe a three-generation family case series with a heterozygous ∼5.1 Mb novel contiguous gene deletion of chromosome 2p22.3-p22.2 involving 11 genes, including LTBP1. The deletion has been identified in the proband, father and grandfather, who all have a phenotype consistent with a TAAS. Findings include thoracic aortic dilation, ptosis, malar hypoplasia, high arched palate, retrognathia, pes planus, hindfoot deformity, obstructive sleep apnea, and low truncal tone during childhood with joint laxity that progressed to reduced joint mobility over time. While the three affected individuals did not meet criteria for either MFS or LDS, they shared features of both. Although the deletion includes 11 genes, given the relationship between LTBP1, TGF-ß, and fibrillin-1, LTBP1 stands out as one of the possible candidate genes for the clinical syndrome observed in this family. More studies are necessary to evaluate the potential role of LTBP1 in the pathophysiology of TAAS.

PMID: 29350460 [PubMed - as supplied by publisher]



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Is nighttime laparoscopic general surgery under general anesthesia safe?

Is nighttime laparoscopic general surgery under general anesthesia safe?

Ulus Travma Acil Cerrahi Derg. 2018 Jan;24(1):20-24

Authors: Koltka AK, İlhan M, Ali A, Gök AFK, Sivrikoz N, Yanar TH, Günay MK, Ertekin C

Abstract
BACKGROUND: Fatigue and sleep deprivation can affect rational decision-making and motor skills, which can decrease medical performance and quality of patient care. The aim of the present study was to investigate the association between times of the day when laparoscopic general surgery under general anesthesia was performed and their adverse outcomes.
METHODS: All laparoscopic cholecystectomies and appendectomies performed at the emergency surgery department of a tertiary university hospital from 01. 01. 2016 to 12. 31. 2016 were included. Operation times were divided into three groups: 08.01-17.00 (G1: daytime), 17.01-23.00 (G2: early after-hours), and 23.01-08.00 (G3: nighttime). The files of the included patients were evaluated for intraoperative and postoperative surgery and anesthesia-related complications.
RESULTS: We used multiple regression analyses of variance with the occurrence of intraoperative complications as a dependent variable and comorbidities, age, gender, body mass index (BMI), ASA score, and operation time group as independent variables. This revealed that nighttime operation (p<0.001; OR, 6.7; CI, 2.6-16.9) and older age (p=0.004; OR, 1.04; CI, 1.01-1.08) were the risk factor for intraoperative complications. The same analysis was performed for determining a risk factor for postoperative complications, and none of the dependent variables were found to be associated with the occurrence of postoperative complications.
CONCLUSION: Nighttime surgery and older patient age increased the risk of intraoperative complications without serious morbidity or mortality, but no association was observed between the independent variables and the occurrence of postoperative complications.

PMID: 29350363 [PubMed - in process]



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Convection-enhanced delivery of cetuximab conjugated iron-oxide nanoparticles for treatment of spontaneous canine intracranial gliomas.

Convection-enhanced delivery of cetuximab conjugated iron-oxide nanoparticles for treatment of spontaneous canine intracranial gliomas.

J Neurooncol. 2018 Jan 19;:

Authors: Freeman AC, Platt SR, Holmes S, Kent M, Robinson K, Howerth E, Eagleson J, Bouras A, Kaluzova M, Hadjipanayis CG

Abstract
Cetuximab conjugated iron-oxide nanoparticles (cetuximab-IONPs) have shown both in-vitro and in-vivo anti-tumor efficacy against gliomas. The purpose of this pilot study was to evaluate the safety and potential efficacy of cetuximab-IONPs for treatment of spontaneously occurring intracranial gliomas in canines after convection-enhanced delivery (CED). The use of CED allowed for direct infusion of the cetuximab-IONPs both intratumorally and peritumorally avoiding the blood brain barrier (BBB) and limiting systemic effects. A total of eight dogs participated in the study and only two developed mild post-operative complications, which resolved with medical therapy. All canines underwent a single CED treatment of the cetuximab-IONPs over 3 days and did not receive any further adjuvant treatments. Volumetric analysis showed a median reduction in tumor size of 54.9% by MRI at 1-month (4-6 weeks) follow-up. Five dogs were euthanized due to recurrence of neurological signs other than seizures, two due to recurrent seizures, and one dog died in his sleep. Median survival time after surgery was 248 days (mean 367 days).

PMID: 29350351 [PubMed - as supplied by publisher]



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Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood.

Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood.

Clin Rheumatol. 2018 Jan 19;:

Authors: Wadeley A, Clarke E, Leverment S, Sengupta R

Abstract
The study aims were to assess the prevalence of good or poor sleep in a cohort of axial spondyloarthritis patients and to investigate its correlation with a range of objectively and subjectively measured variables in order to develop a model for distinguishing good from poor sleepers. Five hundred ninety-eight patients with ankylosing spondylitis and 61 with non-radiographic axial spondyloarthritis completed the Jenkins Sleep Evaluation Questionnaire. Measures of disease activity, mobility, function, mood, fatigue, quality of life, work productivity, night-time pain and general health were gathered. Patients with ankylosing spondylitis or non-radiographic axial spondyloarthritis were initially compared. With the exception of waking up tired less often and having lower mobility and functioning, the two groups were similar so were combined for subsequent analysis. Twenty-nine percent of all patients were classified as good sleepers and 19% as poor sleepers. Poor sleepers had higher disease activity and fatigue scores and more night-time back pain than good sleepers. They reported poorer quality of life, general health, mood and work-related measures. A model incorporating mood, gender, fatigue and objective and subjective judgements of disease activity correctly classified 87.3% of good and poor sleepers. Poor sleep was strongly associated with poor mood, female gender, greater fatigue, greater disease activity (specifically, spinal pain and stiffness) and better mobility; however, the direction of causality between poor sleep and markers of active disease was undetermined. This study also highlights the need to standardise the measurement of sleep disturbance in axSpA to facilitate comparisons between patient groups and interventions.

PMID: 29350332 [PubMed - as supplied by publisher]



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