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The rational clinical examination

Eric W Meisberger, Sjoerd J G Bakker, Marco S Cune
BACKGROUND: Ultrasonic instrumentation under magnification may facilitate mobilization of screw remnants but may induce heat trauma to surrounding bone. An increase of 5°C is considered detrimental to osseointegration. The objective of this investigation was to examine the rise in temperature of the outer implant body after 30 s of ultrasonic instrumentation to the inner part, in relation to implant type, type of ultrasonic equipment, and the use of coolants in vitro. METHODS: Two ultrasonic devices (Satelec Suprasson T Max and Electro Medical Systems (EMS) miniMaster) were used on five different implant types that were provided with a thermo couple (Astra 3...
December 2015: Int J Implant Dent
Vit Weinberger, Marketa Bednarikova, David Cibula, Michal Zikan
Introduction Serous tubal intraepithelial carcinoma (STIC) is most likely precursor lesion of the most part of high-grade serous pelvis carcinomas, carcinosarcoma and undifferentiated carcinoma with incidence of 0.6% to 7% in BRCA carriers or women with strong family history of breast or ovarian carcinoma. STIC is a pathomorphologically and immunohistochemically detectable lesion which biological significance and clinical relevance is unknown. Areas covered We investigate methods of STIC diagnostics and we present an overview of recent studies and available knowledge on surgical management, adjuvant chemotherapy and subsequent follow-up procedure in women with an isolated STIC...
October 12, 2016: Expert Review of Anticancer Therapy
Rikke Thaarup Wesselhöft
Major depressive disorder (MDD) is a frequent and painful mental disorder considered among the five leading causes of disability in Western countries by the World Health Organization. MDD occurs at all ages, but childhood onset MDD has a more severe course with longer depressive episodes, more suicidality, and more frequent hospitalization, than later onset MDD. Childhood seems to be a window of opportunity for prevention of mental disorders, and subsequently prevention of MDD onset in childhood is recommended...
October 2016: Danish Medical Journal
Liang Chen, Shunfang Yang, Jinqi Jiang, Ying Zhang, Hui Feng, Jie Cao, Xinyue Ge, Wenhui Xie
BACKGROUND: A great individual differences to chemotherapeutic effects existed in the patient with advanced lung cancer. How to choose the optimum regimens to achieve the individuation and maximum effect of chemotherapy for lung cancer is worth exploring. The study was designed to examine the effect of ex vitro chemo-sensitivity assay in xeno-free culture of autologous malignant effusion cells from patients with advanced lung adenocarcinoma. METHODS: The 50 treatment-naive patients with lung adenocarcinoma complicated with malignant pleural or pericardial effusions were enrolled...
September 20, 2016: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
Han Liang, Jingyu Deng
Based upon studies from randomized clinical trials, the extended (D2) lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Due to the limitation of low metastatic rate in para-aortic nodes (PAN) in JCOG9501, the clinical benefit of D2+ para-aortic nodal dissection (PAND) for patients with stage T4 and/or stage N3 disease, which is very common in China and other countries except Japan and Korea, cannot be determined...
August 2016: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Bradley M Wertheim, Andrew J Aguirre, Roby P Bhattacharyya, John Chorba, Ashutosh P Jadhav, Vanessa B Kerry, Eric A Macklin, Gabriela Motyckova, Shveta Raju, Kent Lewandrowski, Daniel P Hunt, Douglas E Wright
BACKGROUND: Overutilization of clinical laboratory testing in the inpatient setting is a common problem. The objective of this project was to develop an inexpensive and easily-implemented intervention to promote rational laboratory utilization without compromising resident education or patient care. METHODS: The study comprised of a cluster-randomized, controlled trial to assess the impact of a multifaceted intervention of education, guideline development, elimination of recurring lab orders, unbundling of laboratory panels, and redesign of the daily progress note on laboratory test ordering...
