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Stacy Loeb, Yasin Folkvaljon, Caitlin Curnyn, David Robinson, Ola Bratt, Pär Stattin
Importance: Active surveillance is an important option to reduce prostate cancer overtreatment, but it remains underutilized in many countries. Models from the United States show that greater use of active surveillance is important for prostate cancer screening to be cost-effective. Objectives: To perform an up-to-date, nationwide, population-based study on use of active surveillance for localized prostate cancer in Sweden. Design, Setting, and Participants: Cross-sectional study in the National Prostate Cancer Register (NPCR) of Sweden from 2009 through 2014...
October 20, 2016: JAMA Oncology
Søren Hess, Evan C Frary, Oke Gerke, Poul Henning Madsen
Pulmonary embolism (PE) is a common, ubiquitous, and potentially lethal disease. As symptoms and clinical findings are notoriously nonspecific, diagnostic imaging is essential to avoid undertreatment as well as overtreatment. Controversies remain regarding first-line imaging in suspected PE. The two main contemporary contenders are ventilation/perfusion scintigraphy with single-photon emission computed tomography (V/Q SPECT) with or without additional low-dose CT (SPECT/CT) and CT angiography (CTA). We present our results from a systematic review and meta-analysis of the diagnostic performances of these modalities: V/Q SPECT, V/Q SPECT/CT, and CTA are all viable options, but we consider V/Q SPECT/CT to be superior in most clinical settings with better overall diagnostic performance, that is, pooled sensitivities (97...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Rahul Tyagi, Marcin R Zgoda, Rachel Short
National Health Service Quality Improvement Scotland (NHS QIS) published a health technology scoping report in 2006 acknowledging that there are serious concerns within Scotland in relation to Developmental Dysplasia of Hip (DDH) as there is no formal screening program in place and there are significant variations between NHS boards leading to confusion for staff and parents. NHS QIS identified need for audit work to improve hip screening in Scotland. The aim of this study is review of current practice of selective screening for DDH...
September 19, 2016: Orthopedic Reviews
Manuel de la Matta
It is universally accepted that deep sedation involves more risks than light-to-moderate sedation. Deep sedation for endoscopic explorations is normally provided by anesthesiologists in Spain and in most countries of the European Unión. The present debate about deep sedation-anesthesia states goes beyond the topic of cardiovascular and respiratory adverse events, and targets the cognitive consequences and global increased mortality of uncontrolled sedation states, especially in specific fragile populations...
October 19, 2016: Revista Española de Enfermedades Digestivas
Bo Carlberg
The J curve hypothesis propose that the relation between blood pressure and risk for cardiovascular events is non-linear. Instead of a decreased risk with lower blood pressure, the risk increases at lower blood pressures. This issue has been discussed for many years, and is still a hot topic. The debates have most often had its origin in the question about how far blood pressure should be lowered with antihypertensive drugs.One one hand, we know that many patients with hypertension is not treated to targets according to guidelines and that this contributes to the high risk for cardiovascular diseases in patients with hypertension...
September 2016: Journal of Hypertension
Giovanni Veronesi, Simona Giampaoli, Francesco Gianfagna, Luigi Palmieri, Diego Vanuzzo, Guido Grassi, Giancarlo Cesana, Marco M Ferrario
OBJECTIVE: To evaluate the clinical utility of the CAMUNI-MATISS 20-year risk score, recently validated for the Italian population, as additional screening tool for individuals at "low" (ESC-SCORE Project predicted 10-year risk ≤ 1%; no preventive action), "intermediate" (ESC-SCORE 1-4%; lifestyle modification/statin treatment) and "high" risk (ESC-SCORE≥ 4% or diabetes; statin treatment) according to the Italian regulation. DESIGN AND METHOD: 40-65 years old initially CVD-free participants to 7 population-based cohorts enrolled in Northern and Central Italy between 1986 and 1996 were followed-up (median 16 years, IQR: 12-20) to the first occurrence of coronary event or ischemic stroke (fatal or non-fatal), coronary or carotid revascularizations...
