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Showing papers by "Bethesda Hospital published in 2016"


Journal ArticleDOI
TL;DR: Outpatient treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events and comparisons with N-terminal pro-brain natriuretic peptide (NT-proBNP) testing were compared.
Abstract: Rationale Outpatient treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce. Objectives To validate the utility and safety of selecting patients with PE for outpatient treatment by the Hestia criteria and to compare the safety of the Hestia criteria alone with the Hestia criteria combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) testing. Methods We performed a randomized noninferiority trial in 17 Dutch hospitals. We randomized patients with PE without any of the Hestia criteria to direct discharge or additional NT-proBNP testing. We discharged the latter patients as well if NT-proBNP did not exceed 500 ng/L or admitted them if NT-proBNP was greater than 500 ng/L. The primary endpoint was 30-day adverse outcome defined as PE- or bleeding-related mortality, cardiopulmonary resuscitation, or intensive care unit admission. The noninferiority margin for the primary endpoint was 3.4%. Measurements and main results We randomized 550 patients. In the NT-proBNP group, 34 of 275 (12%) had elevated NT-proBNP values and were managed as inpatients. No patient (0 of 34) with an elevated NT-proBNP level treated in hospital (0%; 95% confidence interval [CI], 0-10.2%), versus no patient (0 of 23) with a post hoc-determined elevated NT-proBNP level from the direct discharge group (0%; 95% CI, 0-14.8%), experienced the primary endpoint. In both trial cohorts, the primary endpoint occurred in none of the 275 patients (0%; 95% CI, 0-1.3%) subjected to NT-proBNP testing, versus in 3 of 275 patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.25). During the 3-month follow-up, recurrent venous thromboembolism occurred in two patients (0.73%; 95% CI, 0.1-2.6%) in the NT-proBNP group versus three patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.65). Conclusions Outpatient treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events. Given the low number of patients with elevated NT-proBNP levels, this trial was unable to draw definite conclusions regarding the incremental value of NT-proBNP testing in patients who fulfill the Hestia criteria. Clinical trial registered with www.trialregister.nl/trialreg/admin/rctview.asp?TC=2603 (NTR2603).

106 citations


Journal ArticleDOI
TL;DR: This review provides a comprehensive description of ILBC characteristics, including epidemiology, clinical features, molecular genetics and histomorphology, and discusses future translational research directions, which promises new options for targeted ILBC therapy.
Abstract: Infiltrating lobular breast cancer (ILBC) is the most common special breast cancer subtype. This review provides a comprehensive description of ILBC characteristics, including epidemiology, clinical features, molecular genetics and histomorphology. Twenty detailed supplemental data tables guide through primary data of more than 200 original studies. Meta-analyses indicate that ILBC is at least twice as common in the Western world as it is in other geographic regions. ILBC is over-represented in so-called interval carcinomas and in primary metastatic breast cancer. ILBC is also associated higher age, higher pT stage and hormone receptor (ER/PR) positivity. Pathological complete response rates after neoadjuvant chemotherapy are low, ranging between 0% and 11%. Positive resection margins after breast-conserving surgery are comparatively frequent and 17% to 65% of patients undergo a second surgical intervention. Depending on the morphological stringency in the diagnosis of ILBC, lack of E-cadherin expression is observed in 55% to 100% of cases. CDH1/E-cadherin mutation detection rates vary between 12% and 83%. Various additional molecular factors, including PIK3CA, TP53, FOXA1, FGFR1, ZNF703 and BCAR4, have been implicated in ILBC or progression of lobular carcinoma in situ (LCIS) to invasive cancer and are discussed in detail. Eight instructive figure plates recapitulate the histomorphology of ILBC and its variants. Furthermore, we draw attention to rarely addressed histological details, such as two-sided nuclear compression and fat-avoiding growth at the invasion front. Last but not least, we discuss future translational research directions and emphasize the concept of synthetic lethality, which promises new options for targeted ILBC therapy.

101 citations


Journal ArticleDOI
TL;DR: Double diabetes seems to be an independent and important risk factor for persons with T1DM in developing macrovascular and microvascular comorbidities and patients should be identified and development of MS should be avoided.

