Search

Objective: To investigate the effects of single-dose intravenous dexamethasone on inflammatory responses, pain, nausea, and vomiting after uterine artery embolisation (UAE).Design: Prospective, randomised, double-blind, and placebo-controlled study.Setting: Tertiary-care University centre in Korea.Population: Patients undergoing UAE for the treatment of symptomatic fibroids or adenomyosis.Methods: Patients were randomised to receive either intravenous dexamethasone (10 mg; dexamethasone group) or normal saline (control group) 1 hour before UAE. Both groups received fentanyl-based intravenous patient-controlled analgesia (PCA) during the 24 hours after UAE.Main Outcome Measures: The primary outcomes were the inflammatory and stress responses measured by white blood cell count, neutrophil percentage, C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol. Secondary outcomes were severity of pain and incidence of nausea and vomiting.Results: Sixty-four patients were enrolled and 59 patients completed the study. CRP, IL-6, and cortisol were significantly lower in the dexamethasone group compared with the control group during the 24 hours after UAE. Although the cumulative dose of fentanyl and additional analgesics administered during the 24 hours after UAE were similar between the two groups, pain scores were significantly lower in the dexamethasone group from 12 hours after UAE, and the incidence of severe nausea and vomiting was lower in the dexamethasone group.Conclusions: The administration of single-dose intravenous dexamethasone as an adjunct to fentanyl-based intravenous PCA is effective in reducing inflammation and pain during the first 24 hours after UAE.Tweetable Abstract: Dexamethasone is effective in reducing inflammation and pain after uterine artery embolisation. [ABSTRACT FROM AUTHOR]

We evaluated the clinical utility of combined [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT), as well as CT and magnetic resonance imaging (MRI) in identifying nodal metastases in the contralateral neck in patients with head and neck squamous cell carcinoma (HNSCC). A total of 114 patients were preoperatively evaluated with PET/CT and CT/MRI. Histopathologic analysis from bilateral neck dissection tissues was used as the gold standard in assessing these imaging techniques. Of the 114 patients, 63 (55%) had neck metastases and 26 (23%) had contralateral neck metastases. On a per-level basis, FDG PET/CT was significantly more sensitive and accurate than CT/MRI in the ipsilateral (88% vs. 70%, P<0.01 and 93% vs. 89%, P<0.01, respectively) and contralateral (52% vs. 36%, P<0.01 and 91% vs. 90%, P=0.039, respectively) neck. PET/CT and CT/MRI were less sensitive in detecting contralateral than ipsilateral neck metastases due to the lower incidence of metastases and smaller nodes on the contralateral side. Combined PET/CT is superior to CT/MRI in detecting metastatic neck nodes in HNSCC patients. However, PET/CT may not abrogate the need for contralateral neck surgery or radiotherapy in these patients. [ABSTRACT FROM AUTHOR]