September 2016: Journal of Hypertension
Youngsin Jung, Erik K St Louis
REM sleep behavior disorder (RBD) is a common parasomnia disorder affecting between 1 and 7 % of community-dwelling adults, most frequently older adults. RBD is characterized by nocturnal complex motor behavior and polysomnographic REM sleep without atonia. RBD is strongly associated with synucleinopathy neurodegeneration. The approach to RBD management is currently twofold: symptomatic treatment to prevent injury and prognostic counseling and longitudinal follow-up surveillance for phenoconversion toward overt neurodegenerative disorders...
November 2016: Current Treatment Options in Neurology
Alireza Najafian, Salem I Noureldine, Faris Azar, Chady Atallah, Gina Trinh, Eric B Schneider, Ralph P Tufano, Martha A Zeiger
BACKGROUND: Molecular markers associated with thyroid malignancy are increasingly being used as differential diagnostic tools for thyroid nodules. However, little has been reported recently regarding the prevalence of these markers in benign lesions. We systematically reviewed the literature to examine studies that reported on the prevalence of these markers in benign thyroid lesions. METHODS: Appropriate papers published between January 01, 2000 and April 30, 2015 and cataloged on PubMed, Embase, Cochrane, Scopus and Web of Science databases by combining different keywords for ''thyroid tumor'' with both general and specific keywords for ''molecular marker'' by using ''AND'' as the Boolean operator...
October 17, 2016: Thyroid: Official Journal of the American Thyroid Association
Kim To, Iain J Nixon
In recent decades, our understanding of thyroid cancer has improved significantly with the recognition that differentiated thyroid cancer (DTC) has good survival and oncological outcomes. Along with the recent rise in the detection of otherwise subclinical tumours due to improved diagnostics, there has been much debate on how aggressive one should be when performing thyroid and lymph node surgery. The use of risk stratification to categorize patients into low, intermediate and high risk has led to a more tailored approach to treating differentiated thyroid cancer...
June 2016: Indian Journal of Medical Research
Patrick C Sanger, Vlad V Simianu, Cameron E Gaskill, Cheryl Al Armstrong, Andrea L Hartzler, Ross J Lordon, William B Lober, Heather L Evans
BACKGROUND: Postoperative surgical site infections (SSI) are common and costly. Most occur post-discharge, and may result in potentially preventable readmission and/or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision-making. STUDY DESIGN: Web-based simulation survey using convenience sample of providers with expertise in surgical infections...
October 13, 2016: Journal of the American College of Surgeons
Michael S Leapman, Peter R Carroll
INTRODUCTION: Selective treatment approaches for prostate cancer (PCa) are warranted given the highly varied nature of the disease and the consequences associated with definitive therapy. MATERIALS AND METHODS: We present a stepwise overview of strategies to not treat PCa, ranging from improved early detection practices that seek to improve the yield at initial diagnosis, as well as refinements to risk prediction and the performance of active surveillance. RESULTS: Adherence to screening guidelines is non-uniform...
October 13, 2016: Urologic Oncology
L-C Horn, C E Brambs, R Handzel, G Mehlhorn, D Schmidt, K Schierle
The majority of precancerous lesions of the lower female genital tract (intraepithelial neoplasia, IN) are caused by human papillomavirus (HPV) infections resulting in cellular atypia and in turn an altered tissue architecture. Depending on the pathogenesis, a distinction is made between vulvar intraepithelial neoplasia (VIN) classified as classical VIN associated with high-risk HPV infections (u-VIN) and differentiated VIN (d-VIN), which is associated with lichen sclerosus et atrophicus and p53 alterations...
October 13, 2016: Der Pathologe
Rico D Bense, Christos Sotiriou, Martine J Piccart-Gebhart, John B A G Haanen, Marcel A T M van Vugt, Elisabeth G E de Vries, Carolien P Schröder, Rudolf S N Fehrmann
BACKGROUND: Not all breast cancer patients benefit from neoadjuvant or adjuvant therapy, resulting in considerable undertreatment or overtreatment. New insights into the role of tumor-infiltrating immune cells suggest that their composition, as well as their functionality, might serve as a biomarker to enable optimal patient selection for current systemic therapies and upcoming treatment options such as immunotherapy. METHODS: We performed several complementary unbiased in silico analyses on gene expression profiles of 7270 unrelated tumor samples of nonmetastatic breast cancer patients with known clinical follow-up...
