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Background: Laryngoscopy is a diagnostic procedure utilized in critical care to examine and visualize the larynx through the diversion of upper airway structures. Its primary functions are airway management and tracheal intubation. The objective of this study was to detect the predictors of laryngeal exposure during microlaryngeal surgery (MLS). Methods: An analytical cross-sectional study was conducted on a consecutive sample of 100 patients presenting laryngeal lesions that were trans-orally microsurgeries to treat various glottic diseases (biopsies revealed 68% benign lesions such as vocal fold polyps, cysts, and nodules, and 32% glottic masses) and prepared for MLS. Results: This study included 100 patients presenting laryngeal lesions from both sexes with the age of 47.0 ± 14.7 years, in multivariate logistic regression analysis, all these parameters were significant predictors for Cormack–Lehane and Italian Grading (P < 0.05). Body mass index (BMI) (OR = 3.449, 95% CI = 2.463–8.187), mandibular protrusion test (OR = 2.981, 95% CI = 1.922–4.044), mento-sternal length (OR = 3.722, 95% CI = 1.980–7.794), and atlanto-occipital joint (AOJ) extension (OR = 1.572, 95% CI = 1.865–4.263). Cormack–Lehane and Italian Grading was significantly associated with BMI, mandibular protrusion test, Mallampati Index, mento-thyroid, mento-sternal length, and AOJ extension, it increased with BMI of > 35, with more protruded mandible (class C), higher Mallampati Index (class III) and shorter mento-sternal distance (≤ 12.5 cm). Conclusions: During microlaryngeal surgery, BMI, mandibular protrusion test, Mallampati Index, mento sternal and AOJ extension were significant predictors of Cormack–Lehane and Italian Grading which makes it easier for laryngeal exposure. [ABSTRACT FROM AUTHOR]

Background: A fistula is an unusual communication between the skin and an inward organ or between the organs. The current study aimed to determine the role of magnetic resonance imaging (MRI) in the diagnosis, description, and classification of fistula-in-ano. Additionally, the study aimed to compare the MRI findings with the operative findings, which is considered the gold standard in our study. Methods: The present study is a prospective study and was carried out on a group of 61 patients: 52 males and 9 females with a mean age of 41 years, who were suspected to have perianal fistulae presented clinically with discharge or localized pain or were asymptomatic. A preoperative MRI was conducted for fistula-in-ano evaluation in these patients from October 2019 till the end of October 2021. A surgeon conducted a physical examination of all patients to document the number and location of cutaneous openings following a full medical history. The MRI images were evaluated and interpreted by multiple expert radiologists who had more than 5 years of experience in analyzing MRI. In the cases (in 3 cases, 4.92%) where there were discrepancies in their interpretations, a senior radiologist's evaluation was considered the final result and was confirmed surgically. Subsequently, the MRI findings were correlated with surgical findings to indicate the specificity, sensitivity, and accuracy of such MRI findings. Results: The MRI technique was the routine (i.e., without contrast administration) technique in 36 (59.02%) patients, with contrast administration in 21 (34.43%) patients and with anesthesia/sedation (uncomfortable, anxious, and claustrophobic patients need to minimize their motion artifact to improve the quality and obtain more detailed images) in 4 (6.56%) patients. The MRI pathology of the studied patients revealed normal findings in 1 (1.64%) patient, anal fissure/early developing tract in 6 (9.84%) patients, and established tract (sinus/fistula) in 54 (88.52%) patients. Park's and St. James's University Hospital classifications were utilized to categorize the patients, with the most common fistula types based on the Park's classification: intersphincteric (44.3%) and transsphincteric (29.5%). Based on the St. James's classification, grade 1 (intersphincteric (34.4%)) and grade 4 (transsphincteric with abscess/side branch (16.4%)) were the most prevalent. A substantial consensus was reached between MRI and surgery findings for classifying tracts, side branches, and abscesses formation with sensitivity, specificity, and accuracy of 100%, 85.71%, and 98.36%, respectively. Conclusions: MRI is a valuable tool in managing patients with perianal fistulas due to its ability to detect hidden areas of infection (such as abscesses) and secondary extensions. These factors contribute to the high recurrence rate after surgery. Additionally, MR imaging can define the anatomical relationships between the fistula and anal sphincters, helping to predict the likelihood of fecal incontinence following surgery. [ABSTRACT FROM AUTHOR]

Background: The pre-season preparatory period is considered key for optimizing the physical fitness levels needed to withstand congested match periods and preventing injuries during the regular soccer season. This study contrasted the effects s of neuromuscular training (NMT) versus an endurance-dominated training (ET) program conducted during the preseason on measures of physical fitness and injury occurrence in female soccer players. Methods: Twenty-four female soccer players aged 17.0 ± 1.3 years from a professional soccer club participated in this study. Players were randomly assigned to NMT (n = 12) or ET (n = 12) groups according to their playing position. The preseason intervention program lasted six weeks, with three weekly sessions with a duration of 45–60 min per session. Exercises in the NMT group included muscle strengthening exercises, plyometrics, agility and dynamic stability exercises, while the ET group practiced a traditional pre-season training program consisting of running and sprinting exercises, fartlek, and high-intensity interval training. The training volumes were similar in the two study groups. Anthropometric measurements, physical fitness tests (i.e., linear and change-of-direction speed, muscle strength and power tests) and the overall injury rate per 1000 h of exposure (training, match) were recorded throughout the season. Results: No between group differences were found at pre (T1). Significant group-by-time interactions were observed for the 5, 10, and 30-m linear sprint speed tests (p < 0.001, 2.16 < d < 2.58), the T-test (p = 0.024, d = 1.03), the squat (p < 0.001, d = 4.04), and the countermovement jump test (p < 0.001, d = 2.21), the Loughborough soccer passing test (LSPT) (p = 0.019, d = 1.08), and the 1-RM back squat test (p < 0.001, d = 2.53). Post-hoc tests indicated that NMT provided larger improvements for SJ, CMJ, 1-RM back squat, the 5-m sprint, 10-m sprint, 30-m sprint, T-test and LSPT compared to ET (1.07 > d > 2.77). The injury rate across the season was significantly lower in the NMT (5.1/1000 h exposure) compared to ET (11.8/1000 h exposure) (p = 0.014). Conclusions: The findings support that six-weeks of preseason NMT versus ET induced larger performance improvements, and significantly reduced injury occurrence in elite female soccer players. Key points: • Our results indicate that the integration of 45 to 60 min of preseason neuromuscular training, three times per week, for 6 weeks, can improve physical fitness and prevent injuries in young female soccer players. • The present study demonstrated that the neuromuscular training program can reduce the incidence injury rate by more than 50% and the burden by more than 65% compared to the endurance-dominated training. • Neuromuscular training is an effective approach during the preseason period to improve diverse measures of physical fitness and to reduce injury occurrence. • Preseason neuromuscular training appears to improve the fitness level of female soccer players and as such could allow them to compete at the high level. [ABSTRACT FROM AUTHOR]

Background: Frequency discrimination underlies more complicated auditory activities like speech comprehension and interpretation. However, intensity differences indicate how far apart noises are. This study aimed to evaluate and compare results of frequency modulation and difference limen for intensity in children with cochlear Implants (CI) as well as normal hearing children. Results: This case–control work was performed on 40 children, aged from 5–18 years, divided into two equal groups: a study group with unilateral CI and a control group with normal peripheral hearing. All patients were subjected to otological examination, audiological evaluation, frequency modulation difference limen (FMDL) and difference limen for intensity (DLI) tests. Patients with CI, as compared to normal hearing (NH) subjects, required significantly higher frequencies to discriminate FMDL and DLI respectively (P value = 0.001). At 2000 and 4000 Hz: FMDL had a significant diagnostic power for patients with CI (AUC = 0.980, 0.998 respectively, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity. While, at 4000 Hz: DLI had a significant diagnostic power for patients with CI (AUC = 0.999, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity. Conclusion: A statistically substantial variation was observed among CI and NH children in FMDL and DLI at all frequencies tested. Patients with CI required significantly higher frequencies to discriminate as compared to NH subjects. Frequencies at 2000 Hz and 4000 Hz possess the best specificity and sensitivity of FMDL. While frequency 4000 Hz possess the best specificity and sensitivity of DLI. [ABSTRACT FROM AUTHOR]

