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World Journal of Radiology Nov 2016To find accompanying anomalies of typical and atypical Scheuermann's disease (SD) is reported in the present study.
AIM
To find accompanying anomalies of typical and atypical Scheuermann's disease (SD) is reported in the present study.
METHODS
Study included 20 patients (16 men and 4 women) who had radiological imaging radiography, magnetic resonance imaging (MRI) and computed tomography, if available, due to back pain, curved back and low back pain in November 2011-February 2016 period. Patients were categorized into typical and atypical patterns based on the region involved. Thoracic kyphosis values were measured using real Cobb angle. Accompanying disc degeneration, herniations and spinal cord pathologies were studied using MRI.
RESULTS
Age of the patients ranged from 11.0 to 23.0 (mean 17.2 ± 3.0). Typical pattern of SD were detected in 15 patients while atypical pattern were detected in 5 patients. Cobb angle range was 40.2-67.2 (mean 55.5 ± 8.7) in typical Scheuermann's patients and 24.7-49.9 (mean 36.7 ± 10.8) in atypical ones. Intervertebral level was affected and had the measures of 3-8 (mean 5.3 ± 1.6) and 7-9 (mean 8.2 ± 0.8) in typical and atypical Scheuermann's patients, respectively. Level of degenerative disc disease in MRI was 1-7 discs (mean 4.1 ± 1.7) in typical patients and 5-10 discs (mean 7.6 ± 1.9) in atypical patients.
CONCLUSION
SD can be seen in typical and atypical patterns, typical being more frequent. Because degenerative disc diseases, herniations and cord pathologies such as syringomyelia can accompany SD (albeit more common in atypical pattern), it is necessary to evaluate these patients with plain radiography and MRI together.
PubMed: 27928471
DOI: 10.4329/wjr.v8.i11.895 -
Pathology, Research and Practice Aug 2020Endometrial ablation for abnormal uterine bleeding is used as a less invasive alternative to hysterectomy, however, in cases of treatment failure hysterectomy may be...
BACKGROUND
Endometrial ablation for abnormal uterine bleeding is used as a less invasive alternative to hysterectomy, however, in cases of treatment failure hysterectomy may be finally performed. The histologic changes in these post-treatment uteri are not well-described.
OBJECTIVE
To describe the histological findings in post-endometrial ablation uteri.
STUDY DESIGN
During a ten-year period, 321 patients were treated with endometrial ablation. Twenty-five patients (7.8%), 10 treated with NovaSure® and 15 treated with ThermaChoice® endometrial ablation were finally subjected to hysterectomy mostly due to persistent uterine bleeding. Histologic features of these hysterectomies are described.
RESULTS
The patients' age ranged from 33 to 73 years (mean 44.5) and 34-53 (mean 42) for the NovaSure® and ThermaChoice® group, respectively. The time from endometrial ablation to hysterectomy was 2-24 months (mean 8.8) and 2-60 months (mean 23.2) for the two groups, respectively (p = 0.01). Hysterectomies performed later (mean 22 months) showed no fibrosis (p = 0.04) compared with those performed earlier (mean 5 months). Endometrial lining was found more frequently in hysterectomies performed later (mean 13 months) than those performed earlier (mean 2 months, p = 0.0004). Abundant necrotic tissue of myometrial origin was found in 28% of the cases, but it was not associated with the time of hysterectomy (p = 0.2). A zonation effect and vascular changes also seen. Granulomatous reaction was not found. Ten patients (40%) harbored adenomyosis and another three (12%) extensive leiomyomas/diffuse leiomyomatosis.
CONCLUSION
Necrosis, fibrosis and vascular changes are found during the first year of post-thermal uterine effect. Hysterectomies performed later show less prominent changes and almost normal endometrial lining. Adenomyosis is found in an important part of post-endometrial ablation hysterectomies.
Topics: Adult; Aged; Endometrial Ablation Techniques; Female; Humans; Hysterectomy; Middle Aged; Radiofrequency Ablation; Retrospective Studies; Treatment Failure; Uterine Hemorrhage; Uterus
PubMed: 32475645
DOI: 10.1016/j.prp.2020.152992 -
Langenbeck's Archives of Surgery May 2023No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours.
