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Clinical uncertainity

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https://www.readbyqxmd.com/read/28819868/one-level-step-section-histological-analysis-is-insufficient-to-confirm-complete-pathological-response-after-neoadjuvant-chemoradiation-for-rectal-cancer
#1
M A Pereira, A R Dias, S F Faraj, C S R Nahas, A R Imperiale, C F S Marques, G C Cotti, B C Camargo, S C Nahas, E S de Mello, U Ribeiro
BACKGROUND: Neoadjuvant chemoradiation therapy (nCRT) for rectal cancer may lead to cure. As we currently lack reliable methods to clinically confirm the absence of disease, some patients undergo radical resection and have pathological complete response (pCR) still undergo surgery. Furthermore, it is uncertain if conventional one-level histopathological analysis is accurate enough to determine complete response. Confirming pCR is essential to determine the prognosis and to consider the patient's inclusion in trials of adjuvant therapy...
August 17, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28819707/metastatic-melanoma-prognostic-factors-and-survival-in-patients-with-brain-metastases
#2
E Frinton, D Tong, J Tan, G Read, V Kumar, S Kennedy, C Lim, R E Board
Brain metastases from malignant melanoma carry a poor prognosis. Novel systemic agents have improved overall survival (OS), but the value of whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) remains uncertain. The melanoma-specific graded prognostic assessment (msGPA) provides useful prognostic information, but the relevance to the modern-day population has not been validated. Since 2011, 53 patients received treatment for brain metastases from malignant melanoma at the Rosemere Cancer Centre medical oncology clinic...
August 17, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/28818884/contributions-of-a-hand-held-fan-to-self-management-of-chronic-breathlessness
#3
Tim Luckett, Jane Phillips, Miriam J Johnson, Morag Farquhar, Flavia Swan, Teresa Assen, Priyanka Bhattarai, Sara Booth
This study explored the benefits of a hand-held fan as perceived by patients with chronic breathlessness and their carers.A secondary multimethod analysis was conducted of interview data collected in three clinical trials. Two researchers independently coded level of benefit qualitatively reported by each patient. Univariate and multivariate statistics were used to explore perceived benefit as a factor of sex, age and diagnosis. Qualitative analysis used an integrative method.133 patients commented on the fan, of whom 72 had a carer...
August 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28817654/investigating-spousal-concordance-of-diabetes-through-statistical-analysis-and-data-mining
#4
Jong-Yi Wang, Chiu-Shong Liu, Chi-Hsuan Lung, Ya-Tun Yang, Ming-Hung Lin
OBJECTIVE: Spousal clustering of diabetes merits attention. Whether old-age vulnerability or a shared family environment determines the concordance of diabetes is also uncertain. This study investigated the spousal concordance of diabetes and compared the risk of diabetes concordance between couples and noncouples by using nationally representative data. METHODS: A total of 22,572 individuals identified from the 2002-2013 National Health Insurance Research Database of Taiwan constituted 5,643 couples and 5,643 noncouples through 1:1 dual propensity score matching (PSM)...
2017: PloS One
https://www.readbyqxmd.com/read/28817464/biologics-for-idiopathic-inflammatory-myopathies
#5
Siamak Moghadam-Kia, Rohit Aggarwal, Chester V Oddis
PURPOSE OF REVIEW: As treatment of refractory cases of idiopathic inflammatory myopathies (IIMs) has been challenging, there is growing interest in assessing novel biologics that target various pathways implicated in the pathogenesis of IIM. RECENT FINDINGS: In the largest clinical trial in adult and juvenile IIM assessing the effectiveness of rituximab, the primary outcome was not met but 83% of this refractory group of IIM patients met a predefined definition of improvement and rituximab demonstrated a significant glucocorticoid-sparing effect...
