Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 10/25/17

Τετάρτη 25 Οκτωβρίου 2017

New designs for new epidemiology.

No abstract available

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On the analysis of case-control studies in cluster-correlated data settings.

In resource-limited settings, long-term evaluation of national anti-retroviral treatment (ART) programs often relies on aggregated data, the analysis of which may be subject to ecological bias. As researchers and policy-makers consider evaluating individual-level outcomes such as treatment adherence or mortality, the well-known case-control design is appealing in that it provides efficiency gains over random sampling. In the context that motivates this paper, valid estimation and inference requires acknowledging any clustering although, to our knowledge, no statistical methods have been published for the analysis of case-control data for which the underlying population exhibits clustering. Furthermore, in the specific context of an ongoing collaboration in Malawi, rather than performing case-control sampling across all clinics, case-control sampling within clinics has been suggested as a more practical strategy. To our knowledge, while similar outcome-dependent sampling schemes have been described in the literature, a case-control design specific to correlated data settings is new. In this paper we describe this design, discuss balanced versus unbalanced sampling techniques, and provide a general approach to analyzing case-control studies in cluster-correlated settings based on inverse probability-weighted generalized estimating equations. Inference is based on a robust sandwich estimator with correlation parameters estimated to ensure appropriate accounting of the outcome-dependent sampling scheme. We conduct comprehensive simulations, based in part on real data on a sample of N=78,155 program registrants in Malawi between 2005-2007, to evaluate small-sample operating characteristics and potential trade-offs associated with standard case-control sampling or when case-control sampling is performed within clusters. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Outcome-related, auxiliary variable sampling designs for longitudinal binary data.

Background: Epidemiologists have long used case-control and related study designs to enhance variability of response and information available to estimate exposure-disease associations. Less has been done for longitudinal data. Methods: We discuss an epidemiological study design and analysis approach for longitudinal binary response data. We seek to gain statistical efficiency by over-sampling relatively informative subjects for inclusion into the sample. In this methodological demonstration, we develop this concept by sampling repeatedly from an existing cohort study to estimate the relationship of chronic obstructive pulmonary disease to past-year smoking in a panel of baseline smokers. To account for over-sampling, we describe a sequential offsetted regressions approach for valid inferences in this setting. Results: Targeted sampling can lead to increased statistical efficiency when combined with sequential offsetted regressions. Efficiency gains are degraded with increased prevalence of the disease response variable, with decreased association between the sampling variable and the response, and with other design and analysis parameters, providing guidance to those wishing to use these types of designs in the future. Conclusions: These designs hold promise for efficient use of resources in longitudinal cohort studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Extending the case-control design to longitudinal data: stratied sampling based on repeated binary outcomes.

We detail study design options that generalize case-control sampling when longitudinal outcome data are already collected as part of a primary cohort study, but new exposure data must be retrospectively processed for a secondary analysis. Furthermore, we assume that cost will limit the size of the subsample that can be evaluated. We describe a novel class of stratified outcome-dependent sampling designs for longitudinal binary response data where distinct strata are created for subjects who never, sometimes, and always experienced the event of interest during longitudinal follow-up. Individual designs within this class are differentiated by the stratum-specific sampling probabilities. We show for parameters associated with time-varying exposures, subjects who experience the event/outcome at some but not at all of the follow-up times (i.e., those who exhibit response variation) are highly informative. If the time-varying exposure varies exclusively within individuals (i.e., intraclass correlation coefficient is 0), then sampling all subjects with response variability can yield highly precise parameter estimates even when compared to an analysis of the original cohort. The flexibility of the designs and analysis procedures also permits estimation of parameters that correspond to time-fixed covariates, and we show that with an imputation-based estimation procedure, baseline covariate associations can be estimated with very high precision irrespective of the design. We demonstrate features of the designs and analysis procedures via a plasmode simulation using data from the Lung Health Study. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Iterative Learning Control Experimental Results in Twin-Rotor Device

This paper presents the results of applying the Iterative Learning Control algorithms to a Twin-Rotor Multiple-Input Multiple-Output System (TRMS) in order to achieve high performance in repetitive tracking of trajectories. The plant, which is similar to a prototype of helicopter, is characterized by its highly nonlinear and cross-coupled dynamics. In the first phase, the system is modelled using the Lagrangian approach and combining theoretical and experimental results. Thereafter, a hierarchical control architecture which combines a baseline feedback controller with an Iterative Learning Control algorithm is developed. Finally, the responses of the real device and a complete analysis of the learning behaviour are exposed.

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Editorial Board

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Christian Bioethics would like to thank the following guest reviewers for their help during the past year:

Ray Barfield

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Cover

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The Image of God, the Need for God, and Bioethics

Abstract

This article identifies several key implications of humanity's creation in God's image for the field of bioethics. First, the article develops a biblically sound understanding of what it means to be in God's image, contrasting it with another understanding that has long been widespread. In order to help adjudicate which understanding is more in line with the meaning that the Bible intends, the article next describes a biblical perspective on humanity's weakness and need for God that serves as a context for humanity's creation in God's image. The final part of the article then explains how Christian bioethics is dependent (on God) and otherwise distinctive from other outlooks. For example, being in God's image affects: how one resolves bioethical challenges, the positions one takes on bioethical challenges, and the degree to which one engages bioethical challenges.

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Putting Image into Practice: Imago Dei , Dignity, and Their Bioethical Import

Abstract

In this paper, I examine the role that the imago Dei plays in bioethical considerations of dignity. In so doing, I rely on resources primarily from the Roman Catholic tradition to articulate what it means to understand dignity as related to the imago Dei and what the normative implications of such an account would be in bioethics. After explaining reasons for narrowing the scope of discussions of dignity, I take up what reflection on what the imago Dei means for humanity, relying on the concepts of mystery, conformation, and vocation. I conclude with a brief consideration of Ruth Macklin's now infamous critique of dignity and a discussion of the broader implications of relying on the imago Dei in an account of dignity for bioethics.

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Radical Dependence and the Imago Dei : Bioethical Implications of Access to Healthcare for People with Disabilities

Abstract

As more people with disabilities (PWD) participate in many different settings where they once may have been excluded, nondisabled folks have become more accustomed to both casual and commercial interactions with them. And yet, many of these same people may ask about the general and critical needs for healthcare that PWD will have from time to time and whether or not they should receive extraordinary levels of medical care in times of health crisis. The subtext of this whether-or-not thinking may be: aren't they better off dead? But, I wonder, are the standards of care for PWD really different from standards for the nondisabled? And, I question, whose quality of life is at stake in cases involving a person with disabilities? This essay explores the ethical implications of the questions of standards and quality that an imago Dei theological anthropology of radical dependence challenges. This anthropology is then used to unlock the content and context of human relationality in matters of human flourishing, particularly in terms of healthcare needs for PWD.

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John Kilner’s Understanding of The Imago Dei and The Ethical Treatment of Persons with Disabilities

Abstract

The ethical care and treatment of persons with disabilities is important both for society and the church, but it can be challenging and daunting. The Georgetown principles and the counsel of Scripture can provide appropriate guidance. Nevertheless, the issues often remain difficult and sometimes confusing. It is vital to show mercy to dying patients—including those with disabilities. Withdrawing and withholding life-sustaining treatment can in some cases, however, be made prematurely, especially for disabled patients, largely because of a history of devaluing such persons. John Kilner's book, Dignity and Destiny: Humanity in the Image of God, contends that the divine image in humans, contrary to many, was not marred, damaged, or destroyed by sin. The image likewise is not defined by certain traits and capabilities. Misunderstandings of this have resulted in the disadvantaging of people with disabilities and a denial of their dignity. The present study summarizes and explores this aspect of Kilner's thesis, including the biblical and ethical foundations. The case of a disabled patient, "Michael," applies this understanding of the image and offers assistance for end-of-life decision-making for persons with disabilities.

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Created in the Image of God: Bioethical Implications of the Imago Dei

Abstract

Reference to the Imago Dei expresses a foundational relationship between God and man, with implications for properly appreciating basic human goods and human flourishing, which in turn have repercussions for appropriate medical decision-making. Although this theological theme is often invoked as if its meaning and implications are evident and clear, they are not. What does it mean to be created in the image of God? And, what are the implications of that meaning for central questions in bioethics? The authors in this issue of Christian Bioethics consider the ways in which foundational, and at times very different, understandings of being created in the image of God lead to particular understandings of appropriate biomedical moral choice. This essay draws on the theological reflections of Saint Basil and Saint Maximos, among others, to set our reflections regarding the Imago Dei within the recognition that Christian bioethics must be grounded in the Church's mystical experience of God and work to orient us towards Him. Approached correctly, medicine can play an important role in one's life, but secular goals should not undermine Christian moral truths, and medical care must not replace Christian spiritual therapy for the soul.

