Predictors of ARTHROCENTESIS outcome on JOINT effusion in PATIENTS with DISC displacement without REDUCTION

To investigate the preoperative variables of patients with articular disc displacement without reduction (DDWOR) that may influence the results of arthrocentesis on joint effusion (JE).

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Concurrent chemoradiotherapy alone is feasible for esophageal squamous cell carcinoma patients not suitable for surgery

We thank Dr. Adenis A for the interest in our study.

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Consolidation chemotherapy after definite concurrent chemoradiation in patients with non-operable esophageal cancer: Is it useful?

Definitive chemoradiation (CRT) [definitive CRT (dCRT)] is considered as standard of care for esophageal cancer patients not suitable for surgery due to the local extent of disease or as a result of comorbidities [1]. Since the report of the RTOG 85-01 trial [2], four courses of cisplatin (CDDP)/5-fluorouracil (FU) combined with radiation therapy are regarded as standard for dCRT [1]. Oxaliplatin/FU/folinic acid (FOLFOX) can also be delivered as a safe and convenient alternative of CDDP/FU, following the results of the PRODIGE-5 trial [3,4].

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Perilesional edema in brain cancer: Independent prognosticator or epiphenomenon of biomolecular signature?

We read with great interest the paper by Liang entitled "The extent of edema and tumor synchronous invasion into the subventricular zone and corpus callosum classify outcomes and radiotherapy strategies of glioblastomas" [1] that has addressed the importance of perilesional edema (PE) and of the invasion into synchronous subventricular zone and corpus callosum (sSVZCC), as a strong prognostic factor in an homogeneous cohort of glioblastoma patients.

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Gadolinium Accumulation in the Deep Cerebellar Nuclei and Globus Pallidus After Exposure to Linear but Not Macrocyclic Gadolinium-Based Contrast Agents in a Retrospective Pig Study With High Similarity to Clinical Conditions

Objective The aim of this retrospective study was to determine the gadolinium (Gd) concentration in different brain areas in a pig cohort that received repeated administration of Gd-based contrast agents (GBCAs) at standard doses over several years, comparable with a clinical setting. Material and Methods Brain tissue was collected from 13 Göttingen mini pigs that had received repeated intravenous injections of gadopentetate dimeglumine (Gd-DTPA; Magnevist) and/or gadobutrol (Gadovist). The animals have been included in several preclinical imaging studies since 2008 and received cumulative Gd doses ranging from 7 to 129 mmol per animal over an extended period. Two animals with no history of administration of GBCA were included as controls. Brain autopsies were performed not earlier than 8 and not later than 38 months after the last GBCA application. Tissues from multiple brain areas including cerebellar and cerebral deep nuclei, cerebellar and cerebral cortex, and pons were analyzed for Gd using inductively coupled plasma mass spectrometry. Results Of the 13 animals, 8 received up to 48 injections of gadobutrol and Gd-DTPA and 5 received up to 29 injections of gadobutrol only. In animals that had received both Gd-DTPA and gadobutrol, a median (interquartile range) Gd concentration of 1.0 nmol/g tissue (0.44-1.42) was measured in the cerebellar nuclei and 0.53 nmol/g (0.29-0.62) in the globus pallidus. The Gd concentration in these areas in gadobutrol-only animals was 50-fold lower with median concentrations of 0.02 nmol/g (0.01-0.02) for cerebellar nuclei and 0.01 nmol/g (0.01-0.01) for globus pallidus and was comparable with control animals with no GBCA history. Accordingly, in animals that received both GBCAs, the amount of residual Gd correlated with the administered dose of Gd-DTPA (P ≤ 0.002) but not with the total Gd dose, consisting of Gd-DTPA and gadobutrol. The Gd concentration in cortical tissue and in the pons was very low (≤0.07 nmol/g tissue) in all animals analyzed. Conclusion Multiple exposure to macrocyclic gadobutrol is not associated with Gd deposition in brain tissue of healthy pigs. A single additional administration of linear Gd-DTPA is sufficient for Gd accumulation in the nucleus dentatus and globus pallidus, underlining the importance of obtaining a complete GBCA history in clinical studies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication September 29, 2017; and accepted for publication, after revision, November 11, 2017. Conflicts of interest and sources of funding: none declared. Correspondence to: Janina Boyken, PhD, Institute of Physiology, Charité University Medicine, 10115 Berlin, Germany. E-mail: janina.boyken@charite.de. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Gadolinium Accumulation in the Deep Cerebellar Nuclei and Globus Pallidus After Exposure to Linear but Not Macrocyclic Gadolinium-Based Contrast Agents in a Retrospective Pig Study With High Similarity to Clinical Conditions

Objective The aim of this retrospective study was to determine the gadolinium (Gd) concentration in different brain areas in a pig cohort that received repeated administration of Gd-based contrast agents (GBCAs) at standard doses over several years, comparable with a clinical setting. Material and Methods Brain tissue was collected from 13 Göttingen mini pigs that had received repeated intravenous injections of gadopentetate dimeglumine (Gd-DTPA; Magnevist) and/or gadobutrol (Gadovist). The animals have been included in several preclinical imaging studies since 2008 and received cumulative Gd doses ranging from 7 to 129 mmol per animal over an extended period. Two animals with no history of administration of GBCA were included as controls. Brain autopsies were performed not earlier than 8 and not later than 38 months after the last GBCA application. Tissues from multiple brain areas including cerebellar and cerebral deep nuclei, cerebellar and cerebral cortex, and pons were analyzed for Gd using inductively coupled plasma mass spectrometry. Results Of the 13 animals, 8 received up to 48 injections of gadobutrol and Gd-DTPA and 5 received up to 29 injections of gadobutrol only. In animals that had received both Gd-DTPA and gadobutrol, a median (interquartile range) Gd concentration of 1.0 nmol/g tissue (0.44-1.42) was measured in the cerebellar nuclei and 0.53 nmol/g (0.29-0.62) in the globus pallidus. The Gd concentration in these areas in gadobutrol-only animals was 50-fold lower with median concentrations of 0.02 nmol/g (0.01-0.02) for cerebellar nuclei and 0.01 nmol/g (0.01-0.01) for globus pallidus and was comparable with control animals with no GBCA history. Accordingly, in animals that received both GBCAs, the amount of residual Gd correlated with the administered dose of Gd-DTPA (P ≤ 0.002) but not with the total Gd dose, consisting of Gd-DTPA and gadobutrol. The Gd concentration in cortical tissue and in the pons was very low (≤0.07 nmol/g tissue) in all animals analyzed. Conclusion Multiple exposure to macrocyclic gadobutrol is not associated with Gd deposition in brain tissue of healthy pigs. A single additional administration of linear Gd-DTPA is sufficient for Gd accumulation in the nucleus dentatus and globus pallidus, underlining the importance of obtaining a complete GBCA history in clinical studies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication September 29, 2017; and accepted for publication, after revision, November 11, 2017. Conflicts of interest and sources of funding: none declared. Correspondence to: Janina Boyken, PhD, Institute of Physiology, Charité University Medicine, 10115 Berlin, Germany. E-mail: janina.boyken@charite.de. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Going from evidence to recommendations: Can GRADE get us there?

Going from evidence to recommendations: Can GRADE get us there?

J Eval Clin Pract. 2018 Jan 05;:

Authors: Mercuri M, Baigrie B, Upshur REG

Abstract
The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a number of professional medical societies and organizations as a means for orienting the development of clinical guidelines. As a result, the method of GRADE has implications on how health care is delivered and patient outcomes. In this paper, we reveal several issues with the underlying logic of GRADE that warrant further discussion. First, the definitions of the "grades of evidence" provided by GRADE, while explicit, are functionally vague. Second, the "criteria for assigning grade of evidence" is seemingly arbitrary and arguably logically incoherent. Finally, the GRADE method is unclear on how to integrate evidence grades with other important factors, such as patient preferences, and trade-offs between costs, benefits, and harms when proposing a clinical practice recommendation. Much of the GRADE method requires judgement on the part of the user, making it unclear as to how the framework reduces bias in recommendations or makes them more transparent-both goals of the programme. It is our view that the issues presented in this paper undermine GRADE's justificatory scheme, thereby limiting the usefulness of GRADE as a tool for developing clinical recommendations.

PMID: 29314554 [PubMed - as supplied by publisher]

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Historical Origins of the Tuskegee Experiment: The Dilemma of Public Health in the United States.

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Historical Origins of the Tuskegee Experiment: The Dilemma of Public Health in the United States.

Uisahak. 2017 Dec;26(3):545-578

Authors: Park J

Abstract
The Tuskegee Study of Untreated Syphilis in the Negro Male was an observational study on African-American males in Tuskegee, Alabama between 1932 and 1972. The U. S. Public Health Service ran this study on more than 300 people without notifying the participants about their disease nor treating them even after the introduction of penicillin. The study included recording the progress of disease and performing an autopsy on the deaths. This paper explores historical backgrounds enabled this infamous study, and discusses three driving forces behind the Tuskegee Study. First, it is important to understand that the Public Health Service was established in the U. S. Surgeon General's office and was operated as a military organization. Amidst the development of an imperial agenda of the U.S. in the late 19th and early 20th centuries, the PHS was responsible for protecting hygiene and the superiority of "the American race" against infectious foreign elements from the borders. The U.S. Army's experience of medical experiments in colonies and abroad was imported back to the country and formed a crucial part of the attitude and philosophy on public health. Secondly, the growing influence of eugenics and racial pathology at the time reinforced discriminative views on minorities. Progressivism was realized in the form of domestic reform and imperial pursuit at the same time. Major medical journals argued that blacks were inclined to have certain defects, especially sexually transmitted diseases like syphilis, because of their prodigal behavior and lack of hygiene. This kind of racial ideas were shared by the PHS officials who were in charge of the Tuskegee Study. Lastly, the PHS officials believed in continuing the experiment regardless of various social changes. They considered that black participants were not only poor but also ignorant of and even unwilling to undergo the treatment. When the exposure of the experiment led to the Senate investigation in 1973, the participating doctors of the PHS maintained that their study offered valuable contribution to the medical research. This paper argues that the combination of the efficiency of military medicine, progressive and imperial racial ideology, and discrimination on African-Americans resulted in the Tuskegee Syphilis Experiment.