Background: Doppler ultrasonography is essential to provide insights into hemodynamic alterations and liver function changes in pre-cirrhotic and cirrhotic patients. Utilizing Doppler examinations, this study aims to explore the correlation between hepatic arterial hemodynamics and Model for end-stage liver disease (MELD) scores in chronic liver disease patients. Methods: A study of 50 chronic liver disease patients included sonographic assessments, measuring liver, portal vein size, and flow. Hepatic artery velocity, resistive index (RI), pulsatility index (PI), and acceleration time (AT) were evaluated. Biochemical parameters (serum bilirubin, creatinine, INR) were used to calculate MELD scores, compared with different Doppler sonographic parameters. Results: The study found a mean peak systolic velocity (PSV) of 107.42 ± 48.10, with end-diastolic velocity (EDV) of 26.40 ± 14.68, RI of 0.74 ± 0.06, and PI of 1.47 ± 0.24. The mean MELD score was 19.28 ± 6.09. Correlations between MELD scores and PSV, EDV, RI, PI, and AT did not yield statistically significant correlations. 80% of subjects displayed high RI (> 0.7) values in the hepatic artery, and a significant correlation was found between portal vein thrombosis and hepatic artery PSV and RI (p < 0.05). Conclusions: Hepatic artery RI and PSV show a significant correlation with portal vein thrombosis. Doppler ultrasonography, while not directly tied to MELD scores, is valuable for non-invasive liver disease monitoring when invasive methods are impractical. Further research is needed to unravel the relationships between hemodynamic changes, MELD scores, and clinical outcomes in a broader patient population. [ABSTRACT FROM AUTHOR]

Background: Postoperative hypocalcemia in laryngectomy patients can occur when part or whole of the thyroid gland has been removed. Preservation of the parathyroid glands in situ is considered one of the initial measures to prevent postoperative hypocalcemia even if all thyroid gland is removed. Our study aims to assess the efficacy of parathyroid gland preservation in situ to prevent postoperative hypocalcemia in cases where total laryngectomy is done with total thyroidectomy. Methods: The study included all laryngectomy patients done during a period from April 2020 to May 2021. Parathyroid gland preservation was done in both primary (12 cases) and salvage (16 cases). Both PTH and corrected calcium level were measured at different time points and used as a guide for further replacement. Results: We studied the association between outcome including recovery from transient hypocalcemia and certain variables like age, type of surgery, stage of tumor, and extent of neck dissection. Regarding type of surgery, all patients that underwent primary laryngectomy were totally recovered (n = 12, 100%); however, salvage cases were partially recovered (n = 10, 62.5%). Conclusion: Parathyroid preservation is achievable in cases of salvage laryngectomy in addition to primary laryngectomy with total thyroidectomy. Early monitoring of the patients PTH and Ca during their hospital stay is a good indicator of successful preservation. Long-term follow-up is advised for potential recovery from transient hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationships between protein intake from various food sources and cardiometabolic risk markers in Italian older adults. Design: Cross-sectional study. Setting: Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns). Participants: People 65+ years who provided a written informed consent. Measurements: Blood pressure (BP), blood glucose, total blood cholesterol, and anthropometric indices were assessed. Daily protein intake was estimated for 12 food items listed in a food frequency questionnaire. Results: Three-thousand four-hundred twenty-four older adults (mean age: 72.7 ± 5.7 years; 55% women) were included in the study. Results of linear regression analysis indicated that protein intake from several food sources was negatively associated with BP, waist and hip circumferences, and waist-to-hip ratio in both sexes. Blood glucose levels were inversely associated with many protein sources in women. Positive associations were observed between some protein sources and total blood cholesterol in both men and women. Conclusion: Our findings suggest that dietary protein is differentially associated with cardiometabolic risk factors depending on sex and food sources. [ABSTRACT FROM AUTHOR]

Background: Symptom expression in SARS-CoV-2 infection (COVID-19) may affect patients already symptomatic with cancer. Patient-reported outcomes (PROs) can describe symptom burden during the acute and postacute stages of COVID-19 and support risk stratification for levels of care. At the start of the COVID-19 pandemic, our purpose was to rapidly develop, launch through an electronic patient portal, and provide initial validation for a PRO measure of COVID-19 symptom burden in patients with cancer. Methods: We conducted a CDC/WHO web-based scan for COVID-19 symptoms and a relevance review of symptoms by an expert panel of clinicians treating cancer patients with COVID-19 to create a provisional MD Anderson Symptom Inventory for COVID-19 (MDASI-COVID). English-speaking adults with cancer who tested positive for COVID-19 participated in the psychometric testing phase. Patients completed longitudinal assessments of the MDASI-COVID and the EuroQOL 5 Dimensions 5 Levels (EQ-5D-5L) utility index and visual analog scale, which were presented through an electronic health record patient portal. To test the validity of the MDASI-COVID to distinguish between known groups of patients, we hypothesized that patients hospitalized, including having a hospitalization extended, for COVID-19 versus those not hospitalized would experience higher symptom burden. Correlation of mean symptom severity and interference scores with relevant EQ-5D-5L scores tested concurrent validity. The reliability of the MDASI-COVID was evaluated by calculating Cronbach alpha coefficients and test-retest reliability was evaluated by calculating Pearson correlation coefficients between the initial assessment and a second assessment no more than 14 days later. Results: The web-based scan found 31 COVID-19-related symptoms; rankings of a 14-clinician expert panel reduced this list to 11 COVID-specific items to be added to the core MDASI. Time from literature scan start in March 2020 to instrument launch in May 2020 was 2 months. Psychometric analysis established the MDASI-COVID's reliability, known-group validity, and concurrent validity. Conclusions: We were able to rapidly develop and electronically launch a PRO measure of COVID-19 symptom burden in patients with cancer. Additional research is needed to confirm the content domain and predictive validity of the MDASI-COVID and define the symptom burden trajectory of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Discrepancies in symptom assessment between providers and patients are reported in cancer care, and the use of patient-reported outcome measures (PROMs) has been recommended for patients receiving palliative care. However, the status of the routine use of PROMs in palliative care in Japan is presently unclear. Therefore, this study aimed to clarify this complex question. To this end, we administered a questionnaire survey either online or via telephone interviews (questionnaire: sent to 427 designated cancer hospitals, 423 palliative care units [PCUs], and 197 home hospices; interviews: conducted at 13 designated cancer hospitals, nine PCUs, and two home hospices). Results: Questionnaires were returned from 458 institutions (44% response rate). We found that 35 palliative care teams (PCTs, 15%), 66 outpatient palliative care services (29%), 24 PCUs (11%) and one (5%) home hospice routinely used PROMs. The most frequently implemented instrument was the Comprehensive Care Needs Survey questionnaire. Moreover, 99 institutions (92%) that routinely used PROMs responded these instruments as useful in relieving patients' symptoms; and moreover, the response rate in regard to usefulness in symptom management was higher than that of institutions that did not routinely use PROMs (p = 0.002); > 50% of the institutions that routinely used PROMs stated that use of these instruments was influenced by disease progression and patients' cognitive function. Moreover, 24 institutions agreed to be interviewed, and interviews demonstrated the benefits of and the barriers to the implementation of PROMs. Effective methods used in the implementation of PROMs were introduced as efforts to reduce the burden placed on patients and to promote healthcare providers' education in the use of PROMs. Conclusions: This survey quantified the status of the routine use of PROMs within specialized palliative care in Japan, revealed barriers to wider PROM use, and identified needed innovations. Only 108 institutions (24%) routinely used PROMs within specialized palliative care. Based on the results of the study, it is necessary to carefully consider the usefulness of PROs in clinical palliative care, perform careful selection of PROMs according to the patient's condition, and evaluate how specifically to introduce and operate PROMs. [ABSTRACT FROM AUTHOR]

Background: New daily persistent headache (NPDH) is a rare primary headache that is highly disabling. The pathophysiology of NDPH is still unclear, and we aimed to reveal the underlying mechanism of NDPH through functional magnetic resonance imaging (fMRI) analysis. Methods: In this cross-sectional study, thirty patients with NDPH and 30 healthy controls (HCs) were recruited. The blood oxygen level-dependent (BOLD) sequences of all participants were obtained using the GE 3.0 T system. We performed ReHo, ALFF (conventional band: 0.01–0.08 Hz, slow-5: 0.01–0.027 Hz, slow-4: 0.027–0.073 Hz) and seed-based to the whole brain functional connectivity (FC) analysis in the NDPH and HC groups. The sex difference analysis of ReHo, ALFF, and FC values was conducted in the NDPH group. We also conducted Pearson's correlation analysis between ReHo, ALFF, FC values and clinical characteristics (pain intensity, disease duration, HIT-6, GAD-7, PHQ-9, and PSQI scores). Results: Both increased ReHo (PFWE-corr = 0.012) and ALFF values (0.01–0.08 Hz, PFWE-corr = 0.009; 0.027–0.073 Hz, PFWE-corr =0.044) of the left middle occipital gyrus (MOG_L) were found in the NDPH group compared to the HC group. There was no significant difference in FC maps between the two groups. Compared to the HC group, no difference was found in ReHo (p = 0.284), ALFF (p = 0.246), and FC (p = 0.118) z scores of the MOG_L in the NDPH group. There was also no sex difference in ReHo (p = 0.288), ALFF (p = 0.859), or FC z score (p = 0.118) of the MOG_L in patients with NDPH. There was no correlation between ReHo, ALFF, FC z scores and clinical characteristics after Bonferroni correction (p < 0.05/18). Conclusions: Patients with NDPH may have abnormal activation of the visual system. Abnormal visual activation may occur mainly in higher frequency band of the classical band. No sex differences in brain activity were found in patients with NDPH. [ABSTRACT FROM AUTHOR]