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The Image of God and Human Dignity: A Complex Conversation

Abstract

Despite a limited number of Scriptural texts describing human beings as made in the "image" and "likeness" of God, such language has been widely invoked in both classical and current theology and ethics. In this essay, I first discuss the variety of ways that theological voices have developed this theme. I then consider the possible implications of different understandings of image/likeness for Christian living and normative practice, because different interpretations offer useful examples of how fundamental theological themes play out in the moral life, both methodologically and substantively. Finally, I analyze the links often drawn between image/likeness language and appeals to "human dignity," a term widely invoked in both religious and secular debates. In addressing that linkage, I consider whether faith-based claims about human dignity based on image/likeness language function independently, that is, without further specification in terms of other, perhaps more determinative, principles and norms. I also consider whether such religious understandings of the image/likeness theme, as the basis for dignity-claims, provide additions to, or correctives of, secular accounts of dignity.

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Selected abstracts of the third international congress of Immunology, Asthma and Allergy 2017, Iran

The third congress of Immunology, Asthma and Allergy (ICIAA) took place at the Imam Hall of Imam Khomeini Hospital, 15-17 February 2017. This congress was held under the presidency of Prof. Mostafa Moin jointly by Immunology, Asthma and Allergy Research Institute (IAARI), Iranian Society of Asthma & Allergy (ISAA), Tehran University of Medical Sciences (TUMS), Iran UNESCO Chair in Health Education and with endorsement of many outstanding national and international organizations including:

European Academy of Allergy And Clinical Immunology (EAACI),

European Society for Immunodeficiency (ESID),

World Allergy Organization (WAO),

Jeffrey Modell Foundation (JMF),

The International union of Immunological Societies (IUIS),

Latin American Society for Immunodeficiencies (LASID),

The International Patient Organisation for Primary Immunodeficiencies (IPOPI),

Affrican Society for Immunodeficiencies (ASID),

Asia Pacific Society for Immunodeficiency,

International Nursing Group for Immunodeficiencies (INGID).

Pathogenesis, diagnosis and treatment of primary immune deficiencies, asthma and allergy were discussed in ICIAAI 2017 from new and different aspects. More than 500 scientists, professors and young researchers from Iran, United States of America, Germany, Italy, Sweden, England, the Netherlands and Hungary participated in this event. Selected abstracts of the congress are published in the following supplement issue of Iranian Journal of Allergy, Asthma and Immunology (IJAAI).

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Primary care scribes: writing a new story for safety net clinics

The spread of electronic health records systems (EHRs) poses challenges for both patient and provider care experience. Limited research suggests that scribes offer potential benefits to productivity and clinician satisfaction in emergency health and specialty settings. We conducted this evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR 2011–2014. The scribe programme trained and managed scribes for 51 providers (25% participation) from 5 of 12 San Francisco Health Network primary care clinics. We evaluated the programme using four measures. Providers reported spending less time out of clinic completing notes after sessions with scribes versus sessions without scribes (14.0 min vs 30.2 min, p<0.01). The rate of incomplete EHR notes at 72 hours was not significantly different for clinics using and not using scribes (16.9% vs 16.7%, p=0.4). Mean visit length using EHR-recorded provider cycle time was shorter for sessions with scribes (24.0 min), compared with sessions without scribes (26.4 min, p<0.01). Patients at clinics using scribes were as likely to recommend their provider (74.5%), compared with patients at clinics not using scribes (74.3%). Limitations of our evaluation include selection bias and possible confounding by clinic- and provider-level factors. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.

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Cancer Registry follow-up for 17 million person-years of a nationwide maternity cohort

Abstract

Population-based Finnish Maternity Cohort (FMC) comprises 2M first trimester sera collected from 1M women during 33 years. Informed consent is by the opt-out principle, and linkages with cancer and population registries provide a base for over time and over generation studies. Follow-up for 17M person-years by the end of 2014 can identify 39,700 cases of invasive cancer and 18,900 cases of premalignant breast and cervix lesions, and basal cell carcinoma diagnosed after serum sampling. For women with multiple pregnancies, serial samples taken before cancer diagnosis are available. Offspring of the women have developed more than 4000 cancers. For 100,000 individuals, samples taken during the pregnancies of both their mothers and grandmothers enable familial cancer studies. FMC continues to collect samples, and surveillance of exposures or interventions like vaccination programs is feasible. In summary, the FMC is a unique, accessible biobank for epidemiological, biomarker, and surveillance studies on cancer.

We announce a biobank comprising virtually the entire population of Finnish females, who have been pregnant since 1983. The Finnish Maternity Cohort (FMC) is linkable with population-based health registers including the Finnish Cancer Registry. Serial prediagnostic serum samples and comprehensive data accessible over three generations provide possibilities for unique study settings. Selected examples on the use of the FMC in cancer studies hopefully stimulate international quest for this open access resource.

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Fracture

Fracture: A break in bone or cartilage. Although usually a result of trauma, a fracture can be the result of an acquired disease of bone, such as osteoporosis, or of abnormal formation of bone in a congenital disease of bone, such as osteogenesis imperfecta ('brittle bone disease'). Fractures are classified according to their character and location (for example, greenstick fracture of the radius).

MedTerms (TM) is the Medical Dictionary of MedicineNet.com.
We Bring Doctors' Knowledge To You

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Study protocol for the 'HelpMeDoIt! randomised controlled feasibility trial: an app, web and social support-based weight loss intervention for adults with obesity

Introduction

HelpMeDoIt! will test the feasibility of an innovative weight loss intervention using a smartphone app and website. Goal setting, self-monitoring and social support are three key facilitators of behaviour change. HelpMeDoIt! incorporates these features and encourages participants to invite 'helpers' from their social circle to help them achieve their goal(s).

Aim

To test the feasibility of the intervention in supporting adults with obesity to achieve weight loss goals.

Methods and analysis

12-month feasibility randomised controlled trial and accompanying process evaluation. Participants (n=120) will be adults interested in losing weight, body mass index (BMI)> 30 kg/m² and smartphone users. The intervention group will use the app/website for 12 months. Participants will nominate one or more helpers to support them. Helpers have access to the app/website. The control group will receive a leaflet on healthy lifestyle and will have access to HelpMeDoIt! after follow-up. The key outcome of the study is whether prespecified progression criteria have been met in order to progress to a larger randomised controlled effectiveness trial. Data will be collected at baseline, 6 and 12 months. Outcomes focus on exploring the feasibility of delivering the intervention and include: (i) assessing three primary outcomes (BMI, physical activity and diet); (ii) secondary outcomes of waist/hip circumference, health-related quality of life, social support, self-efficacy, motivation and mental health; (iii) recruitment and retention; (iv) National Health Service (NHS) resource use and participant borne costs; (v) usability and acceptability of the app/website; and (vi) qualitative interviews with up to 50 participants and 20 helpers on their experiences of the intervention. Statistical analyses will focus on feasibility outcomes and provide initial estimates of intervention effects. Thematic analysis of qualitative interviews will assess implementation, acceptability, mechanisms of effect and contextual factors influencing the intervention.

Ethics and dissemination

The protocol has been approved by the West of Scotland NHS Research Ethics Committee (Ref: 15/WS/0288) and the University of Glasgow MVLS College Ethics Committee (Ref: 200140108). Findings will be disseminated widely through peer-reviewed publication and conference presentations.

Trial registration number

ISRCTN85615983.

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Systematic review of interventions for improving the performance of community health workers in low-income and middle-income countries

Objective

To systematically review and critically appraise the evidence for the effects of interventions to improve the performance of community health workers (CHWs) for community-based primary healthcare in low- and middle-income countries.

Design

Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods

19 electronic databases were searched with a highly sensitive prespecified strategy and the grey literature examined, completed July 2016. Randomised controlled trials evaluating interventions to improve CHW performance in low- and middle-income countries were included and appraised for risk of bias. Outcomes were biological and behavioural patient outcomes (primary), use of health services, quality of care provided by CHWs and CHW retention (secondary).

Results

Two reviewers screened 8082 records; 14 evaluations were included. Due to heterogeneity and lack of clear outcome data, no meta-analysis was conducted. Results were presented in a narrative summary. The review found one study showing no effect on the biological outcomes of interest, though these moderate quality data may not be indicative of all biological outcomes. It also found moderate quality evidence of the efficacy of performance improvement interventions for (1) improving behavioural outcomes for patients, (2) improving use of services by increasing the absolute number of patients who access services and, perhaps, better identifying those who would benefit from such services and (3) improving CHW quality of care in terms of upstream measures like completion of prescribed activities and downstream measures like adherence to treatment protocols. Nearly half of studies were compound interventions, making it difficult to isolate the effects of individual performance improvement intervention components, though four specific strategies pertaining to recruitment, supervision, incentivisation and equipment were identified.

Conclusions

Variations in recruitment, supervision, incentivisation and equipment may improve CHW performance. Practitioners should, however, assess the relevance and feasibility of these strategies in their health setting prior to implementation. Component selection experiments on a greater range of interventions to improve performance ought to be conducted.