September 9, 2016: American Journal of Medicine
Heidi R Hofer, Rocky S Tuan
Adult mesenchymal stem cells (MSCs) represent a subject of intense experimental and biomedical interest. Recently, trophic activities of MSCs have become the topic of a number of revealing studies that span both basic and clinical fields. In this review, we focus on recent investigations that have elucidated trophic mechanisms and shed light on MSC clinical efficacy relevant to musculoskeletal applications. Innate differences due to MSC sourcing may play a role in the clinical utility of isolated MSCs. Pain management, osteochondral, nerve, or blood vessel support by MSCs derived from both autologous and allogeneic sources have been examined...
2016: Stem Cell Research & Therapy
Ya Z Liu, Keqi Wang, Xiang Li, Bin Chen
BACKGROUND: The aim of this study was to provide reasonable guidelines for type II diabetes patients with proteinuria to recover their metabolic parameters. METHODS: A cross-sectional study was conducted in selected groups of type 2 diabetic patients. Hypoglycemic and antihypertensive drug use was recorded. Certain physical examinations were conducted including routine urine test, urinary albumin/creatinine ratio (ACR), metabolic parameters of blood glucose and lipid, and other biochemical indicators...
December 2016: Minerva Endocrinologica
Kieran C O'Doherty, Emily Christofides, Jeffery Yen, Heidi Beate Bentzen, Wylie Burke, Nina Hallowell, Barbara A Koenig, Donald J Willison
BACKGROUND: Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections...
2016: BMC Medical Ethics
LaKrista Morton, Alison Elliott, Jennifer Cleland, Vincent Deary, Christopher Burton
OBJECTIVE: To develop a taxonomy of explanations for patients with persistent physical symptoms. METHODS: We analysed doctors' explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often "medically-unexplained," physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. RESULTS: We analysed 138 explanations provided by five general practitioners to 38 patients...
August 17, 2016: Patient Education and Counseling
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
Owen Whooley
Commensuration - the comparison of entities according to a common quantitative metric - is a key process in efforts to rationalize medicine. The push toward evidence-based medicine and quantitative assessment has led to the proliferation of metrics in healthcare. While social scientific attention has revealed the effects of these metrics once institutionalized - on clinical practice, on medical expertise, on outcome assessment, on valuations of medical services, and on experiences of illness - less attention has been paid to the process of developing metrics...
October 2016: Social Science & Medicine
Luise I M Pernar, Ryan Lockridge, Colleen McCormack, Judy Chen, Scott A Shikora, David Spector, Ali Tavakkoli, Ashley H Vernon, Malcolm K Robinson
Abdominal CT (abdCT) scans are frequently ordered for Roux-en-Y gastric bypass (RYGB) patients presenting to the emergency department (ED) with abdominal pain, but often do not reveal intra-abdominal pathology. We aimed to develop an algorithm for rational ordering of abdCTs. We retrospectively reviewed our institution's RYGB patients presenting acutely with abdominal pain, documenting clinical and laboratory data, and scan results. Associations of clinical parameters to abdCT results were examined for outcome predictors...
October 2016: Obesity Surgery
Douglas S Ross, Henry B Burch, David S Cooper, M Carol Greenlee, Peter Laurberg, Ana Luiza Maia, Scott A Rivkees, Mary Samuels, Julie Ann Sosa, Marius N Stan, Martin A Walter
BACKGROUND: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS: The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011...
October 2016: Thyroid: Official Journal of the American Thyroid Association
Adrian P Wiegmans, Mariska Miranda, Shu Wen Wen, Fares Al-Ejeh, Andreas Möller
The molecular rationale to induce synthetic lethality, by targeting defective homologous recombination repair in triple negative breast cancer (TNBC), has proven to have several shortcomings. Not meeting the expected minimal outcomes in clinical trials has highlighted common clinical resistance mechanisms including; increased expression of the target gene PARP1, increased expression or reversion mutation of BRCA1, or up-regulation of the compensatory homologous recombination protein RAD51. Indeed, RAD51 has been demonstrated to be an alternative synthetic lethal target in BRCA1-mutated cancers...