Objective: To examine patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska Native (AN) and white women living in Alaska. Methods: We used data from the 2000-2003 population-based Pregnancy Risk Assessment Monitoring System to describe patterns of self-reported prenatal tobacco use among AN and white women. We used multiple variable logistic regression analysis to identify maternal factors associated with quitting and relapse. The final sample included 5,458 women. Results: During 2000-2003, the prevalence of any tobacco use before pregnancy was twofold higher among AN women than among white women (60.0 vs. 27.5%), and the prevalence of any tobacco use during pregnancy and after pregnancy were each nearly threefold higher. Of the 25.8% (SE 0.9) of white women who smoked before pregnancy, 49.0% (SE 2.1) reported that they quit during pregnancy and of those, 41.1% (SE 2.9) relapsed postpartum. Of the 38.5% (SE 0.9) of AN women who smoked before pregnancy, 35.7% (SE 1.4) quit, and of those 57.0% (SE 2.4) relapsed. Of the 14.2% of AN women who chewed tobacco before pregnancy, 15.7% (SE 1.7) quit, and of those, 52.9% (SE 5.9) relapsed. Conclusion: During 2000-2003, the prevalence of tobacco use was two to three times higher among AN women than among white women before, during, and after pregnancy. In addition, AN women had lower quit rates and higher relapse rates than white women. Comprehensive, culturally appropriate tobacco control approaches targeting AN women are needed to increase cessation during pregnancy and to decrease relapse. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic value of the anterior chamber depth (ACD) of a globe as seen on CT for detecting open-globe injury.Methods: We enrolled 28 patients with unilateral open-globe injury confirmed by surgery and 28 controls with other types of orbital trauma. The diagnostic value of the difference of the ACDs between globes was evaluated by ROC analysis. The diagnostic performance of the following CT findings suggesting open-globe injury was also determined from independent analysis by two readers, i.e. change in the ACD and the globe contour, obvious volume loss of the globe, dislocated/deformed lens, intraocular foreign body/air and intraocular haemorrhage.Results: The ACD measurements were possible only in 15 patients with open-globe injuries. A difference in the ACDs > or =0.4 mm resulted in 0.85 of the area under the ROC curve with a sensitivity of 73% and specificity of 100% (p = 0.0001). The presence of one or more of the CT findings had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 89%.Conclusions: Change in the ACD is a helpful CT finding for detecting open-globe injury. A difference in the ACDs > or =0.4 mm is a helpful diagnostic criterion with excellent specificity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine trends in prenatal cigarette smoking and smokeless tobacco use among Alaska Native (AN) and white women in Alaska. METHODS: Using 1996-2003 data from the population-based Pregnancy Risk Assessment Monitoring System, we determined trends in self-reported prenatal tobacco use among AN and white women and used chi-square tests and multiple variable logistic regression analysis to identify maternal factors associated with prenatal tobacco use. RESULTS: Over the study period, prevalence of any tobacco use during pregnancy declined by 27% among AN women (from 55.8 to 40.9%) (P < 0.0001) and by 17% among white women (from 18.8 to 15.6%) (P < 0.0001). In 2003, among AN women the prevalence of self-reported smokeless tobacco use was 16.9%, cigarette smoking was 25.7%, and any tobacco use was 40.9%; corresponding values for white women were 0.4, 15.0, and 15.6%, respectively. Western Alaska had the highest prevalence of tobacco use. CONCLUSION: The prevalence of tobacco use decreased between 1996 and 2003, but remained higher among AN women than white women, especially for smokeless tobacco. Support for cessation interventions targeting pregnant women should be made a public health priority in Alaska. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To provide a current estimate of the prevalence of prepregnancy obesity in the United States. METHODS: We analyzed 2004-2005 data from 26 states and New York City (n = 75,403 women) participating in the Pregnancy Risk Assessment Monitoring System, an ongoing, population-based surveillance system that collects information on maternal behaviors associated with pregnancy. Information was obtained from questionnaires self-administered after delivery or from linked birth certificates; prepregnancy body mass index was based on self-reported weight and height. Data were weighted to provide representative estimates of all women delivering a live birth in each particular state. RESULTS: In this study, about one in five women who delivered were obese; in some state, race/ethnicity, and Medicaid status subgroups, the prevalence was as high as one-third. State-specific prevalence varied widely and ranged from 13.9 to 25.1%. Black women had an obesity prevalence about 70% higher than white and Hispanic women (black: 29.1%; white: 17.4%; Hispanic: 17.4%); however, these race-specific rates varied notably by location. Obesity prevalence was 50% higher among women whose delivery was paid for by Medicaid than by other means (e.g., private insurance, cash, HMO). CONCLUSION: This prevalence makes maternal obesity and its resulting maternal morbidities (e.g., gestational diabetes mellitus) a common risk factor for a complicated pregnancy. [ABSTRACT FROM AUTHOR]

The assumption that heritage language fluency is an essential component of ethnic identity, and that both factors are important predictors of school effort, was tested across two ethnic groups spanning multiple generations of immigrants. The sample consisted of 207 immigrant Chinese (first- and second-generation) and 354 Mexican (first-, second-, and third-generation) adolescents. The findings demonstrate that heritage language fluency is an important component of ethnic identity for second-generation Mexican adolescents, but not for second-generation Chinese adolescents. Thus, for this latter group, it may not be appropriate to use identity measures that assess heritage language fluency as a part of the general dimension of ethnic identity. The findings also show that higher reading and writing skills in Spanish are significant predictors of school effort for all three generations of Mexican adolescents; in addition, higher ethnic identity exploration is related to the school effort of second-generation Mexican adolescents. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: The possible influence of apolipoprotein E (ApoE) genotype on the response to acetylcholinesterase inhibitor therapy in patients with Alzheimer's disease (AD) remains a matter of controversy. In order to address this issue, we investigated the effects of ApoE genotype on the clinical response to donepezil in patients with mild to moderate AD. METHODS: An open study was carried out in 51 patients with probable AD who were treated with 5-10 mg of donepezil per day for 48 weeks. RESULTS: Eighteen (35.3%) of the 51 patients had 1 or 2 ApoE epsilon4 alleles. ApoE epsilon4 carriers with AD showed a mean 1.1-point increase from the baseline score of 23.9 on the 70-point Alzheimer's Disease Assessment Scale-Cognitive Component at 48 weeks, while the ApoE epsilon4 noncarrier group showed a 3.1-point increase from the baseline score of 22.5 (p = 0.03). The ApoE epsilon4 carrier group exhibited a mean 0.13-point worsening from the baseline score of 0.97 on the Korean Instrumental Activities of Daily Living at 48 weeks, while the ApoE epsilon4 noncarrier group exhibited a 0.17-point worsening from the baseline score of 0.64 (p = 0.05). CONCLUSION: AD patients who carry the ApoE epsilon4 allele may respond more favorably to donepezil than epsilon4 noncarriers. [ABSTRACT FROM AUTHOR]