PMID: 29311536 [PubMed - in process]

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Diagnosis and management of children with primary ciliary dyskinesia.

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Diagnosis and management of children with primary ciliary dyskinesia.

Nurs Child Young People. 2017 Sep 11;29(7):38-47

Authors: Harris A

Abstract
Primary ciliary dyskinesia (PCD) is a rare, genetic disorder of the motile cilia characterised by chronic lung disease, nasal and sinus disease, chronic ear infections with glue ear leading to possible hearing impairment, and subfertility. Half of patients have organ laterality defects. Despite symptoms being present from birth, PCD remains underdiagnosed. Early diagnosis and symptom management may reduce morbidity, improve quality of life and ensure children are adequately supported to meet their full potential. This article seeks to raise awareness of PCD in children's nurses who are well placed to identify children for referral to the national PCD diagnostic service. It examines the clinical characteristics of the disease along with the complexities and limitations of diagnostic testing. In addition, it explores the management of children with PCD within the national PCD management service for children.

PMID: 29115761 [PubMed - indexed for MEDLINE]

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Evaluation of Hypocaloric Diet With Protein Supplementation in Middle-Aged Sarcopenic Obese Women: A Pilot Study.

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Evaluation of Hypocaloric Diet With Protein Supplementation in Middle-Aged Sarcopenic Obese Women: A Pilot Study.

Obes Facts. 2017;10(3):160-167

Authors: Sammarco R, Marra M, Di Guglielmo ML, Naccarato M, Contaldo F, Poggiogalle E, Donini LM, Pasanisi F

Abstract
OBJECTIVE: The aim of this study was to evaluate the efficacy of a nutritional program, which is characterized by a different modulation of proteins, in adult patients with sarcopenic obesity.
METHODS: We studied 18 obese women aged 41-74 years. Obesity was diagnosed as fat mass > 34.8% and sarcopenia was defined when lean body mass was <90% of the subject's ideal fat free mass. All subjects were randomly assigned to different nutritional interventions: Hypocaloric diet plus placebo (A) and hypocaloric high-protein diet (1.2-1.4 g / kg body weight reference / day) (B). Anthropometric measurements, body composition, resting energy expenditure, handgrip test, Short Physical Performance Battery (SPPB), and SF-36 questionnaire were evaluated at baseline and after 4 months.
RESULTS: Weight significantly decreased in both groups. Women with high-protein diet preserved lean body mass compared to low-calorie diet and improved significantly muscle strength; SPPB score did not change in both groups. SF-36 test showed a significant change for general health after 4 months in group B.
CONCLUSIONS: In our study, sarcopenic obese patients with high-protein diet showed an improvement in muscle strength. Furthermore, dietary protein enrichment may represent a protection from the risk of sarcopenia following a hypocaloric diet.

PMID: 28528340 [PubMed - indexed for MEDLINE]

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The humanistic and economic burden of Dravet syndrome on caregivers and families: Implications for future research.

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The humanistic and economic burden of Dravet syndrome on caregivers and families: Implications for future research.

Epilepsy Behav. 2017 May;70(Pt A):104-109

Authors: Jensen MP, Brunklaus A, Dorris L, Zuberi SM, Knupp KG, Galer BS, Gammaitoni AR

Abstract
We reviewed the current literature with respect to the humanistic and financial burdens of Dravet Syndrome (DS) on the caregivers of children with DS, in order to (1) identify key unanswered questions or gaps in knowledge that need to be addressed and then, based on these knowledge gaps, (2) propose a research agenda for the scientific community to address in the coming decade. The findings support the conclusion that caring for a child with DS is associated with significant humanistic burden and direct costs. However, due in part to the paucity of studies, as well as the lack of measures of specific burden domains, there remains much that is not known regarding the burden of caregiving for children with DS. To address the significant knowledge gaps in this area, research is needed that will: (1) identify the specific domains of caregivers' lives that are impacted by caring for a child with DS; (2) identify or, if needed, develop measures of caregiving impact in this area; (3) identify the factors that influence DS caregiving burden; (4) develop and evaluate the efficacy of treatments for reducing the negative impact of DS and its comorbidities on DS caregivers; (5) quantify the direct medical costs associated with DS and DS comorbidities and identify the factors that influence these costs; and (6) quantify and fully explore the indirect costs of DS. Research that addresses these goals will provide the empirical foundation needed for improving the quality of life of children with DS and their families.

PMID: 28431364 [PubMed - indexed for MEDLINE]

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Localized shape abnormalities in the thalamus and pallidum are associated with secondarily generalized seizures in mesial temporal lobe epilepsy.

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Localized shape abnormalities in the thalamus and pallidum are associated with secondarily generalized seizures in mesial temporal lobe epilepsy.

Epilepsy Behav. 2017 May;70(Pt A):259-264

Authors: Yang L, Li H, Zhu L, Yu X, Jin B, Chen C, Wang S, Ding M, Zhang M, Chen Z, Wang S

Abstract
Mesial temporal lobe epilepsy (mTLE) is a common type of drug-resistant epilepsy and secondarily generalized tonic-clonic seizures (sGTCS) have devastating consequences for patients' safety and quality of life. To probe the mechanism underlying the genesis of sGTCS, we investigated the structural differences between patients with and without sGTCS in a cohort of mTLE with radiologically defined unilateral hippocampal sclerosis. We performed voxel-based morphometric analysis of cortex and vertex-wise shape analysis of subcortical structures (the basal ganglia and thalamus) on MRI of 39 patients (21 with and 18 without sGTCS). Comparisons were initially made between sGTCS and non-sGTCS groups, and subsequently made between uncontrolled-sGTCS and controlled-sGTCS subgroups. Regional atrophy of the ipsilateral ventral pallidum (cluster size=450 voxels, corrected p=0.047, Max voxel coordinate=107, 120, 65), medial thalamus (cluster size=1128 voxels, corrected p=0.049, Max voxel coordinate=107, 93, 67), middle frontal gyrus (cluster size=60 voxels, corrected p<0.05, Max voxel coordinate=-30, 49.5, 6), and contralateral posterior cingulate cortex (cluster size=130 voxels, corrected p<0.05, Max voxel coordinate=16.5, -57, 27) was found in the sGTCS group relative to the non-sGTCS group. Furthermore, the uncontrolled-sGTCS subgroup showed more pronounced atrophy of the ipsilateral medial thalamus (cluster size=1240 voxels, corrected p=0.014, Max voxel coordinate=107, 93, 67) than the controlled-sGTCS subgroup. These findings indicate a central role of thalamus and pallidum in the pathophysiology of sGTCS in mTLE.

PMID: 28427841 [PubMed - indexed for MEDLINE]

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Funding sources and financial disclosures, and their relationship to study outcomes and level of evidence in the Journal of Shoulder and Elbow Surgery.

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Funding sources and financial disclosures, and their relationship to study outcomes and level of evidence in the Journal of Shoulder and Elbow Surgery.

J Shoulder Elbow Surg. 2017 Jun;26(6):e193-e197

Authors: Foughty Z, Antalis MS, Ringenberg J, Hall AD

Abstract
HYPOTHESIS/BACKGROUND: Concern exists regarding the reliability of published manuscripts due to influence of industry funding and author financial conflicts of interest (COI). We aim to determine whether COI affect the outcome of a research study or the level of evidence (LOE).
METHODS: We reviewed 244 consecutive original articles in Journal of Shoulder and Elbow Surgery from January 2014 to December 2014. Articles included only those available in the printed journal. For LOE, 178 articles from the Shoulder and Elbow section were used (basic science articles were excluded). COI was determined by comparing financial disclosures and stated funding sources to the study content.
RESULTS: COI were present in 44 of 244 articles (18%); of these, 24 (55%) had positive outcomes. Of the 200 without COI, 128 (64%) had positive outcomes. This difference in proportions was determined to be significant (P = .007). COI were present in 27 shoulder and elbow articles; of these, only 1 was LOE I or II (4%). Of the 151 without COI, 34 (23%) were LOE I or II. This difference in proportions was determined to be significant (P = .023).
CONCLUSION: We found that Journal of Shoulder and Elbow Surgery articles with COI are neither more likely to have positive outcomes nor higher LOE than those with no COI. Although the χ2 analysis found a statistically significant relationship between COI and study outcomes, the study outcomes were more often positive in articles without COI. This is contrary to previously published analyses that found outcomes to be more positive in articles with COI.

PMID: 28395946 [PubMed - indexed for MEDLINE]

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Validation of the facial dysfunction domain of the Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale.

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Validation of the facial dysfunction domain of the Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale.

Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2437-2442

Authors: Lodder WL, Adan GH, Chean CS, Lesser TH, Leong SC

Abstract
The objective of this study is to evaluate the strength of content validity within the facial dysfunction domain of the Penn Acoustic Neuroma Quality-of-Life (PANQOL) Scale and to compare how it correlates with a facial dysfunction-specific QOL instrument (Facial Clinimetric Evaluation, FaCE). The study design is online questionnaire survey. Members of the British Acoustic Neuroma Association received both PANQOL questionnaires and the FaCE scale. 158 respondents with self-identified facial paralysis or dysfunction had completed PANQOL and FaCE data sets for analysis. The mean composite PANQOL score was 53.5 (range 19.2-93.5), whilst the mean total FaCE score was 50.9 (range 10-95). The total scores of the PANQOL and FaCE correlated moderate (r = 0.48). Strong correlation (r = 0.63) was observed between the PANQOL's facial dysfunction domain and the FaCE total score. Of all the FaCE domains, social function was strongly correlated with the PANQOL facial dysfunction domain (r = 0.66), whilst there was very weak-to-moderate correlation (range 0.01-0.43) to the other FaCE domains. The current study has demonstrated a strong correlation between the facial dysfunction domains of PANQOL with a facial paralysis-specific QOL instrument.

PMID: 28391530 [PubMed - indexed for MEDLINE]

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Quality of life independently predicts long-term mortality but not vascular events: the Northern Manhattan Study.

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Quality of life independently predicts long-term mortality but not vascular events: the Northern Manhattan Study.

Qual Life Res. 2017 Aug;26(8):2219-2228

Authors: Liang JW, Cheung YK, Willey JZ, Moon YP, Sacco RL, Elkind MSV, Dhamoon MS

Abstract
PURPOSE: Cardiovascular disease is a major contributor to morbidity and mortality, and prevention relies on accurate identification of those at risk. Studies of the association between quality of life (QOL) and mortality and vascular events incompletely accounted for depression, cognitive status, social support, and functional status, all of which have an impact on vascular outcomes. We hypothesized that baseline QOL is independently associated with long-term mortality in a large, multi-ethnic urban cohort.
METHODS: In the prospective, population-based Northern Manhattan Study, Spitzer QOL index (SQI, range 0-10, with ten signifying the highest QOL) was assessed at baseline. Participants were followed over a median 11 years for stroke, myocardial infarction (MI), and vascular and non-vascular death. Multivariable Cox proportional hazards regression estimated hazard ratio and 95% confidence interval (HR, 95% CI) for each outcome, with SQI as the main predictor, dichotomized at 10, adjusting for baseline demographics, vascular risk factors, history of cancer, social support, cognitive status, depression, and functional status.
RESULTS: Among 3298 participants, mean age was 69.7 + 10.3 years; 1795 (54.5%) had SQI of 10. In fully adjusted models, SQI of 10 (compared to SQI <10) was associated with reduced risk of all-cause mortality (HR 0.80, 95% CI 0.72-0.90), vascular death (0.81, 0.69-0.97), non-vascular death (0.78, 0.67-0.91), and stroke or MI or death (0.82, 0.74-0.91). In fully adjusted competing risk models, there was no association with stroke (0.93, 0.74-1.17), MI (0.98, 0.75-1.28), and stroke or MI (1.03, 0.86-1.24). Results were consistent when SQI was analyzed continuously.
CONCLUSION: In this large population-based cohort, highest QOL was inversely associated with long-term mortality, vascular and non-vascular, independently of baseline primary vascular risk factors, social support, cognition, depression, and functional status. QOL was not associated with non-fatal vascular events.

PMID: 28357682 [PubMed - indexed for MEDLINE]

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Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: a case report.

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Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: a case report.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 07;:

Authors: Aerden T, Grisar K, Nys M, Politis C

Abstract
We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography indicated increased cortical density of the mandibular lower border. Scintigraphy and single-photon emission computed tomography revealed metabolic hyperactivity in that region without pathologic lymph nodes. A bone biopsy specimen of the mandibular lower border did not have inflammation or cytologic atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism as a result of hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared. Increased cortical density is a rare manifestation of secondary hyperparathyroidism, which normally causes the lamina dura to vanish and produces a ground-glass appearance as a result of blurring of the trabecular bone pattern. Because focal hyperostosis can have multiple benign or malignant causes, radiologic examination of the jaw bones is indispensable for evaluating orofacial pain. Increased cortical density may be caused by metabolic diseases, requiring further investigations, including biopsy and blood analysis.

PMID: 29310888 [PubMed - as supplied by publisher]

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PET/CT with 18F Fluorocholine as an Imaging Biomarker for Chronic Liver Disease: A Preliminary Radiopathologic Correspondence Study in Patients with Liver Cancer.

PET/CT with 18F Fluorocholine as an Imaging Biomarker for Chronic Liver Disease: A Preliminary Radiopathologic Correspondence Study in Patients with Liver Cancer.

Radiology. 2018 Jan 09;:171333

Authors: Kwee SA, Wong L, Chan OTM, Kalathil S, Tsai N

Abstract
Purpose To determine the relationship between hepatic uptake at preoperative fluorine 18 (18F) fluorocholine combined positron emission tomography (PET) and computed tomography (CT) and the histopathologic features of chronic liver disease in patients with Child-Pugh class A or B disease who are undergoing hepatic resection for liver cancer. Materials and Methods Forty-eight patients with resectable liver tumors underwent preoperative 18F fluorocholine PET/CT. Mean liver standardized uptake value (SUVmean) measurements were obtained from PET images, while histologic indexes of inflammation and fibrosis were applied to nontumor liver tissue from resection specimens. Effects of histopathologic features on liver SUVmean were examined with analysis of variance. Results Liver SUVmean ranged from 4.3 to 11.6, correlating significantly with Knodell histologic activity index (ρ = -0.81, P < .001) and several clinical indexes of liver disease severity. Liver SUVmean also differed significantly across groups stratified by necroinflammatory severity and Metavir fibrosis stage (P < . 001). The area under the receiver operating characteristic curve for 18F fluorocholine PET/CT detecting Metavir fibrosis stage F1 or higher was 0.89 ± 0.05, with an odds-ratio of 3.03 (95% confidence interval: 1.59, 5.88) and sensitivity and specificity of 82% and 93%, respectively. Conclusion Correlations found in patients undergoing hepatic resection for liver cancer between liver 18F fluorocholine uptake and histopathologic indexes of liver fibrosis and inflammation support the use of 18F fluorocholine PET/CT as a potential imaging biomarker for chronic liver disease. © RSNA, 2018.

PMID: 29315063 [PubMed - as supplied by publisher]

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Invasive Breast Cancer: Prognostic Value of Peritumoral Edema Identified at Preoperative MR Imaging.

Invasive Breast Cancer: Prognostic Value of Peritumoral Edema Identified at Preoperative MR Imaging.

Radiology. 2018 Jan 09;:171157

Authors: Cheon H, Kim HJ, Kim TH, Ryeom HK, Lee J, Kim GC, Yuk JS, Kim WH

Abstract
Purpose To determine the prognostic value of peritumoral edema identified at preoperative breast magnetic resonance (MR) imaging for disease recurrence in patients with invasive breast cancer. Materials and Methods Between January 2011 and December 2012, 353 women (median age, 49 years; range, 27-77 years) with invasive breast cancer who had undergone preoperative MR imaging and mastectomy or breast-conserving surgery were identified. Two radiologists independently reviewed peritumoral edema on the basis of the degree of the signal intensity surrounding the tumor on T2-weighted images. The association of disease recurrence with peritumoral edema and clinical-pathologic features was assessed by using the multivariate Cox proportional hazards model and the integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI) indexes. Results Twenty-four patients (6.8%) had disease recurrence after 27.2 months of median follow-up. At multivariate analysis, higher N stage (hazard ratio = 4.84, P = .002) and the presence of lymphovascular invasion (hazard ratio = 2.48, P = .044) and peritumoral edema (hazard ratio = 2.77, P = .022) were independent factors associated with disease recurrence. IDI and continuous NRI showed significant improvement in the accuracy of the association with disease recurrence when peritumoral edema was added to established clinical-pathologic features (IDI = 0.061, P < .001; continuous NRI = 0.334, P = .012). Conclusion Peritumoral edema identified at preoperative MR imaging is independently associated with disease recurrence. Peritumoral edema assessment may provide better prognostication in patients with invasive breast cancer. © RSNA, 2018.

PMID: 29315062 [PubMed - as supplied by publisher]

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ACR BI-RADS Assessment Category 4 Subdivisions in Diagnostic Mammography: Utilization and Outcomes in the National Mammography Database.

ACR BI-RADS Assessment Category 4 Subdivisions in Diagnostic Mammography: Utilization and Outcomes in the National Mammography Database.