81 citations


Journal ArticleDOI
TL;DR: Women with PCOS may have subfertility and women should be aware of factors affecting fertility, in particular the impact of obesity and age, as well as the increased risk of pregnancy-related complications.
Abstract: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to one in five reproductive-aged women. It is underpinned by insulin resistance and hyperandrogenism and is associated with metabolic, reproductive, and psychological features. Women with PCOS have higher rates of obesity and central adiposity compared with women without PCOS, and weight strongly influences prevalence and clinical severity of PCOS. Women with PCOS may have subfertility and women should be aware of factors affecting fertility, in particular the impact of obesity and age. Once pregnant, women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes, hypertensive disorders, premature delivery, and delivery by cesarean section. The offspring of women with PCOS may have increased risk of congenital abnormalities and hospitalization in childhood. Clinicians should be aware of the increased risk and screen, prevent, and manage accordingly.

69 citations


Journal ArticleDOI
TL;DR: Current smoking is associated with an impaired response to TNFi in axSpA and this effect was numerically smaller in patients with elevated baseline C-reactive protein (CRP) level.
Abstract: Objectives To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort. Methods Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses. Results A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively). Conclusions Current smoking is associated with an impaired response to TNFi in axSpA.

49 citations


Journal ArticleDOI
TL;DR: A large number of malnutrition assessment methods are used in cancer research and content validity of these methods varies widely, but none of these assessment methods has acceptable content validity when compared against a construct based on ESPEN and ASPEN definitions of malnutrition.

41 citations


Journal ArticleDOI
TL;DR: In type 2 diabetes patients with dementia, higher rates of hypoglycemia and other diabetes-related comorbidities were observed, and the risks of a glucocentric and intense diabetes management with insulin and a focus on tight glycemic control without considering other factors may outweigh the benefits in elderly T2D patients withComorbid dementia.

37 citations


Journal ArticleDOI
TL;DR: In this article, the authors presented the method and results of a systematic qualitative research of 20 BPD female patients undergoing individual psychoanalytical music therapy in an acute psychiatric context, identifying typical interaction patterns arising from the relationship between patient and therapist and also from the significance of music.
Abstract: Music therapy for patients suffering from borderline personality disorder (BPD) has been a standard treatment option for many years in in-patient psychiatric work The BPD symptoms, such as identity disturbance, emotional regulation and unstable relationships, lead to challenging and stormy therapy sessions for all therapists of all disciplines In music therapy, difficulties in treatment include, for example, the patient’s refusal to play, extreme loud music or withdrawal from the process This article presents the method and results of a systematic qualitative research of 20 BPD female patients undergoing individual psychoanalytical music therapy in an acute psychiatric context The aim of the research was to identify typical interaction patterns, arising from the relationship between patient and therapist and also from the significance of music The method “forming types by understanding” is based on the well-known sociological research method of “ideal types” Abstracted results are generated by contr

31 citations


Journal ArticleDOI
07 Jul 2016-PLOS ONE
TL;DR: This research presents a novel probabilistic procedure that allows for direct measurement of the response of the immune system to earthquake-triggered landsliding.
Abstract: Background Approximately one million malaria cases were reported in India in 2015, based on microscopy. This study aims to assess the malaria prevalence among hospitalised fever patients in India identified by PCR, and to evaluate the performance of routine diagnostic methods. Methods During June 2011-December 2012, patients admitted with acute undifferentiated fever to seven secondary level community hospitals in Assam (Tezpur), Bihar (Raxaul), Chhattisgarh (Mungeli), Maharashtra (Ratnagiri), Andhra Pradesh (Anantapur) and Tamil Nadu (Oddanchatram and Ambur) were included. The malaria prevalence was assessed by polymerase chain reaction (PCR), routine microscopy, and a rapid diagnostic test (RDT) with PCR as a reference method. Results The malaria prevalence by PCR was 19% (268/1412) ranging from 6% (Oddanchatram, South India) to 35% (Ratnagiri, West India). Among malaria positive patients P. falciparum single infection was detected in 46%, while 38% had P. vivax, 11% mixed infections with P. falciparum and P. vivax, and 5% P. malariae. Compared to PCR, microscopy had sensitivity of 29% and specificity of 98%, while the RDT had sensitivity of 24% and specificity of 99%. Conclusions High malaria prevalence was identified by PCR in this cohort. Routine diagnostic methods had low sensitivity compared to PCR. The results suggest that malaria is underdiagnosed in rural India. However, low parasitaemia controlled by immunity may constitute a proportion of PCR positive cases, which calls for awareness of the fact that other pathogens could be responsible for the febrile disease in submicroscopic malaria.