Diagnosis codes are used to study SARS-CoV2 infections and COVID-19 hospitalizations in administrative and electronic health record (EHR) data. Using EHR data (April 2020–March 2021) at the Yale-New Haven Health System and the three hospital systems of the Mayo Clinic, computable phenotype definitions based on ICD-10 diagnosis of COVID-19 (U07.1) were evaluated against positive SARS-CoV-2 PCR or antigen tests. We included 69,423 patients at Yale and 75,748 at Mayo Clinic with either a diagnosis code or a positive SARS-CoV-2 test. The precision and recall of a COVID-19 diagnosis for a positive test were 68.8% and 83.3%, respectively, at Yale, with higher precision (95%) and lower recall (63.5%) at Mayo Clinic, varying between 59.2% in Rochester to 97.3% in Arizona. For hospitalizations with a principal COVID-19 diagnosis, 94.8% at Yale and 80.5% at Mayo Clinic had an associated positive laboratory test, with secondary diagnosis of COVID-19 identifying additional patients. These patients had a twofold higher inhospital mortality than based on principal diagnosis. Standardization of coding practices is needed before the use of diagnosis codes in clinical research and epidemiological surveillance of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Several clinical tests exist to assess knee laxity. Although these assessments are the predominant tools of diagnosis, they are subjective and rely on the experience of the clinician. The robotic knee testing (RKT) device has been developed to quantitatively and objectively measure rotational knee laxity. The purpose of this study was primarily to determine the intra-tester reliability of rotational knee laxity and slack, the amount of rotation occurring between the two turning points of the load deformation curve, measured by the RKT device and investigate the differences between female and male measurements. Methods: Ninety-one healthy and moderately active volunteers took part in the study, of which twenty-five participated in the reliability study. Tibial rotation was performed using a servomotor to a torque of 6 N m, while measurements of motion in all 6° of freedom were collected. Reliability measurements were collected over 5 days at similar times of the day. Intra-class correlation coefficient (ICC) values and standard error of measurement (SEM) were determined across the load deformation curves. Linear mixed effects modelling was used to further assess the reliability of the measurement of external and internal tibial rotation using features of the curve (internal/external rotational laxity and slack). Measurements of internal/external rotational laxity and slack were compared between the sexes using the Student t test. Results: Pointwise axial rotation measurements of the tibia had good reliability [ICC (2,1) 0.83–0.89], while reliability of the secondary motions ranged between poor and good [ICC (2,1) 0.31–0.89]. All SEMs were less than 0.3°. Most of the variation of the curve features were accounted for by inter-subject differences (56.2–77.8%) and showed moderate to good reliability. Comparison of the right legs of the sexes revealed that females had significantly larger amounts of internal rotation laxity (females 6.1 ± 1.3° vs males 5.6 ± 0.9°, p = 0.037), external rotation laxity (females 6.0 ± 1.6° vs males 5.0 ± 1.2°, p = 0.002) and slack (females 19.2 ± 4.2° vs males 16.6 ± 2.9°, p = 0.003). Similar results were seen within the left legs. Conclusions: Overall, the RKT is a reliable and precise tool to assess the rotational laxity of the knee joint in healthy individuals. Finally, greater amounts of laxity and slack were also reported for females. [ABSTRACT FROM AUTHOR]

The article looks at a study that expands on the International Society of Pharmacoeconomics and Outcomes Research recommendations by quantifying the biases resulting from categorizing adherence data through a simulation study. Topics covered include three categories of the measurement of adherence, the counterintuitive interpretation of parameter estimates when categorizing adherence, and a list of simulation factors that include the distribution of the adherence predictor.

The article focuses on a study related to effects of health competence, social support and stress on depressive symptoms following cardiac hospitalization. Topics discussed include occurrence of non cardiac comorbidities in coronary heart disease (CHD) patients, prevalence of depression among outpatient and inpatient CHD populations, relationship between serious illness and onset\t of depression and influence of post-discharge stress on depressive symptoms fluctuations.

Background: Although validated radiological scoring systems and histological scoring system of surgically removed degenerated disc are used in assessment of progression of intervertebral disc degeneration, there have not been many studies that integrate these two aspects of assessments. The data available in this respect are very limited. This clinical study was designed to And the correlation between quantitative radiological score (Pfirmann grading system and Modic changes [MC]) and quantitative histological degeneration score (HDS). Materials and Methods: A cohort of 77 patients (45 males, 32 females; mean age of 38 years [range 18-58 years]) who presented with complaints of discogenic pain or radiculopathy at single level were assessed radiologically. They were graded according to the radiological pattern. The surgically excised disc specimen was graded according to HDS. The degree of radiological changes were correlated with the degree of histological changes. Results: Though the overall HDS (0-15) did not show statistically significant correlation with Pfirmann grading system, there were positive association found between mucoid degeneration, chondrocyte proliferation with the Pfirmann grading and mucoid degeneration, which were statistically significant. Female sex also had a higher association with instability pattern. Conclusion: The study shows that the Pfirmann grading system, MCs and HDS can reliably be used as scoring systems for assessing lumbar disc degeneration. The radiological assessment can be used as a noninvasive tool to assess the probable change in content rather than the microstructure of a disc undergoing degeneration. [ABSTRACT FROM AUTHOR]

Background: Although alterations in resting-state neural network have been previously reported in migraine using functional MRI, whether this atypical neural network is frequency dependent remains unknown. The aim of this study was to investigate the alterations of the functional connectivity of neural network and their frequency specificity in migraineurs as compared with healthy controls by using magnetoencephalography (MEG) and concepts from graph theory. Methods: Twenty-three episodic migraine patients with and without aura, during the interictal period, and 23 age- and gender-matched healthy controls at resting state with eye-closed were studied with MEG. Functional connectivity of neural network from low (0.1-1 Hz) to high (80-250 Hz) frequency ranges was analyzed with topographic patterns and quantified with graph theory. Results: The topographic patterns of neural network showed that the migraineurs had significantly increased functional connectivity in the slow wave (0.1-1 Hz) band in the frontal area as compared with controls. Compared with the migraineurs without aura (MwoA), the migraineurs with aura (MwA) had significantly increased functional connectivity in the theta (4-8 Hz) band in the occipital area. Graph theory analysis revealed that the migraineurs had significantly increased connection strength in the slow wave (0.1-1 Hz) band, increased path length in the theta (4-8 Hz) and ripple (80-250 Hz) bands, and increased clustering coefficient in the slow wave (0.1-1 Hz) and theta (4-8 Hz) bands. The clinical characteristics had no significant correlation with interictal MEG parameters. Conclusions: Results indicate that functional connectivity of neural network in migraine is significantly impaired in both low- and high-frequency ranges. The alteration of neural network may imply that migraine is associated with functional brain reorganization. [ABSTRACT FROM AUTHOR]

Background: Central information processing, visible in evoked potentials like the contingent negative variation (CNV) is altered in migraine patients who exhibit higher CNV amplitudes and a reduced habituation. Both characteristics were shown to be normalized under different prophylactic migraine treatment options whereas Progressive Muscle Relaxation (PMR) has not yet been examined. We investigated the effect of PMR on clinical course and CNV in migraineurs in a quasi-randomized, controlled trial. Methods: Thirty-five migraine patients and 46 healthy controls were examined. Sixteen migraineurs and 21 healthy participants conducted a 6-week PMR-training with CNV-measures before and after as well as three months after PMR-training completion. The remaining participants served as controls. The clinical course was analyzed with two-way analyses of variance (ANOVA) with repeated measures. Pre-treatment CNV differences between migraine patients and healthy controls were examined with t-tests for independent measures. The course of the CNV-parameters was examined with three-way ANOVAs with repeated measures. Results: After PMR-training, migraine patients showed a significant reduction of migraine frequency. Preliminary to the PMR-training, migraine patients exhibited higher amplitudes in the early component of the CNV (iCNV) and the overall CNV (oCNV) than healthy controls, but no differences regarding habituation. After completion of the PMR-training, migraineurs showed a normalization of the iCNV amplitude, but neither of the oCNV nor of the habituation coefficient. Conclusions: The results confirm clinical efficacy of PMR for migraine prophylaxis. The pre-treatment measure confirms altered cortical information processing in migraine patients. Regarding the changes in the iCNV after PMR-training, central nervous mechanisms of the PMR-effect are supposed which may be mediated by the serotonin metabolism. [ABSTRACT FROM AUTHOR]