Radiology. 2018 Jan 09;:170770

Authors: Elezaby M, Li G, Bhargavan-Chatfield M, Burnside ES, DeMartini WB

Abstract
Purpose To determine the utilization and positive predictive value (PPV) of the American College of Radiology (ACR) Breast Imaging Data and Reporting System (BI-RADS) category 4 subdivisions in diagnostic mammography in the National Mammography Database (NMD). Materials and Methods This study involved retrospective review of diagnostic mammography data submitted to the NMD from January 1, 2008 to December 30, 2014. Utilization rates of BI-RADS category 4 subdivisions were compared by year, facility (type, location, census region), and examination (indication, finding type) characteristics. PPV3 (positive predictive value for biopsies performed) was calculated overall and according to category 4 subdivision. The χ2 test was used to test for significant associations. Results Of 1 309 950 diagnostic mammograms, 125 447 (9.6%) were category 4, of which 33.3% (41 841 of 125 447) were subdivided. Subdivision utilization rates were higher (P < .001) in practices that were community, suburban, or in the West; for examination indication of prior history of breast cancer; and for the imaging finding of architectural distortion. Of 41 841 category 4 subdivided examinations, 4A constituted 55.6% (23 258 of 41 841) of the examinations; 4B, 31.8% (13 302 of 41 841) of the examinations; and 4C, 12.6% (5281 of 41 841) of the examinations. Pathologic outcomes were available in 91 563 examinations, and overall category 4 PPV3 was 21.1% (19 285 of 91 563). There was a statistically significant difference in PPV3 according to category 4 subdivision (P < .001): The PPV of 4A was 7.6% (1274 of 16 784), that of 4B was 22% (2317 of 10 408), and that of 4C was 69.3% (2839 of 4099). Conclusion Although BI-RADS suggests their use, subdivisions were utilized in the minority (33.3% [41 841 of 125 447]) of category 4 diagnostic mammograms, with variability based on facility and examination characteristics. When subdivisions were used, PPV3s were in BI-RADS-specified malignancy ranges. This analysis supports the use of subdivisions in broad practice and, given benefits for patient care, should motivate increased utilization. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29315061 [PubMed - as supplied by publisher]

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Physico-chemical, hydration, cooking, textural and pasting properties of different adzuki bean ( Vigna angularis ) accessions

Abstract

Physico-chemical, hydration, cooking, textural and pasting properties of thirteen adzuki bean (Vigna angularis) accessions were studied. Protein and ash content ranged from 18.82 to 24.52% and 2.02 to 7.03%, respectively. Bulk density and seed weight of the adzuki seed ranged from 0.76 to 1.00 g/mL and 74.87 to 148.20 g/1000 seeds, respectively. Hydration capacity, swelling capacity and cooking time ranged from 0.05 to 0.12 g/seed, 0.04 to 0.15 mL/seed and 48.67 to 74.33 min, respectively. Different accessions showed significant variations in their physicochemical, cooking, hydration and texture properties. Swelling capacity showed significantly positive correlation with L* value. Hardness of soaked grain varied ranged between 68.67 and 120.25 N and had significant positive correlation with gumminess and chewiness. The springiness and chewiness of cooked seeds showed highly significant positive correlation. Peak viscosity, breakdown viscosity, final viscosity, setback viscosity and pasting temperature of adzuki bean flour ranged from 1979 to 2373 cP, 45 to 183 cP, 2954 to 4004 cP, 931 to 1666 cP and 75.02 to 78.27 °C, respectively. Peak viscosity and breakdown viscosity were negatively correlated to amylose content while setback viscosity showed positive correlation.

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Margaret McCartney: When a crisis is the predictable outcome of poor policy making

When is a crisis not a crisis? The “crisis” may be felt differently in the UK’s four NHSs, but these services are being pushed beyond reasonable capacity. I’ve little doubt that the coping...

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Simon Denegri: Piloting patient involvement

bmj;360/jan10_2/j5782/FAF1faDuncan SmithBiographySimon Denegri, 50, is national director for patients and the public in research at the National Institute for Health Research. He has also chaired an...

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Communitisation of healthcare: peer support groups for chronic disease care in rural India

Historically, health systems evolved to tackle the most prevalent illnesses—primarily acute infections and injuries. The management of chronic diseases requires the sustained motivation of patients...

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Vorleistungspflichten von Pensionskassen

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Trends in Costs of Thyroid Disease Treatment in Denmark during 1995–2015

Background: Iodine fortification (IF) may contribute to changes in costs of thyroid disease treatment through changes in disease patterns. From a health economic perspective, assessment of the development in costs of thyroid disease treatment in the population is pertinent. Objectives: To assess the trends in annual medicine and hospital costs of thyroid disease treatment during 1995–2015 in Denmark, i.e., before and after the introduction of mandatory IF in 2000. Methods: Information on treatments for thyroid disease (antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment) was obtained from nationwide registers. Costs were valued at 2015 prices using sales prices for medicines and the Danish Diagnosis-Related Group (DRG) and Danish Ambulatory Grouping System (DAGS) tariffs of surgeries/radioiodine treatments. Results were adjusted for changes in population size and age and sex distribution. Results: The total direct medicine and hospital costs of thyroid disease treatment increased from EUR ∼190,000 per 100,000 persons in 1995 to EUR ∼270,000 per 100,000 persons in 2015. This was mainly due to linearly increased costs of thyroid hormone therapy and increased costs of thyroid surgery since 2008. Costs of antithyroid medication increased slightly and transiently after IF, while costs of radioiodine treatment remained constant. Costs of thyroid hormone therapy and thyroid surgery did not follow the development in the prevalence of hypothyroidism and structural thyroid diseases observed in concurrent studies. Conclusion: The costs of total direct medicine and hospital costs for thyroid disease treatment in Denmark increased from 1995 to 2015. This is possibly due to several factors, e.g., changes in treatment practices, and the direct effect of IF alone remains to be estimated.
Eur Thyroid J

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Issue Information

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Exented Abstracts from the 10th EFAD Conference

Ann Nutr Metab 2018;72:65–79

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Breast cancer extent and survival among diabetic women in a Finnish nationwide cohort study

Abstract

Breast cancer (BC) and diabetes mellitus (DM) are major health problems. We examined the association between DM and BC stage at diagnosis and subsequent survival in a Finnish cohort of female BC patients. All BC cases (N = 73,170) diagnosed in 1995-2013 with dates and causes of death were identified from the Finnish Cancer Registry. Participation in organized mammography screening was obtained from Mass Inspection Registry. Information on DM diagnoses and background conditions recorded during 1995-2013 were obtained from national Care Register for Health Care and merged to data on medication use from the national Prescription Register. Logistic regression with adjustment for mammography screening and age at BC diagnosis was used to evaluate the risk of advanced stage BC at diagnosis. Cox regression was used to evaluate overall and BC survival. Analyses were adjusted for age, background conditions and mammography screening. Survival analyses were further adjusted for tumor extent, histology and primary treatment. Of the cohort 11,676 (16.0%) had DM. Screening participation did not differ by diabetes. Compared to non-diabetic women, diabetics had more often locally advanced (Odds ratio, OR 1.26; 95% CI 1.18-1.35) or metastatic BC (OR 1.59; 95% CI 1.44-1.75) at diagnosis. During a median follow-up of 5.8 years after BC diagnosis 10,900 (14.9%) women died of BC. Risk of BC death was higher among diabetic compared to non-diabetic women (HR 1.36; 95% CI 1.27-1.46). Risk of BC death increased with duration of DM. This supports DM as a risk factor for fatal BC. This article is protected by copyright. All rights reserved.

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Leukocyte telomere length in relation to risk of lung adenocarcinoma incidence: Findings from the Singapore Chinese Health Study

Abstract

Telomeres are crucial in the maintenance of chromosome integrity and genomic stability. Critically short telomeres can trigger programmed cell death while cells with longer telomeres may have increased likelihood of replicative errors, resulting in genetic mutations and chromosomal alterations, and ultimately promoting oncogenesis. Data on telomere length and lung cancer risk from large prospective cohort studies are spare. Relative telomere length in peripheral blood leukocytes was quantified using a validated monochrome multiplex quantitative polymerase chain reaction (qPCR) method in 26,540 participants of the Singapore Chinese Health Study. After a follow-up of 12 years, 654 participants developed lung cancer including 288 adenocarcinoma, 113 squamous cell carcinoma, and 253 other/unknown histological type. The Cox proportional hazard regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI). HR of lung adenocarcinoma for individuals in the highest comparing the lowest 20 percentile of telomere length was 2.84 (95% CI 1.94-4.14, P_trend<0.0001). This positive association was present in never smokers (P_trend<0.0001), ever smokers (P_trend=0.0010), men (P_trend=0.0003), women (P_trend<0.0001), and in shorter (P_trend=0.0002) and longer (P_trend=0.0001) duration of follow-up. There was no association between telomere length and risk of squamous cell carcinoma or other histological type of lung cancer in all or subgroups of individuals. The agreement of results from this prospective cohort study with those of previous prospective studies and Mendelian randomization studies suggest a possible etiological role of telomere length in the development of lung adenocarcinoma. This article is protected by copyright. All rights reserved.