30 citations


Journal ArticleDOI
28 Jul 2016-PLOS ONE
TL;DR: Evidence is provided that down-regulation of DKK3 especially promotes tumorigenesis of the aggressive basal breast cancer subtype and further studies decoding the underlying molecular mechanisms of Dkk3-mediated effects may help to identify novel targeted therapies for this clinically highly relevant breastcancer subtype.
Abstract: Dickkopf 3 (DKK3) has been associated with tumor suppression of various tumor entities including breast cancer. However, the functional impact of DKK3 on the tumorigenesis of distinct molecular breast cancer subtypes has not been considered so far. Therefore, we initiated a study analyzing the subtype-specific DKK3 expression pattern as well as its prognostic and functional impact with respect to breast cancer subtypes. Based on three independent tissue cohorts including one in silico dataset (n = 30, n = 463 and n = 791) we observed a clear down-regulation of DKK3 expression in breast cancer samples compared to healthy breast tissue controls on mRNA and protein level. Interestingly, most abundant reduction of DKK3 expression was detected in the highly aggressive basal breast cancer subtype. Analyzing a large in silico dataset comprising 3,554 cases showed that low DKK3 mRNA expression was significantly associated with reduced recurrence free survival (RFS) of luminal and basal-like breast cancer cases. Functionally, DKK3 re-expression in human breast cancer cell lines led to suppression of cell growth possibly mediated by up-regulation of apoptosis in basal-like but not in luminal-like breast cancer cell lines. Moreover, ectopic DKK3 expression in mesenchymal basal breast cancer cells resulted in partial restoration of epithelial cell morphology which was molecularly supported by higher expression of epithelial markers like E-Cadherin and down-regulation of mesenchymal markers such as Snail 1. Hence, we provide evidence that down-regulation of DKK3 especially promotes tumorigenesis of the aggressive basal breast cancer subtype. Further studies decoding the underlying molecular mechanisms of DKK3-mediated effects may help to identify novel targeted therapies for this clinically highly relevant breast cancer subtype.

30 citations


Journal ArticleDOI
TL;DR: The effectiveness of a second TNFi is significantly impaired in patients with axSpA after PLR to a first TNFi compared with SLR, and similar results were demonstrated in patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria.
Abstract: With regard to switching tumor necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA), conflicting results have been reported as to whether the effectiveness of a second TNFi depends on the reason for discontinuation of the first TNFi. Patients with a clinical diagnosis of axSpA starting a second TNFi in the Swiss Clinical Quality Management cohort were included. Effectiveness of treatment at 1 year, as well as drug survival, was compared between subgroups having discontinued the first TNFi because of lack of response, adverse events (AEs), or other reasons. Lack of response was further divided into primary or secondary lack of response (PLR or SLR, respectively), depending on whether the first TNFi was stopped before or after 6 months of treatment. Among 632 patients with axSpA, median survival of a second TNFi was 1.1 years after PLR and 3.8 years after SLR (p = 0.003). At least moderate disease activity as defined by an Ankylosing Spondylitis Disease Activity Score using the erythrocyte sedimentation rate (ASDAS-ESR) <2.1 was achieved after 12 months by 11 %, 39 %, 26 %, and 39 % of patients who discontinued their first TNFi because of PLR, SLR, AEs, and other reasons, respectively (p = 0.01). Only 4 % of patients achieved an ASDAS-ESR inactive disease state after PLR, in comparison to 22 % of those after SLR. Similar results were demonstrated in patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria for axSpA (n = 488): ASDAS-ESR <2.1 was achieved after 12 months by 9 %, 41 %, 29 %, and 39 % of patients who discontinued their first TNFi because of PLR, SLR, AEs, and other reasons, respectively (p = 0.01). The effectiveness of a second TNFi is significantly impaired in patients with axSpA after PLR to a first TNFi compared with SLR.