January 2017: Journal of the National Cancer Institute
Samuel G Schumacher, Maarten van Smeden, Nandini Dendukuri, Lawrence Joseph, Mark P Nicol, Madhukar Pai, Heather J Zar
Evaluation of tests for the diagnosis of childhood pulmonary tuberculosis (CPTB) is complicated by the absence of an accurate reference test. We present a Bayesian latent class analysis in which we evaluated the accuracy of 5 diagnostic tests for CPTB. We used data from a study of 749 hospitalized South African children suspected to have CPTB from 2009 to 2014. The following tests were used: mycobacterial culture, smear microscopy, Xpert MTB/RIF (Cepheid Inc.), tuberculin skin test (TST), and chest radiography...
October 13, 2016: American Journal of Epidemiology
Marianna Grigerová, Martin Griger, Emília Mojtová, Ján Podoba
Low risk differentiated thyroid microcarcinoma therapy is a controversial area of thyroid tumor management. Major international medical societies and reputable institutes consider lobectomy to be sufficient therapeutic intervention for the pT1a cN0cM0 stage of papillary thyroid microcarcinoma. However different views and therapeutic strategies exist and result in unnecessary overtreatment and worsening of patients quality of life. We researched the course of the differentiated thyroid microcarcinoma in patients using different therapeutic strategies: lobectomy, total thyroidectomy, total thyroidectomy with central compartment prophylactic lymphadenectomy and total thyroidectomy followed by radioactive iodine treatment...
2016: Vnitr̆ní Lékar̆ství
Shingo Hatakeyama, Tohru Yoneyama, Yuki Tobisawa, Chikara Ohyama
The application of prostate-specific antigen (PSA) in prostate cancer (PC) screening, diagnosis, and prognosis has improved the clinical management of PC patients. However, the PSA assay has been faced with criticism due to its potential association with over-diagnosis and subsequent overtreatment of patients with indolent disease. The United States Preventive Services Task Force incited much debate over PSA-based screening in 2012 by recommending against this approach. However, the PSA assay remains the first-line tool for the early detection of PC...
October 11, 2016: International Journal of Clinical Oncology
Uwe Wollina, Anastasya A Chokoeva, Georgi Tchernev
Auricular pseudocysts are uncommon benign lesions of the pinna. The etiology is not well understood but repeated trauma is considered as a possible trigger. Exact diagnosis is important to avoid overtreatment with disfigurement. Various surgical approaches can be used in accordance to the stage of the lesion. Minor invasive procedures provide good results with low recurrence rates.
October 11, 2016: Wiener Medizinische Wochenschrift
Tristan Barrett, Masoom A Haider
OBJECTIVE: Active surveillance (AS) has emerged as a management strategy for preventing overtreatment of indolent prostate cancer. Selection of patients for AS has traditionally proved challenging and resulted in 20-30% misclassification rates. MRI has potential to help overcome this limitation, broaden selection criteria to increase recruitment, and minimize the invasive nature of AS follow-up. CONCLUSION: The main issues surrounding MRI and AS are the heterogeneity of inclusion criteria, the definition of significant disease, and agreement about what constitutes radiologic progression...
October 11, 2016: AJR. American Journal of Roentgenology
Yara Backes, Leon Mg Moons, Marco R Novelli, Jeroen D van Bergeijk, John N Groen, Tom Cj Seerden, Matthijs P Schwartz, Wouter H de Vos Tot Nederveen Cappel, Bernhard Wm Spanier, Joost Mj Geesing, Koen Kessels, Marjon Kerkhof, Peter D Siersema, G Johan A Offerhaus, Anya N Milne, Miangela M Lacle
T1 colorectal cancer can be mimicked by pseudo-invasion in pedunculated polyps. British guidelines are currently one of the few which recommend diagnostic confirmation of T1 colorectal cancer by a second pathologist. The aim of this study was to provide insights into the accuracy of histological diagnosis of pedunculated T1 colorectal cancer in daily clinical practice. A sample of 128 cases diagnosed as pedunculated T1 colorectal cancer between 2000 and 2014 from 10 Dutch hospitals was selected for histological review...
October 7, 2016: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Paola Portillo-Sanchez, Rene Rodriguez-Gutierrez, Juan P Brito
No abstract text is available yet for this article.
October 3, 2016: JAMA Internal Medicine
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