Background: Chronic migraine is a disabling, under-recognized, and undertreated disorder that increases health burdens. The aim of this study was to evaluate phenotypic features and the relevance of accompanying symptoms of migraine attacks in chronic migraine. Method: This study was conducted as part of an ongoing Turkish Headache Database Study investigating the clinical characteristics and outcomes of headache syndromes in the Turkish population. The electronic database was examined retrospectively, and 835 patients with chronic migraine were included. Results: Patient group consisted of 710 women and 125 men (85 and 15 %, respectively). Mean patient age was 36.8 ± 13.5 years, median value of migraine onset was 60 months (18-120), median headache frequency was 25 days per month (16-30), median of attack duration was 12 h (4-24), and median of intensity was eight (7-9). Increasing headache days per month were inversely related with the presence of nausea, vomiting, phonophobia, and photophobia. Longer duration of headache (months) and higher visual analog scale (VAS) for headache intensity were associated with all accompanying symptoms. Phonophobia, nausea, photophobia, and vomiting were the most frequent accompanying symptoms (experienced by 80.2, 77.6, 71.2, and 40.9 % of patients, respectively). Osmophobia was also frequent in chronic migraine patients (53.4 %) and was closely associated with other accompanying symptoms. Vertigo and dizziness were observed less frequently, and they were not associated with accompanying symptoms. Conclusion: Phenotype of chronic migraine may be associated with the course of chronification. Duration of illness and attack intensity were closely related with the presence of accompanying symptoms, although headache frequency was found to be inversely related to the presence of accompanying symptoms. Osmophobia was also a frequent symptom and was closely related with other accompanied symptoms, unlike vertigo and dizziness. Inclusion of osmophobia into the diagnostic criteria might improve accurate diagnosis of chronic migraine. [ABSTRACT FROM AUTHOR]

The article presents a study on a new weight loss intervention for persons who emotionally eat. The findings revealed that adding skills which target one's ability to modify emotions may not improve the short-term efficacy of a standard behavioral weight loss treatment (SBT) for most African-American women, that overall results indicate that persons who emotionally eat achieve weight loss when joining a SBT program for over 20 weeks, and that the long term effects of SBT need further studies.

The article discusses a study which aims to validate the theory that veterans who participated in Acceptance and Commitment Therapy (ACT) for chronic pain experience less pain intensity, a reduction in illness- and wellness-focused coping approach and a willingness to apply a self-management plan. Topics include the Stepped Care Model of Pain Management endorsed by the U.S. Veterans Affairs (VA) and outcome measures which include the Readiness questionnaire, and Oswestry disability index (ODI).

This study was conducted to determine whether facial photographs obtained simultaneously with radiographs improve radiologists' detection rate of wrong-patient errors, when they are explicitly asked to include the photographs in their evaluation. Radiograph-photograph combinations were obtained from 28 patients at the time of portable chest radiography imaging. From these, pairs of radiographs were generated. Each unique pair consisted of one new and one old (comparison) radiograph. Twelve pairs of mismatched radiographs (i.e., pairs containing radiographs of different patients) were also generated. In phase 1 of the study, 5 blinded radiologist observers were asked to interpret 20 pairs of radiographs without the photographs. In phase 2, each radiologist interpreted another 20 pairs of radiographs with the photographs. Radiologist observers were not instructed about the purpose of the photographs but were asked to include the photographs in their review. The detection rate of mismatched errors was recorded along with the interpretation time for each session for each observer. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between the two phases. A p value of <0.05 was considered significant. The error detection rates without (0/20 = 0 %) and with (17/18 = 94.4 %) photographs were different ( p = 0.0001). The average interpretation times for the set of 20 radiographs were 26.45 (SD 8.69) and 20.55 (SD 3.40) min, for phase 1 and phase 2, respectively (two-tailed Student t test, p = 0.1911). When radiologists include simultaneously obtained photographs in their review of portable chest radiographs, there is a significant improvement in the detection of labeling errors. No statistically significant difference in interpretation time was observed. This may lead to improved patient safety without affecting radiologists' throughput. [ABSTRACT FROM AUTHOR]

The objective of this RCT was to assess the efficacy of an online pain self-management program with adults who had a self-reported doctor diagnosis of arthritis pain (N = 228). Participants were recruited via flyers and online postings then randomized to the experimental condition or the wait-list control condition. Individuals in the experimental condition reported significantly (1) increased arthritis self-efficacy and (2) reduced pain catastrophizing from baseline to follow up compared to those in the control condition. High user engagement (>204.5 min on the website) was also significantly associated with improved self-management outcomes. These findings suggest that use of an online self-management program may positively impact self-efficacy and catastrophizing among adults with arthritis pain at 6 month follow up. Nonsignificant findings for hypothesized variables such as pain intensity and health behaviors are also discussed. Future longitudinal research is needed to assess if cognitive changes associated with participation in an online self-management program leads to reduced pain. [ABSTRACT FROM AUTHOR]

Background: Most studies on sepsis were conducted in developed countries. The aim of this study is to report on a series of patients with sepsis in a tertiary hospital in a developing country. Methods: Patients admitted through the emergency department of a single university-based institution between January 2008 and June 2012, with a final diagnosis of sepsis, bacteremia, or septic shock, were retrieved. A sample of 97 patients was selected. Vital signs at presentation, number of SIRS criteria, use of vasopressors and steroids, and in-hospital mortality were recorded. Results: The mean age was 70.09 ± 16.82, ranging from 19 to 96 years; 48.5 % were females and 51.5 % were males; 42.3 % of the patients were found to be bacteremic. IV fluid requirement during the first 6 h was 1.75 ± 1.96 l. The time for antibiotic initiation was 3.43 ± 4.48 h, with 87.6 % of the antibiotics initiated in the emergency department. Norepinephrine was the most commonly used vasopressor (38.1 %) followed by dopamine (8.2 %), and the inotrope dobutamine (4.1 %); 45.3 % of the patients were admitted to the intensive care unit (ICU), and the remaining 54.7 % were managed on the general practice unit (GPU). A total of 30 (30.9 %) septic patients died. The 28-day mortality was 20.6 %. Deceased patients had greater vasopressor use, a longer stay in the ICU (p = 0.001), and a longer time to norepinephrine use (p = 0.004). Conclusions: This is the first study providing an in-depth analysis of sepsis patients in a developing country, looking at in-hospital mortality, SIRS criteria utility, and at the overall sepsis management. [ABSTRACT FROM AUTHOR]

With the implementation of the PACS in the hospital, there is an increasing demand from the clinicians for immediate access and display of radiological images. Recently, our hospital has installed the first wireless local area network (WLAN)-based direct digital radiography (DDR) portable radiography system. The DDR portable radiography system allows wireless retrieval of modality worklist and wireless transmission of portable X-ray image on the console to the Picture Archiving and Communication System (PACS), via WLAN connection of wireless fidelity (Wi-Fi). The aim of this study was to analyze the workflow and performance between the WLAN-based DDR portable radiography system and the old practice using conventional portable X-ray machine with computed radiography (CR) system. A total of 190 portable chest X-ray examinations were evaluated and timed, using the conventional portable X-ray machine with CR from March to April of 2012 and using the new DDR portable radiography system on December of 2012 ( n = 97 for old system and n = 93 for DDR portable system). The time interval of image becoming available to the PACS using the WLAN-based DDR portable radiography system was significantly shorter than that of the old practice using the conventional portable X-ray machine with CR (6.8 ± 2.6 min for DDR portable system; 23 ± 10.2 min for old system; p < 0.0001), with the efficiency improved by 70 %. The implementation of the WLAN-based DDR portable radiography system can enhance the workflow of portable radiography by reduction of procedural steps. [ABSTRACT FROM AUTHOR]