Journal ArticleDOI
TL;DR: The high sensitivity of the U/DHU ratio at t = 120 min for detecting DPD deficiency, as defined by D PD activity in PBMCs, showed that the oral U loading dose can effectively identify patients with reduced DPD activity.
Abstract: AIM Dihydropyrimidine dehydrogenase (DPD) deficiency can lead to severe toxicity following 5-fluorouracil (5FU) or capecitabine (CAP) treatment Uracil (U) can be used as a probe to determine systemic DPD activity The present study was performed to assess the sensitivity and specificity of a U loading dose for detecting DPD deficiency METHODS Cancer patients with Common Toxicity Score (CTC) grade III or IV toxicity after the first or second cycle of 5-FU or CAP treatment were asked to participate Based on DPD activity in PBMCs, patients were divided into two groups: DPD activity in peripheral blood mononuclear cells (PBMCs) <5 nmol mg(-1) *h(-1) (deficient group) and ≥ 5 nmol mg(-1) *h(-1) U 500 mg m(-2) was administered orally and plasma concentrations of U and dihydrouracil (DHU) were determined In the deficient group, polymerase chain reaction amplification of all 23 coding exons and flanking intronic regions of DPYD was performed A U pharmacokinetic model was developed and used to determine the maximum enzymatic conversion capacity (Vmax ) of the DPD enzyme for each patient The sensitivity and specificity of Vmax, U concentration and the U/DHU concentration ratio were determined RESULTS A total of 47 patients were included (19 DPD deficient, 28 DPD normal) Of the pharmacokinetic parameters investigated, a sensitivity and specificity of 80% and 98%, respectively, was obtained for the U/DHU ratio at t = 120 min CONCLUSIONS The high sensitivity of the U/DHU ratio at t = 120 min for detecting DPD deficiency, as defined by DPD activity in PBMCs, showed that the oral U loading dose can effectively identify patients with reduced DPD activity

Journal ArticleDOI
TL;DR: To explore the effect of comedication with conventional synthetic disease‐modifying antirheumatic drugs (DMARDs) on drug retention and clinical effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (SpA).
Abstract: Objective To explore the effect of comedication with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) on drug retention and clinical effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (SpA). Methods The study included all patients starting treatment with a TNFi in a large prospective cohort of axial SpA patients (Swiss Clinical Quality Management in axial SpA). Crude drug retention was analyzed using the Kaplan-Meier method, and in adjusted analyses, Cox proportional hazards regression was used to model TNFi discontinuation. We evaluated multiple disease activity measures and validated clinical response criteria over time. Results A total of 2,765 TNFi treatment courses were included from 1,914 patients with axial SpA, 20.4% in combination with a conventional synthetic DMARD. In unadjusted analyses, the monotherapy group had significantly shorter median TNFi retention time (32.7 months) compared to the cotherapy group (39.1 months) (P = 0.04). In multivariate adjusted analyses, the monotherapy group had significantly lower TNFi retention, with a hazard ratio (HR) of 1.17 (95% confidence interval [95% CI] 1.01–1.35). This effect was even larger when only infliximab-treated patients were considered, with an HR for monotherapy of 1.36 (95% CI 1.06–1.74). Clinical response rates were almost identical at 1 year, with a change in the Bath Ankylosing Spondylitis Disease Activity Index of −2.02 and −2.00 (P = 0.83) and a change in the Ankylosing Spondylitis Disease Activity Score using C-reactive protein of −1.14 and −1.12 (P = 0.45) in the monotherapy and cotherapy groups, respectively. Conclusion We demonstrate an association between the combination of a TNFi with conventional synthetic DMARDs and improved drug retention in patients with axial SpA, particularly in the subgroup of patients with infliximab.