August 16, 2017: Current Opinion in Rheumatology
https://www.readbyqxmd.com/read/28817401/challenges-in-the-anesthetic-management-of-ambulatory-patients-in-the-mri-suites
#6
Jasper Deen, Yzabel Vandevivere, Peter Van de Putte
PURPOSE OF REVIEW: MRI is becoming an indispensable diagnostic tool. The need for prolonged motion-free periods has substantially increased the need for deep sedation or anesthesia in a challenging environment. This review summarises recent literature with respect to pharmacological sedative strategies, nonpharmacological alternative approaches, airway management and safety issues in the ambulatory setting. RECENT FINDINGS: Most literature researches the pediatric patient population...
August 16, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28816693/multiple-frequency-matching-treatment-strategy-for-tinnitus
#7
Yuan Tao, Xiaodong Chang, Sheng Ye, Guangxing Chu, Tian Guan, Jian Wang, Peiying Zeng
OBJECTIVE: The first aim was to integrate commonly used tinnitus measures into a comprehensive questionnaire. Second, the effectiveness of a masking therapy based on multiple-frequency matching was verified in a clinical study. This study investigated the feasibility of a new treatment strategy for tinnitus, with two main foci. MATERIALS AND METHODS: Compare multiple-frequency matching with traditional masking therapy (Single-frequency matching) through clinical trials...
August 2017: Journal of International Advanced Otology
https://www.readbyqxmd.com/read/28816175/-medical-evaluation-for-suspected-sexual-violence-against-girls
#8
Margret Edda Ornolfsdottir, Ebba Margret Magnusdottir, Jon R Kristinsson, Reynir Tomas Geirsson
INTRODUCTION: Sexual violence against children is a hidden problem. Medical examination and evaluation is needed to search for possible injuries, exclude infections, procure legal evidence and ensure the child´s welfare. We assessed medical evaluations done at Landspitali University Hospital and in the Reykjavik Children's House, a specialized clinic for childhood abuse cases. MATERIAL AND METHODS: Retrospective descriptive analysis was performed on the standardized medical examinations...
July 2017: Læknablađiđ
https://www.readbyqxmd.com/read/28815031/capsule-retention-related-to-small-bowel-capsule-endoscopy-a-large-european-single-center-10-year-clinical-experience
#9
Artur Nemeth, Gabriele Wurm Johansson, Jörgen Nielsen, Henrik Thorlacius, Ervin Toth
BACKGROUND: The most concerning complication of video capsule endoscopy (VCE) is capsule retention (CR) in the gastrointestinal (GI) tract although clinical outcome and management of patients with CR are still uncertain in a large single center material. OBJECTIVES: The aim of this retrospective study was to investigate incidence, causes, risk factors, management and clinical outcomes of CR in a large single center between 2001 and 2011. RESULTS: 2401 consecutive small-bowel (SB) VCEs were performed...
August 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28814255/current-evidence-on-the-evaluation-and-management-of-fever-without-a-source-in-infants-aged-0-90-days-a-review
#10
Joyee G Vachani, Kenya McNeal-Trice, Sowdhamini S Wallace
BACKGROUND: Despite development of risk stratification tools decades ago, the best strategy for evaluation and management of young infants with fever without a clear source remains uncertain. OBJECTIVE: To describe the variability in current practice and review recently published evidence in three key areas: inflammatory markers as a tool for risk stratification, impact of viral testing, and optimal observation time on antibiotics. METHODS: Articles were identified using PubMed, Scopus, and Cochrane databases and via experts...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28813123/pharmacotherapy-for-hypertension-in-adults-aged-18-to-59-years
#11
REVIEW
Vijaya M Musini, Francois Gueyffier, Lorri Puil, Douglas M Salzwedel, James M Wright
BACKGROUND: Hypertension is an important risk factor for adverse cardiovascular events including stroke, myocardial infarction, heart failure and renal failure. The main goal of treatment is to reduce these events. Systematic reviews have shown proven benefit of antihypertensive drug therapy in reducing cardiovascular morbidity and mortality but most of the evidence is in people 60 years of age and older. We wanted to know what the effects of therapy are in people 18 to 59 years of age...