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Sexual orientation identity and tobacco and hazardous alcohol use: findings from a cross-sectional English population survey

Objectives

To assess the association between tobacco and hazardous alcohol use and sexual orientation and whether such an association could be explained by other sociodemographic characteristics.

Design

Cross-sectional household survey conducted in 2014–2016.

Setting

England, UK.

Participants

Representative English population sample (pooled n=43 866).

Main outcomes

Sexual orientation identity (lesbian/gay, bisexual, heterosexual, prefer-not-to-say); current tobacco and hazardous alcohol use (defined as Alcohol Use Disorders Identification Test Score ≥8). All outcomes were self-reported.

Results

Due to interactions between sexual orientation and gender for substance use, analyses were stratified by gender. Tobacco use prevalence was significantly higher among lesbian/gay (women: 24.9%, 95% CI 19.2% to 32.6%; men: 25.9%, 95% CI 21.3% to 31.0%) and bisexual participants (women: 32.4%, 95% CI 25.9% to 39.6%; men: 30.7%, 95% CI 23.7% to 30.7%) and significantly lower for prefer-not-to-say participants in women (15.5%, 95% CI 13.5% to 17.8%) but not men (22.7%, 95% CI 20.3% to 25.3%) compared with heterosexual participants (women: 17.5%, 95% CI 17.0% to 18.0%; men: 20.4%, 95% CI 19.9% to 21.0%; p<0.001 for omnibus test). Similarly, hazardous alcohol use was significantly more prevalent for lesbian/gay (women: 19.0%, 95% CI 14.0% to 25.3%; men: 30.0%, 25.2%–35.3%) and bisexual participants (women: 24.4%, 95% CI 18.7% to 31.3%; men: 24.3%, 95% CI 17.9% to 32.1%) and lower for prefer-not-to-say participants (women: 4.1%, 95% CI 3.0% to 5.4%; men: 13.7%; 95% CI 11.8% to 16.0%) compared with heterosexuals (women: 8.3%, 95% CI 7.9% to 8.7%; men: 18.4%, 95% CI 17.9% to 18.9%; p<0.001 for omnibus test). However, after adjusting for sociodemographic confounders, tobacco use was similar across all sexual orientation groups among both women and men. By contrast, sexual orientation differences in hazardous alcohol use remained even after adjustment among women but not for bisexual and gay men.

Conclusions

In England, higher rates of tobacco use among sexual minority men and women appear to be attributable to other sociodemographic factors. Higher rates of hazardous alcohol use among sexual minority men may also be attributable to these factors, whereas this is not the case for sexual minority women.

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Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands: a qualitative review of review committee judgements

AbstractObjectives

To assess how Dutch regional euthanasia review committees (RTE) apply the euthanasia and physician-assisted suicide (EAS) due care criteria in cases where the criteria are judged not to have been met ('due care not met' (DCNM)) and to evaluate how the criteria function to set limits in Dutch EAS practice.

Design

A qualitative review using directed content analysis of DCNM cases in the Netherlands from 2012 to 2016 published on the RTE website (http://ift.tt/2zQybkI) as of 31 January 2017.

Results

Of 33 DCNM cases identified (occurring 2012–2016), 32 cases (97%) were published online and included in the analysis. 22 cases (69%) violated only procedural criteria, relating to improper medication administration or inadequate physician consultation. 10 cases (31%) failed to meet substantive criteria, with the most common violation involving the no reasonable alternative (to EAS) criterion (seven cases). Most substantive cases involved controversial elements, such as EAS for psychiatric disorders or 'tired of life', in incapacitated patients or by physicians from advocacy organisations. Even in substantive criteria cases, the RTE's focus was procedural. The cases were more about unorthodox, unprofessional or overconfident physician behaviours and not whether patients should have received EAS. However, in some cases, physicians knowingly pushed the limits of EAS law. Physicians from euthanasia advocacy organisations were over-represented in substantive criteria cases. Trained EAS consultants tended to agree with or facilitate EAS in DCNM cases. Physicians and families had difficulty applying ambiguous advance directives of incapacitated patients.

Conclusion

As a retrospective review of physician self-reported data, the Dutch RTEs do not focus on whether patients should have received EAS, but instead primarily gauge whether doctors conducted EAS in a thorough, professional manner. To what extent this constitutes enforcement of strict safeguards, especially when cases contain controversial features, is not clear.

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Cognitive complexity of clients and counsellors during motivation-based treatment for smoking cessation: an observational study on occasional smokers in a US college sample

Objective

Motivational interviewing (MI) is a widely used and promising treatment approach for aiding in smoking cessation. The present observational study adds to other recent research on why and when MI works by investigating a new potential mechanism: integrative complexity.

Setting

The study took place in college fraternity and sorority chapters at one large midwestern university.

Participants

Researchers transcribed MI counselling sessions from a previous randomised controlled trial focused on tobacco cessation among college students and subsequently scored clients' and counsellors' discussions across four counselling sessions for integrative complexity.

Interventions

This is an observational secondary analysis of a randomised controlled trial that tested the effectiveness of MI. We analysed the relationship between integrative complexity and success at quitting smoking in the trial.

Primary and secondary outcome measures

Success in quitting smoking:Participants were categorised into two outcome groups (successful quitters vs failed attempters), created based on dichotomous outcomes on two standard variables: (1) self-reported attempts to quit and (2) number of days smoked via timeline follow-back assessment procedures that use key events in participants' lives to prompt their recall of smoking.

Results

We found (1) significantly higher complexity overall for participants who tried to quit but failed compared with successful quitters (standardised β=0.36, p<0.001, (Lower Confidence Interval.)LCI=0.16, (Upper Confidence Interval) UCI=0.47) and (2) the predictive effect of complexity on outcome remains when controlling for standard motivational and demographic variables (partial r(102)=–0.23, p=0.022).

Conclusions

Taken together, these results suggest that cognitive complexity is uniquely associated with successful quitting in MI controlled trials, and thus may be an important variable to more fully explore during treatment.

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Development and pilot testing of a decision aid for the initiation of antipsychotic medications in persons with dementia in long-term care using a systematic approach: a study protocol

Introduction

Antipsychotic medications are commonly used in long-term care to treat neuropsychiatric symptoms of dementia despite concerns that their risks (eg, infection, falls, death) may outweigh their benefits. This study protocol outlines the development and pilot testing of a decision aid for antipsychotic medications that is tailored to the information needs of residents with dementia in long-term care and family caregivers (or decision makers). The goals of the decision aid are to help residents and caregivers (1) better understand the risks and benefits of antipsychotic medications in long-term care, and (2) make informed decisions about their use (or non-use).

Methods and analysis

This multiphased study is being conducted between October 2016 and September 2018. In phase I, the decision aid will be developed after consultation with a steering group, review of scientific evidence on outcomes associated with pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care, review of guidelines for the use of antipsychotic medications in long-term care, and review of guidelines for writing health information for patients and families. The decision aid will also be alpha-tested and redrafted, as necessary, in phase I. In phase II, implementation and reporting guidelines for the decision aid will be developed in collaboration with Directors of Care in long-term care. In phase III, the decision aid will be (1) beta-tested with residents with dementia in long-term care and caregivers not involved in the design phase, and (2) assessed by an external panel of experts.

Ethics and dissemination

Ethical approval for this study has been granted by the Research Ethics Board at the University of Saskatchewan, approval number Beh 16-465. Findings from this study will be disseminated via conference presentations, publications, presentations to policy makers and plain language summaries to residents with dementia in long-term care and their caregivers.

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Sex differences in survival of patients with type 2 diabetes in primary care (ZODIAC-50)

Objective

To investigate sex differences in survival of primary care treated patients with type 2 diabetes (T2D) in the Netherlands.

Setting

Primary care.

Participants

A total of 1815 patients who participated in a prospective observational cohort study (Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC)) were included of which 56% was female. Inclusion took place in 1998, 1999 and 2001. Vital status was assessed in 2013.

Main outcome measure

Relative survival of men and women with T2D. The relative survival rate was expressed as the ratio of observed survival of patients divided by the survival of the general population in the Netherlands with comparable age.

Results

After 14 years, 888 (49%) patients had died. The relative survival rate was 0.88 (0.81–0.94) for men and 0.82 (0.76–0.87) for women with T2D after 14 years (p value for difference between sexes=0.169). In patients without a history of cardiovascular diseases (CVD), the relative survival was 0.99 (0.94–1.05) in men and 0.92 (0.87–0.97) in women (p value for difference between sexes=0.046).

Conclusions

The survival of men and women with T2D was 12% and 18% lower, respectively, after 14 years of follow-up compared with men and women in the general population. This corresponds to a decrease in median survival of 2.2 and 3.5 years in men and women, respectively. Only for patients with T2D without a history of CVD, a significantly lower relative survival in women compared with men with T2D was found.

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Projecting diabetes prevalence among Mexicans aged 50 years and older: the Future Elderly Model-Mexico (FEM-Mexico)

Objective

Diabetes has been growing as a major health problem and a significant burden on the population and on health systems of developing countries like Mexico that are also ageing fast. The goal of the study was to estimate the future prevalence of diabetes among Mexico's older adults to assess the current and future health and economic burden of diabetes.