Journal ArticleDOI
TL;DR: Exposures to maternal smoking and higher cord blood estrogens at delivery were associated with a reduced sperm output in adulthood, andOptimal adult testicular function depends on being born at or above average weight, and maintaining optimal growth and adiposity into adulthood.
Abstract: Context: The impact of early life events on testicular function in adulthood is not well understood. Objective: To study the early influences of fetal growth, exposures to cigarette smoke in utero and cord blood estrogens, and the influences of growth and adiposity in childhood through adolescence; on testicular function in adulthood. Design: Male members of the Western Australian Pregnancy Cohort (Raine) were contacted at 20–22 years of age. Of 913 contacted, 423 (56%) agreed to participate; 404 underwent a testicular ultrasound, 365 provided a semen sample, and reproductive hormones were measured (384). Fetal growth measurements (n = 137), umbilical cord estrogen concentrations (n = 128), cord testosterone (T) (n = 125), and child-adulthood growth charts (n = 395) were available. Results: Median sperm output for the 18.6% of men exposed in utero to smoking was lower than nonexposed (82.4 × 106 vs 123.1 × 106; P = .029). Sperm output in adulthood was inversely correlated with cord serum estradiol (P = .0...

Journal ArticleDOI
TL;DR: The Dutch version of the Vancouver Symptom Score for Dysfunctional Elimination Syndrome displayed moderate to good reliability and validity properties for the patient and parent versions.

Journal ArticleDOI
TL;DR: Across different organizational models for medical ward care, there are variations in time per task, time per bed and provider continuity, and the wards with PAs had the highest provider continuity.
Abstract: Rationale, aims and objectives Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. Methods In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. Results We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). Conclusion Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.

Journal ArticleDOI
TL;DR: This international multicenter analysis of surgical techniques for mandibular repositioning shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise.
Abstract: Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlossmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.

Journal ArticleDOI
TL;DR: Oocyte size and texture differ in the early stages of the first cell cycle, according to patients with and without polycystic ovary syndrome and patients with PCOS undergoing IVM.


Journal ArticleDOI
TL;DR: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy and selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate should be considered.
Abstract: Purpose: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. Methods: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. Results: The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. Conclusion: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.

Journal ArticleDOI
23 Sep 2016-BJUI
TL;DR: To analyse the Australian experience of high‐volume Fellowship‐trained Laparoscopic Radical Prostatectomy (LRP) surgeons, a large number of surgeons have had Fellowship training in laparoscopic radical prostate surgery.
Abstract: Objectives To analyse the Australian experience of high-volume Fellowship-trained Laparoscopic Radical Prostatectomy (LRP) surgeons. Materials and Methods 2943 LRP cases were performed by nine Australian surgeons. The inclusion criteria were a prospectively collected database with a minimum of 100 consecutive LRP cases. The surgeons’ LRP experience commenced at various times from July 2003 to September 2009. Data were analysed for demographic, peri-operative, oncological and functional outcomes. Results The mean age of patients were 61.5 years and mean preoperative PSA 7.4 ng/ml. Mean operating time was 168 minutes with conversion to open surgery in 0.5% and a blood transfusion rate of 1.1%. Overall mean length of stay was 2.5 days. 73.6% of pathological specimens were pT2 and 86.3% had Gleason Score >7. Overall positive surgical margins (PSM) occurred in 15.9% with pT2 PSM 9.8%, pT3a PSM 30.8% and pT3b PSM 39.2%. Mean urinary continence at 12 months was 91.4% (data available from five surgeons). Mean 12 months potency after bilateral nerve spare was 47.2% (data available from four surgeons). Biochemical recurrence occurred in 10.6% (mean follow up 17 months). Conclusion The Australian experience of Fellowship trained surgeons performing LRP demonstrates favourable peri-operative, oncological and functional outcomes in comparison to published data for open, laparoscopic and robotic assisted radical prostatectomy. In our Australian centres, LRP remains an acceptable minimally invasive surgical treatment for prostate cancer despite the increasing use of robotic assisted surgery.