Cost effectiveness is becoming an increasingly important factor for stakeholders faced with decisions about adding a new vaccine into national immunization programmes versus alternative use of resources. Evaluating cost effectiveness, taking into account the relevant biological, clinical, epidemiological and economic factors of a vaccination programme, generally requires use of a model. This review examines the modelling approaches used in cost-effectiveness analyses (CEAs) of vaccination programmes.After overviewing the key attributes of models used in CEAs, a framework for categorising theoretical models is presented. Categories are based on three main attributes: static/dynamic; stochastic/deterministic; and aggregate/individual based. This framework was applied to a systematic review of CEAs of all currently available vaccines for the period of 1976 to May 2007. The systematic review identified 276 CEAs of vaccination programmes. The great majority (83%) of CEAs were conducted in the setting of high-income countries. Only a few vaccines were widely studied, with 57% of available CEAs being focused on the varicella, influenza, hepatitis A, hepatitis B or pneumococcal vaccine. Several time trends were evident, indicating that the number of vaccine CEAs being published is increasing; the main health outcome measures are moving away from the number of cases prevented towards quality-adjusted and unadjusted life-years gained, and more complex models are beginning to be used. The modelling approach was often not adequately described. Of the 208 CEAs that could be categorized according to the framework, around 90% were deterministic, aggregate-level static models. Although a dynamic transmission model is required to account for herd-immunity effects, only 23 of the CEAs were dynamic. None of the CEAs were individual based. To improve communication about the cost effectiveness of vaccination programmes, we believe the first step is for analysts to be more transparent with each other. A clear description of the model type using consistent terminology and justification for the model choice must begin to accompany all CEAs. As a minimum, we urge modellers to provide an explicit statement about the following attributes: static/dynamic; stochastic/deterministic; aggregate/individual based; open/closed. Where relevant, time intervals (discrete/continuous) and (non)linearity should also be described. Enhanced methods of assessing model performance and validity are also required. Our results emphasize the need to improve modelling methods for CEAs of vaccination programmes; specifically, model choice, construction, assessment and validation. [ABSTRACT FROM AUTHOR]

This longitudinal study examined whether supportive parenting mediates relations between parent–child differences in cultural orientation (generational dissonance) and depressive symptoms with a sample of 451 first and second generation Chinese American parents and adolescents (12–15 years old at time 1). Using a person-centered approach, meaningful typologies of cultural orientation were derived for fathers, mothers, and adolescents. Overall, results provided support, though qualified, for the notion that generational dissonance is linked to depressive symptoms through decreased supportive parenting. In general, having a parent with a bicultural profile seemed to be most advantageous if adolescents similarly had a bicultural profile, whereas more American oriented adolescents with more Chinese oriented parents reported the least supportive parenting and most depressive symptoms. Directions for future research and the benefits of using a person-centered approach in research of acculturation and generational dissonance are discussed. [ABSTRACT FROM AUTHOR]

Advances in technology have reduced the risk of fracture of ceramic total hip arthroplasty implants, but concerns remain about fracture of both components. We retrospectively reviewed 133 patients (157 hips) who had cementless alumina-on-alumina total hip arthroplasties with a sandwich-type acetabular component. Six patients (seven hips) died and five patients (six hips) were interviewed by telephone (95% followup). The 122 patients (144 hips) examined had a minimum followup of 36 months (average, 45 months; range, 36-68 months). All acetabular cups and femoral stems were radiographically stable at the last followup. Five hips in five patients (3.5%) were revised because of ceramic liner fractures. Ceramic liner fractures occurred at a mean of 35 months (range, 24-48 months) postoperatively. Acetabular cups in the fracture group (n = 5) were more anteverted than those in the nonfracture group (n = 139). In three patients the fracture apparently occurred during squatting, resulting in hyperflexion and wide hip abduction. Early ceramic liner fracture was associated with impingement associated with excessive anteversion of the acetabular cup in Korean patients who habitually squat. [ABSTRACT FROM AUTHOR]