August 5, 2016: Oncotarget
Yonghong Xiao, Jin Wang, Ping Shen, Beiwen Zheng, Yingdong Zheng, Lanjuan Li
The objective of this study was to understand the impact of implementation of the Essential Medicine Policy (EMP) on the rational use of antibiotics in primary medical institutions in China. A retrospective survey was conducted in 39 primary medical institutions to compare the efficacy of EMP in rational antibiotic use. All institutions completed the survey 1 year before and 1 year after implementation of the EMP. In particular, antibiotic use and its rationality were closely examined. The institutions mainly dealt with common diseases, especially non-infectious chronic diseases...
October 2016: International Journal of Antimicrobial Agents
S A Karpishchenko, O I Dolgov
The objective of the present study was to improve the procedures for extended and restricted laser-assisted laryngoplasty in the patients presenting withparalytic laryngeal stenosis and to evaluate the outcome of the surgical interventionsdiffering in extent. The study included 51 patients (47 women and 4 men) at the age varying from 18 to 78 years. Twenty five of these patients had a tracheostoma. The examination was focused on the detection of the following characteristics: vocal fold angle, body mass index, age, specific anatomical and physiological features of the larynx, clinically significant concomitant pathologies, engagement in voice and speech professional activities as well as the influence of paramedical factors...
2016: Vestnik Otorinolaringologii
Jinxin Zhao, Soon-Ee Cheah, Kade D Roberts, Roger L Nation, Philip E Thompson, Tony Velkov, Zongjun Du, Matthew D Johnson, Jian Li
Polymyxin B and colistin are exclusively active against Gram-negative pathogens and have been used in the clinic as a last-line therapy. In this study, we investigated the antimicrobial activity of a novel polymyxin, FADDI-019, against Staphylococcus aureus. MIC and time-kill assays were employed to measure the activity of FADDI-019 against S. aureus ATCC 700699. Cell morphology was examined with scanning electron microscopy (SEM), and cell membrane polarity was measured using flow cytometry. Transcriptome changes caused by FADDI-019 treatment were investigated using transcriptome sequencing (RNA-Seq)...
July 2016: MSphere
Anna Maria van Eijk, Lalitha Ramanathapuram, Patrick L Sutton, Nandini Peddy, Sandhya Choubey, Stuti Mohanty, Aswin Asokan, Sangamithra Ravishankaran, G Sri Lakshmi Priya, Justin Amala Johnson, Sangeetha Velayutham, Deena Kanagaraj, Ankita Patel, Nisha Desai, Nikunj Tandel, Steven A Sullivan, Samuel C Wassmer, Ranveer Singh, K Pradhan, Jane M Carlton, H C Srivasatava, Alex Eapen, S K Sharma
BACKGROUND: Repellents such as coils, vaporizers, mats and creams can be used to reduce the risk of malaria and other infectious diseases. Although evidence for their effectiveness is limited, they are advertised as providing an additional approach to mosquito control in combination with other strategies, e.g. insecticide-treated nets. We examined the use of repellents in India in an urban setting in Chennai (mainly Plasmodium vivax malaria), a peri-urban setting in Nadiad (both P. vivax and P...
2016: Parasites & Vectors
James M Mok, Maximilian Martinez, Harvey E Smith, Daniel M Sciubba, Peter G Passias, Andrew Schoenfeld, Robert E Isaacs, Alexander R Vaccaro, Kris E Radcliff
BACKGROUND: In a bundled payment system, a single payment covers all costs associated with a single episode of care. Spine surgery may be well suited for bundled payments because of clearly defined episodes of care, but the impact on current practice has not been studied. We sought to examine how a theoretical bundled payment strategy with financial disincentives to resource utilization would impact practice patterns. METHODS: A multiple-choice survey was administered to spine surgeons describing eight clinical scenarios...
2016: International Journal of Spine Surgery
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