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The efficacy and safety of anti-PD-1/PD-L1 antibodies combined with chemotherapy or CTLA4 antibody as a first-line treatment for advanced lung cancer

Abstract

Checkpoint inhibitors show promising efficacy in advanced lung cancer, especially in non-small cell lung cancer. This meta-analysis was conducted to explore the therapeutic efficacy and safety of anti-PD-1/PD-L1 antibodies combined with chemotherapy or CTLA4 antibody as first-line treatments for patients with advanced lung cancer. A systematic search was performed in databases for this system review and quantitative meta-analysis. Twelve trials were finally enrolled in the meta-analysis. Our analyses revealed that the combined overall response rate (ORR) and disease control rate (DCR) for immune checkpoint inhibitors combined with chemotherapy for the treatment of non-small cell lung cancer (NSCLC) were 47.0% (95% CI: 34.2% - 60.2%) and 80.9% (95% CI: 69.4% - 88.7%), respectively. The combined ORR and DCR for CTLA4 antibody combined with chemotherapy for the treatment of small-cell lung cancer (SCLC) were 65.4% (61.1%-69.5%) and 87.6% (84.5%-90.2%), respectively. The combined six-month progression-free survival rates (PFSRs_6m) for NSCLC and SCLC were 50.2% (95% CI: 21.9% - 78.4%) and 30.7% (21.2%-40.3%), respectively, and the OSRs_1y were 56.4% (39.1%-73.7%) and 36.9% (33.3%-40.5%), respectively. In addition, the combined ORR and DCR for the checkpoint inhibitors plus CTLA4 antibody treatment group in NSCLC were 29.6% (95% CI: 11.4%-57.8%) and 48.7% (16.8%-81.7%), respectively. In subgroup analyses, a significant improvement in PFS was observed in NSCLC and SCLC, with a combined hazard ratio and 95% confidence interval of 0.841 (0.737-0.961) and 0.856 (0.756-0.968), respectively. In summary, synergistic activity and an acceptable safety profile were observed with checkpoint inhibitor plus chemotherapy combination treatment in lung cancer. This article is protected by copyright. All rights reserved.

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Strategies for phasing and imputation in a population isolate

ABSTRACT

In the search for genetic associations with complex traits, population isolates offer the advantage of reduced genetic and environmental heterogeneity. In addition, cost-efficient next-generation association approaches have been proposed in these populations where only a subsample of representative individuals is sequenced and then genotypes are imputed into the rest of the population. Gene mapping in such populations thus requires high-quality genetic imputation and preliminary phasing. To identify an effective study design, we compare by simulation a range of phasing and imputation software and strategies. We simulated 1,115,604 variants on chromosome 10 for 477 members of the large complex pedigree of Campora, a village within the established isolate of Cilento in southern Italy. We assessed the phasing performance of identical by descent based software ALPHAPHASE and SLRP, LD-based software SHAPEIT2, SHAPEIT3, and BEAGLE, and new software EAGLE that combines both methodologies. For imputation we compared IMPUTE2, IMPUTE4, MINIMAC3, BEAGLE, and new software PBWT. Genotyping errors and missing genotypes were simulated to observe their effects on the performance of each software. Highly accurate phased data were achieved by all software with SHAPEIT2, SHAPEIT3, and EAGLE2 providing the most accurate results. MINIMAC3, IMPUTE4, and IMPUTE2 all performed strongly as imputation software and our study highlights the considerable gain in imputation accuracy provided by a genome sequenced reference panel specific to the population isolate.

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High Isotropic Resolution T2 Mapping of the Lumbosacral Plexus with T2-Prepared 3D Turbo Spin Echo

Abstract

Purpose

Isotropic high-resolution three-dimensional (3D) magnetic resonance neurography (MRN) is increasingly used to depict even small and highly oblique nerves of the lumbosacral plexus (LSP). The present study introduces a T2 mapping sequence (T2-prepared 3D turbo spin echo) that is B1-insensitive and enables quantitative assessment of LSP nerves.

Methods

In this study 15 healthy subjects (mean age 28.5 ± 3.8 years) underwent 3 T MRN of the LSP area three times. The T2 values were calculated offline on a voxel-by-voxel basis and measured at three segments (preganglionic, ganglionic, postganglionic) of three LSP nerves (S1, L5, L4) by two independent investigators (experienced and novice). Normative data for the different nerves were extracted and intraclass correlation coefficients (ICCs) were calculated to assess reproducibility and interobserver reliability of T2 measurements.

Results

The T2 mapping showed excellent reproducibility with ICCs ranging between 0.99 (S1 preganglionic) and 0.89 (L5 postganglionic). Interobserver reliability was less robust with ICCs ranging between 0.78 (S1 preganglionic) and 0.44 (L5 postganglionic) for S1 and L5. A mean T2 value of 74.6 ± 4.7 ms was registered for preganglionic segments, 84.7 ± 4.1 ms for ganglionic and 65.4 ± 2.5 ms for postganglionic segments, respectively. There was a statistically significant variation of T2 values across the nerve (preganglionic vs ganglionic vs postganglionic) for S1, L5, and L4.

Conclusion

Our approach enables isotropic high-resolution and B1-insensitive T2 mapping of LSP nerves with excellent reproducibility. It might reflect a robust and clinically useful method for future diagnostics of LSP pathologies.

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Mechanical Thrombectomy Using the new Solitaire™ Platinum Stent-retriever

Abstract

Background and Purpose

The application of radiopaque markers to the Solitaire™ stent-retriever for better visibility during mechanical thrombectomy (MT) has the potential to alter the well-known characteristics of the device; however, it is uncertain whether this adjustment influences efficacy or safety of the enhanced stent-retriever.

Methods

Retrospective analysis of stroke databases of three comprehensive stroke centers. Our investigation was focused on technical and angiographic parameters, including procedure times, reperfusion results (thrombolysis in cerebral infarction, TICI), periprocedural complications and favorable early neurological recovery at discharge (modified Rankin scale ≤2 or National Institutes of Health Stroke Scale, NIHSS = 0 or ∆NIHSS ≥ 10), from consecutive patients with acute anterior circulation ischemic stroke treated with a Solitaire™ Platinum stent-retriever between October 2016 and March 2017.

Results

A total of 75 patients (male: n = 27, 36%, age in years: mean (SD): 75 (±12), median baseline NIHSS: 17 (interquartile range IQR: 11–21), n = 41, 54.7% received additional i. v. thrombolytics) were treated with a median number of 2 device passes (range: 1–5). The median time from groin puncture to final TICI was 56 min (IQR: 41–79). In 69 patients (92%) TICI 2b-3 was achieved. Early neurological recovery was seen in 47 (62.7%) patients. The following periprocedural complications occurred: vasospasms (n = 7, 9.3%), emboli into a new territory (n = 4, 5.3%), symptomatic intracranial hemorrhage (n = 3, 4%), difficulties during device delivery/deployment (n = 1, 1.3%).

Conclusion

The usage of the Solitaire™ Platinum stent-retriever for MT in acute ischemic stroke patients was highly effective and was not accompanied by an increased periprocedural complication rate.

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Heterogeneity Signs on Noncontrast Computed Tomography Predict Hematoma Expansion after Intracerebral Hemorrhage: A Meta-Analysis

Background and Purpose. Hematoma expansion (HE) is related to clinical deterioration after intracerebral hemorrhage (ICH) and noncontrast computed tomography (NCCT) signs are indicated as predictors for HE but with inconsistent conclusions. We aim to clarify the correlations of NCCT heterogeneity signs with HE by meta-analysis of related studies. Methods. PubMed, Embase, and Cochrane library were searched for eligible studies exploring the relationships between NCCT heterogeneity signs (hypodensity, mixed density, swirl sign, blend sign, and black hole sign) and HE. Poor outcome and mortality were considered as secondary outcomes. Odds ratio (OR) and its 95% confidence intervals (CIs) were selected as the effect size and combined using random effects model. Results. Fourteen studies were included, involving 3240 participants and 435 HEs. The summary results suggested statistically significant correlations of heterogeneity signs with HE (OR, 5.17; 95% CI, 3.72–7.19, ), poor outcome (OR, 3.60; 95% CI, 1.98–6.54, ), and mortality (OR, 4.64; 95%, 2.96–7.27, ). Conclusions. Our findings suggested that hematoma heterogeneity signs on NCCT were positively associated with the increased risk of HE, poor outcome, and mortality rate in ICH.

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Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

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S100B, Homocysteine, Vitamin B12, Folic Acid, and Procalcitonin Serum Levels in Remitters to Electroconvulsive Therapy: A Pilot Study

Background. Electroconvulsive therapy (ECT) is one of the most effective treatment options for refractory depressed patients. To date, there are only a few predictors of response. Aim. The aim was to identify predictive biomarkers of remission to ECT on a molecular level. Methods. 11 patients suffering from a major depressive episode—according to the Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)—underwent 10 ECT sessions. Blood samples were taken, and the depression severity was assessed before, one hour and 24 hours after sessions 1, 4, 7, and 10 using the Montgomery Asberg Depression Rating Scale (MADRS). A MADRS total score 

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Energy Demand Forecasting: Combining Cointegration Analysis and Artificial Intelligence Algorithm

Energy is vital for the sustainable development of China. Accurate forecasts of annual energy demand are essential to schedule energy supply and provide valuable suggestions for developing related industries. In the existing literature on energy use prediction, the artificial intelligence-based (AI-based) model has received considerable attention. However, few econometric and statistical evidences exist that can prove the reliability of the current AI-based model, an area that still needs to be addressed. In this study, a new energy demand forecasting framework is presented at first. On the basis of historical annual data of electricity usage over the period of 1985–2015, the coefficients of linear and quadratic forms of the AI-based model are optimized by combining an adaptive genetic algorithm and a cointegration analysis shown as an example. Prediction results of the proposed model indicate that the annual growth rate of electricity demand in China will slow down. However, China will continue to demand about 13 trillion kilowatt hours in 2030 because of population growth, economic growth, and urbanization. In addition, the model has greater accuracy and reliability compared with other single optimization methods.