Journal ArticleDOI
TL;DR: Application of the factor and newly formulated acceptance criteria demonstrated prediction of nortriptyline plasma concentrations based on DBS concentrations.
Abstract: Background: A bridging study of plasma and DBS concentrations for therapeutic drug monitoring of antidepressants was performed. Results & methodology: Potassium-based hematocrit analysis was included. In addition, we defined acceptance criteria based on the differences between individual data points of plasma and DBS concentrations. These criteria were applied to test acceptability of error found in predicted nortriptyline plasma concentrations. Potassium-based hematocrit predicted a negative bias for DBS concentrations of amitriptyline, but not for the other compounds. To predict plasma concentrations of antidepressants based on DBS concentrations, a factor of 0.8, 0.65, 0.84 and 0.78 was found for nortriptyline, desmethylclomipramine, venlafaxine and desmethylvenlafaxine, respectively. Discussion & conclusion: Application of the factor and newly formulated acceptance criteria demonstrated prediction of nortriptyline plasma concentrations based on DBS concentrations.

Journal ArticleDOI
TL;DR: Anal chromoendoscopy is safe and effective in diagnosing AIN in a population of HIV-infected patients and may become a valuable new tool to manage AIN and to prevent anal malignancy in HIV-positive patients.
Abstract: Introduction Anal carcinoma represents an increasing problem in HIV-infected patients. Anal intraepithelial neoplasia (AIN), the precursor lesion, is currently diagnosed by high-resolution anoscopy (HRA) using optical magnification derived from gynecological colposcopy. This prospective study evaluates anal chromoendoscopy (ACE) using standard gastroenterological video-endoscopes in diagnosing AIN. Methods After clinical examination, proctoscopy and surface staining with acetic acid followed by Lugol’s solution, ACE was performed with a mucosectomy cap on the tip of the endoscope. Biopsy specimens were collected from areas with a pathological staining pattern and from areas with normal appearance; combined results were considered as reference. Results Two hundred eleven HIV-positive patients seen between 2007 and 2013 were evaluated. Of these, 95.7 % were males, and the median age was 45 years. In 86.7 %, the mode of HIV transmission was sex among males. Combination antiretroviral treatment was applied in 75.8 %. The sensitivity of ACE in diagnosing AIN was 0.85, the specificity was 0.55, the positive predictive value was 0.50, and the negative predictive value (NPV) was 0.87. Diagnostic performance increased in individuals with high-grade lesions (NPV: 0.99) and in the second study period from 2011 to 2013. Side effects were rare and of minor clinical relevance. Conclusions Anal chromoendoscopy is safe and effective in diagnosing AIN in a population of HIV-infected patients. It is particularly useful for the exclusion of high-grade lesions that have the strongest risk of progression to anal carcinoma. Therefore, ACE may become a valuable new tool to manage AIN and to prevent anal malignancy in HIV-positive patients.

Journal ArticleDOI
TL;DR: The reliability of 3D ultrasound of the supraspinatus tendon depends on the level of experience of the sonographer, and new diagnostic criteria have to be established and taught even to experienced 2D sonographers to improve reproducibility.
Abstract: BACKGROUND Three-dimensional (3D) ultrasound of the shoulder is characterized by a comparable accuracy to two-dimensional (2D) ultrasound. No studies investigating 2D versus 3D inter-rater reliability in the detection of supraspinatus tendon tears taking into account the level of experience of the raters have been carried out so far. OBJECTIVES The aim of this study was to determine the inter-rater reliability in the analysis of 3D ultrasound image sets of the supraspinatus tendon between sonographer with different levels of experience. PATIENTS AND METHODS Non-interventional, prospective, observational pilot study of 2309 images of 127 adult patients suffering from unilateral shoulder pain. 3D ultrasound image sets were scored by three raters independently. The intra-and interrater reliabilities were calculated. RESULTS There was an excellent intra-rater reliability of rater A in the overall classification of supraspinatus tendon tears (2D vs 3D κ = 0.892, pairwise reliability 93.81%, 3D scoring round 1 vs 3D scoring round 2 κ = 0.875, pairwise reliability 92.857%). The inter-rater reliability was only moderate compared to rater B on 3D (κ = 0.497, pairwise reliability 70.95%) and fair compared to rater C (κ = 0.238, pairwise reliability 42.38%). CONCLUSIONS The reliability of 3D ultrasound of the supraspinatus tendon depends on the level of experience of the sonographer. Experience in 2D ultrasound does not seem to be sufficient for the analysis of 3D ultrasound imaging sets. Therefore, for a 3D ultrasound analysis new diagnostic criteria have to be established and taught even to experienced 2D sonographers to improve reproducibility.

