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Nguefack C Tchente, G Brichant, M Nisolle
Asherman's syndrome (AS) is a partial or complete obliteration of the uterine cavity after intrauterine trauma. Approximately 90 % of severe AS cases occur after abortion curettage or postpartum curettage. Clinical signs and symptoms are abnormalities of the cycle (hypomenorrhoea or amenorrhoea) and fertility disorders. We have reviewed the recent literature on AS following the description of a typical clinical case. The management of AS is not easy. It must be done by experienced surgeons. Realization of several surgeries is sometimes mandatory, with the use of anti-adhesive devices between interventions...
October 2018: Revue Médicale de Liège
Joe Iwanaga, Emily Simonds, Marc Vetter, Mayank Patel, Rod J Oskouian, R Shane Tubbs
The inferior gluteal nerve has been traditionally described as a solely motor branch innervating the gluteus maximus. However, during routine dissection of the gluteal region, a cutaneous branch of the inferior gluteal nerve was identified. As the gluteal region is vulnerable to the development of pressure ulcers and iatrogenic injury with for example, surgical approaches and injection therapies, a comprehensive understanding of its cutaneous innervation is important. Therefore, the aim of this study was to elucidate the anatomy of this cutaneous branch of the inferior gluteal nerve in a series of cadavers...
October 18, 2018: Clinical Anatomy
Junguo Cao, Ting Lei, Fan Chen, Chaochao Zhang, Chengyuan Ma, Haiyan Huang
RATIONALE: A sellar mass in children is most often seen in craniopharyngeal tumors, intracranial germ cell tumors, or pituitary adenomas. However, pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is not commonly seen in children. PATIENT CONCERNS: A 10-year-old girl was admitted due to growth retardation and obesity for 4 years. On physical examination, the patient had a height of 118 cm, body weight of 46 kg, body mass index (BMI) of 33.0 kg/m...
October 2018: Medicine (Baltimore)
Ming Wei, Yuxiang Ma, Long Yin
INTRODUCTION: The endovascular treatment of intracranial atherosclerotic stenosis has become a common intervention. However, few reports are available regarding stenting performed for hypoplastic vertebral artery (HVA) with multiple atherosclerotic lesions. Combining multiple neuroendovascular devices provides more possibilities for technical success. We describe a stenting technique using a distal intracranial catheter (Navien) for providing an approach to an HVA with multiple existing atherosclerotic lesions...
October 2018: Medicine (Baltimore)
Joshua D Namm, Randal P Morris, Fred L Speck, Ronald W Lindsey
BACKGROUND: The objective of this study was to determine the impact of the type and orientation of peripheral screw placement in an eccentrically positioned locking plate on the structural integrity of the plate-diaphyseal bone interface. We hypothesized that central placement of the screw at the end of the plate in this setting is more important than screw type (locking versus nonlocking) to limiting the risk of subsequent fracture. METHODS: Twenty osteoporotic fourth-generation composite left humeri were divided into 4 groups and plated with stainless-steel 6-hole locking plates and 4...
October 17, 2018: Journal of Bone and Joint Surgery. American Volume
Eric J Warm, Benjamin Kinnear, Matthew Kelleher, Dana Sall, Eric Holmboe
W. Edwards Deming, in his System of Profound Knowledge, asserts that leaders who wish to transform a system should understand four essential elements: appreciation for a system, theory of knowledge, knowledge about variation, and psychology. The Accreditation Council for Graduate Medical Education (ACGME) introduced the milestones program as a part of the Next Accreditation System to create developmental language for the six core competencies and facilitate programmatic assessment within graduate medical education systems...
October 16, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
David Wendler
OBJECTIVES: Evaluate the reasons why attempts at redirection, especially at the end of life, often fail, and patients and families insist on treating the underlying illness. SETTING: Conflicts between patients and caregivers regarding the appropriate course of treatment. MAIN RESULTS: Clinicians typically understand requests for treatment merely as means to obtain effective care. However, patients and families often request treatment as a way to exert their agency, avoid a sense of responsibility for unwanted outcomes, and express compassion...