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Subcutaneous Granulomatous Inflammation due to Basidiobolomycosis: Case Reports of 3 Patients in Buruli Ulcer Endemic Areas in Benin

Background. Basidiobolomycosis is a rare subcutaneous mycosis, which can be mistaken for several other diseases, such as soft tissue tumors, lymphoma, or Buruli ulcer in the preulcerative stage. Microbiological confirmation by PCR for Basidiobolus ranarum and culture yield the most specific diagnosis, yet they are not widely available in endemic areas and with varying sensitivity. A combination of histopathological findings, namely, granulomatous inflammation with giant cells, septate hyphal fragments, and the Splendore-Hoeppli phenomenon, can confirm basidiobolomycosis in patients presenting with painless, hard induration of soft tissue. Case Presentations. We report on three patients misdiagnosed as suffering from Buruli ulcer, who did not respond to Buruli treatment. Histopathological review of the tissue sections from these patients suggests basidiobolomycosis. All patients had been lost to follow-up, and none received antifungal therapy. On visiting the patients at their homes, two were reported to have died of unknown causes. The third patient was found alive and well and had experienced local spontaneous healing. Conclusion. Basidiobolomycosis is a rare subcutaneous fungal disease mimicking preulcerative Buruli ulcer. We stress the importance of the early recognition by clinicians and pathologists of this treatable disease, so patients can timely receive antifungal therapy.

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Lévy Process-Driven Asymmetric Heteroscedastic Option Pricing Model and Empirical Analysis

This paper describes the peak, fat tail, and skewness characteristics of asset price via a Lévy process. It applies asymmetric GARCH model to depict asset price’s random volatility characteristics and builds a GARCH-Lévy option pricing model with random jump characteristics. It also uses circular maximum likelihood estimation technology to improve the stability of model parameter estimation. In order to test the model’s pricing results, we use Hong Kong Hang Seng Index (HSI) price data and its option data to carry out empirical studies. Results prove that the pricing bias of EGARCH-Lévy model is lower than that of standard Heston-Nandi (HN) model in the financial industry. For short-term, middle-term, and long-term European-style options, the pricing error of EGARCH-Lévy model is the lowest.

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The Stability of the Solutions for a Porous Medium Equation with a Convection Term

This paper studies the initial-boundary value problem of a porous medium equation with a convection term. If the equation is degenerate on the boundary, then only a partial boundary condition is needed generally. The existence of the weak solution is proved by the monotone convergent method. Moreover, according to the different boundary value conditions, the stability of the solutions is studied. In some special cases, the stability can be proved without any boundary value condition.

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Matrine Ameliorates Colorectal Cancer in Rats via Inhibition of HMGB1 Signaling and Downregulation of IL-6, TNF-α, and HMGB1

Matrine may be protective against colorectal cancer (CRC), but how it may work is unclear. Thus, we explored the underlying mechanisms of matrine in CRC. Matrine-related proteins and CRC-related genes and therapeutic targets of matrine in CRC were predicted using a network pharmacology approach. Five targets, including interleukin 6 (IL-6), the 26S proteasome, tumor necrosis factor alpha (TNF-α), transforming growth factor beta 1 (TGF-β1) and p53, and corresponding high-mobility group box 1 (HMGB1) signaling and T helper cell differentiation were thought to be associated with matrine’s mechanism. Expression of predicted serum targets were verified in a 1,2-dimethylhydrazine dihydrochloride-induced CRC model rats that were treated with matrine (ip) for 18 weeks. Data show that matrine suppressed CRC growth and decreased previously elevated expression of IL-6, TNF-α, p53, and HMGB1. Matrine may have had a therapeutic effect on CRC via inhibition of HMGB1 signaling, and this occurred through downregulation of IL-6, TNF-α, and HMGB1.

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Severe Hyperthyroidism Complicated by Agranulocytosis Treated with Therapeutic Plasma Exchange: Case Report and Review of the Literature

Aim. To present a case of Graves’ disease complicated by methimazole induced agranulocytosis treated with therapeutic plasma exchange (TPE) and review of the literature. Case Presentation. A 21-year-old patient with a history of Graves’ disease presented to the endocrine clinic. His history was significant for heat intolerance, weight loss, and tremors. Upon examination he had tachycardia, smooth goiter, thyroid bruit, and hyperactive reflexes. He was started on methimazole and metoprolol and thyroidectomy was to be done once his thyroid function tests normalized. On follow-up, the patient symptoms persisted. Complete blood count done showed a white blood cell count of 2100 (4000–11,000 cells/cu mm) with a neutrophil count of 400 cells/cu mm, consistent with neutropenia. He was admitted to the hospital and underwent 3 cycles of TPE and was also given filgrastim. He improved clinically and his thyroxine (T4) levels also came down. Thyroidectomy was done. He was discharged on levothyroxine for postsurgical hypothyroidism. Conclusion. Plasmapheresis may be useful in the treatment of hyperthyroidism. It works by removing protein bound hormones and also possibly inflammatory cytokines. Further studies are needed to clarify the role of various modalities of TPE in the treatment of hyperthyroidism.

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Permeability Evolution and Particle Size Distribution of Saturated Crushed Sandstone under Compression

In this research, the particle size distribution and permeability of saturated crushed sandstone under variable axial stresses (0, 2, 4, 8, 12, and 16 MPa) were studied. X-ray Computed Tomography results revealed that particle crushing is likely to occur considerably as the axial stress is approaching 4 MPa, which results in the change of pore structure greatly. During compression, the particle size distribution satisfies the fractal condition well, and the fractal dimension of particle size distribution is an effective method for describing the particle crushing state of saturated crushed sandstone. When the axial stress increases from 0 MPa to 4 MPa, the fractal dimension of the particle size distribution increases rapidly by over 60% of the total increase (0–16 MPa), and the permeability decreases sharply by about 85% of the total decrease. These results indicate that 4 MPa is a key value in controlling the particle size distribution and the permeability of the saturated crushed sandstone under axial compression. The permeability is influenced by the initial gradation of the specimens, and a larger Talbot exponent corresponds to a larger permeability.

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Agranulocytosis Associated with Topiramate: A Case Report and Review of Published Cases

A 41-year-old female presented to the hospital with sore throat and shortness of breath. She was hypoxic with an oxygen saturation of 87% in room air. Physical examination revealed swollen uvula with exudates. She had been started on topiramate for treatment of migraine few months ago. The dose of topiramate was increased to 100 mg twice daily 2 weeks ago. Complete blood count revealed an absolute neutrophil count (ANC) of 8 c/mm3. She was intubated and started on broad-spectrum antibiotics. She was transferred to our hospital on the fifth day of hospitalization. On arrival, her absolute neutrophil count was 10 c/mm3. Her agranulocytosis was attributed to topiramate after ruling out other possible causes. ANC improved after topiramate was stopped. ANC increased to 1000 after 5 days of stopping topiramate. We also reviewed published cases of topiramate-associated agranulocytosis. Agranulocytosis is a rare side effect of topiramate, and only 3 case reports have been published so far. In all cases, agranulocytosis developed after months of topiramate therapy and when dose was increased to 200 mg daily suggesting a dose-dependent effect. Next steps would be further research on the pathogenesis of agranulocytosis associated with topiramate and creation of registry for data synthesis.

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Comparison of Two Toric IOL Calculation Methods

Purpose. To compare two calculators for toric intraocular lens (IOL) calculation and to evaluate the prediction of refractive outcome. Methods. Sixty-four eyes of forty-five patients underwent cataract surgery followed by implantation of a toric intraocular lens (Zeiss Torbi 709 M) calculated by a standard industry calculator using front keratometry values. Prediction error, median absolute error, and refractive astigmatism error were evaluated for the standard calculator. The predicted postoperative refraction and toric lens power values were evaluated and compared after postoperative recalculation using the Barrett calculator. Results. We observed a significant undercorrection in the spherical equivalent (0.19 D) by using a standard calculator (). According to the Baylor nomogram and the refractive influence of posterior corneal astigmatism (PCA), undercorrection of the cylinder was lower for patients with WTR astigmatism, because of the tendency of overcorrection. An advantage of less residual postoperative SE, sphere, and cylinder for the Barrett calculator was observed when retrospectively comparing the calculated predicted postoperative refraction between calculators (). Conclusion. Consideration of only corneal front keratometric values for toric lens calculation may lead to postoperative undercorrection of astigmatism. The prediction of postoperative refractive outcome can be improved by using appropriate methods of adjustment in order to take PCA into account.

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Relationship between the Apical Preparation Diameter and the Apical Seal: An In Vitro Study

Objectives. The aim of the study is to define the relationship between the apical preparation diameter and the apical sealing ability to highlight the importance of the preservation of the diameter and the original position of the apical foramen. Materials and Methods. 50 extracted maxillary incisors were randomly allocated into three groups of 15 teeth each (n = 15) according to the apical preparation size: Group 1: finishing file F1 corresponding to size 20 reached the working length (ProTaper Universal system Dentsply®); Group 2: prepared up to size 30 corresponding to finishing file F30; Group 3: prepared up to size 50 corresponding to finishing file F5. Five teeth were assigned to positive and negative control groups. After the filling of the root canals, the teeth were isolated and immersed in a dye solution, then cut longitudinally, photographed, and the dye penetration were calculated using a computer software. Results. Comparison of the three different apical preparation sizes showed no statistically significant differences regarding the apical microleakage. Conclusion. The most important value of the dye penetration was observed in the group with the largest apical diameter.