Design

A simulation study using longitudinal data from three waves (2001, 2003 and 2012) of the Mexican Health and Aging Study and adapting the Future Elderly Model to simulate four scenarios of hypothetical interventions that would reduce diabetes incidence and to project the future diabetes prevalence rates among populations 50 years and older.

Participants

Data from 14 662 participants with information on self-reported diabetes, demographic characteristics, health and mortality.

Outcome measures

We obtained, for each scenario of diabetes incidence reduction, the following summary measures for the population aged 50 and older from 2012 to 2050: prevalence of diabetes, total population with diabetes, number of medical visits.

Results

In 2012, there were approximately 20.7 million persons aged 50 and older in Mexico; 19.3% had been diagnosed with diabetes and the 2001–2003 diabetes incidence was 4.3%. The no-intervention scenario shows that the prevalence of diabetes is projected to increase from 19.3% in 2012 to 34.0% in 2050. Under the 30% incidence reduction scenario, the prevalence of diabetes will be 28.6% in 2050. Comparing the no-intervention scenario with the 30% and 60% diabetes incidence reduction scenarios, we estimate a total of 816 320 and 1.6 million annual averted cases of diabetes, respectively, for the year 2020.

Discussion

Our study underscores the importance of diabetes as a disease by itself and also the potential healthcare demands and social burden of this disease and the need for policy interventions to reduce diabetes prevalence.

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An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific region: the "Ten Countries Study"

Objective

To determine physicians' knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region.

Setting

A formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment.

Participants

Practising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark.

Primary outcome

An assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions.

Results

1078 physicians completed the questionnaire from the Asia-Pacific region; only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines; this was significantly worse than physicians from the UK (35% vs 61%, p<0.001). Knowledge of prevalence (24%), inheritability (41%) and CVD risk (9%) of FH were also suboptimal. The majority of the physicians considered laboratory interpretative commenting as being useful (81%) and statin therapy as an appropriate cholesterol-lowering therapy (89%) for FH management.

Conclusions

The study identified important gaps, which are readily addressable, in the awareness and knowledge of FH among physicians in the region. Implementation of country-specific guidelines and extensive work in FH education and awareness programmes are imperative to improve the care of FH in the region.

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Lung function at term in extremely preterm-born infants: a regional prospective cohort study

Objectives

To compare lung function of extremely preterm (EP)-born infants with and without bronchopulmonary dysplasia (BPD) with that of healthy term-born infants, and to determine which perinatal characteristics were associated with lung function at term and how predictive these measurements were for later respiratory health in EP-born infants.

Methods

Perinatal variables were recorded prospectively, and tidal breathing parameters were measured at term-equivalent age using electromagnetic inductance plethysmography. Respiratory morbidity was defined by hospital readmissions and/or treatment with asthma medications during the first year of life.

Results

Fifty-two EP-born infants (mean gestational age 26¹, range 22⁶–27⁶ weeks) and 45 term-born infants were included. There was evidence of significant airway obstruction, higher tidal volumes and increased minute ventilation in the EP-born infants with and without BPD, although generally more pronounced for those with BPD. Male gender, antenatal steroids and number of days on continuous positive airway pressure were associated with lung function outcomes at term. A prediction model incorporating two unrelated tidal breathing parameters, BPD, birth weight z-score and gender, predicted respiratory morbidity in the first year of life with good accuracy (area under the curve 0.818, sensitivity and specificity 81.8% and 75.0%, respectively).

Conclusion

Lung function measured at term-equivalent age was strikingly abnormal in EP-born infants, irrespective of BPD. Tidal breathing parameters may be of value in predicting future pulmonary health in infants born premature.

Trial registration number

NCT01150396; Results.

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Bi-modal stimulation in the treatment of tinnitus: a study protocol for an exploratory trial to optimise stimulation parameters and patient subtyping

Introduction

Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus. Bimodal neuromodulation is emerging as a promising treatment for this condition. The main objectives of this study are to investigate the relevance of interstimulus timing and the choices of acoustic and tongue stimuli for a proprietary bimodal (auditory and somatosensory) neuromodulation device, as well as to explore whether specific subtypes of patients are differentially responsive to this novel intervention for reducing the symptoms of chronic tinnitus.

Methods and analysis

This is a two-site, randomised, triple-blind, exploratory study of a proprietary neuromodulation device with a pre–post and 12-month follow-up design. Three different bimodal stimulation parameter sets will be examined. The study will enrol 342 patients, split 80:20 between two sites (Dublin, Ireland and Regensburg, Germany), to complete 12 weeks of treatment with the device. Patients will be allocated to one of three arms using a stepwise stratification according to four binary categories: tinnitus tonality, sound level tolerance (using loudness discomfort level of <60 dB SL as an indicator for hyperacusis), hearing thresholds and presence of a noise-induced audiometric profile. The main indicators of relative clinical efficacy for the three different parameter sets are two patient-reported outcomes measures, the Tinnitus Handicap Inventory and the Tinnitus Functional Index, after 12 weeks of intervention. Clinical efficacy will be further explored in a series of patient subtypes, split by the stratification variables and by presence of a somatic tinnitus. Evidence for sustained effects on the psychological and functional impact of tinnitus will be followed up for 12 months. Safety data will be collected and reported. A number of feasibility measures to inform future trial design include: reasons for exclusion, completeness of data collection, attrition rates, patient's adherence to the device usage as per manufacturer's instructions and evaluation of alternative methods for estimating tinnitus impact and tinnitus loudness.

Ethics and dissemination

This study protocol is approved by the Tallaght Hospital/St. James's Hospital Joint Research Ethics Committee in Dublin, Ireland, and by the Ethics Committee of the University Clinic Regensburg, Germany. Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences.

Trial registration number

The trial is registered on ClinicalTrials.gov (NCT02669069) Pre-results.

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How do workplaces, working practices and colleagues affect UK doctors career decisions? A qualitative study of junior doctors career decision making in the UK

Objectives

This study draws on an in-depth investigation of factors that influenced the career decisions of junior doctors.

Setting

Junior doctors in the UK can choose to enter specialty training (ST) programmes within 2 years of becoming doctors. Their specialty choices contribute to shaping the balance of the future medical workforce, with views on general practice (GP) careers of particular interest because of current recruitment difficulties. This paper examines how experiences of medical work and perceptions about specialty training shape junior doctors' career decisions.

Participants

Twenty doctors in the second year of a Foundation Training Programme in England were recruited. Purposive sampling was used to achieve a diverse sample from respondents to an online survey.

Results

Narrative interviewing techniques encouraged doctors to reflect on how experiences during medical school and in medical workplaces had influenced their preferences and perceptions of different specialties. They also spoke about personal aspirations, work priorities and their wider future.

Junior doctors' decisions were informed by knowledge about the requirements of ST programmes and direct observation of the pressures under which ST doctors worked. When they encountered negative attitudes towards a specialty they had intended to choose, some became defensive while others kept silent. Achievement of an acceptable work-life balance was a central objective that could override other preferences.

Events linked with specific specialties influenced doctors' attitudes towards them. For example, findings confirmed that while early, positive experiences of GP work could increase its attractiveness, negative experiences in GP settings had the opposite effect.

Conclusions

Junior doctors' preferences and perceptions about medical work are influenced by multiple intrinsic and extrinsic factors and experiences. This paper highlights the importance of understanding how perceptions are formed and preferences are developed, as a basis for generating learning and working environments that nurture students and motivate their professional careers.

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Long-Term Effect of Pulsed Nd-YAG Laser Combined with Exercise on Bone Mineral Density in Men with Osteopenia or Osteoporosis: 1 Year of Follow-Up

Photomedicine and Laser Surgery , Vol. 0, No. 0.

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Aptamer affinity ligands in protein chromatography

Publication date: Available online 18 October 2017
Source:Biochimie
Author(s): Gérald Perret, Egisto Boschetti
The present review deals with the place of single chain oligonucleotide ligands (aptamers) in affinity chromatography applied to proteins. Aptamers are not the only affinity ligands available but they represent an emerging and highly promising route that advantageously competes with antibodies in immunopurification processes.A historical background of affinity chromatography from the beginning of the discipline to the most recent outcomes is first presented. Then the focus is centered on aptamers which represent the last step so far to the long quest for affinity ligands associating very high specificity, availability and strong stability against most harsh cleaning agents required in chromatography. Then technologies of ligand selection from large libraries followed by the most appropriate chemical grafting approaches are described and supported by a number of bibliographic references.Experimental results assembled from relevant published paper are reported; they are selected by their practical applicability and potential use at large scale.The review concludes with specific remarks and future developments that are expected in the near future to turn this technology into a large acceptance for preparative applications.