August 16, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28809446/deferasirox-for-managing-iron-overload-in-people-with-thalassaemia
#12
REVIEW
Claudia Bollig, Lisa K Schell, Gerta Rücker, Roman Allert, Edith Motschall, Charlotte M Niemeyer, Dirk Bassler, Joerg J Meerpohl
BACKGROUND: Thalassaemia is a hereditary anaemia due to ineffective erythropoiesis. In particular, people with thalassaemia major develop secondary iron overload resulting from regular red blood cell transfusions. Iron chelation therapy is needed to prevent long-term complications.Both deferoxamine and deferiprone are effective; however, a review of the effectiveness and safety of the newer oral chelator deferasirox in people with thalassaemia is needed. OBJECTIVES: To assess the effectiveness and safety of oral deferasirox in people with thalassaemia and iron overload...
August 15, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28807990/investigating-the-genetic-causes-of-sudden-unexpected-death-in-children-through-targeted-next-generation-sequencing-analysis
#13
Laura J Dewar, Miguel Alcaide, Daniel Fornika, Luisa D'Amato, Sanam Shafaatalab, Charles M Stevens, Thambirajah Balachandra, Susan M Phillips, Shubhayan Sanatani, Ryan D Morin, Glen F Tibbits
BACKGROUND: Inherited arrhythmia syndromes are responsible for a significant portion of autopsy-negative sudden unexpected death (SUD) cases, but molecular autopsy used to identify potentially causal variants is not routinely included in SUD investigations. We collaborated with a medical examiner's office to assist in finding a diagnosis for their autopsy-negative child SUD cases. METHODS AND RESULTS: 191 child SUD cases (<5 years of age) were selected for analyses...
August 2017: Circulation. Cardiovascular Genetics
https://www.readbyqxmd.com/read/28807605/adjuvant-hpv-vaccination-for-anal-cancer-prevention-in-hiv-positive-men-who-have-sex-with-men-the-time-is-now
#14
Ashish A Deshmukh, Scott B Cantor, Elisabeth Fenwick, Elizabeth Y Chiao, Alan G Nyitray, Elizabeth A Stier, Stephen E Goldstone, Timothy Wilkin, Jagpreet Chhatwal
IMPORTANCE: Outcomes of treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, remain uncertain. Emerging evidence shows that post HSIL treatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves the effectiveness of treatment. However, no recommendations exist regarding the use of qHPV vaccine as an adjuvant form of therapy. Our objective was to determine whether post-treatment adjuvant vaccination should be adopted in HIV-infected MSM (individuals at highest risk for anal cancer) on the basis of cost-effectiveness determined using existing evidence or whether future research is needed...
August 11, 2017: Vaccine
https://www.readbyqxmd.com/read/28807242/efficacy-and-safety-of-combination-therapy-of-chemoembolization-and-radiofrequency-ablation-with-different-time-intervals-for-hepatocellular-carcinoma-patients
#15
Yue-Min Feng, Xing Wang, Le Wang, Xiao-Wen Ma, Hao Wu, Hao-Ran Bu, Xiao-Yu Xie, Jian-Ni Qi, Qiang Zhu
BACKGROUND AND OBJECTIVES: Combination of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) has become an effective alternative therapy for hepatocellular carcinoma (HCC). In clinical practice, the choice of time interval between TACE and RFA is a key point for curative effect, but optimal time interval is uncertain in guidelines. We aim to explore the optimal time interval for HCC patients of Child-Pugh classification A or B. METHODS: Two hundred and thirty-three HCC patients of Child A or B who had undergone TACE and RFA were enrolled and divided into seven groups according to different time intervals (1-7weeks)...