AIM
To evaluate outcomes for OA, TLA, PRA, and RA from RCTs.
METHODS
A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny.
RESULTS
Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA.
CONCLUSION
LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy.
PROSPERO REGISTRATION
CRD42022301005.
Topics: Humans; Middle Aged; Adrenal Gland Neoplasms; Adrenalectomy; Laparoscopy; Length of Stay; Network Meta-Analysis; Retroperitoneal Space; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37145303
DOI: 10.1007/s00423-023-02911-7 -
The Medical Journal of Malaysia Jul 2022The aim of this study was to compare temperature readings measured at the forehead and wrist against the tympanic temperature which is generally accepted as the standard.
BACKGROUND
The aim of this study was to compare temperature readings measured at the forehead and wrist against the tympanic temperature which is generally accepted as the standard.
METHOD
This is a cross-sectional study carried out on 325 people from the general population entering a private hospital for consultation or work. Forehead and wrist temperature was taken using the CEFC RoHS K3 model (China) and tympanic temperature using the Braun Thermoscan 7 Thermometer Irt6520 by the same investigator on consenting individuals.
RESULTS
There was no significant difference between the forehead (mean =36.6, standard deviation, SD=0.30) and tympanic (mean=36.6, SD=0.41), Z= -1.609, p=0.108. However, there was significant difference between the wrist (mean=36.4, SD= 0.28) and tympanic (mean=36.6, SD=0.41) temperature values, Z= -8.749, p<0.001, the former being lower. Temperature measured at forehead (mean=36.6, SD=0.30) was also significantly higher than the wrist (mean=36.4, SD=0.28), Z= -9.381, p<0.001. The wrist temperature values were lower than forehead and tympanic.
CONCLUSION
Forehead temperature values are better representatives of the core temperature (tympanic) and be the preferred site of measurement compared to the wrist.
Topics: Body Temperature; Cross-Sectional Studies; Forehead; Humans; Prospective Studies; Temperature
PubMed: 35902943
DOI: No ID Found -
Ophthalmology Feb 2018To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial... (Review)
Review
PURPOSE
To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction.
METHODS
Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment.
RESULTS
After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%-47%) at 6 months. Overall change in spherical equivalent was +0.43 diopters (D; range, -1.17 to +1.2 D), with minimal induced astigmatism of +0.03 D (range, -0.03 to +1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%-76%). Intraocular pressure elevation was the second most common complication (range, 0%-22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%-12.5%), secondary graft failure (mean, 2.2%; range, 0%-6.3%), and immune rejection (mean, 1.9%; range, 0%-5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet's stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%-82%), endothelial rejection (mean, 10%; range, 0%-45%), and primary graft failure (mean, 5%; range, 0%-29%). Mean EC loss after DSEK was 37% at 6 months.
CONCLUSIONS
The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK.
Topics: Academies and Institutes; Descemet Stripping Endothelial Keratoplasty; Fuchs' Endothelial Dystrophy; Humans; Ophthalmology; United States
PubMed: 28923499
DOI: 10.1016/j.ophtha.2017.08.015 -
Frontiers in Psychology 2021Individuals can perceive the mean emotion or mean identity of a group of faces. It has been considered that individual representations are discarded when extracting a...
Individuals can perceive the mean emotion or mean identity of a group of faces. It has been considered that individual representations are discarded when extracting a mean representation; for example, the "element-independent assumption" asserts that the extraction of a mean representation does not depend on recognizing or remembering individual items. The "element-dependent assumption" proposes that the extraction of a mean representation is closely connected to the processing of individual items. The processing mechanism of mean representations and individual representations remains unclear. The present study used a classic member-identification paradigm and manipulated the exposure time and set size to investigate the effect of attentional resources allocated to individual faces on the processing of both the mean emotion representation and individual representations in a set and the relationship between the two types of representations. The results showed that while the precision of individual representations was affected by attentional resources, the precision of the mean emotion representation did not change with it. Our results indicate that two different pathways may exist for extracting a mean emotion representation and individual representations and that the extraction of a mean emotion representation may have higher priority. Moreover, we found that individual faces in a group could be processed to a certain extent even under extremely short exposure time and that the precision of individual representations was relatively poor but individual representations were not discarded.