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Nutrient regulation of pancreatic β-cell proliferation

Publication date: Available online 5 October 2017
Source:Biochimie
Author(s): Valentine S. Moullé, Julien Ghislain, Vincent Poitout
Excess consumption of energy-dense foods combined with a sedentary lifestyle is driving an obesity epidemic. Although obesity is closely associated with insulin resistance, most individuals meet the insulin demand by increasing their functional β-cell mass. Those who eventually develop type 2 diabetes are distinguished by a failure in this compensatory process. Although a causal role of insulin resistance in compensatory β-cell responses has received considerable experimental support, precisely how the β cell senses changes in the metabolic environment is still unknown. As metabolism of glucose, lipids and amino acids is profoundly altered in obesity, it is not surprising that these nutrients are conspicuous among the factors proposed to contribute. In this review we summarise our understanding of the role of nutrients, in particular glucose, fatty acids and amino acids in β-cell compensation with a particular emphasis on their relation to insulin resistance-induced factors and their underlying mechanism of action. Finally, we describe the concept of epigenetic programming and review recent studies illustrating how the status of the β cell epigenome is a product of its nutrient environment, and how metabolic programming of the β cell contributes to diabetes risk.

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N6-adenine DNA methylation demystified in eukaryotic genome: From biology to pathology

Publication date: Available online 24 October 2017
Source:Biochimie
Author(s): Nidarshana Chaturvedi Parashar, Gaurav Parashar, Harsh Nayyar, Rajat Sandhir
N⁶-methyl-2′-deoxyadenosine (m6dA) is a well characterized DNA modification in prokaryotes. Its existence in eukaryotic DNA remained doubtful until recently. Evidence suggests that the m6dA levels decrease with the increasing complexity of eukaryotic genomes. Analysis of m6dA levels in genome of lower eukaryotes reveals its role in gene regulation, nucleosome positioning and early development. In higher eukaryotes m6dA is enriched in nongenic region compared to genic region, preferentially in chromosome X and 13 suggesting a chromosome bias. High levels of m6dA during embryogenesis as compared to adult tissues are indicative of its importance during development and possible association with regeneration capabilities. Further, decreased levels of m6dA in diabetic patients has been correlated with expression of Fat mass and obesity-associated (FTO) which acts as m6A demethylase. m6dA levels have also been reported to be decreased in different types of cancers. The present review highlights the role of m6dA modification in eukaryotic genomes and its functional importance in regulation of physiological and pathological processes.

Graphical abstract

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Aptamers as therapeutic middle molecules

Publication date: Available online 16 October 2017
Source:Biochimie
Author(s): Yoshikazu Nakamura
Therapeutic molecules can be classified as low-, middle- and high-molecular weight drugs depending on their molecular masses. Antibodies represent high-molecular weight drugs and their clinical applications have been developing rapidly. Aptamers, on the other hand, are middle-molecular weight molecules that are short, single-stranded nucleic acid sequences that are selected in vitro from large oligonucleotide libraries based on their high affinity to a target molecule. Hence, aptamers can be thought of as a nucleic acid analog to antibodies. However, several viewpoints hold that the potential of aptamers arises from interesting characteristics that are distinct from, or in some cases, superior to those of antibodies. Recently, therapeutic middle molecules gain considerable attention as protein-protein interaction (PPI) inhibitors. This review summarizes the recent achievements in aptamer development in our laboratory in terms of PPI and non-PPI inhibitors.

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Using binding competitors of albumin to promote the removal of protein-bound uremic toxins in hemodialysis: Hope or pipe dream?

Publication date: January 2018
Source:Biochimie, Volume 144
Author(s): Nans Florens, Dan Yi, Laurent Juillard, Christophe O. Soulage
Chronic kidney disease is associated with the accumulation of a large range of uremic retention solutes as referred to as uremic toxins. Some of these compounds belong to the group of Protein Bound Uremic Toxins (PBUT) due to their tight interactions with plasma proteins and especially serum albumin. These PBUT therefore exist in the bloodstream into two forms: a major bound (and non-diffusible) fraction and a minor free fraction. As a result, these compounds are poorly removed by most of the renal replacement therapies (such as hemodialysis) and their concentration can hardly be decreased in end-stage renal disease patients. An increase of the free fraction of PBUT could be achieved using chemical displacers that could compete with PBUT for binding to serum albumin. This review summarizes and discusses the interest of chemicals displacers as a valuable option to enhance PBUT removal in CKD patients.

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Therapeutic potential of Mediator complex subunits in metabolic diseases

Publication date: Available online 20 October 2017
Source:Biochimie
Author(s): Amol Ranjan, Suraiya A. Ansari
The multisubunit Mediator is an evolutionary conserved transcriptional coregulatory complex in eukaryotes. It is needed for the transcriptional regulation of gene expression in general as well as in a gene specific manner. Mediator complex subunits interact with different transcription factors as well as components of RNA Pol II transcription initiation complex and in doing so act as a bridge between gene specific transcription factors and general Pol II transcription machinery. Specific interaction of various Mediator subunits with nuclear receptors (NRs) and other transcription factors involved in metabolism has been reported in different studies. Evidence indicates that ligand-activated NRs recruit Mediator complex for RNA Pol II-dependent gene transcription. These NRs have been explored as therapeutic targets in different metabolic diseases; however, they show side-effects as targets due to their overlapping involvement in different signaling pathways. Here we discuss the interaction of various Mediator subunits with transcription factors involved in metabolism and whether specific interaction of these transcription factors with Mediator subunits could be potentially utilized as therapeutic strategy in a variety of metabolic diseases.

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The antimicrobial peptide nisin Z induces selective toxicity and apoptotic cell death in cultured melanoma cells

Publication date: Available online 17 October 2017
Source:Biochimie
Author(s): Angélique Lewies, Johannes Frederik Wentzel, Hayley van Dyk, Lissinda Hester Du Plessis
Reprogramming of cellular metabolism is now considered one of the hallmarks of cancer. Most malignant cells Reprogramming of cellular metabolism is now considered one of the hallmarks of cancer. Most malignant cells present with altered energy metabolism which is associated with elevated reactive oxygen species (ROS) generation. This is also evident for melanoma, the leading cause of skin cancer related deaths. Altered mechanisms affecting mitochondrial bioenergetics pose attractive targets for novel anti-cancer therapies. Antimicrobial peptides have been shown to exhibit selective anti-cancer activities. In this study, the anti-melanoma potential of the antimicrobial peptide, nisin Z, was evaluated in vitro. Nisin Z was shown to induce selective toxicity in melanoma cells compared to non-malignant keratinocytes. Furthermore, nisin Z was shown to negatively affect the energy metabolism (glycolysis and mitochondrial respiration) of melanoma cells, increase reactive oxygen species generation and cause apoptosis. Results also indicate that nisin Z can decrease the invasion and proliferation of melanoma cells demonstrating its potential use against metastasis associated with melanoma. As nisin Z seems to place a considerable extra burden on the energy metabolism of melanoma cells, combination therapies with known anti-melanoma agents may be effective treatment options.

Graphical abstract

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DCF1 subcellular localization and its function in mitochondria

Publication date: Available online 23 October 2017
Source:Biochimie
Author(s): Yanlu Chen, Ruili Feng, Guanghong Luo, Jianjian Guo, Yajiang Wang, Yangyang Sun, Lili Zheng, Tieqiao Wen
Dendritic cell factor 1 (DCF1) is a transmembrane protein that plays important roles in regulating neural stem cell differentiation and dendritic spine formation. Apart from its cytoplasmic functions, DCF1 plays a role in autophagy during the regulation of amyloid precursor proteins. However, the subcellular localization of DCF1 remains unknown. Therefore, in this study, DCF1 tagged with green fluorescent protein was transiently expression in HelaS3 and HEK293T cells. The results showed that DCF1 was widely expressed in different organelles, including the mitochondria, Golgi apparatus, endoplasmic reticulum, endosomes and lysosomes. An iodixanol step gradient further confirmed that DCF1 is localized to the mitochondria, endosomes, lysosomes, endoplasmic reticulum, and proteasome. Finally, functional analysis of the mitochondria revealed that DCF1 affected the expression and localization of MGST1. This study presents a comprehensive evaluation of the subcellular localization of DCF1, which provides important information on complex functions mediated by DCF1.

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Thermodynamic study of aptamers binding to their target proteins

Publication date: Available online 18 October 2017
Source:Biochimie
Author(s): Taiichi Sakamoto, Eric Ennifar, Yoshikazu Nakamura
Aptamers are nucleic acids that bind to a target molecule with high affinity and specificity, which are selected from systematic evolution of ligands by exponential enrichment (SELEX). Aptamers feature high affinity and specificity to their target molecule and a large structural diversity; biophysical tools, together with structural studies, are essential to reveal the mechanism of aptamers recognition. Furthermore, understanding the mechanism of action would also contribute to their development for therapeutic applications. Isothermal titration calorimetry (ITC) is a fast and robust method to study the physical basis of molecular interactions. In a single experiment, it provides all thermodynamic parameters of a molecular interaction, including dissociation constant, Kd; Gibbs free energy change, ΔG; enthalpy change, ΔH; entropy change, ΔS; and stoichiometry, N. The development of modern microcalorimeters significantly contributed to the expansion of the ITC use in biological systems. Therefore, ITC has been applied to the development of small therapeutic agents that bind to target proteins and is increasingly being used to study aptamer-target protein interactions. This review focuses on thermodynamic approaches for understanding the molecular principles of aptamer–target interactions.