Background: Unstable intertrochanteric fractures in elderly patients are associated with a high rate of complications. The purpose of this investigation was to compare the results of long-stem cementless calcar-replacement hemiarthroplasty with those of treatment with a proximal femoral nail for unstable intertrochanteric fractures in elderly patients.Methods: Fifty-eight elderly patients with an AO/OTA type 31-A2 intertrochanteric fracture of the femur were randomized into two treatment groups and were followed for a minimum of two years. The twenty-nine patients in Group I were treated with a long-stem cementless calcar-replacement prosthesis, and the twenty-nine patients in Group II were treated with a proximal femoral nail. The two treatment groups were comparable with regard to demographic and injury variables.Results: There were no significant differences between the groups in terms of functional outcomes, hospital stay, time to weight-bearing, or general complications. Patients treated with a proximal femoral nail had a shorter operative time, less blood loss, fewer units of blood transfused, a lower mortality rate, and lower hospital costs compared with those treated with the long-stem cementless calcar-replacement prosthesis.Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture, a proximal femoral nail provides superior clinical outcomes but no advantage with regard to functional outcome when compared with a long-stem cementless calcar-replacement arthroplasty.Level Of Evidence: Therapeutic Level I. [ABSTRACT FROM AUTHOR]

Background: Many authors have reported good results with the use of vascularized fibular grafts to treat large osteonecrotic lesions of the femoral head. To our knowledge, there have been no prospective case-controlled studies comparing the effectiveness of vascularized fibular grafting with that of nonvascularized fibular grafting for the prevention of progression and collapse of the lesion.Methods: Nineteen patients (twenty-three hips) with a large osteonecrotic lesion of the femoral head (Stage IIC in ten hips, Stage IIIC in two, and Stage IVC in eleven, according to the classification system of Steinberg et al.) underwent vascularized fibular grafting. This group was retrospectively matched according to the etiology, stage, and size of the lesion to a group of nineteen patients (twenty-three hips) who underwent nonvascularized fibular grafting during the same time period. A prospective case-controlled study of the two groups, with a mean duration of follow-up of four years, was then performed.Results: The mean Harris hip score improved for 70% of the hips treated with a vascularized graft and 35% of the hips treated with a nonvascularized graft (p < 0.05). At the time of the final follow-up, nine of the ten hips with a Stage-IIC lesion treated with a vascularized fibular graft had not collapsed whereas seven of the thirteen hips with a larger lesion (Stage IIIC or IVC) had collapsed. Three hips (13%) were converted to a total hip replacement. The mean dome depression measured 2.8 mm. In the group treated with a nonvascularized graft, five of the ten Stage-IIC hips had not collapsed and eleven of the thirteen hips with a larger lesion had collapsed. Five (22%) of the hips were converted to a total hip replacement. The mean dome depression measured 4.3 mm. The rates of radiographic progression and collapse were significantly lower and the mean dome depression was significantly less in the group treated with a vascularized fibular graft (p < 0.05).Conclusions: Vascularized fibular grafting was associated with better clinical results and was more effective than nonvascularized fibular grafting for the prevention of collapse of the femoral head in a matched population with a Steinberg Stage-IIC or larger osteonecrotic lesion. The results of vascularized grafting were best when the procedure was used to treat precollapse lesions (Steinberg Stage IIC). [ABSTRACT FROM AUTHOR]