September 2017: Surgical Oncology
https://www.readbyqxmd.com/read/28806769/effects-of-statin-therapy-on-clinical-outcomes-after-acute-myocardial-infarction-in-patients-with-advanced-renal-dysfunction-a-propensity-score-matched-analysis
#16
Jin Sug Kim, Weon Kim, Ji Yoon Park, Jong Shin Woo, Tae Won Lee, Chun Gyoo Ihm, Yang Gyun Kim, Ju-Young Moon, Sang Ho Lee, Myung Ho Jeong, Kyung Hwan Jeong
OBJECTIVE: Lipid lowering therapy is widely used for the prevention of cardiovascular complications after acute myocardial infarction (AMI). However, some studies show that this benefit is uncertain in patients with renal dysfunction, and the role of statins is based on the severity of renal dysfunction. In this study, we investigated the impact of statin therapy on major adverse cardiac events (MACEs) and all-cause mortality in patients with advanced renal dysfunction undergoing percutaneous coronary intervention (PCI) after AMI...
2017: PloS One
https://www.readbyqxmd.com/read/28802696/community-acquired-pneumonia-visualized-on-computed-tomography-but-not-chest-x-ray-pathogens-severity-and-clinical-outcomes
#17
Cameron P Upchurch, Carlos G Grijalva, Richard G Wunderink, Derek J Williams, Grant W Waterer, Evan J Anderson, Yuwei Zhu, Eric M Hart, Frank Carroll, Anna M Bramley, Seema Jain, Kathryn M Edwards, Wesley H Self
BACKGROUND: The clinical significance of pneumonia visualized on computed tomography (CT) in the setting of a normal chest x-ray (CXR) is uncertain. METHODS: In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens, and outcomes of patients with pneumonia visualized on CT but not on concurrent CXR (CT-only pneumonia) and those with pneumonia visualized on CXR...
August 9, 2017: Chest
https://www.readbyqxmd.com/read/28802662/the-metastasis-status-and-tumor-burden-associated-ca125-level-combined-with-the-cd4-cd8-ratio-predicts-the-prognosis-of-patients-with-advanced-pancreatic-cancer-a%C3%A2-new-scoring-system
#18
C Yang, H Cheng, G Luo, Y Lu, M Guo, K Jin, Z Wang, X Yu, C Liu
INTRODUCTION: Although CA125 and the tumor immune response have been reported to be associated with pancreatic cancer, their prognostic value for advanced pancreatic cancer patients undergoing chemotherapy remain uncertain. We thus studied the prognostic value of the combination of the CA125 level with the CD4/CD8 ratio. METHODS: After excluding patients who were lost to follow-up or for whom complete clinical data were missing, 369 participants were ultimately examined...
July 29, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28802505/soft-tissue-tumors-of-uncertain-histogenesis-a-review-for-dermatopathologists
#19
REVIEW
Darya Buehler, Paul Weisman
The mesenchymal tumors discussed herein represent a heterogeneous group of neoplasms with distinctive morphologic, immunophenotypic, and molecular genetic features. These uncommon tumors often arise in the dermis and subcutis and can pose a major diagnostic challenge to dermatopathologists because they closely mimic melanoma, carcinoma, fibrous histiocytoma, schwannoma, or granulomatous inflammation. This article reviews the clinical presentation, histopathology, differential diagnosis, and diagnostic pitfalls of epithelioid sarcoma, clear cell sarcoma, perivascular epithelioid cell tumor, ossifying fibromyxoid tumor, pleomorphic hyalinizing angiectatic tumor, and hemosiderotic fibrolipomatous tumor...
September 2017: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/28801304/how-accurate-is-your-activity-tracker-a-comparative-study-of-step-counts-in-low-intensity-physical-activities
#20
Parastoo Alinia, Chris Cain, Ramin Fallahzadeh, Armin Shahrokni, Diane Cook, Hassan Ghasemzadeh
BACKGROUND: As commercially available activity trackers are being utilized in clinical trials, the research community remains uncertain about reliability of the trackers, particularly in studies that involve walking aids and low-intensity activities. While these trackers have been tested for reliability during walking and running activities, there has been limited research on validating them during low-intensity activities and walking with assistive tools. OBJECTIVE: The aim of this study was to (1) determine the accuracy of 3 Fitbit devices (ie, Zip, One, and Flex) at different wearing positions (ie, pants pocket, chest, and wrist) during walking at 3 different speeds, 2...
August 11, 2017: JMIR MHealth and UHealth
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