Background: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians' attitudes to the ED environment when caring for patients who present with advanced cancer, and how these attitudes are affected by access to palliative care services, palliative care education, staff type, ED experience and patient demographic, hospital type and region. Methods: We electronically surveyed clinicians from the College of Emergency Nursing Australasia, Australian College of Emergency Nursing and Australasian College for Emergency Medicine working in an Australian ED. Results: Respondents were 444 doctors and 237 nurses. They reported overcrowding, noise, lack of time and privacy as barriers to care. Most (93.3%) agreed/strongly agreed that the dying patient should be allocated private space in ED. 73.6% (451) felt unable to provide a desired level of care to advanced cancer patients in ED. Clinician attitudes were affected by staff type, experience, ED demographic and hospital type, but not education in palliative care. Conclusions: ED environments place pressure on clinicians delivering care to people with advanced cancer. Integrating palliative care services in ED and redesigning EDs to better match its multifaceted functions should be considered. [ABSTRACT FROM AUTHOR]

Background: Percutaneous vertebroplasty (PVP) has been gradually used for osteoporotic vertebral compression fracture (OVCF) treatment, but severe osteoporotic vertebral body compression fractures (sOVCFs) due to the difficulty in performing a puncture and the characteristics of the fractured vertebrae, it has been considered as a contraindication to PVP. The aim of the following study was to evaluate the feasibility of a unilateral, three-dimensional (3D), accurate puncture in percutaneous vertebroplasty (PVP) for a single, severely osteoporotic vertebral body compression fracture (ssOVCFs). Materials and Methods: 57 patients received PVP in the current study. Feasibility of a unilateral approach was judged before surgery using the 64-slice helical computed tomography (CT) multiplanar reconstruction technique, a 3D accurate puncture plan was then determined. The skin bone distance, puncture angle and needle insertion depth were recorded during surgery. 2D CT rechecking was performed for any complication at day 1 after operation. Preoperative and postoperative numerical data were compared. Results: The procedure was completed smoothly in all patients. 2D CT scanning at day 1 after operation did not show any puncture related complications. Visual analog scoring (VAS) showed that the score at day 3 after surgery was reduced to 1.7 ± 0.4 (0-2.9 scale) from the preoperative 7.9 ± 2.1 (6.1-9.5 scale). No significant differences in measure numerical data were found before and after the surgery. At 12 months followup three patients presented with nonadjacent level fractures, VAS for other patients were 1.2 ± 0.3 (0-2.1 scale). Conclusions: Application of CT scanning for a unilateral 3D puncture design helps realize an accurate puncture in PVP. It is a safe and effective method for ssOVCFs treatment. [ABSTRACT FROM AUTHOR]

Limited research has addressed how social support in the form of a pet can affect both sympathetic and hypothalamic-pituitary-adrenal reactivity in response to a psychological challenge. The present study examined the effects of social support on salivary cortisol and heart rate (HR). Forty-eight participants were randomly assigned to three different conditions (human friend, novel dog, or control). All participants completed the Trier Social Stress Test and provided cortisol, HR, and State-Trait Anxiety Inventory measures. For participants paired with a dog, overall cortisol levels were attenuated throughout the experimental procedure, and HR was attenuated during the Trier Social Stress Test. For all groups, state anxiety increased after the Trier Social Stress Test, and HR during the Trier Social Stress Test was a predictor of cortisol. These results suggest that short-term exposure to a novel dog in an unfamiliar setting can be beneficial. They also suggest a possible mechanism for the beneficial effect associated with affiliation with pets. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effects of weight loss with and without exercise on 1) dietary prescription adherence and 2) non-structured activity in postmenopausal women. Design: Longitudinal study. Setting: Clinical research setting with facility based exercise and nutrition education. Participants: Overweight and obese women, 45-76 years old. Intervention: 6 months of weight loss alone (WL; N=38) or with aerobic exercise (AEX+WL; N=41). Measurements: Cardiorespiratory fitness (VOmax), resting metabolic rate (RMR), seven day food intake, and physical activity (by Actical accelerometers worn in a subset subgroup: WL: N=10; AEX+WL: N=15) were assessed before and after the interventions. Results: Both interventions resulted in similar weight loss (~9%) and no signficant changes in RMR, while only the AEX+WL group improved VOmax (~10%). At baseline, the AEX+WL group consumed slightly more protein than the WL group (P<0.01). Macronutrient intake did not change following AEX+WL, but the WL group decreased their fat intake and increased their carbohydrates and protein intakes (Ps<0.05), which resulted in similar macronutrient intakes between groups post-intervention. Weekday total activity counts decreased 22% (P<0.05) following WL. This change tended (P=0.07) to be different than the lack of change in non-structured activity observed following AEX+WL. Conclusion: Although similar dietary adherence was observed, these data suggest that postmenopausal women undergoing weight loss may benefit from the addition of exercise to prevent the decline in non-structured activity observed following weight loss alone. [ABSTRACT FROM AUTHOR]

Certain gene polymorphisms are associated with human aging. This study investigated polymorphisms of a metabolism-related gene, Klotho, and an inflammatory gene, IL6, for association with the aging process in a healthy Han Chinese population. A total of 482 healthy subjects were recruited and divided into aging and young groups according to chronological age and biological age. Snapshots were used to detect a Klotho gene tag SNP (rs571118) and the F-SNPs rs9536314 (F352V) and rs9527025 (C370S), and an interleukin 6 (IL-6) gene tag SNP (rs1524107) and the F-SNPs rs1800795 (−174G/C) and rs1800796 (−572G/C). Klotho F352V and IL-6-174G/C was G homozygous, C370S was T homozygous while IL-6-572G/C MAF less than 5%. There was a statistically significant difference in the Klotho rs571118 SNP between chronological age groups, but not biological age groups. However, other SNPs, including IL-6 gene SNPs, didn't correlate with age in the Han Chinese population. Human aging is a complex process that includes chronological and biological aging. Our current data showed that Klotho gene rs571118 SNP was associated with chronological aging, but not biological aging, in a Han Chinese population. Further study will investigate genetic build up for the difference between chronological and biological aging. [ABSTRACT FROM AUTHOR]

Objectives: To determine the usefulness of physical phenotype of frailty, cognitive impairment, and serum albumin for risk stratification of elderly medical impatients. Design: Prospective, observational cohort study. Setting: A general internal medicine unit of a university hospital in Italy. Participants: Inpatients with an average age of 80.8 ± 7.5 yr (N=470). Measurements: Frailty was defined using the Study of Osteoporotic Fractures Index, a parsimonious version of the physical phenotype (two of the following markers: weight loss, inability to rise five times from a chair, and exhaustion). Two frailty markers from non-physical dimensions were also evaluated: cognitive impairment (Mini-Cog score < 3) and low serum albumin on ward admission (< 3,5 gr/dl). Logistic regression adjusted for preadmission and admission-related confounders was used to investigate whether the physical phenotype of frailty and the two non-physical markers were associated with ward length of stay and unfavorable discharge (death plus any other ward discharge disposition different from direct return home). Areas Under the receiver operating characteristic Curve (AUCs) and Likelihood Ratios (LRs) were used for evaluation of discriminatory ability and clinical usefulness of significant predictors. Results: The physical phenotype of frailty was associated with both study outcomes (p<0.010) but the association was mainly mediated by chair standing ability. Non-physical markers were associated only with unfavourable discharge (p<0.001). All of these predictors, either alone or in combination, had poor discriminatory ability (AUCs < 0.70) and poor clinical usefulness (+LRs near 1) for the study outcomes. Conclusions: The physical phenotype of frailty appears of limited clinical use for risk stratification of older medical inpatients. Combination with markers from nonphysical dimensions does not improve its prognostic abilities. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of dietary habits with high total antioxidant capacity (TAC) with frailty among elderly Japanese women. Design: Cross-sectional multicenter study. Setting: Thirty-five of 47 prefectures in Japan. Participants: 2121 grandmothers or acquaintances of dietetic students aged 65 and older. Measurements: Dietary TAC and food intakes were calculated using a validated brief-type self-administered diet history questionnaire. The TAC value of each food was assigned using four different assays, ferric reducing ability of plasma (FRAP), oxygen radical absorbance capacity (ORAC), Trolox equivalent antioxidant capacity (TEAC), and total radical-trapping antioxidant parameter (TRAP). Frailty was defined as the presence three or more of the following four components: slowness and weakness (two points), exhaustion, low physical activity, and unintentional weight loss. Results: The number of subjects with frailty was 486 (23%). Multivariate adjusted ORs (95% CI) for frailty in the highest compared to the lowest quintile were 0.35 (0.24, 0.53) for FRAP, 0.35 (0.23, 0.52) for ORAC, 0.40 (0.27, 0.60) for TEAC, and 0.41 (0.28, 0.62) for TRAP. The intakes of green tea, coffee, vegetables, and fruits which contribute to dietary TAC were also associated with lower odds of frailty (the range of multivariate adjusted OR: 0.47 for vegetables to 0.77 for green tea), although the odds ratios were less marked than those of dietary TAC. Conclusions: Dietary habits with high TAC showed a stronger inverse association with frailty in elderly Japanese women than the individual foods examined. [ABSTRACT FROM AUTHOR]