Objectives To examine the low response rates to the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for American Indian (AI) mothers by comparing characteristics of AI participants, AI non-participants, non-Hispanic White (NHW) participants, and NHW non-participants. Methods We analyzed 2000-2002 data from states whose population was at least 5% AI or Alaska Native (AN) (n = 10). Mothers who returned a questionnaire (regardless of completion) or who spoke by telephone with PRAMS personnel were defined as contacts. Mothers who completed a PRAMS questionnaire were defined as respondents. We described overall and state-specific maternal characteristics from birth certificates for both those who were contacted and those not contacted and computed contact and response rates. Results Contact rates varied by state, ranging from 49% to 92% for AI and AN mothers and 82-93% for NHW mothers. However, once contacted, most mothers completed a questionnaire (85-99%). Both AI and NHW mothers were less likely to be contacted if they were <29 years of age, unmarried, multiparous and had <=12 years of education. Conclusions Recognized predictors of response to PRAMS surveys were similar for AI and NHW mothers. Although contact rates among AI mothers were low when compared to whites, both AI and NHW mothers who were successfully contacted had high participation rates. Ultimately, evidence from states with high response rates for AI suggests that successful efforts will require experience and may be state-specific. In addition, increased state and tribal collaboration may facilitate improved PRAMS contact and response rates among AI. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the amount of tagged stool and fluid significantly affects the radiation exposure in low-dose screening CT colonography performed with an automatic tube-current modulation technique.Methods: The study included 311 patients. The tagging agent was barium (n = 271) or iodine (n = 40). Correlation was measured between mean volume CT dose index (CTDI (vol)) and the estimated x-ray attenuation of the tagged stool and fluid (ATT). Multiple linear regression analyses were performed to determine the effect of ATT on CTDI (vol ) and the effect of ATT on image noise while adjusting for other variables including abdominal circumference.Results: CTDI (vol) varied from 0.88 to 2.54 mGy. There was no significant correlation between CTDI (vol) and ATT (p = 0.61). ATT did not significantly affect CTDI (vol) (p = 0.93), while abdominal circumference was the only factor significantly affecting CTDI (vol) (p < 0.001). Image noise ranged from 59.5 to 64.1 HU. The p value for the regression model explaining the noise was 0.38.Conclusion: The amount of stool and fluid tagging does not significantly affect radiation exposure. [ABSTRACT FROM AUTHOR]

Objective: To prospectively evaluate the technical feasibility of percutaneous real-time contrast-enhanced ultrasound (CEUS) guided biopsy of focal hepatic lesions that are not confidently localised on B-mode US.Methods: The study included 44 patients (mean age, 61.3 years) whose biopsy target could not be confidently localised on B-mode US performed by two independent radiologists. Biopsy was attempted under the guidance of both CEUS and B-mode US simultaneously displayed on a single monitor. Final diagnosis was established based on the pathological examination of the biopsy specimen as well as on clinical and radiological follow-up.Results: The size and depth of the target lesions were 18.0 +/- 9.0 mm (mean +/- SD) and 41.8 +/- 17.2 mm respectively. Five patients with negative or indistinct CEUS findings did not undergo biopsy, while 39 patients completed the biopsy. In 38 of the 39 patients, the biopsy result was concordant with the final diagnosis. In the remaining one patient, the biopsy failed to prove metastasis. As there were six cases of technical failure, the technical success rate was 86% (38/44). The sensitivity in diagnosing malignancy was 88% (30/34).Conclusion: Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localised on B-mode US. [ABSTRACT FROM AUTHOR]

Background: The performance of the computer-aided detection (CAD) system can be determined by the sensitivity and false-positive marks rate, therefore these factors should be improved by upgrading the software version of the CAD system. Purpose: To compare retrospectively the performances of two software versions of a commercially available CAD system when applied to full-field digital mammograms for the detection of breast cancers in a screening group. Material and Methods: Versions 3.1 and 8.3 of a CAD software system (ImageChecker, R2 Technology) were applied to the full-field digital mammograms of 130 women (age range 36-80, mean age 53 years) with 130 breast cancers detected by screening. Results: The overall sensitivities of the version 3.1 and 8.3 CAD systems were 92.3% (120 of 130) and 96.2% (125 of 130) (P=0.025), respectively, and sensitivities for masses were 78.3% (36 of 46) and 89.1% (41 of 46) (P=0.024) and for microcalcifications 100% (84 of 84) and 100% (84 of 84), respectively. Version 8.3 correctly marked five lesions of invasive ductal carcinoma that were missed by version 3.1. Average numbers of false-positive marks per image were 0.38 (0.15 for calcifications, 0.23 for masses) for version 3.1 and 0.46 (0.13 for calcifications, 0.33 for masses) for version 8.3 (P=0.1420). Conclusion: The newer version 8.3 of the CAD system showed better overall sensitivity for the detection of breast cancer than version 3.1 due to its improved sensitivity for masses when applied to full-field digital mammograms. [ABSTRACT FROM AUTHOR]