October 16, 2018: Critical Care Medicine
Stefan Boes, Bente Thamsen, Mattia Haas, Marianne Schmid Daners, Mirko Meboldt, Marcus Granegger
OBJECTIVE: The hydraulic properties of implantable rotary blood pumps (RBPs) determine their interaction with the cardiovascular system. A systematic comparison in this regard has not yet been performed for different clinically used RBPs. Aim of this study was to describe the hydraulic characteristics of four RBPs with a universal mathematical model and to compare their behavior under clinical operating conditions. METHODS: First, static and dynamic pump properties of four RBPs (HVAD, Heartmate II, Heartmate 3 and Incor) including their peripheral components were identified in an in-vitro setup; results were translated into mathematical models based on principles of turbomachinery including the low and backflow region...
October 18, 2018: IEEE Transactions on Bio-medical Engineering
Danielle Whiting, Mohamed Mohamed
Introduction Surgeons must ensure operative notes are legible and sufficiently detailed, outlined by 21 criteria in Good Surgical Practice guidelines (2014). Our aim was to introduce an electronic operating proforma to improve quality of operation notes. Methods Two audits were performed six months apart, after an education session and introduction of an electronic operating proforma, assessing adherence to the guidelines. Results were compared and analysed using Chi-square and Fisher's exact tests. Results In both audits, notes for 187 operations performed over a two-week period were studied...
October 18, 2018: Journal of Perioperative Practice
Jun Gao, Ming Li
BACKGROUND: Antipsychotic treatment is effective in the treatment of psychosis, although it also brings with it some unwanted side effects and is associated with low compliance. Finding a non-pharmacological alternative for antipsychotic treatment is highly desirable. AIMS: This preclinical study examined the 'antipsychotic' efficacy of such a behavioral technique using a conditioned avoidance response model. This technique, termed reinforcement attenuation (RA), is to administer a brief footshock (0...
October 18, 2018: Journal of Psychopharmacology
Alessandra Pierangeli, Carolina Scagnolari, Guido Antonelli
Respiratory syncytial virus (RSV) is the most common cause of infant hospitalization and causes a high burden of disease in the elderly, too. This enveloped negative-stranded RNA virus has been recently reclassified in the Pneumoviridae family. Infections of the respiratory cells happens when the two major surface glycoproteins, G and F, take contact with the cell receptor CX3CR1 and mediate entry by fusion, respectively. Viral mRNA transcription, genomic RNA synthesis and nucleocapsid formation occur in large cytoplasmic inclusion bodies to avoid recognition by the host innate immune response...
October 18, 2018: Minerva Pediatrica
Catherine Slack, Abigail Wilkinson, Jessica Salzwedel, Paul Ndebele
INTRODUCTION: Clinical trials of biomedical HIV prevention modalities require the cooperation of multiple stakeholders. Key stakeholders, such as community members, may have stark vulnerabilities. Consequently, calls for HIV prevention researchers to implement "stakeholder engagement" are increasingly common. Such engagement is held to benefit inter-stakeholder relations, stakeholders themselves and the research itself. The ethics review process presents a unique opportunity to strengthen stakeholder engagement practices in HIV prevention trials...
October 2018: Journal of the International AIDS Society
Maya Kagan, Michal Itzick, Ahuva Even-Zohar, Ester Zychlinski
The current study assessed the association between demographic factors (age, relationship status, and education), psychosocial factors (self-rated health and self-reported loneliness), and factors related to attitudes and behaviors associated with seeking help (prior experience with social workers, attitudes towards social workers, and the stigma attached to seeking help from social workers, and the self-reported likelihood of seeking social workers' help among older men in Israel. The data were collected through structured questionnaires, administered to a sample of 256 older men...
November 2018: American Journal of Men's Health
Ramy Rahmé, Lionel Adès
Myelodysplastic syndromes (MDS) are clonal stem cell disorders mostly affecting the elderly. They are classified into lower and higher risk MDS according to prognostic scoring systems. In higher-risk patients, treatments should aim to modify the disease course by avoiding progression to acute myeloid leukemia, and therefore to improve survival. Areas covered: Stem cell transplantation remains the only curative treatment when feasible, but this concerns a small minority of patients. Treatment is principally based on hypomethylating agents (HMAs)...