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Including the ‘Spiritual’ Within Mental Health Care in the UK, from the Experiences of People with Mental Health Problems

Abstract

Spirituality as a dimension of quality of life and well-being has recently begun to be more valued within person-centred treatment approaches to mental health in the UK. The aim of this paper is to provide indicators of the extent to which accessing a spiritual support group may be useful within mental health recovery from the view point of those in receipt of it. The study design was a small-scale exploratory study utilising mixed methods. Quantitative methods were used to map the mental health, general well-being and social networks of the group. These were complimented by a semi-structured open-ended interview which allowed for Interpretative Phenomenological Analysis (IPA) of the life-history accounts of nine individuals with mental health problems who attended a ‘spirituality support group’. Data from unstructured open-ended interviews with five faith chaplains and a mental health day centre manager were also analysed using thematic analysis. The views of 15 participants are therefore recounted. Participants reported that the group offered them: an alternative to more formal religious organisations, and an opportunity to settle spiritual confusions/fears. The ‘group’ was also reported to generally help individual’s subjective feelings of mental wellness through social support. Whilst the merits of spiritual care are appealing, convincing services to include it within treatment may still be difficult.

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Patient Appreciation of Student Chaplain Visits During Their Hospitalization

Abstract

Spiritual care is associated with improved health outcomes and higher patient satisfaction. However, chaplains often cover many hospital units and thus may not be able to serve all patients. Involving student chaplains in patient spiritual care may allow for more patients to experience the support of spiritual care. In this study, we surveyed 93 patients hospitalized on general medical units at a tertiary care center who were visited by nine student chaplain summer interns. The results indicated that the majority of patients appreciated student chaplain visits and these encounters may have positively influenced their overall hospital experience. Thus, student chaplains could be a way to extend valuable spiritual care in settings where chaplaincy staff shortages preclude access.

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Altruism and Religion: A New Paradigm for Organ Donation

Abstract

Activity of NGO’s supporting living donor kidney donations can affect the shortage of kidneys. Matnat Chaim is a Jewish orthodox organization active in Israel since 2009. This is a voluntary organization with aims to shorten and eliminate the waiting list for kidneys. Since the beginning of its activity, it has said to play a key role in 379 kidney transplantations. In 2015, out of 174 live donor kidney transplantations that took place in Israel, Matnat Chaim had a key role in 88 of them (50.6%). We found some ethical issues concerning the organization's activity. The donor can restrict his or her donation to specific characteristics of recipient which can result in organs transplanted in a homogeneous group of the population. Another issue is the question of whether nudging people to kidney donation takes place and whether it is valid to do so. We found that Matnat Chaim does a great deal for promotion and intermediation of kidney donations in Israel. This form of promotion can be implemented by other organizations and countries.

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Nursing Students’ Perceptions of Spirituality and Spiritual Care; An Example of Turkey

Abstract

This descriptive survey study aimed to explore how nursing students perceive spirituality/spiritual care and investigate the variables acting on their perception. Data were collected using the Spirituality and Spiritual Care Rating Scale with 500 students from the Faculty of Nursing. The students’ median score regarding their perception of spirituality and spiritual care indicates a “conceptual confusion” related with these concepts. Female students have higher scale scores than male students (z = 2.19, p < 0.05). Students’ awareness of spirituality and related concepts, and their acquisition of spiritual care skills will allow them to provide spiritual care after graduation.

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Exploring Religiosity, Self-Esteem, Stress, and Depression Among Students of a Cypriot University

Abstract

The purpose of this study was to explore the relationship between Religiosity, Self-esteem, Stress, and Depression among nursing students, social work students, and early-education students of a Cypriot University. The data were collected using four questionnaires. The results indicate a significant positive association between Depression and Stress. Greater levels of Self-esteem were found to be associated with lower depression levels in correlation analysis, while strength of Religious and Spiritual Beliefs was correlated negatively with depression. The results of the current study highlight the need for early intervention in order to promote students mental well-being.

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The Relationship of Anxiety and Depression to Subjective Well-Being in a Mainland Chinese Sample

Abstract

This pilot study examines anxiety, depression, and well-being in a mainland Chinese sample and discusses the implications for mental health care. The Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy—Spiritual Well-being, and the Body Mind Spirit Well-Being Inventory were administered to 60 mainland China residents. Correlational analyses revealed significant relationships among depression, anxiety, and every domain of well-being except the faith domain. Levels of depression and anxiety are inversely related to levels of well-being in a mainland Chinese sample. Chinese culture was expected to moderate this relationship; however, this was not confirmed by the results.

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The Moral Injury Symptom Scale-Military Version

Abstract

The purpose of this study was to develop a multi-dimensional measure of moral injury symptoms that can be used as a primary outcome measure in intervention studies that target moral injury (MI) in Veterans and Active Duty Military with PTSD. This was a multi-center study of 427 Veterans and Active Duty Military with PTSD symptoms recruited from VA Medical Centers in Augusta, Los Angeles, Durham, Houston, and San Antonio, and from Liberty University in Lynchburg. Internal reliability of the Moral Injury Symptom Scale-Military Version (MISS-M) was examined along with factor analytic, discriminant, and convergent validity. Participants were randomly split into two equal samples, with exploratory factor analysis conducted in the first sample and confirmatory factor analysis in the second. Test–retest reliability was assessed in a subsample of 64 Veterans. The 45-item MISS-M consists of 10 theoretically grounded subscales assessing guilt, shame, moral concerns, religious struggles, loss of religious faith/hope, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation. The Cronbach’s alpha of the overall scale was .92 and of individual subscales ranged from .56 to .91. The test–retest reliability was .91 for the total scale and ranged from .78 to .90 for subscales. Discriminant validity was demonstrated by relatively weak correlations with other psychosocial, religious, and physical health constructs, and convergent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms. The MISS-M is a reliable and valid multi-dimensional symptom measure of moral injury that can be used in studies targeting MI in Veterans and Active Duty Military with PTSD symptoms and may also be used by clinicians to identify those at risk.

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Investigating the Relationship Between Religiosity and Psychological Distress Among Surgical Inpatients: A Pilot Study

Abstract

Psychological distress may hinder recovery following surgery. Studies examining the relationship between psychological distress and religiosity in the acute post-operative setting are lacking. The present study investigated this relationship, evaluated protocol design, and explored coping mechanisms. Psychological distress of surgical inpatients was assessed using the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL). Religiosity was assessed using the Santa Clara Strength of Religious Faith Questionnaire. Correlations were obtained using Minitab software. Qualitative analysis identified coping mechanisms. Of eligible inpatients, 13/54 were recruited. No significant correlation was found between religiosity and psychological distress. The RSCL had a strong correlation with HADS (R = 0.82, p = 0.001). Assessment of distress was >2 min faster using RSCL compared to HADS. Relationships with pets, friends or family, and God emerged as the most common coping mechanism. Given study limitations, no conclusion was drawn regarding the relationship between religiosity and psychological distress. Weaknesses in study protocol were identified, and recommendations were outlined to facilitate the definitive study. This includes use of RSCL instead of HADS. Further study is warranted to explore how to strengthen relationships for inpatients.

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Conquests Compared. The Ottoman Expansion in the Balkans and the Mashreq in an Islamicate context

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The effect of food on the pharmacokinetics of niraparib, a poly(ADP-ribose) polymerase (PARP) inhibitor, in patients with recurrent ovarian cancer

Abstract

Purpose

Niraparib is a highly selective inhibitor of PARP-1 and PARP-2 approved in the United States for maintenance treatment of adult patients with recurrent ovarian cancer in complete or partial response to platinum-based chemotherapy. In this open-label crossover study, we evaluated the effects of food on niraparib pharmacokinetics (PK) and safety.

Methods

Patients received a single 300-mg dose of niraparib either after a high-fat meal or under fasting conditions. After a 7-day PK assessment, all patients received a second 300-mg dose of niraparib under the opposite condition, followed by 7-day PK assessment. Blood samples for PK analyses were collected at baseline (on days 1 and 8) and up to 168 h post-dose. Bioequivalence between conditions was defined by the 90% confidence intervals (CIs) for area under the plasma concentration–time curve (AUC) from 0 to last measurable concentration (AUC_0–last) and from 0 to infinity (AUC_0–∞) being within the 80–125% range.

Results

The high-fat meal/fasting ratios of geometric least-squares means for AUC_0–last and AUC_0–∞ were 106.8 (90% CI 97.8–116.6) and 110.1 (90% CI 99.7–121.6), respectively, indicating bioequivalence between conditions. Mean half-life, maximum plasma concentration (C_max), and time to C_max after the high-fat meal were similar to, 27% smaller than, and 128% greater than after fasting, respectively. Adverse events were similar between conditions.

Conclusions

A high-fat meal did not impact the PK profile of niraparib, indicating that niraparib can be taken with or without food. Niraparib was safe and well-tolerated.

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A novel sol-gel-derived calcium silicate cement with short setting time for application in endodontic repair of perforations

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@Simple_Trials @penn_state Thanks for letting us know. Much appreciated.

@Simple_Trials @penn_state Thanks for letting us know. Much appreciated.

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Global Distribution Adjustment and Nonlinear Feature Transformation for Automatic Colorization

Automatic colorization is generally classified into two groups: propagation-based methods and reference-based methods. In reference-based automatic colorization methods, color image(s) are used as reference(s) to reconstruct original color of a gray target image. The most important task here is to find the best matching pairs for all pixels between reference and target images in order to transfer color information from reference to target pixels. A lot of attractive local feature-based image matching methods have already been developed for the last two decades. Unfortunately, as far as we know, there are no optimal matching methods for automatic colorization because the requirements for pixel matching in automatic colorization are wholly different from those for traditional image matching. To design an efficient matching algorithm for automatic colorization, clustering pixel with low computational cost and generating descriptive feature vector are the most important challenges to be solved. In this paper, we present a novel method to address these two problems. In particular, our work concentrates on solving the second problem (designing a descriptive feature vector); namely, we will discuss how to learn a descriptive texture feature using scaled sparse texture feature combining with a nonlinear transformation to construct an optimal feature descriptor. Our experimental results show our proposed method outperforms the state-of-the-art methods in terms of robustness for color reconstruction for automatic colorization applications.