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Systematic evaluation of cell-SELEX enriched aptamers binding to breast cancer cells

Publication date: Available online 18 October 2017
Source:Biochimie
Author(s): Laia Civit, Seyed Mohammad Taghdisi, Anna Jonczyk, Silvana Haßel, Carsten Gröber, Michael Blank, H. James Stunden, Marc Beyer, Joachim Schultze, Eicke Latz, Günter Mayer
The sensitive and specific detection of pathogenic cells is essential in clinical diagnostics. To achieve this, molecular tools are required that unequivocally recognise appropriate cell surface molecules, such as biomarkers that come along with disease onset and progression. Aptamers are short single-stranded oligonucleotides that interact with cognate target molecules with high affinity and specificity. Within the last years they have gained an increased attention as cell-recognition tools. Here, we report a systematic analysis of a cell-SELEX procedure, for the identification of aptamers that recognise breast cancer cells. Besides a comparison of conventional (Sanger) with high-throughput sequencing techniques (next-generation sequencing), three different screening techniques have been applied to characterise the binding properties of selected aptamer candidates. This method has been found to be beneficial in finding DNA aptamers, rarely enriched in the libraries. Finally, four DNA aptamers were identified that exhibit broad-spectrum interaction patterns to different cancer cell lines derived from solid tumours.

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Why do antifreeze proteins require a solenoid?

Publication date: Available online 17 October 2017
Source:Biochimie
Author(s): M. Banach, L. Konieczny, I. Roterman
Proteins whose presence prevents water from freezing in living organisms at temperatures below 0 °C are referred to as antifreeze proteins. This group includes molecules of varying size (from 30 to over 300 aa) and variable secondary/supersecondary conformation. Some of these proteins also contain peculiar structural motifs called solenoids. We have applied the fuzzy oil drop model in the analysis of four categories of antifreeze proteins: 1 – very small proteins, i.e. helical peptides (below 40 aa); 2 – small globular proteins (40–100 aa); 3 – large globular proteins (>100 aa) and 4 – proteins containing solenoids. The FOD model suggests a mechanism by which antifreeze proteins prevent freezing. In accordance with this theory, the presence of the protein itself produces an ordering of water molecules which counteracts the formation of ice crystals. This conclusion is supported by analysis of the ordering of hydrophobic and hydrophilic residues in antifreeze proteins, revealing significant variability – from perfect adherence to the fuzzy oil drop model through structures which lack a clearly defined hydrophobic core, all the way to linear arrangement of alternating local minima and maxima propagating along the principal axis of the solenoid (much like in amyloids). The presented model – alternative with respect to the ice docking model – explains the antifreeze properties of compounds such as saccharides and fatty acids. The fuzzy oil drop model also enables differentiation between amyloids and antifreeze proteins.

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Bar versus ball attachments for implant-supported overdentures in complete edentulism: A systematic review

Abstract

Background

Implant-supported overdenture is one of the most predictable treatment options used in complete edentulism. However, differences have been reported between bar and ball attachments used to retain overdentures in terms of patient satisfaction and prosthesis retention.

Purpose

The purpose of this study is to compare the effectiveness of bar and ball attachments for conventionally loaded implant-supported overdentures in completely edentulous patients to improve patient satisfaction and prosthesis retention.

Materials and methods

We conducted the review according to the Cochrane methods and following MECIR standards. We searched Cochrane Oral Health Group Trial register, Cochrane Central Register of Controlled Trials, MEDLINE, and the WHO ICTRP (March 31, 2017). Two review authors assessed trials for inclusion and risk of bias, extracted data, and checked for accuracy. We have expressed results as risk ratio or mean differences, together with their 95% confidence intervals.

Results

We included 10 trials (465 participants). After 5 y, one trial reported higher patient satisfaction when bar attachment was used (MD 1.30, 95% CI 0.20–2.40), and reported no difference between both systems in prosthesis retention (MD −0.90, 95% CI −1.90 to 0.10). Two trials reported no implant failures after 1 and 5 y in both attachments. Downgrading of evidence was based on the unclear risk of bias of included studies and the wide CI crossing the line of no effect.

Conclusions

There is insufficient evidence to support bar or ball attachment to be used with implant-supported overdentures in completely edentulous patients to improve patient satisfaction and prosthesis retention (PROSPERO 2014:CRD42014014594).

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Clinical Thyroidology for the Public – Highlighted Article

From Clinical Thyroidology for the Public: There has been a steady rise of thyroid cancers over the past several decades. Some of this is likely due to the increased use of imaging such as CT scans. However, it is likely that other factors play a role as well, including chemicals in our environment. Read More….

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology for the Public – Highlighted Article appeared first on American Thyroid Association.

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On the testing of Hardy-Weinberg proportions and equality of allele frequencies in males and females at biallelic genetic markers

ABSTRACT

Standard statistical tests for equality of allele frequencies in males and females and tests for Hardy-Weinberg equilibrium are tightly linked by their assumptions. Tests for equality of allele frequencies assume Hardy-Weinberg equilibrium, whereas the usual chi-square or exact test for Hardy-Weinberg equilibrium assume equality of allele frequencies in the sexes. In this paper, we propose ways to break this interdependence in assumptions of the two tests by proposing an omnibus exact test that can test both hypotheses jointly, as well as a likelihood ratio approach that permits these phenomena to be tested both jointly and separately. The tests are illustrated with data from the 1000 Genomes project.

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Impact of sample collection participation on the validity of estimated measures of association in the National Birth Defects Prevention Study when assessing gene-environment interactions

Abstract

To better understand the impact that nonresponse for specimen collection has on the validity of estimates of association, we examined associations between self-reported maternal periconceptional smoking, folic acid use, or pregestational diabetes mellitus and six birth defects among families who did and did not submit buccal cell samples for DNA following a telephone interview as part of the National Birth Defects Prevention Study (NBDPS). Analyses included control families with live born infants who had no birth defects (N = 9,465), families of infants with anorectal atresia or stenosis (N = 873), limb reduction defects (N = 1,037), gastroschisis (N = 1,090), neural tube defects (N = 1,764), orofacial clefts (N = 3,836), or septal heart defects (N = 4,157). Estimated dates of delivery were between 1997 and 2009. For each exposure and birth defect, odds ratios and 95% confidence intervals were calculated using logistic regression stratified by race-ethnicity and sample collection status. Tests for interaction were applied to identify potential differences between estimated measures of association based on sample collection status. Significant differences in estimated measures of association were observed in only four of 48 analyses with sufficient sample sizes. Despite lower than desired participation rates in buccal cell sample collection, this validation provides some reassurance that the estimates obtained for sample collectors and noncollectors are comparable. These findings support the validity of observed associations in gene-environment interaction studies for the selected exposures and birth defects among NBDPS participants who submitted DNA samples.

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On the testing of Hardy-Weinberg proportions and equality of allele frequencies in males and females at biallelic genetic markers

ABSTRACT

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Impact of sample collection participation on the validity of estimated measures of association in the National Birth Defects Prevention Study when assessing gene-environment interactions

Abstract

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Effect of Perceived Discrimination on Depressive Symptoms in 1st- and 2nd-Generation Afghan-Americans

Abstract

While it is well established that Afghan refugees are disproportionately affected by mental health problems, limited evidence exists concerning the psychosocial needs of their children who are transitioning to adulthood in the United States; that is, of 1st- and 2nd-generation Afghan-Americans. The purpose of this study was to examine the effect of perceived discrimination on depressive symptoms in this population, and to determine whether discrimination is buffered by ethnic identity and social support. A convenience sample of 133 1st- and 2nd-generation Afghan-Americans participated in this study by completing a brief survey. We used OLS regression methods to control for covariates, and to sequentially test study hypotheses. The results show that perceived discrimination was significantly associated with high levels of depression. Furthermore, the effect of discrimination on depression was not buffered by ethnic identity or social support. We found that perceived discrimination was a significant source of stress and a risk-factor for negative mental health outcomes among 1st- and 2nd-generation Afghan-Americans. Future research should examine additional pre-dispositional and protective factors for discriminatory experiences and associated health outcomes.

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The impact of a resident-run review curriculum and USMLE scores on the Otolaryngology in-service exam

Describe the association of USMLE Step 1 scores and the institution of a dedicated board review curriculum with resident performance on the Otolaryngology training examination.

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Low rate of positive bronchoscopy for suspected foreign body aspiration in infants

To describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body.

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Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI)

The aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese. 

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Low rate of positive bronchoscopy for suspected foreign body aspiration in infants

To describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body.