Journal ArticleDOI
TL;DR: This study was conducted to determine if NARV increases prior to VT in patients with implantable cardioverter defibrillators (ICDs), and whether this link to clinical arrhythmia is unproven.
Abstract: BACKROUND T-wave alternans (TWA) is associated with ventricular tachycardia (VT). Nonalternans repolarization variability (NARV) precedes VT in certain experimental models, but its link to clinical arrhythmia is unproven. This study was conducted to determine if NARV increases prior to VT in patients with implantable cardioverter defibrillators (ICDs). METHODS TWA and NARV were calculated from shock-channel electrograms preceding onset of VT or non-VT events in patients with an ICD. In each patient, presence of both a VT and a non-VT event with the same QRS morphology before the event was required. Mixed linear model was used for data analysis, using heart rate (HR) and the number of analyzed beats as covariates. RESULTS Five hundred and sixty-eight events from 64 patients (males/females 51/13, 67 ± 13 years) were analyzed. HR preceding non-VT events was higher than before VT events (RR interval 595 ± 159 vs 706 ± 111 ms; P < 0.0001). Both TWA and NARV increased with increasing HR (P < 0.001). TWA decreased with increasing number of analyzed beats. When controlled for number of analyzed beats and HR, both TWA and NARV were higher before VT than before non-VT events (P < 0.002 and P < 0.0005, respectively). CONCLUSIONS NARV is elevated prior to spontaneous VT onset. Both NARV and TWA increase with HR. The decrease of TWA with increasing number of analyzed beats may indicate contamination with NARV or noise when only a small number of beats is available for analysis. NARV might be useful for VT prediction in the future.

Journal ArticleDOI
TL;DR: Assumed circuits involved in the pathomechanism of discharges during NREM sleep in ESES are discussed based on the findings.
Abstract: OBJECTIVES A retrospective study has been done at the Bethesda Children's Hospital Epilepsy Center with those patients whose EEG records fulfilled in one or more records the criteria of electrical status epilepticus in slow wave sleep (ESES) pattern, occupying at least 75% of NREM sleep with bilateral discharges, and had detailed disease history and long term follow-up data, between 2000 and 2012. PATIENTS AND METHODS--Thirty-three patients (mean 11.1 +/- 4.2 years of age) were studied by 171 sleep EEG records. Sleep was recorded after sleep deprivation or during spontaneous sleep at least for one hour length of NREM. From the 492 EEGs, 171 sleep records were performed (average five/patient). Average follow-up time was 7.5 years. Eighty-two ESES records have been analyzed in 15 non-lesional and 18 lesional (11 with dysgenetic and seven with perinatal-asphyxic or vascular origin) patients. Variability of seizure types, seizure frequency and frequency of status epilepticus was higher in the lesional group. Impairment of the cognitive functions was moderate and partial in the non-lesional, while severely damaged in the lesional group. RESULTS EEG records of 29 patients shawed unihemispherial spike fields with a perpendicular axis (in anterior, medial and posterior variants) to the Sylvian fissure, regardless their lesional or non-lesional origin. Only three (lone nonlesional and two lesional) patients had bilateral synchronous spike-wave discharges with bilateral symmetric frontocentral spike fields. The individual discharges of the sleep EEG pattern were very similar to the awake interictal records except their extension in time and field, their increased number, amplitude, and continuity of them and furthermore in the increased trans-hemispheral propagation and their synchronity. CONCLUSIONS Assumed circuits involved in the pathomechanism of discharges during NREM sleep in ESES are discussed based on our findings.