PubMed: 34671297
DOI: 10.3389/fpsyg.2021.713212 -
Journal of the American Pharmacists... 2021Pharmacists are positioned in unique and important roles in health care in their ability to care for the lesbian, gay, bisexual, and transgender (LGBT) population. For...
BACKGROUND
Pharmacists are positioned in unique and important roles in health care in their ability to care for the lesbian, gay, bisexual, and transgender (LGBT) population. For example, pharmacists are a highly prevalent, accessible provider type, and informal surveys have shown that LGBT patients may be more comfortable asking their pharmacists sensitive medication questions rather than their primary provider.
OBJECTIVES
To demonstrate gaps in LGBT cultural competency among student pharmacists and propose specific recommendations on the number of LGBT patient exposures and educational hours that can significantly improve LGBT cultural competency.
METHODS
Student pharmacists (N = 275) at 3 universities in the United States completed a survey comprising demographics, experiential variables (i.e., number of LGBT patients and LGBT hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores were stratified by 1-point increments, and experiential variable means were computed per each stratification to characterize the mean LGBT patients and hours of student pharmacists with higher scores and those with lower scores.
RESULTS
Student pharmacists reported low numbers of annual LGBT patients (Mean = 3.82, SD = 9.54), annual LGBT curricular hours (Mean = 0.55, SD = 0.95), and annual LGBT extracurricular hours (Mean = 2.50, SD = 15.42). They reported very high attitudinal awareness (Mean = 6.19, SD = 1.02), moderate knowledge (Mean = 5.00, SD = 1.25), and low clinical preparedness (Mean = 3.26, SD = 1.33). Student pharmacists who cared for 25 or more LGBT patients and received 10 or more LGBT total hours reported significantly higher preparedness, knowledge, and overall cultural competency.
CONCLUSION
Student pharmacists have shortcomings in LGBT cultural competency and limited LGBT patient exposure and education. To improve LGBT cultural competency, pharmacy schools and accrediting bodies should consider ensuring that student pharmacists receive at least a total of 25 LGBT patient contacts and 10 LGBT formal education hours across their pharmacy education.
Topics: Cultural Competency; Female; Humans; Pharmacists; Sexual and Gender Minorities; Students; Transgender Persons; United States
PubMed: 33715973
DOI: 10.1016/j.japh.2021.02.009 -
Journal of Hypertension Dec 2020Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is...
OBJECTIVES
Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is unknown whether 24-h oscillographic pulse rate measurement as an approximation of HR derived from ambulatory blood pressure monitoring (ABPM) associates with cardiovascular outcomes in hypertensive patients.
METHODS
We evaluated ABPM recordings from 56 901 patients with complete 3373 421 HR measures entering the final analysis from the Spanish Blood Pressure Monitoring Registry for a median follow-up time of 5.1 years. We explored the association of office HR, mean 24-h HR, mean day HR, mean night HR as well as day-night HR differences, morning mean HR, morning HR surge and night peak HR to all-cause death, cardiovascular death and noncardiovascular death. Data were analyzed by Cox regression analysis, analysis of variance and chi-square test.
RESULTS
The Spanish ABPM Registry recorded data in 223 primary care centers in Spain from 2004 until 31 December 2014 at the end of recruitment. Office HR was 3.5 bpm higher than mean 24-h HR, office mean HR versus mean night was 10.4 bpm higher and mean day versus mean night HR 9.3 bpm higher, while there were no relevant difference between office and mean day HR. Office mean, 24-h day and night HR more than 90 bpm were associated with an increased risk for all-cause and noncardiovascular death, whereas for cardiovascular death only mean night HR was predictive. The strongest association to all-cause death was observed with mean night HR [hazard ratio 3.80 (2.87-5.03)], mean 24-h HR [2.85 (2.30-3.54)] and mean day HR [2.22 (1.83-2.70)]. Day-night dipping of more than 8 bpm was associated with a 20% lesser risk on all-cause, cardiovascular and noncardiovascular death. Results were robust after adjusting for relevant risk indicators.
CONCLUSION
HR parameters derived from ABPM provide important information, in particular association with death by mean night HR, mean 24-h HR and reduced day-night HR dipping less than 8 bpm superior to office HR.