Pain acceptance contributes significantly to the effectiveness of pain treatment outcomes. Nevertheless, little research has been conducted to examine whether a decrease in acceptance contributes to a deterioration in post treatment functioning. The aim of this study was to assess the role of pain acceptance in relation to process and outcome variables in the six-months following the conclusion of a pain program. Adults with chronic pain ( N = 120) completed assessments at the completion of a 3-week multidisciplinary treatment program and 6-months post-treatment. Process measures included the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8); the catastrophizing scale of the Pain Response Self-Statement Scale; the coping cognitions scale of the Pain Response Self-Statement Scale; and the Tampa Scale of Kinesiophobia. Outcome measures included the Roland Morris Disability Questionnaire; the depression scale of the Depression Anxiety and Stress Scale; and two measures of physical functioning. Deterioration in acceptance of pain was significantly associated with deterioration in depression and disability, even when catastrophizing cognitions and kinesiophobia were accounted for. Decrease in acceptance was the strongest predictor of reliable deterioration in depression and disability. Results indicated the CPAQ-8 has utility as a measure for monitoring patient functioning post-treatment. [ABSTRACT FROM AUTHOR]

There has been little research examining the psychological antecedents of safety-oriented behavior aimed at reducing myopia risk. This study utilizes self-determination theory (SDT) and the theory of planned behavior (TPB) to understand the role of motivational and social-cognitive factors on individuals' near-work behavior. Adopting a prospective design, undergraduate students (n = 107) completed an initial questionnaire based on SDT in week 1, a second questionnaire containing measures of TPB variables in week 2, and objective measures of reading distance and visual acuity in week 6. The data were analyzed by variance-based structural equation modeling. The results showed that perceived autonomy support and autonomous motivation from SDT significantly predicted attitude, subjective norm, and perceived behavioral control from the TPB. These social-cognitive factors were significantly associated with intention and intention significantly predicted reading distance. The relationships in the model held when controlling for visual acuity. In conclusion, the integrated model of SDT and the TPB may help explain myopia-preventive behaviors. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of (risk of) undernutrition in Dutch elder Parkinson's disease patients as well as it's risk factors. Design: Observational cross-sectional study. Setting: An outpatient clinic at the department Neurology of Medical Centre Leeuwarden, a large teaching hospital. Participants: 102 outpatients with Parkinson's disease aged 65 years and older were recruited. Measurements: Data regarding various aspects of undernutrition including socio-demographic aspect, disease characterisitics, nutritional status, appetite and overall-physical and psychological functioning were collected. Results: Undernutrition was diagnosed in 2.0% and 20.5% of the patients were categorized as being at risk of undernutrition. Care dependency and appetite were the two risk factors with the highest predictive value for an unfavorable nutritional status. Conclusion: Of Dutch elderly patients with Parkinson's Disease 22.5% had an unfavourable nutritional status. Dependency and appetite were the two risk factors with the highest predictive value fort his outcome. Because undernutrition can be regarded as a geriatric syndrome a comprehensive nutritional assessment should be done followed by nutritional interventions next to interventions focused on the risk factors. Further studies are needed to evaluate these interventions. [ABSTRACT FROM AUTHOR]

Background: Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days. Methods: We conducted a medical record review to include syncope patients age ≥ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed. Results: Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age ≥ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure < 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen > 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0- 10) was found to accurately stratify patients into low risk (score < 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score > 1, ≥ 10% SAE risk). Conclusion: We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this will be a potentially useful clinical decision tool for emergency physicians, may allow judicious use of health care resources, and may improve patient care and safety. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the association between the impaired nutritional status and frailty in acute hospitalised elderly patients by using two tools, the MNA®-SF (Mini Nutritional Assessment® short-form) and the SHARE-FI (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe). Design: Cross-sectional study. Setting: Acute hospitalised, community-dwelling elderly patients were recruited at internal medicine wards in Vienna, Austria. Participants: 133 men (39%) and women (61%) aged 74 (65-97) years. Measurements: MNA®-SF was used to investigate malnutrition (<7 points) and patients at risk of malnutrition (8 to 11 points). By using the SHARE-FI, subjects were classified as frail, pre-frail or robust. A factor analysis was applied to identify overlaps between the MNA®-SF and SHARE-FI items. Internal consistency of different dimensions was assessed by using Cronbach's Alpha. Results: Malnutrition or risk of malnutrition was found in 76.7% of the total sample and in 46.8% of robust, in 69.0% of pre-frail, and in 93.0% of frail participants. Frailty or prefrailty was found in 75.9% of the total sample and in 45.1% of the subjects with no risk of malnutrition, in 80.9% of subjects at risk of malnutrition, and in 94.1% of malnourished patients. The two used tools show overlaps in three dimensions: (1) nutrition problems, (2) mobility problems and (3) anthropometric items with a moderate to strong internal consistency (Cronbach's Alpha of 0.670, 0.834 and 0.946, respectively). 64.7% of the total sample (79.5% of frail and 87.9% of malnourished subjects) would participate in a home-based muscle training and nutritional intervention program. Conclusions: This study underlines the association and the overlap between frailty and impaired nutritional status. There is a high readiness to participate in a program to tackle the problems associated with malnutrition and frailty, especially in those, who would benefit most from it. [ABSTRACT FROM AUTHOR]

Background: Religious belief can be used as a pain coping strategy. Our purpose was to evaluate the relationship between headache and religious activity using prospective data from a large population-based study. Methods: This longitudinal cohort study used data from two consecutive surveys in the Nord-Trøndelag Health Survey (HUNT 2 and 3) performed in 1995-1997; and 2006-2008. Among the 51,383 participants aged ≥ 20 years who answered headache questions at baseline, 41,766 were eligible approximately 11 years later. Of these, 25,177 (60%) completed the question in HUNT 3 regarding religious activity. Frequent religious attendees (fRA) (used as a marker of stronger religious belief than average) were defined as those who had been to church/prayer house at least once monthly during the last six months. Results: In the multivariate analyses, adjusting for known potential confounders, individuals with headache 1-14 days/month in HUNT 2 were more likely to be fRA 11 years later than headache-free individuals. Migraine at baseline predisposed more strongly to fRA at follow-up (OR = 1.25; 95% CI 1.19-1.40) than did non-migrainous headache (OR = 1.13; 95% 1.04-1.23). The odds of being fRA was 48% increased (OR 1.48; 95% 1.19-1.83) among those with migraine 7-14 days/month at baseline compared to subjects without headache. In contrast, headache status at baseline did not influence the odds of being frequent visitors of concerts, cinema and/or theatre at follow-up 11 years later. Conclusions: In this prospective study, headache, in particular migraine, at baseline slightly increased the odds of being fRA 11 years later. [ABSTRACT FROM AUTHOR]

Objective: Aging is associated with decreases in muscle mass, strength, power (sarcopenia) and bone mineral density (BMD). The aims of this study were to investigate in elderly the role of sarcopenia on BMD loss by a path model, including adiposity, inflammation, and malnutrition associations. Methods: Body composition and BMD were measured by dual X-ray absorptiometry in 159 elderly subjects (52 male/107 female; mean age 80.3 yrs). Muscle strength was determined with dynamometer. Serum albumin and PCR were also assessed. Structural equations examined the effect of sarcopenia (measured by Relative Skeletal Muscle Mass, Total Muscle Mass, Handgrip, Muscle Quality Score) on osteoporosis (measured by Vertebral and Femoral T-scores) in a latent variable model including adiposity (measured by Total Fat Mass, BMI, Ginoid/Android Fat), inflammation (PCR), and malnutrition (serum albumin). Results: The sarcopenia assumed a role of moderator in the adiposity-osteoporosis relationship. Specifically, increasing the sarcopenia, the relationship adiposity-osteoporosis (β: −0.58) decrease in intensity. Adiposity also influences sarcopenia (β: −0.18). Malnutrition affects the inflammatory and the adiposity states (β: +0.61, and β: −0.30, respectively), while not influencing the sarcopenia. Thus, adiposity has a role as a mediator of the effect of malnutrition on both sarcopenia and osteoporosis. Malnutrition decreases adiposity; decreasing adiposity, in turn, increase the sarcopenia and osteoporosis. Conclusions: This study suggests such as in a group of elderly sarcopenia affects the link between adiposity and BMD, but not have a pure independent effect on osteoporosis. [ABSTRACT FROM AUTHOR]