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Effects of Chronic Lymphocytic Thyroiditis on the Clinicopathological Features of Papillary Thyroid Cancer

Background: The effects of chronic lymphocytic thyroiditis (CLT) on the presentation and outcome of papillary thyroid carcinoma (PTC) have long been a topic of controversy. Objective: To evaluate the effect of coexistent CLT on the clinicopathological features of PTC. Design: Retrospective study. Patients: All patients with PTC who had been followed by the 2 co-investigators (Juan Rivera and Richard J. Payne) between 2006 and 2011 were included. Results: CLT was present in 35% (166) of the included patients and was associated with a higher proportion of patients with TNM stage I (p = 0.027) and fewer patients with persistent disease (p = 0.014) in comparison with the PTC-only group. Analysis of the data based on age (#x3c;45 or #x3e;45 years) revealed that in the older group, the presence of CLT was associated with fewer patients with persistent disease (p = 0.03) and capsular invasion (p = 0.05). However, in patients #x3c;45 years of age, the presence of CLT was associated with more capsular invasion (p = 0.003) and extrathyroidal extension (p = 0.004) compared with the PTC-only group. Conclusions: CLT in patients with PTC was associated with lower-stage disease and less disease persistence in patients #x3e;45 years of age. In patients #x3c;45 years, the presence of CLT appeared to be associated with unfavorable pathological features.
Eur Thyroid J

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BMI 35 kg/m 2 does not fit everyone: a modified STOP-Bang questionnaire for sleep apnea screening in the Chinese population

Abstract

Purpose

The STOP-Bang questionnaire is the most widely used to detect surgical patients at high risk of obstructive sleep apnea (OSA). However, the body mass index (BMI) cutoff value in the original STOP-Bang questionnaire is 35 kg/m²; the BMI in the Chinese population is lower than that. We aimed to establish a more appropriate BMI cutoff value in the STOP-Bang questionnaire for Chinese patients.

Methods

A total of 790 consecutive patients scheduled to undergo surgery at our hospital were included in this prospective study. All patients were asked to complete the STOP-Bang questionnaire and undergo a 7-h overnight polysomnography (PSG). The ability of STOP-Bang questionnaire to detect moderate to severe OSA (AHI ≥ 15 events/h) was assessed.

Results

When the BMI cutoff value was set at 28 kg/m², the questionnaire had the highest Youden index, although no significant differences were found in the sensitivity of the test compared with the original BMI cutoff in total and in male patients. In females, changing the BMI cutoff value from 35 to 28 kg/m² resulted in the sensitivity of the test significantly increasing from 79.2% (74.9–83.5) to 89.3% (84.4–94.1), while the decrease in specificity was minor (from 43.6% [41.2–46.0] to 38.2% [36.1–40.3]), and the Youden index was highest (0.27) at this cutoff value. When the STOP-Bang questionnaire score was 4, the highest Youden index was obtained.

Conclusions

We recommend using a BMI cutoff value (28 kg/m²), and a STOP-Bang score ≥ 4 allows the anesthetist to identify patients with high risk of OSA.

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Role of Spiritual Sentiments in Improving the Compliance of Water Intake in Patients with Urolithiasis

Abstract

The aim of this study was to compare the compliance for water intake and rate of recurrence between spiritually motivated and non-motivated patients of renal tract stone disease. It is a multi centric prospective cohort study, conducted in Department of Urology, Institute of Kidney Diseases and Peshawar Medical College, from January 10, 2009 to December 2012. A total of 180 patients with comparable demographic, IQ, EQ and BMI after achieving complete stone clearance were divided into two equal groups. Both groups were instructed to increase the water intake timetable according to AUA guidelines. Group ‘A’ comprising of 90 patients who were identified as spiritually motivated patients based on questioner of FICA 12 is also instructed that increasing the water intake is mentioned in contemporary Islamic medicine. No spiritual instruction was given to Group B. The instructed guidelines and practice for amount and timing of water intake were recalled from participants at the end of 6 and 12 months. The data were recorded on structured proforma and was analyzed using SPSS version 17. The mean age of the patient in Group A was 37.5 years (18–70 years), while in Group B it was 34 years (18–65 years). Urolithiasis affected predominantly male gender in both groups. Sixty-five patients (72.2 %) in Group A have significant compliance (p < 0.001) for water intake over Group B (46 %). The spiritually motivated Group A has significantly reduced rate of recurrence of stones in 23 patients versus 37 in Group B. The spiritually motivated patients had significantly better compliance for water intake and reduced rate of recurrence versus non-motivated individuals in urolithiasis.

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Importance of Religion or Spirituality and Mental Health in Canada

Abstract

Using the latest mental health cycle of the Canadian Community Health Survey (N = 20,868), this paper examines how the importance of religion or spirituality in one’s life associates with mental health. Based on this question, the population is divided into three groups of high religiosity, average religiosity, and secularized. Secularized individuals are shown to have large deficits in all the psychological markers suggested to mediate the relationship between religiosity and mental health, compared to the two other groups. In spite of these deficits, the secularized and the highly religious are found almost equally more likely to rate their mental health as excellent, than the individuals with average religiosity. Interestingly, these two groups are also more likely to rate their mental health as poor. Considering the ability to deal with day-to-day demands and unexpected problems in life as the dependent variable yields comparable results. Various explanations are explored.

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Attitudinal Determinants of Turkish Diabetic Patients and Physicians About Ramadan Fasting

Abstract

The aim of the study was to investigate whether fasting diabetic patients received recommendations regarding fasting or they consulted the physicians before and during Ramadan along with the affect of sociodemographic factors on Ramadan fasting. The study was conducted on 190 diabetic patients after 2014 Ramadan Month. A questionnaire was collected regarding sociodemographic characteristics, diabetes-related characteristics, recommendations of physicians, and behavioral patterns of fasting patients. Overall 41.6% of diabetic patients fasted during Ramadan. 83.5% of them did not go to physician during Ramadan, 65.8% did not consult physicians before fasting and 12.7% were informed by physicians regarding fasting and diabetes. Result of the study was that both physicians and patients were not well aware of the importance of pre-Ramadan education and close follow-up during fasting.

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The Concepts of Hope and Fear in the Islamic Thought: Implications for Spiritual Health

Abstract

The Holy Qur’ān and medieval Islamic writings have many references to “hope” (rajā) and “fear” (khawf) as both single and paired concepts. However, a comprehensive analytical study on these two notions from an Islamic point of view still seems lacking. Both paper and electronic documents related to Islamic and Qur’ānic literature are being used in this study. Also Web resources are searched for keywords of fear, hope and Islam in three languages of Arabic, English and Persian, including Tanzil.net, Almaany.com, Tebyan.net, Holyquran.net, Noorlib.ir, Hawzah.net and Google Scholar. Findings indicate that hope and fear are comprised of three conceptual elements: emotional, cognitive and behavioral, and are identified as “praiseworthy” hope or fear, when associated with God as the ultimate object. Nonetheless, this praiseworthy hope or fear is only distinguishable as “true,” when both are in equilibrium, a necessary condition for spiritual health, which results to perfection. Islam rejects excessive hope or excessive fear, describing both as a “pseudo”-type, which would respectively contribute to self-deceit and despair, and end in spiritual decline.

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The Ashtanga Yoga Hindi Scale: An Assessment Tool Based on Eastern Philosophy of Yoga

Abstract

The study imports the concept of Ashtanga Yoga from the eastern philosophy of Yoga. There is a major disconnect between theory and data in Indian Psychology. Indian Psychology provides a rich theoretical base for understanding optimal human functioning. However, the theories have not been tested due to paucity of tools. A test developed on Ashtanga Yoga is reported. Data were collected in two phases from 550 participants. The data were analyzed using exploratory factor analysis. Seven factors were extracted as the theory indicates. Overall reliability of the scale was found to be excellent (α = 0.88), and the criterion-related validity was satisfactory as correlations were found to be 0.46 and 0.48 (p < 0.01) for Flourishing and SPANE-P, respectively, and −0.22 (p < 0.01) for SPANE-N.

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The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Abstract

Religiosity has been associated with greater body weight. Less is known about South Asian religions and associations with weight. Cross-sectional analysis of the MASALA study (n = 906). We examined associations between religious affiliation and overweight/obesity after controlling for age, sex, years lived in the USA, marital status, education, insurance status, health status, and smoking. We determined whether traditional cultural beliefs, physical activity, and dietary pattern mediated this association. The mean BMI was 26 kg/m². Religious affiliation was associated with overweight/obesity for Hindus (OR 2.12; 95 % CI: 1.16, 3.89), Sikhs (OR 4.23; 95 % CI: 1.72, 10.38), and Muslims (OR 2.79; 95 % CI: 1.14, 6.80) compared with no religious affiliation. Traditional cultural beliefs (7 %), dietary pattern (1 %), and physical activity (1 %) mediated 9 % of the relationship. Interventions designed to promote healthy lifestyle changes to reduce the burden of overweight/obesity among South Asians need to be culturally and religiously tailored.

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