Treating young patients with femoral head osteonecrosis (ON) remains challenging. Anatomic stems were introduced in the 1980s and 1990s to improve the proximal canal fit in an attempt to enhance long-term implant survival, an important aspect of treating young patients. We began using one design in 1993 and asked three questions to confirm whether the design criteria improved outcomes in patients with ON: (1) What is the long term survivorship of these implants?; (2) What is the amount and rate of wear?; and (3) What is the incidence of osteolysis? We retrospectively reviewed 56 patients (69 hips) who underwent THA for femoral head ON with a cementless anatomic stem proximally coated with hydroxyapatite. Four patients (four hips) were lost to followup and 16 patients (19 hips) died. In the remaining 36 patients (46 hips) the minimum followup was 10 years (mean, 11.2 years; range, 10-13 years). The mean age at operation was 48.6 years. The average Harris hip score at last followup was 87 points. Worst-case survivorship was 58.1% at 13 years and best-case was 93.3%. The average linear wear of the polyethylene liner was 2.02 mm and the average annual wear was 0.18 mm per year. Thirty-seven hips (80%) had femoral osteolysis and 14 (30%) had acetabular osteolysis. One patient who had extensive femoral osteolysis and stem loosening was revised at 11.2 years postoperatively. The high rates of polyethylene wear and osteolysis are of concern. [ABSTRACT FROM AUTHOR]

Brain Respiration (BR)-training is a unique form of breathing exercise that develops potential ability by facilitating brain function. It is recognized as an effective method of improving the scholastic aptitude and emotional stability of children. The present study was designed to investigate the characteristics of the EEG during this training. Spectral analysis was used to examine the relative power in the EEG of 12 children while they practiced BR-training, and these were compared to those of 12 matched controls. BR-trainees showed a lower theta rhythm than the controls before the training session began and lower beta2 power before, during and after the session. In contrast, the BR subjects showed greater relative alpha1 power than the controls in the left frontal region during BR-training, which persisted throughout the BR-training schedule. There is evidence that decreased theta and beta waves may be correlated with emotional maturation, whilst increased alpha waves are associated with educational achievement. These findings enhance our understanding of the neurophysiological basis of the effects of BR-training upon emotion and maturation. [ABSTRACT FROM AUTHOR]

Objectives Postoperative surgical site infection ( SSI) is a frequent postoperative complication in patients with oral cancer and significantly affects patient recovery and medical expenses. The aim of this study was to examine the predictors of SSI in patients undergoing major surgery for oral or oropharyngeal squamous cell carcinoma ( OSCC) and to determine the relationship between perioperative albumin and the development of SSI. Subjects and methods In 337 consecutive patients who underwent clean-contaminated surgery for OSCC, serum albumin, glucose, and hemoglobin levels were perioperatively measured. Differences between the groups were examined using Fisher's exact test, Mann-Whitney U-test, and multiple logistic regression analysis. Results Surgical site infection was detected in 88 (26.1%) patients with median time to development of 10 (2-25) days. Multiple logistic regression analysis showed that only postoperative serum albumin < 2.5 g dl−1 was an independent variable predictive of SSI ( P = 0.003). The duration of hospital stay was negatively correlated with postoperative albumin ( R2 = -0.302, P < 0.001). Conclusion Early postoperative hypoalbuminemia <2.5 g dl−1 is an independent risk factor for the development of SSI in patients undergoing oral cancer surgery. Clinicians should be aware of the implications of postoperative hypoalbuminemia and consider more intensive postoperative care in these patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the feasibility of Volume NT(TM) , a new technique that automatically archives mid-sagittal plane views and measures the maximum nuchal translucency (NT) thickness, by comparing its measurements with those made with conventional two- (2D) and three-dimensional (3D) techniques. METHODS: This was a prospective study of 130 singleton pregnancies undergoing NT screening at 11 + 0 to 13 + 6 weeks of gestation. Fetuses with enlarged NT or multiple anomalies and those in the prone position were excluded. Success rate of NT measurement was assessed using Volume NT(TM) , 2D and 3D techniques. In cases in which all three techniques were successful, intra- and interobserver bias and levels of agreement for NT measurements within and between techniques were evaluated using Bland-Altman plots. RESULTS: Of 130 cases enrolled into the study, 16 were excluded from analysis due to enlarged NT (n = 3), prone position (n = 2) or missing data (n = 11). Among the 114 cases analyzed, NT measurement was successful by the conventional 2D method in 95.6% (109/114) of cases and by 3D and Volume NT(TM) measurements in 103 and 93 cases, respectively. Success rate was not significantly different between methods. In 89 cases, NT values were available using all three methods. Among them, mean ± SD 2D-NT was 1.3 ± 0.4 mm, 3D-NT was 1.2 ± 0.4 mm and Volume NT(TM) was 1.3 ± 0.4 mm. The mean differences of the intra- and interobserver variability of each method were not significantly different from zero for each method. CONCLUSIONS: Volume NT(TM) , a novel technique for automated NT measurement, is apparently reproducible and comparable with conventional 2D and 3D ultrasound techniques for NT measurement. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We developed a Tele-Airway Management System (TAMS) which contained two high quality videocameras which were set up to view the frontal and lateral parts of the patient. Another endoscopic camera, a videolaryngoscope, was used to view the anatomy of the airway. One patient monitor was used to view the vital signs and there was also a PC terminal. A study was conducted in two separate emergency departments with 33 novice intubators (medical students and interns of the department). Remote consultation was provided by a board certified emergency physician. The time taken to complete endotracheal intubation for the TAMS group was 82.1 s (SE 4.9) and was 103.8 s (SE 7.9) in the videolaryngoscope-only group. The difference was significant (P = 0.03). The success rate of endotracheal intubation within 2 min was 94% for the TAMS group and 63% in the videolaryngoscope-only group (P = 0.04). With a wireless communication system, the TAMS could be installed in an ambulance, which might allow paramedics to perform safe and effective airway management in the field. [ABSTRACT FROM AUTHOR]