Background: The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Materials and Methods: Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. Results: All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem–shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Conclusions: Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation. [ABSTRACT FROM AUTHOR]

Objectives: Objectives: To investigate patients’ views about their lowest tolerable blood glucose level and explore symptoms they may develop below that level. Design: A semi-structured patient interview. Setting: Outpatient clinic for older people (≥75 years) with diabetes. Participants: Patients attending an outpatient clinic over a six months period who are monitoring their blood glucose at home and able to participate in interview. Results: Sixty one patients gave answers to the interview questions. Mean (SD) age was 82.3 (3.9) years and 33 (54%) were females. All patients indicated that they were usually aware when hypoglycaemia occurs but the symptoms reported were mostly non specific. The threshold for hypoglycaemia was 5 mmol/L in 13 (21%) patients, 6 mmol/L in 14 (23%) patients, 7 mmol/L in 13 (21%) patients, 8 mmol/L in 17 (28%) patients and 9 mmol/L in 4 (7%) patients. There was no significant difference between patients who were symptomatic at a higher blood glucose level (>6mmo/L) and those who developed symptoms at a lower level (≤6mmol/L). Conclusion: Older people with diabetes who seem to be aware of hypoglycaemia report mostly non specific symptoms. The threshold of experiencing hypoglycaemic symptoms appears to be higher than the usually defined <4mmol/L. [ABSTRACT FROM AUTHOR]

This study aims to evaluate whether the distribution of vessels inside and adjacent to tumor region at three-dimensional (3-D) power Doppler ultrasonography (US) can be used for the differentiation of benign and malignant breast tumors. 3-D power Doppler US images of 113 solid breast masses (60 benign and 53 malignant) were used in this study. Blood vessels within and adjacent to tumor were estimated individually in 3-D power Doppler US images for differential diagnosis. Six features including volume of vessels, vascularity index, volume of tumor, vascularity index in tumor, vascularity index in normal tissue, and vascularity index in surrounding region of tumor within 2 cm were evaluated. Neural network was then used to classify tumors by using these vascular features. The receiver operating characteristic (ROC) curve analysis and Student's t test were used to estimate the performance. All the six proposed vascular features are statistically significant ( p < 0.001) for classifying the breast tumors as benign or malignant. The A (area under ROC curve) values for the classification result were 0.9138. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis performance based on all six proposed features were 82.30 (93/113), 86.79 (46/53), 78.33 (47/60), 77.97 (46/59), and 87.04 % (47/54), respectively. The p value of A values between the proposed method and conventional vascularity index method using z test was 0.04. [ABSTRACT FROM AUTHOR]

The objective was to examine the association between lifestyle and risk for diabetes. For an average of 9.9 years, this study prospectively followed a cohort of 7,211 (2,524 men and 4,687 women) community residents aged 30-69 years without diabetes at a health check-up conducted between April 1990 and March 1992 until diabetes was confirmed or until the end of 2006. The subjects were divided into 6 groups according to their total scores of Breslow's lifestyle index (1-2, 3, 4, 5, 6 and 7 points). The association between lifestyle and diabetes incidence was investigated using Cox proportional hazards regression models. The results showed that the multivariate-adjusted hazard ratios were 0.45 in subjects who scored 5 points, 0.39 in subjects who scored 6 points, and 0.31 in subjects who scored 7 points, compared with subjects who scored 1-2 points. These data indicate that the healthy behaviors prevent the incidence of diabetes. [ABSTRACT FROM AUTHOR]

Objective: XXXto assess the effect on cognition of a controlled intervention testing Mediterranean diets (MedDiet). Design: XXXrandomized trial after 6.5 years of nutritional intervention. Setting: Eight primary care centers affiliated to the University of Navarra. Participants: A random subsample of 285 participants (95 randomly allocated to each of 3 groups) of the PREDIMED-NAVARRA trial. All of them were at high vascular risk (44.8% men, 74.1± 5.7 years at cognitive evaluation). Interventions: Nutritional intervention comparing two MedDiets (supplemented with extra-virgin olive oil [EVOO] or mixed nuts) versus a low-fat control diet. Participants received intensive education to increase adherence to the intended intervention. Participants allocated to the MedDiet groups received EVOO (1 l/week) or 30 g/day of mixed nuts. Dietary habits were evaluated using a validated 137-item food frequency questionnaire (FFQ). Additionally, adherence to MedDiet was appraised using a 14-item questionnaire both at baseline and yearly thereafter. Measurements: XXXcognitive performance as a main outcome and cognitive status (normal, mild cognitive impairment [MCI] or dementia) as a secondary outcome were evaluated by two neurologists blinded to group assignment after 6.5 years of nutritional intervention. Results: Better post-trial cognitive performance versus control in all cognitive domains and significantly better performance across fluency and memory tasks were observed for participants allocated to the MedDiet+EVOO group. After adjustment for sex, age, education, apolipoprotein E genotype, family history of cognitive impairment/dementia, smoking, physical activity, body mass index, hypertension, dyslipidaemia, diabetes, alcohol and total energy intake, this group also showed lower MCI (OR=0.34 95% CI: 0.12-0.97) compared with control group. Participants assigned to MedDiet+Nuts group did not differ from controls. Conclusion: A long-term intervention with an EVOO-rich MedDiet resulted in a better cognitive function in comparison with a control diet. However, non-significant differences were found for most cognitive domains. Participants allocated to an EVOO-rich MedDiet had less MCI than controls. [ABSTRACT FROM AUTHOR]

Three-dimensional (3-D) surface imaging has gained clinical acceptance, especially in the field of cranio-maxillo-facial and plastic, reconstructive, and aesthetic surgery. Six scanners based on different scanning principles (Minolta Vivid 910®, Polhemus FastSCAN™, GFM PRIMOS®, GFM TopoCAM®, Steinbichler Comet® Vario Zoom 250, 3dMD DSP 400®) were used to measure five sheep skulls of different sizes. In three areas with varying anatomical complexity (areas, 1 = high; 2 = moderate; 3 = low), 56 distances between 20 landmarks are defined on each skull. Manual measurement (MM), coordinate machine measurements (CMM) and computer tomography (CT) measurements were used to define a reference method for further precision and accuracy evaluation of different 3-D scanning systems. MM showed high correlation to CMM and CT measurements (both r = 0.987; p < 0.001) and served as the reference method. TopoCAM®, Comet® and Vivid 910® showed highest measurement precision over all areas of complexity; Vivid 910®, the Comet® and the DSP 400® demonstrated highest accuracy over all areas with Vivid 910® being most accurate in areas 1 and 3, and the DSP 400® most accurate in area 2. In accordance to the measured distance length, most 3-D devices present higher measurement precision and accuracy for large distances and lower degrees of precision and accuracy for short distances. In general, higher degrees of complexity are associated with lower 3-D assessment accuracy, suggesting that for optimal results, different types of scanners should be applied to specific clinical applications and medical problems according to their special construction designs and characteristics. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of malnutrition in ambulatory patients with heart failure is difficult to determine, depending on the timing and methodology. Objective: To determine the nutritional status of outpatients with systolic heart failure with the Mini Nutritional Assessment (MNA) full and short-form versions, and evaluate its relationship with the short-term prognosis, biomarkers and quality of life. Methods: Fifty consecutive (70% male), geriatric (74.3+ 6.2years old) stable outpatient with heart failure (NYHA class II 68%, III 32%) and left ventricular ejection fraction of 26.7 +11.5% were included and followed during 12 months. At a routine visit to the heart failure clinic, the MNA, the Minnesota Living with Heart Failure questionnaire (MLHFQ) were applied. According to the MNA screening score the nutritional status was classified using the MNA full (MNA-F) and the short-form (MNA-F) versions of the questionnaire. The recorded events were death and hospitalization. Statistics: The-survival and hospitalizations curves were evaluated with the Log-Rank test and Cox Regression analysis. The association between parameters was analyzed with the Pearson and Spearmann correlation coefficient. Results: (1) The mortality and hospitalization rates were 12% and 42%, respectively. (2) With the MNA-SF 7.6% of the patients had malnutrition and 20% were at risk of malnutrition. There was a good agreement (90%) between the MNA-SF and the MNA-F classifications. (3) There was a significant relationship between the MNA screening score and the MLHFQ (rs= −0.592 p<0.00l), Nt-ProBNP (rs= −0.49 p<0.001) and total plasma protein (r= 0.672 p=0.006); (3) The-MNA-SF nutritional classification was associated with the 12 months survival (Log-Rank p=0.044) and hospitalization (Log-Rank p=0.005) curves. (4) Those patients with malnutrition by the MNA-SF were at greater risk of death (HR= 8.0 p=0.059) and hospitalization (HR 8.1 p=0.008). Conclusion: The MNA is useful for the evaluation of the nutritional status of elderly outpatients with systolic heart failure. It is a good predictor of the short-term outcome and is also associated with the quality of life and Nt-ProBNP. [ABSTRACT FROM AUTHOR]