Journal ArticleDOI
TL;DR: Interrater reliability of the Cognitive Performance Test (CPT), a standardized, occupation-based assessment that measures cognitive-functional capacity in older adults with neurocognitive disorders, was strong among all raters, with expert raters yielding higher coefficients than novice raters.
Abstract: The rigor of occupation-based standardized assessments that rely on observational scoring procedures depends on proven reliability among test administrators. This study measured interrater reliability of the Cognitive Performance Test (CPT), a standardized, occupation-based assessment that measures cognitive-functional capacity in older adults with neurocognitive disorders. To capture a range of experience among test administrators, two sets of raters-four expert and three novice-scored video recordings of 10 patients administered the CPT. Interrater reliability results were strong among all raters (intraclass correlation coefficient [ICC] = .93), with expert raters (ICC = .97) yielding higher coefficients than novice raters (ICC = .93). Spearman's ρ correlation coefficients were high among all raters (rs = .92-1.00). Practitioners can be confident that results of the CPT give accurate and consistent information to the health care team, family members, and patients when administered with fidelity using standardized protocols.

Book ChapterDOI
01 Jan 2016
TL;DR: In this article, the authors explore significant attributes common to national, private, and generic brands and profile the developing generic branded product buyer and find that consumers tend to rely heavily upon stored information in the majority of their purchases.
Abstract: Consumers tend to rely heavily upon stored information in the majority of their purchases. Prevalent among such information is brand identification. National, private and generic branded products are now evident in many U.S. markets. This paper seeks to explore significant attributes common to national, private, and generic brands and to profile the developing generic branded product buyer.

Journal ArticleDOI
TL;DR: This exceptionally rare anatomic variant of a partially duplicated uterine artery proved to be beneficial for the safety of the embolization in the case; however, it is far more likely that such a variant would be unfavorable in some types of gynecological operative and minimally invasive techniques.
Abstract: Anatomic variants of the uterine artery are rare, with the absence of one of the uterine arteries presumably being the most abundant variant. A duplicated uterine artery is mentioned in the medical literature, but to the best of our knowledge, an angiographic study has never been published. A partially duplicated uterine artery is an extremely rare variant not previously mentioned in the literature, and it could lead to technical difficulties or cause problems in various gynecological interventions. We present the case of a 45-year-old Caucasian woman with a uterine fibroid and typical fibroid-related symptoms who came to our department to get treated with fibroid embolization. During the procedure, angiography revealed a partial or segmental duplicated left uterine artery. This exceptionally rare anatomic variant proved to be beneficial for the safety of the embolization in our case; however, it is far more likely that such a variant would be unfavorable in some types of gynecological operative and minimally invasive techniques. Knowledge of the anatomic variant of a partially duplicated uterine artery is important, especially for gynecologists performing minimally invasive surgical procedures.

Journal ArticleDOI
01 Jun 2016
TL;DR: Bae Youl Lee, Seung Don Yoo, Seund Ah Lee, JinMann Chon, Dong Hwan Kim, Yong Seol Jeong, Seong Gyu Noh, Mi Ae Lee, W oo Jin Lee, Eun Hye Kim, Sung Jae Kang, Jae Cheong Ryu Department of Rehabilitation and Physical Medicine, Kyung Hee University Hospital, Seoul.
Abstract: Bae Youl Lee, Seung Don Yoo, Seung Ah Lee, JinMann Chon, Dong Hwan Kim, Yong Seol Jeong, Seong Gyu Noh, Mi Ae Lee, W oo Jin Lee, Eun Hye Kim, Sung Jae Kang, Jae Cheong Ryu Department of Rehabilitation and Physical Medicine, Kyung Hee University Hospital, Seoul, Department of Rehabilitation and Physical Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Department of Rehabilitation and Physical Medicine, Bethesda Hospital, Suwon, Korea Orthopedics and Rehabilitation Engineering Center, Incheon, Korea