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Risk avoidance

Anne-Frederique Minsart, François-Pierre Mongeon, Anne-Marie Laberge, Francine Morin, Annie Dore, Line Leduc
OBJECTIVE: To assess obstetric and aortic outcomes in women with Marfan Syndrome according to aortic root diameter, in view of recommendations for caesarean delivery when the aortic root diameter is ≥40 mm in the 2010 American guidelines versus >45 mm in the 2011 European guidelines. STUDY DESIGN: In this retrospective cohort study conducted at Sainte-Justine Mother and Child Tertiary Hospital, 27 pregnancies in 20 women with Marfan Syndrome as defined by the international criteria, were followed prospectively between 1994 and 2017, after excluding women with prior aortic surgery...
September 11, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Jesús Quintero, Cristina Molera, Javier Juamperez, Susanna Redecillas, Silvia Meavilla, Raquel Nuñez, Camila García, Mireia Del Toro, Ángels Garcia, Juan Ortega, Óscar Segarra, Javier Martin de Carpi, Itxarone Bilbao, Ramon Charco
Despite optimal medical treatment and strict low protein diet, the prognosis of propionic acidemia patients is generally poor. We aim to report our experience with liver transplantation in the management of propionic acidemia patients. Six patients with Propionic Acidemia received a liver transplantation at a mean age of 5.2 years (1.3-7.5). The indications for liver transplantation were frequent metabolic decompensations in the first four patients and preventative in the last two. Two patients presented hepatic artery thromboses which were solved through an interventional radiologist approach...
September 22, 2018: Liver Transplantation
Laurine Robert, Grégoire Ficheur, Bertrand Décaudin, Juliette Gellens, Michel Luyckx, Renaud Perichon, Sophie Gautier, François Puisieux, Emmanuel Chazard, Jean-Baptiste Beuscart
Drug-induced hyperkalemia is a frequent and severe complication in hospital setting. Other risk factors may also induce hyperkalemia but the combination of drugs and precipitating factors has not been extensively studied. The aim was to identify drug-induced hyperkalemia events in hospitalized older patients and to describe their combinations with precipitating factors. Two experts analyzed independently retrospective data of patients aged 75 years or more. Experts identified 471 hyperkalemia events and concluded that 379 (80...
September 22, 2018: Clinical Pharmacology and Therapeutics
W Häuser, T Schubert, N Scherbaum, T Tölle
BACKGROUND: One major concern of long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) is the risk of abuse of prescribed opioids. OBJECTIVE: To examine the prevalence and predictors of opioid use-related hospitalizations and potential abuse of prescribed opioids by persons with LTOT for CNCP in a sample representative of the German statutory health insurance companies. METHODS: Retrospective cross-sectional study in 2014. Anonymized German health claims database, including 4,028,618 insured individuals of 69 German statutory health insurances...
September 21, 2018: Der Schmerz
Landry Nfonsam, Shelley Ordorica, Mahdi Ghani, Ryan Potter, Audrey Schaffer, Hussein Daoud, Nasim Vasli, Caitlin Chisholm, Elizabeth Sinclair-Bourque, Jean McGowan-Jordan, Amanda C Smith, Olga Jarinova, Lucas Bronicki
BACKGROUND: Advances in molecular technologies and in-silico variant prediction tools offer wide-ranging opportunities in diagnostic settings, yet they also present with significant limitations. OBJECTIVE: Here, we contextualise the limitations of next-generation sequencing (NGS), multiplex ligation-dependent probe amplification (MLPA) and in-silico prediction tools routinely used by diagnostic laboratories by reviewing specific experiences from our diagnostic laboratory...
September 21, 2018: Journal of Medical Genetics
Ben Van Calster, Laure Wynants, Jan F M Verbeek, Jan Y Verbakel, Evangelia Christodoulou, Andrew J Vickers, Monique J Roobol, Ewout W Steyerberg
CONTEXT: Urologists regularly develop clinical risk prediction models to support clinical decisions. In contrast to traditional performance measures, decision curve analysis (DCA) can assess the utility of models for decision making. DCA plots net benefit (NB) at a range of clinically reasonable risk thresholds. OBJECTIVE: To provide recommendations on interpreting and reporting DCA when evaluating prediction models. EVIDENCE ACQUISITION: We informally reviewed the urological literature to determine investigators' understanding of DCA...