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Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI)

The aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese. 

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'She was sensational:' New Brunswick dentist killed at conference in...

New Brunswick dentist Cindy McCormick was a fearless, vibrant woman, known as much for belting out karaoke tunes as for constantly changing her colourful hairstyles. "She had it all: She was the jock, she was the brainiac, she was gorgeous.

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Minneapolis vet home to construct first-in-the-nation dental clinic

The Minnesota Department of Veterans Affairs announced plans Wednesday to build the first fixed dental clinic in the country on a state veterans home property. Construction is expected to begin immediately, with completion estimated in the spring of 2018 at the Minneapolis Veterans Home campus , the department said.

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Hipoacusia: Un nuevo factor de riesgo para demencia

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Quistes de cuerda vocal: Experiencia en 44 pacientes del Centro de Voz del Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile

RESUMEN Introducción: Los quistes de cuerda vocal son una causa relativamente frecuente de disfonía. Su origen es aún controversial, y su diagnóstico y manejo continúan siendo un desafío clínico. Objetivo: Exponer y analizar las características clínicas de los quistes de cuerda vocal en nuestra serie de pacientes. Material y método: Estudio retrospectivo descriptivo de los pacientes con diagnóstico de quiste de cuerda vocal atendidos en nuestro centro entre junio de 2012 y diciembre de 2015. Resultados: Se atendieron 44 pacientes con diagnóstico de quiste de cuerda vocal, lo que representa el 4,32% de las consultas en nuestro Centro de Voz. La mayoría de los pacientes fueron adultos, y de ellos el 68,29% correspondió a mujeres. El 34,1% de los pacientes fueron sometidos a tratamíento quirúrgico con técnica de microfonocirugía. El 75% de los pacientes operados presentó mejoría en patrón de onda mucosa videolaringoestroboscópica. Todos los pacientes en los que se disponía de encuestas de valoración subjetiva de la voz pre y posoperatorias demostraron mejoría vocal significativa. Conclusión: Los quistes de cuerda vocal son lesiones que afectan a niños y adultos. La videolaringoestroboscopía es clave en el diagnóstico de estas lesiones, y el tratamiento quirúrgico con microfonocirugía es efectiva en cuanto a resultados vocales desde el punto de vista anatómico y funcional.

ABSTRACT Introduction: Vocal cord cysts are a relatively frequent cause of dysphonia. Their origin is still controversial, and their diagnosis and management continue to be a clinical challenge. Aim: To describe and analyze the clinical characteristics of vocal cord cysts in our series of patients. Material and method: Descriptive retrospective study of patients with diagnosis of vocal cord cyst attended in our center between June 2012 and December 2015. Results: 44 patients had the diagnosis of vocal cord cyst, which represents 4.32% of the patients that attended our Voice Center during that period. Most of the patients were adults, and among them 68.29% corresponded to women. 34.1% of the patients were submitted to surgical treatment with microphonosurgery technique. 75% of the surgical patients presented an improvement in the pattern of the videolaryngostroboscopic mucosal wave. All the patients in which pre and postsurgical subjective voice assessment polls were available, showed a significant voice improvement. Conclusion: Vocal cord cysts are lesions that affect both children and adults. The videolaryngostroboscopy evaluation is key in the diagnosis of these lesions, and the surgical treatment with microphonosurgery is effective in terms of anatomical and functional vocal results.

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Sinus Tympani y recidiva en cirugía de colesteatoma

RESUMEN Introducción: El sinus tympani (ST) es una de las áreas que más presenta colesteatoma residual. Recientemente se ha clasificado en 3 tipos de acuerdo a su morfología. Objetivos: Determinar el tipo de ST en los pacientes sometidos a cirugía de colesteatoma y analizar su impacto como factor de recidiva. Material y método: Revisión de fichas clínicas de pacientes sometidos a cirugía de colesteatoma entre los años 2004 y 2015 en el Hospital Regional de Concepción. Análisis de la tomografía axial computarizada (TAC) preoperatoria y posterior evaluación clínica de los pacientes operados mediante mastoidectomía canal wall down (CWD). Resultados: En el periodo descrito se operaron 271 oídos. El 60% de los casos analizados presentó ST tipo A y 40% ST tipo B. Se identificaron 12 casos de recidiva, 3 ST tipo B y 9 ST tipo A, sin diferencia estadísticamente significativa entre ambos. Discusión: Distinto a lo reportado en la literatura el tipo de ST más frecuente en nuestro estudio fue el tipo A, lo que podría corresponder a una variable étnica. Conclusión: El estudio preoperatorio con TAC es una herramienta útil para evaluar el tipo y compromiso del ST. Las diferencias anatómicas entre ST tipo A y B parece no ser un factor determinante de recidiva en mastoidectomías CWD.

ABSTRACT Introduction: Sinus tympani (ST) is one of the areas with the most residual cholesteatoma. Recently it has been classified in 3 types according to its morphology. Aim: To determine the type of ST in patients undergoing cholesteatoma surgery and to analyze its impact as a relapse factor. Material and method: Review of clinical files of patients submitted to cholesteatoma surgery between 2004 and 2015 at the Regional Hospital of Concepción. Preoperative computed axial tomography (CT) analysis and subsequent clinical evaluation of patients operated by canal wall down mastoidectomy (CWD). Results: In the described period 271 ears were operated. 60% of the cases analyzed had ST type A and 40% ST type B. Twelve cases of relapse were identified, 3 ST type B and 9 ST type A, with no statistically significant difference between the two. Discussion: Unlike to what is reported in the literature, the most common ST type in our study was type A, which could correspond to an ethnic variable. Conclusion: The preoperative study with CT is a useful tool to evaluate the type and commitment of ST. The anatomical differences between ST type A and B seems not to be a determinant factor of relapse in CWD mastoidectomies.

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Fibroangioma nasofaríngeo juvenil. Experiencia de 15 años en el Hospital Barros Luco Trudeau

RESUMEN Introducción: El fibroangioma nasofaríngeo juvenil es un tumor vascular benigno localmente agresivo, que afecta casi exclusivamente la nasofaringe de adolescentes de sexo masculino. Su manejo es complejo dada su extensión, naturaleza vascular y sus frecuentes recurrencias. Objetivo: Mostrar la experiencia de 15 años en fibroangioma juvenil en nuestro centro. Material y método: Estudio descriptivo retrospectivo de los pacientes con diagnóstico de ingreso de fibroangioma nasofaríngeo juvenil al Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau entre los años 1997 y 2011, caracterizando al grupo de estudio en cuanto a características clínico-demográficas, vasos aferentes, relación entre etapa tumoral y vascularización, manejo terapéutico, complicaciones y recurrencias. Resultados: Se obtuvo un total de 20 pacientes, todos de sexo masculino, con un promedio de edad de 13,9 años. El síntoma de presentación más frecuente fue la epistaxis a repetición y obstrucción nasal presente en el 90% y 80%, respectivamente. Todos los pacientes se estudiaron con tomografia computarizada y recibieron embolización arterial preoperatoria. La mayoría de los tumores fueron de tipo II (65%) y III (20%), según clasificación de Radkowski. La técnica quirúrgica más empleada fue abierta (57,8%). Radioterapia en un caso. El vaso aferente principal fue la maxilar interno ipsilateral en el 100%. Todos los fibroangiomas etapa III eran además irrigados por la arteria carótida interna. Se encontró 20% de persistencia y 15% de recidiva. Conclusión: Nuestros resultados concuerdan con la gran mayoría de las series publicadas en la literatura. Epistaxis recurrente, obstrucción nasal y tumor nasal unilateral deben hacernos sospechar de esta patología en un adolescente masculino. El tratamiento de elección es la cirugía con embolización preoperatoria. La vía de abordaje endoscópica presenta menor morbilidad posoperatoria en pacientes con estadios I y II de Radkowski. Todos los fibroangiomas con compromiso intracraneano, presentan irrigación también del sistema carotideo interno.

ABSTRACT Introduction: Nasopharyngeal Fibroangioma is a locally aggressive benign vascular tumor. Its management is complex given its size, vascular nature and its frequent recurrences. Aim: To show the experience of 15 years in Juvenile Fibroangioma in our center. Material and method: Retrospective descriptive study of patients admitted with a diagnosis of Juvenile Fibroangioma Nasopharyngeal in the Department of Otolaryngology Hospital Barros Luco Trudeau between 1997 and 2011. Results: A total of 20 patients was obtained. The most common presenting symptom was recurrent epistaxis and nasal obstruction present in 90% and 80% respectively. The most common surgical technique was open (57.8%). Radiotherapy in one case. The main afferent vessel was the ipsilateral internal maxillary in 100%. All Fibroangioma stage III were also supplied by the internal carotid artery. 20% of persistence and 15% of recurrence was found. Conclusion: Recurrent epistaxis, nasal obstruction and unilateral nasal tumor should raise the suspicion of this disease in a male teenager. The treatment of choice is surgery with preoperative embolization. The route of endoscopic approach has less postoperative morbidity in patients with stage I and II of Radkowski. All Fibroangioma with intracranial commitment, have also the internal carotid irrigation system.