Propylthiouracil (PTU) is a drug used to treat hyperthyroidism. A number of adverse effects have been reported with this drug, including fever, agranulocytosis, skin rash, and vasculitis. PTU-induced interstitial pneumonia is rare--only three cases have been reported--and PTU-induced nonspecific interstitial pneumonia (NSIP) has not been reported. We report a patient who developed NSIP after taking PTU for 1 year. She developed dyspnea, cough, and mild fever lasting 1 month, and a chest CT scan showed multifocal patchy consolidation in both lungs. She underwent a surgical lung biopsy, and NSIP was confirmed pathologically. The symptoms and abnormalities seen in the chest radiograph improved after withdrawal of PTU. To our knowledge, this is the first documented case of pathologically proven PTU-induced NSIP. [ABSTRACT FROM AUTHOR]

Bone marrow stem cells (BMSCs) can be obtained from the vertebral body (VB) and iliac crest (IC) for augmenting spinal arthrodesis. However, it is still not evaluated, which of the two sites would have a better BMSCs potential on Proliferation and osteoblastic differentiation is still not evaluated. Fourteen patients (10 men and 4 women) undergoing posterolateral lumbar arthrodesis and pedicle screw instrumentation were involved. The mean age was 54.7 years (range 31-75 years). Bone marrow aspirates were obtained from the vertebral body through the bilateral pedicle and were quantified relative to matched, bilateral aspirates from the iliac crest that were obtained from the same patient and at the same time. The mononuclear cell count and concentration of BMSCs were calculated and compared. Proliferation and osteoblastic differentiation of each of the BMSCs were characterized using biochemical and molecular biology techniques. Concentration (cells/mL) of BMSCs from VB and IC were 3.73 × 10(3) and 3.19 × 10(3), respectively (P > 0.05). VB and IC exhibited similar proliferation pattern at 3, 5 and 7 days, but BMSCs from the VB exhibited an increased mineralization staining with Alizarin Red S at 14 days. BMSCs from both anatomic sites expressed comparable levels of CD29, CD34, CD44, CD90 and CD105. VB and IC displayed similar levels of expression of ALP, type I collagen and osterix, but VB expressed higher level of osteocalcin and Runx-2, especially at 14 and 21 days. Our studies show that BMSCs from VB have osteogenic differentiation potential similar to IC. Based on these findings, we suggest that BMSCs from VB would be comparable candidates for osseous graft supplementation especially in spinal fusion procedures. [ABSTRACT FROM AUTHOR]

Ultraviolet (UV) light is a physical carcinogen, and UV irradiation from sunlight has negative effects on human skin. UVB-induced inflammation is linked to excessive induction of various inflammatory cytokines/chemokines in many types of cells, including keratinocytes. The purpose of this study was to investigate the anti-inflammatory effect of water extract of Zingiber officinale, gingerol, and shogaol on UVB-induced skin damage in the human keratinocyte cell line HaCaT and C57BL/6 mice. To test for an effective compound to protect against inflammation in UV-damaged skin, we prepared a water extract of ginger rhizomes and examined the effects of Z. officinale, gingerol, and shogaol on cell viability and cytokine/chemokine production in UV-irradiated HaCaT cells. We also investigated the in vivo relevance of these findings in C57BL/6 mice using hematoxylin and eosin staining and cytokine measurements. A water extract of Z. officinale, gingerol, and shogaol inhibited production of cytokines in UVB-irradiated HaCaT cells effectively. Treatment with Z. officinale attenuated UVB-induced hyperplasia, infiltration of leukocytes, and dilation of blood vessels in the dermis of mice. Z. officinale, gingerol, and shogaol show potential as anti-inflammatory agents to protect skin against UVB irradiation damage. [ABSTRACT FROM AUTHOR]