September 19, 2018: European Urology
Bonna Leerhøy, B Joseph Elmunzer
Pancreatitis remains the most common and potentially devastating complication of endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Recent advances in prophylaxis have improved but not eliminated this problem, underscoring the importance of ongoing research toward this goal. This review aims to provide an evidence-based approach to post-ERCP pancreatitis prevention through patient selection, risk stratification, procedural technique, and multimodality prophylaxis, and discusses ongoing and future research initiatives in this important area...
October 2018: Gastrointestinal Endoscopy Clinics of North America
Sidharth Totadri, Venkatraman Radhakrishnan, Trivadi S Ganesan, Prasanth Ganesan, Krishnarathnam Kannan, Kadur Mallaiah Lakshmipathy, Ganesarajah Selvaluxmy, Tenali Gnana Sagar
PURPOSE: Treating pediatric Hodgkin lymphoma (HL) involves a delicate balance between cure and reducing late toxicity. Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) identifies patients with early response to chemotherapy, for whom radiotherapy may be avoided. The role of PET-CT in upfront risk stratification and response-adapted treatment is evaluated in this study. METHODS: Patients with HL, who were younger than 18 years, were included...
September 2018: Journal of Global Oncology
Ilona Csoti, Christian Dresel, Björn Hauptmann, Thomas Müller, Christoph Redecker, Tobias Warnecke, Ulrich Wüllner
Epidemiological studies suggest an association of certain foods with the risk of Parkinson's disease. Also, a number of studies revaeled positive effects on disease progression by caffeine, higher uric acid and total cholesterol levels - especially in men. However, it is not yet clear whether a specific dietary concept or the effects of the intestinal microbiota on the human metabolism could play a role in the course of the disease. Given the lack of prospective nutrition studies, only general recommendations can be given: a "balanced" seasonal regional diet with emphasis on vegetables, fruits, nuts, fish, low amount of red meat, and non-processed foods with a low level of simple carbohydrates may be helpful...
September 2018: Fortschritte der Neurologie-Psychiatrie
Seong Son, Woo Kyung Kim, Sang Gu Lee, Yong Ahn
BACKGROUND: Microscopic anterior cervical foraminotomy (MACF) is a surgical technique for unilateral cervical radiculopathy that preserves segmental motion and avoids adjacent segmental degeneration, but little is known of its long-term outcomes. METHODS: A retrospective minimum 10-year follow-up study was conducted on patients treated by one surgeon. Clinical outcomes were assessed using a visual analogue scale (VAS) of neck and arm pain, neck disability index (NDI), and Odom's criteria...
September 18, 2018: World Neurosurgery
Tara D Sutherland, Alagacone Sriskantha, Trevor D Rapson, Benjamin D Kaehler, Gavin A Huttley
Many of the challenges we currently face as an advanced society have been solved in unique ways by biological systems. One such challenge is developing strategies to avoid microbial infection. Social aculeates (wasps, bees and ants) mitigate the risk of infection to their colonies using a wide range of adaptations and mechanisms. These adaptations and mechanisms are reliant on intricate social structures and are energetically costly for the colony. It seems likely that these species must have had alternative and simpler mechanisms in place to ensure the maintenance of hygienic domicile conditions prior to the evolution of these complex behaviours...
2018: PloS One
Iza Ciglenecki, Andrew S Azman, Christine Jamet, Micaela Serafini, Francisco J Luquero, Jean-Clement Cabrol
The use of oral cholera vaccine (OCV) has increased since 2011, when Shanchol, the first OCV suitable for large-scale use, became available. Médecins Sans Frontières considers OCVs an essential cholera outbreak control tool and has contributed to generating new evidence on OCV use in outbreaks. We showed that large-scale mass campaigns are feasible during outbreaks, documented high short-term effectiveness and showed that vaccines are likely safe in pregnancy. We found that a single-dose regimen has high short-term effectiveness, making rapid delivery of vaccine during outbreaks easier, especially given the on-going global vaccine shortage...
September 14, 2018: Journal of Infectious Diseases
Kate Sweeny, Deborah Christianson, Jeanine McNeill
Background: Each year, over 1 million women in the USA undergo diagnostic breast biopsies, many of which culminate in a benign outcome. However, for many patients, the experience of awaiting biopsy results is far from benign, instead provoking high levels of distress. Purpose: To take a multifaceted approach to understanding the psychological experience of patients undergoing a breast biopsy. Method: Female patients (N = 214) were interviewed at an appointment for a breast biopsy, just prior to undergoing the biopsy procedure...