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Causas de rinoplastía secundaria: Análisis de 277 casos

RESUMEN Introducción: La rinoplastía secundaria cada día es más frecuente debido a la creciente popularidad de la cirugía estética y también por las mayores expectativas del paciente y del cirujano. La rinoplastía secundaria ha llegado a ser un campo en evolución con desafíos únicos. Para enfrentarlo adecuadamente el cirujano debe analizar y comprender las necesidades específicas del paciente y las causas anatómicas que generaron el problema y cómo corregirlo. Objetivo: Identificar los problemas anatómicos más frecuentemente encontrados en 277 rinoplastías secundarias y sistematizarlos para una mejor evaluación preoperatoria y planificación quirúrgica. Material y método: Análisis retrospectivo de 1.160 rinoplastías operadas por el otorrinolaringólogo Dr. Luis Villarroel entre el 1 de enero de 2006 y el 31 de marzo de 2015, de las cuales 277 son rinoplastías secundarias (24%). En ellas se encontraron 1.197 problemas o deformidades (4,3 promedio), que se dividieron en tercio superior, medio, inferior y endonasales, con una subdivisión de deformidades individuales dentro de cada grupo. También se comparan los resultados encontrados según si la cirugía primaria fue de otro cirujano (rinoplastías secundarias) o del mismo autor (rinoplastías de revisión). Resultados: El 85% de los pacientes presentó problemas en el tercio inferior. Los problemas más frecuentes fueron desviación del tabique nasal (problema endonasal) (56%), punta hiporotada (47%), desviación del dorso óseo (34%) y desviación del dorso cartilaginoso (30%). Las rinoplastías de revisión, comparadas con las secundarias, presentan un porcentaje mayor de problemas de insuficiente resección del dorso óseo y menos dorsos cartilaginosos estrechos. Conclusión: Existen diferentes razones por las que un paciente busca una rinoplastía secundaria. Es importante conocer las causas más frecuentes con el fin de identificar los errores cometidos en el primer caso y evitar dichas prácticas. Es preferible una cirugía primaria conservadora porque evita problemas difíciles de resolver. Esta clasificación nos ayuda a sistematizar el análisis preoperatorio, a saber, dónde estamos teniendo problemas y así corregirlos y obtener mejores resultados quirúrgicos.

ABSTRACT Introduction: Secondary rhinoplasty is becoming increasingly common due to the growing popularity of cosmetic surgery and also by higher expectations of the patient and the surgeon. Secondary rhinoplasty has become an evolving field with unique challenges. To repair the surgeon must properly analyze and understand the specific concerns of the patient and the anatomical causes of why you need a new operation. Aim: To identify anatomical problems most frequently found in 277 secondary and systematize rhinoplasty for better preoperative evaluation and surgical planning. Material and method: Retrospective analysis of 1160 rhinoplasty operated by otolaryngologist Dr. Luis Villarroel between January 1006 and March 31, 2015, of which 277 are secondary rhinoplasty (24%). In this study we found 1197 problems or deformities (average 4.3), They were classified into upper, middle, bottom third ,and endonasal, with an individual deformities subdivision within each group. The results are compared if the primary surgery was another surgeon (secondary rhinoplasty of others) or by the same author (revision rhinoplasty). Results: 85% of patients had problems in the lower third. The most common individual problems identificated were deviated septum (56%), drop tip (47%), bone dorsum deviation (34%), and cartilaginous dorsum desviation (30%). The author presents a higher percentage of insufficient bone resection and less cartilaginous dorsum narrow. Conclusion: There are different reasons why a patient seeks a secondary rhinoplasty. It is important to know the most frequent causes in order to identify the mistakes made in the first instance and avoid them. It's preferable one conservative primary surgery because it avoids difficult problems. This classification helps us to systematize the preoperative analysis and better results.

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Manejo endoscópico de anomalías del cuarto arco branquial: Reporte de tres casos

RESUMEN Las anomalías de cuarto arco branquial corresponden a una entidad patológica infrecuente. Para su manejo existen distintas alternativas terapéuticas siendo una de ellas la cauterización endoscópica. Reportamos 3 casos de senos de cuarto arco branquial tratados mediante cauterización endoscópica en el Hospital Regional de Concepción luego de una revisión de fichas clínicas de todos los pacientes con diagnóstico de anomalías de cuarto arco branquial. Se identificaron tres casos de senos de cuarto arco branquial. Todos corresponden a pacientes de sexo masculino que presentaron cuadro de absceso cervical, diagnosticándose 2 de ellos al presentar recurrencia. Todos fueron tratados mediante cauterización endoscópica de la apertura fistulosa en seno piriforme. Estas anomalías representan vestigios de un trayecto que se origina desde el vértice del seno piriforme. La cauterización endoscópica presenta una serie de ventajas con tasas de recurrencia similares a la cirugía abierta de cuello, menores tasas de complicaciones y costo económico. Las anomalias de cuarto arco branquial constituyen una patología infrecuente y el diagnóstico requiere alta sospecha clínica. El manejo endoscópico ha demostrado ser una alternativa segura y efectiva con menor tasa de complicaciones.

ABSTRACT Anomalies of the fourth branchial arch correspond to an uncommon pathological entity. There are different therapeutic alternatives being one of them the endoscopic cauterization. We report 3 cases of fourth branchial arch anomalies treated by endoscopic cauterization in the Regional Hospital of Concepción. Review of clinical records of all patients with diagnosis of fourth branchial anomalies operated by endoscopic cauterization at the Regional Hospital of Concepción. Cases: Three cases of fourth branchial arch sinus were identified. All of them were male patients who presented with a cervical abscess, diagnosing 2 of them when they recurred. All 3 cases were treated by endoscopic cauterization of the fistulous opening in the piriform sinus. These anomalies represent vestiges of a path that originates from the apex of the piriform sinus. Endoscopic cauterization presents a number of advantages with recurrence rates similar to open neck surgery, with lower complication rates and economic cost. Fourth branchial anomalies constitute an uncommon pathology and the diagnosis requires high clinical suspicion. Endoscopic management has proven to be a safe and effective alternative with a lower rate of complications.

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Manejo endoscópico de osteoma etmoidal con extensión orbitaria: A propósito de un caso

RESUMEN El osteoma es el tumor más frecuente de los senos paranasales, habitualmente asintomático debido a su lento crecimiento, sin embargo, pueden desarrollarse síntomas dependiendo del tamaño, localización y extensión, con potencial compromiso de órbita y cerebro. La cirugía está indicada en casos sintomáticos pudiendo realizarse abordaje externo, endoscópico o combinado. Presentamos un caso de osteoma etmoidal con compromiso orbitario resuelto, manejado por medio de la cirugía endoscópica nasal, con apoyo de navegación.

ABSTRACT The osteoma is the most common tumor of the paranasal sinuses, is usually asymptomatic because of their slow growth, however, may develop symptoms depending on the size, location and extent, with potential compromise of orbit and brain. Surgery is indicated in symptomatic cases, with external, endoscopic or combined approach. We present a case of ethmoidal osteoma with orbital involvement managed by endoscopic image guided surgery.

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Paroxismia vestibular: Reporte de un caso

RESUMEN Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

ABSTRACT We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

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Carcinoma parotídeo epitelial-mioepitelial: Presentación de un caso y revisión de la literatura

RESUMEN Se presenta caso de paciente de sexo femenino de 53 años de edad con tumor parotídeo izquierdo de larvada evolución, con crecimiento progresivo y otalgia ipsilateral en los últimos meses, estudiado previamente con tomografía de cuello con contraste y resonancia magnética que destacan masa del lóbulo profundo de la parótida de características imagenológicas benignas. Se realizó parotidectomía del lóbulo profundo con resección tumoral preservando el nervio facial casi en su totalidad con excepción de rama marginal, la biopsia de la pieza quirúrgica fue informada como carcinoma epitelialmioepitelial de bajo grado, un tumor infrecuente de las glándulas salivales. Se decidió completar la parotidectomía superficial y realizar vaciamiento ganglionar selectivo lateral ipsilateral, complementando el tratamiento con radioterapia. Además se presenta una revisión de la literatura correspondiente.

ABSTRACT We present a case of a 53 years old female patient with a left parotid tumor, with slow evolution, progressive growth and ipsilateral otalgia during later months. She was previously studied by tomography of the neck with contrast and magnetic resonance, which showed the mass of the deep lobe to have benign imaging characteristics. A parotidectomy of deep lobe was performed, with tumoral resection, preserving the facial nerve with the exception of the marginal branch. The biopsy was informed as epithelial-myoephitelial carcinoma, a rare salivary gland tumor. We completed the parotidectomy with neck dissection and Radiotherapy complementary was made. Besides we presented a literature review.

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Τετάρτη 25 Οκτωβρίου 2017

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