Study design:Case series, consecutive sample, survey.Objectives:To examine the incidence of spinal cord injuries sustained as a result of falls compared with other causes, and to investigate rehabilitation outcomes between these two groups.Settings:Tertiary care, spinal cord injury rehabilitation unit (National Spinal Injuries Center), Stoke Mandeville Hospital, UK.Methods:Demographic information and descriptive statistics were examined for individuals sustaining their injury via falls vs non-falls. Statistical analysis investigated rehabilitation outcomes between the groups.Results:The etiology of spinal cord injury (SCI) reported is similar to previous findings. Individuals who sustained their SCI as a result of falls and other causes made equal improvements from the start to end of rehabilitation, according to the Needs Assessment Checklist, a clinical measure of individual rehabilitation needs in 10 domains. However, those in the falls group achieved less overall throughout rehabilitation, and this was significant at pre-discharge for the areas of bladder management, mobility and discharge.Conclusion:Results highlight the need for specific consideration to be made of the rehabilitation needs of individuals who sustain SCI as a result of a fall, and for these to be addressed in rehabilitation programming. [ABSTRACT FROM AUTHOR]

Study design:A prospective, animal model for pharmacological intervention of decompression sickness (DCS), including spinal cord (SC) injury.Background:Signs and symptoms of DCS can include joint pain, skin discoloration, cardiopulmonary congestion and SC injury; severity ranges from trivial to fatal. Non-recompressive therapy for DCS may improve time-to-treatment and therefore impact mortality and morbidity.Objectives:Oxycyte at 5 cc kg−1 provides both SC protection and statistically significant survival benefit in a swine model of DCS. The purpose of this study was to test whether a reduced dose of Oxycyte (3 cc kg−1) would provide similar benefit.Setting:Silver Spring, MD, USAMethods:Male Yorkshire swine (N=50) underwent a non-linear compression profile to 200 fsw (feet of sea water), which was identical to previous work using the 5 cc kg−1 dose of Oxycyte. After 31 min of bottom time, decompression was initiated at 30 fsw per minute until surface pressure was reached. Following decompression and the onset of DCS, intravenous Oxycyte or saline was administered with concurrent 100% O2 for 1 h. The primary end point was DCS-induced mortality, with Tarlov score and SC histopathology as secondary end points.Results:Oxycyte administration of 3 cc kg−1 following surfacing produced no significant detectable survival benefit. Animals that received Oxycyte, however, had reduced SC lesion area.Conclusion:Further studies to determine the lowest fully efficacious dose of Oxycyte for the adjunct treatment of DCS are warranted. [ABSTRACT FROM AUTHOR]

Masses in and around pancreas constitute an important clinical entity in gastrointestinal surgical practice. Most common being adenocarcinoma of head of pancreas followed by inflammatory masses due to chronic pancreatitis. Accurate diagnosis is of central importance as therapeutic strategies range from observation to complete surgical removal including total pancreatectomy.Several tumor markers are available which could help in prognostication and diagnosis of carcinoma pancreas. Carbohydrate antigen 19-9(CA 19-9) is traditionally accepted best marker available. The role of new tumor marker platelet lymphocyte ratio (PLR) has been defined recently in prognostication of carcinoma pancreas. Role of PLR in diagnosing and its efficacy after combining it with CA 19-9 is not known. The aim of study was to assess the demographics of histologically proven neoplastic and inflammatory pancreatic head masses in our department. To assess the role of CA19-9 and platelet lymphocyte ratio(PLR) in determining nature of pancreatic head mass. Data consisted of histologically proven 45 patients .23 having head mass due to chronic pancreatitis and 22 because of neoplastic lesions. Demographics in terms of age, sex, previous pain episodes, presence of jaundice, history of alcohol intake were compared in both groups. Also tumor markers CA 19-9 and PLR individually and in combination were compared in both groups. Cancer pancreas significantly ( p < 0.001) occurred in older age group, was significantly associated with jaundice ( p = 0.005) and weight loss ( p < 0.001). Accuracy in diagnosis of cancer pancreas was similar with CA 19-9 and PLR (68.89 %), where as combining CA 19-9 with PLR showed increased sensitivity(81.82 %) and accuracy(71.11 %) in diagnosing cancer pancreas. Other combinations showed no advantage. PLR is at least as good as CA 19-9 as diagnostic marker to differentiate between malignant and inflammatory head mass of pancreas. [ABSTRACT FROM AUTHOR]

Objectives: To study differences in nutritional status and body composition, by feeding modality, among disabled nursing home residents. Design: A retrospective chart-review study. Setting: A nursing wing of a public urban geriatric center. Participants: Three groups of patients: non-dysphagic, orally-fed dysphagic and percutaneous endoscopic gastrostomy -fed dysphagic patients. Intervention: Standard nursing care Measurements: Basal metabolic rate, total energy expenditure and nitrogen balance under oral or percutaneous endoscopic gastrostomy feeding. Dietary intake was assessed during a 3-days period by daily-food intake protocols and a 24-hours urinary creatinine excretion to detect nitrogen balance and calculate body composition parameters. Results: Data of 117 patients (55.5% females), mean age 84.6±7.5 (range 66-98 years) was analyzed. Dysphagic patients (60) differed from non-dysphagic patients (57) by lower body mass index (p=0.020), fat mass index (p=0.017), daily protein intake (p<0.0001), daily energy intake (p<0.001), protein related energy intake (p<0.001) and a negative nitrogen balance (p<0.001). In regression analyses, dysphagia was associated with increased risk of having a body mass index lower than 22.0kg/m2 (OR=2.60, 95% CI 1.135-5.943), a negative nitrogen balance (OR=2.33, 95% CI 1.063-4.669), a low fat mass index (OR=2.53, 95% CI 1.066-6.007), and low daily protein and energy intakes per body weight (OR=2.87, 95% CI 1.316-6.268 and OR=2.99, 95% CI 1.297-6.880). Compared with orally-fed dysphagic patients (21pts.), percutaneous endoscopic gastrostomy -fed patients (39pts.) received an additional mean energy intake of 30.5% kcal per day and mean protein intake of 26.0%. This additional intake was not associated with improved body composition parameters (such as fat free mass, skeletal mass or body mass index). Conclusion: Dysphagic nursing home residents are characterized by worse nutritional, metabolic and body composition parameters, compared with non-dysphagic residents. Body composition parameters did not differ between orally-fed and percutaneous endoscopic gastrostomy-fed dysphagic patients, despite significantly better nutritional and metabolic parameters in PEG-fed patients. Other approaches (perhaps physical training, pharmacological etc.) should be sought to improve body composition of such patients. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of hyperuricemia and lifestyle risk factors for hyperuricemia in elderly women. Design: Cross-sectional study. Setting: The suburban area of Guangzhou, Guangdong province, China. Participants: The study included 856 Chinese women aged 60 to 102 years who received their annual health examinations in the suburban area of Guangzhou, South China in 2002. Measurements: Information on anthropometric measurements and lifestyle factors were obtained via a questionnaire processed by the attending physicians or nurses. Blood biochemistry was performed after subjects fasted for 8-14 h. Unconditional logistic regression analysis was used to investigate associations between hyperuricemia, meat intake quintiles, physical activity quintiles, and alcohol intake quintiles. Results: The prevalence of hyperuricemia in the studied population was 12.01%. Alcohol, meat and seafood consumption; being overweight or obese; hypertension; and abnormal triglyceride levels were strongly associated with a higher prevalence of hyperuricemia. Physical activity was inversely related to the prevalence of hyperuricemia. The odds ratios for hyperuricemia for quintiles of physical activity were 1.00, 0.74, 0.72, 0.63, and 0.55 (P<0.01). Conclusions: Our data suggest that the prevalence of hyperuricemia is high in elderly women in suburban Guangzhou in Guangdong province of South China. Obesity, meat and seafood intake and alcohol consumption are associated with a higher prevalence of hyperuricemia, whereas daily physical activity is inversely related to the prevalence of hyperuricemia. [ABSTRACT FROM AUTHOR]