October 18, 2018: Expert Review of Hematology
Hildegunn Høberg-Vetti, Geir Egil Eide, Elen Siglen, Wenche Listøl, Marianne Tveit Haavind, Nicoline Hoogerbrugge, Cathrine Bjorvatn
BACKGROUND: Genetic testing is increasing in patients newly diagnosed with cancer. This study investigated the levels, course and predictors of cancer-related distress, defined as intrusion and avoidance, in women undergoing BRCA1/2 testing without pretest genetic counseling shortly after a diagnosis of breast or ovarian cancer. MATERIAL AND METHODS: Unselected for family history or age, 259 women with breast cancer and 50 women with ovarian cancer, underwent BRCA1/2 testing shortly after diagnosis...
October 18, 2018: Acta Oncologica
Glen S Jankowski, Brendan Gough, Helen Fawkner, Emma Halliwell, Phillippa C Diedrichs
OBJECTIVE: To examine men's body dissatisfaction qualitatively. DESIGN: Forty-two British men aged 18-45 years took part in a two-session group intervention across 12 groups. The intervention was designed to improve body dissatisfaction by engaging them in a critique of the appearance ideal through written and behavioural exercises. Main outcome measures/results: Analysis of the topics discussed during the intervention generated two core themes. Theme 1 showed that, in general, men minimised the existence of their own body dissatisfaction while (somewhat surprisingly) outlining the ubiquity and potency of the appearance ideal for men in general...
October 18, 2018: Psychology & Health
Maria Mahmood, Gregory Y Lip
Atrial fibrillation (AF) is the commonest sustained arrhythmia with increasing incidence worldwide. AF is a major cause of morbidity (resulting from heart failure, stroke and hospitalisation) and mortality. The aim of primary and specialist care is to improve patient outcome through early detection of AF and optimal clinical management. In this review, we present the ABC Pathway for the holistic, integrated management of patients diagnosed with AF: "A" Avoid stroke with Anticoagulation; "B" for Better symptom management with patient-centred, symptom directed decisions on rate or rhythm control; and "C" Cardiovascular and comorbidity risk reduction, including lifestyle factors and psychological morbidity...
October 11, 2018: Minerva Medica
Papon Muangsanit, Rebecca J Shipley, James B Phillips
Vascularization plays a significant role in treating nerve injury, especially to avoid the central necrosis observed in nerve grafts for large and long nerve defects. It is known that sufficient vascularization can sustain cell survival and maintain cell integration within tissue-engineered constructs. Several studies have also shown that vascularization affects nerve regeneration. Motivated by these studies, vascularized nerve grafts have been developed using various different techniques, although donor site morbidity and limited nerve supply remain significant drawbacks...
October 17, 2018: Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology
Fatih Yanaral, Faruk Ozgor, Onur Kucuktopcu, Omer Sarilar, Ali Ayranci, Metin Savun, Bahar Yuksel, Murat Binbay
PURPOSE: To evaluate the efficacy and safety of flexible ureterorenoscopy (f-URS) and mini percutaneous nephrolithotomy (mini-perc) in the management of 10-30 millimeter multiple renal stones. MATERIALS AND METHODS: The charts of patients who underwent f-URS or mini-perc for multiple kidney stones between January 2011 and July 2015 were retrospectively analyzed. Patients with multiple 10-30-mm-sized renal stones were enrolled in the study. A total of 374 patients underwent mini-perc and 85 patients met the study inclusion criteria...
October 18, 2018: Urology Journal
Molly M Quinn, Flor Juarez-Hernandez, Molly Dunn, Richard Jason Okamura, Marcelle I Cedars, Mitchell P Rosen
PURPOSE: We aimed to explore how patients make decisions regarding use of preimplantation genetic testing for aneuploidy (PGT-A) for in vitro fertilization (IVF). METHODS: This is a cross-sectional survey at an academic medical center. Three hundred subjects initiating an IVF cycle over 8 weeks were asked to complete a validated survey to determine how they decided whether or not to pursue PGT-A. All patients were previously counseled that the primary goal of PGT-A is to maximize pregnancy rates per embryo transfer...
October 18, 2018: Journal of Assisted Reproduction and Genetics
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