September 18, 2018: Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine
Jared S Winoker, Peter A Pinto, Ardeshir R Rastinehad
PURPOSE OF REVIEW: To discuss contemporary data on the value of multiparametric MRI (mpMRI) for guiding the decision to biopsy men at risk for prostate cancer, as well as its utility in active surveillance programs. RECENT FINDINGS: Although a systematic 12-core biopsy is the current standard of care for men with increased suspicion for prostate cancer, MRI with or without targeted biopsy has been shown to reliably improve the detection of clinically significant disease following a prior negative biopsy...
September 18, 2018: Current Opinion in Urology
Pierre-Olivier Champagne, Florence Cayouette, Anne Lortie, Jean-Claude Decarie, Alexander G Weil
The occipital and marginal sinuses, when present, must be sacrificed in order to open the dura in most posterior fossa surgeries in the pediatric population, including posterior fossa decompression for Type I Chiari malformation (CM-I) with duraplasty. Apart from the immediate risk of hemorrhage, the voluntary occlusion of this structure is almost universally well tolerated. The authors report a case of intracranial hypertension following the sacrifice of occipital and marginal sinuses following posterior fossa decompression with duraplasty for CM-I...
September 21, 2018: Journal of Neurosurgery. Pediatrics
Wendy Kar Yee Ng, Neil Olmscheid, Kellen Worhacz, Debra Sietsema, Scott Edwards
BACKGROUND: Open surgical release of the A1 pulley is the definitive treatment for the common hand condition of trigger finger, or inflammatory stenosing tenosynovitis. Anecdotal evidence among hand surgeons has questioned whether or not recent steroid injection may be related to complications following open trigger finger release, particularly wound infection, but no studies have primarily studied this connection to date. We aimed to determine whether recent steroid injection was associated with postoperative surgical infections...
September 21, 2018: Hand: Official Journal of the American Association for Hand Surgery
Catherine Benedict, Jody-Ann McLeggon, Bridgette Thom, Joanne F Kelvin, Michelle Landwehr, Samantha Watson, Jennifer S Ford
OBJECTIVE: Young adult (YA) cancer survivors who received gonadotoxic therapy are at risk for impaired fertility and/or childbearing difficulties. This study explored the experiences and financial concerns of survivors pursuing family-building through assisted reproductive technology (ART) and adoption. METHODS: Retrospective study of data collected from grant applications for financial assistance with family-building. Grounded theory methodology using an inductive data-driven approach guided qualitative data analysis...
September 20, 2018: Psycho-oncology
Brian D Nicholson, Mei-Man Lee, Dileep Wijeratne, Tim James, Brian Shine, Jason L Oke
To understand Cancer Antigen 125 (CA125) testing in primary care in relation to a national guideline, we conducted a retrospective observational study including CA125 data from a well-defined region in the UK, from 2003 to 2014. 51,033 CA125 tests from 30,737 women were stratified by month and year of testing, location of test request and patient age. Absolute numbers and rates of testing, rates and proportions of positive and negative tests, and frequencies of single and repeat tests were calculated. Negative binomial and logistic regression were used to test the effect of the guideline's introduction...
September 20, 2018: European Journal of Cancer Care
Jingzhi Tan, Kara K Walker, Katherine Hoff, Brian Hare
Dogs live in the dynamic human social networks full of strangers, yet they form strong and selective bonds with familiar caretakers. Little is known about how a bond is initially formed between a dog and a complete stranger. The first-impression hypothesis suggests that interacting with strangers can present an opportunity to form a mutualistic partnership. It predicts that dogs should respond positively toward a complete stranger to facilitate bonding (Prediction 1) and adjust their preferences in response to the perceived risk and benefit of interacting with strangers (Prediction 2)...
September 20, 2018: Learning & Behavior
Diana C Dragnea, Rénuka S Birbal, Lisanne Ham, Isabel Dapena, Silke Oellerich, Korine van Dijk, Gerrit R J Melles
Several treatment options corresponding to the grade of keratoconus have been established. These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus, and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus. Bowman layer transplantation was developed as a procedure for patients with advanced, progressive keratoconus. The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia...
2018: Eye and Vision (London, England)
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