Topics: Adult; Aged; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Cause of Death; Female; Heart Rate; Humans; Hypertension; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Spain
PubMed: 32694335
DOI: 10.1097/HJH.0000000000002565 -
High Blood Pressure & Cardiovascular... Oct 2019Our aim was to determine the difference between measuring blood pressure (BP) with the mean of three determinations versus the mean of the second and the third... (Comparative Study)
Comparative Study
INTRODUCTION
Our aim was to determine the difference between measuring blood pressure (BP) with the mean of three determinations versus the mean of the second and the third determinations in a random general population sample.
METHODS
Epidemiological study of the general population aged ≥ 18 from the Health Area of Toledo (Spain), based on the health card database. Three readings of systolic and diastolic BP were taken with validated oscillometric devices OMRON HEM-907. The mean of the three readings was compared with the mean of the second and third readings after discarding the first measurement. We analyzed age, sex, BMI, abdominal obesity, dyslipidemia, diabetes mellitus, smoking and sedentary lifestyle. A descriptive study was conducted, as well as the agreement in the diagnosis of hypertension.
RESULTS
1532 subjects were analyzed (mean age 49.01 ± 15.79 years old, 55.5% women). Response rate 36.3%. The mean systolic BP with three readings was 125.39 ± 17.43 mmHg, versus 124.33 ± 17.07 mmHg with the mean of the second and third readings (mean difference 1.01 ± 4.31; Cohen's D = 0.059). The mean diastolic BP was 73.93 ± 10.89 versus 73.71 ± 10.93 mmHg with both methods (mean difference 0.19 ± 2.11; Cohen's D = 0.017). Differences by age, sex, BMI, abdominal obesity, dyslipidemia, diabetes, smoking and sedentary lifestyle were all small (Cohen's D < 0.08). The agreement between both models for classifying subjects as hypertensive/non-hypertensive showed a Kappa value = 0.936 (McNemar's test p < 0.001).
CONCLUSIONS
Determining the mean of three readings of BP does not make a significant difference in relation to the reading of the second and third measurements in a sample of general population.
Topics: Adolescent; Adult; Aged; Blood Pressure; Blood Pressure Determination; Female; Humans; Hypertension; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Prevalence; Reproducibility of Results; Risk Factors; Spain; Young Adult
PubMed: 31452090
DOI: 10.1007/s40292-019-00338-0 -
European Journal of Pediatric Surgery :... Jun 2023Sufficient training is needed to acquire and retain the procedural skills needed for the surgical correction of congenital anatomical malformations. This study aims...
INTRODUCTION
Sufficient training is needed to acquire and retain the procedural skills needed for the surgical correction of congenital anatomical malformations. This study aims to assess the opinions of trainees and pediatric surgeons on the use of simulation-based continued at-home training, which can help to acquire these skills.
METHODS
This study consisted of two parts. First, an international survey among trainees and pediatric surgeons assessed their opinions on simulation-based at-home training for pediatric surgical procedures (5-point Likert scale). Second, participants of pediatric colorectal courses were instructed to practice the posterior sagittal anorectoplasty procedure at-home on a simulation model and, subsequently, complete a questionnaire regarding their opinions on continuous at-home training (5-point Likert scale).
RESULTS
A total of 163 participants (83% pediatric surgeons) completed the international survey (response rate 43%). Overall, participants considered the training useful for both laparoscopic (mean 4.7) and open procedures (mean 4.2) and agreed that it may be used at home after a hands-on course (mean 4.3).Twenty participants completed the questionnaire on continued training (response rate 36%). All agreed that at-home training was of added value (mean 4.5) and that the skills were transferable to the clinical setting (mean 4.3). At-home training was regarded a suitable exercise after a hands-on workshop (mean 4.3), but less so without a workshop (mean 3.7, =0.017).
CONCLUSION
Participating trainees and pediatric surgeons were of the opinion that simulation models and at-home training have added value. This implies that simulation-based training may be used more often in pediatric surgical training.
Topics: Humans; Child; Specialties, Surgical; Surgeons; Simulation Training; Clinical Competence
PubMed: 36049776
DOI: 10.1055/s-0042-1745784