Goals Of Work: Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood.Patients and Methods: We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL).Results: Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care.Conclusions: Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the protective role of personal identity consolidation against health risk behaviors in college-attending emerging adults. METHODS: A multisite sample of 1546 college students completed measures of personal identity consolidation and recent risk behavior engagement. RESULTS: Multivariate Poisson regression indicated that personal identity consolidation was negatively related to binge drinking, illicit drug use, sexual risk behaviors, and risky driving. These findings were consistent across gender, ethnicity, and place of residence. CONCLUSIONS: A consolidated sense of personal identity may protect college-attending emerging adults from health-compromising behaviors. Health professionals could incorporate an identity development component into college health programming. [ABSTRACT FROM AUTHOR]

Goals Of Work: The goal of this study was to investigate the utilization of and attitudes toward life-sustaining treatments (LSTs) at the end of life.Materials and Methods: We identified 4,042 families of cancer patients who had died at any of 17 hospitals in Korea during 2004. Among those, we analyzed the interviews provided by 1,592 (39.4%) primary caregivers. Only women who provided information in baseline and follow-up point could be included for internal comparison.Main Results: Most caregivers did not discuss with their patient the option of utilizing the intensive care unit (ICU; 92.7%) or cardiopulmonary resuscitation (CPR; 93.7%) to prolong an ending life. Logistic regressions indicated that the ICU was more likely to be utilized when patients experienced an unexpected medical problem before dying, discussed the ICU with the family caregiver, or were low-educated. CPR was more likely to be used if the patient died within 6 months of diagnosis or the family caregiver was <65 years old. Family caregivers more likely to use the ICU if placed in the same situation again were those whose patients had a higher monthly income or died within 6 months of diagnosis, low-educated, or had utilized the ICU.Conclusions: Our findings underscore the importance of discussing LST with terminally ill patients based on adequate information. [ABSTRACT FROM AUTHOR]

Background: End-of-dose failure is commonly observed as therapeutic levels of sustained-release opioids fall. However, little is known about using these medications for cancer pain control. To determine the dosing frequency of sustained-release opioids (morphine, oxycodone, and transdermal fentanyl) and the prevalence of end-of-dose failure in clinical practice, a patient-reported survey was performed.Methods: A multicenter survey was conducted in 56 hospitals in Korea between June and November 2008.Results: The study enrolled 1,097 cancer outpatients who were prescribed oral sustained-release opioids (morphine or oxycodone) or transdermal fentanyl. Of the oral sustained-release opioid patients, 67.0% took oral sustained-release oral opioids twice daily, while 26.2% took them more than twice daily. Of the transdermal fentanyl patients, 88.8% wore the patch for 72 h. Of the enrolled patients, 48.3% experienced worsening pain just before the next sustained-release opioid dose, and 36.8% of these patients took medication earlier than the prescribed dosing schedule. Patients felt that oral sustained-release opioids gave adequate pain control lasting an average of 9.6 h, versus an average of 62.9 h for transdermal fentanyl.Conclusion: This survey demonstrated that sustained-release opioids are used by patients in a manner that is inconsistent with standard recommendations. End-of-dose failure is suggested to explain increased dosing frequency, and patients reported that adequate pain relief lasted for less time than was stated in the manufacturers' prescription recommendation. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors have been reported to receive less care for other conditions than the general population; however, it is not clear whether patients' behavior also contribute to this. The present study was performed to examine cancer survivors' adherence to antihypertensive medication and factors associated with it, compared to the general population.Methods: We used pharmacy claims and enrollment data from the National Health Insurance, which covers 97% of the Korean population. In total, 2,455,193 subjects, including 12,636 (0.5%) cancer survivors, who were prescribed antihypertensive medications during the calendar year 2004 were identified. A cumulative medication adherence of 80% or above was defined as appropriate medication adherence. Two separate multiple logistic regressions were developed to compare the proportion of appropriate adherence between two populations and to identify factors affecting medication adherence in cancer survivors.Results: Cancer survivors were less likely to have an appropriate medication adherence than the general population (adjusted odds ratio = 0.85; 95% CI, 0.82-0.88). Significant variation was observed in medication adherence according to cancer type. Several other factors, such as older age, low income, living in a rural area, and antihypertensive medication duration, also affected antihypertensive medication adherence. Contrary to the general population, younger survivors showed higher adherence.Conclusions: Clinicians involved in survivor care should check patient adherence to antihypertensive medication, as well as assess the possible reasons for nonadherence. Further studies are warranted to determine the reasons for nonadherence and to establish effective interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]