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2 ["Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis"] 10.1136/annrheumdis-2013-204577 http://dx.doi.org/10.1136/annrheumdis-2013-204577 2014-01-08T03:37:11Z ["Immunology", "General Biochemistry, Genetics and Molecular Biology", "Immunology and Allergy", "Rheumatology"] 89 199 ["0003-4967", "1468-2060"] Annals of the Rheumatic Diseases <jats:sec><jats:title>Objectives</jats:title><jats:p>To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA) to inform the European League Against Rheumatism(EULAR) Task Force treatment recommendations.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Medline, Embase and Cochrane databases were searched for articles published between January 2009 and February 2013 on infliximab, etanercept, adalimumab, certolizumab-pegol, golimumab, anakinra, abatacept, rituximab, tocilizumab and biosimilar DMARDs (bsDMARDs) in phase 3 development. Abstracts from 2011 to 2012 American College of Rheumatology (ACR) and 2011–2013 EULAR conferences were obtained.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Fifty-one full papers, and 57 abstracts were identified. The randomised controlled trials (RCT) confirmed the efficacy of bDMARD+conventional synthetic DMARDs (csDMARDs) versus csDMARDs alone (level 1B evidence). There was some additional evidence for the use of bDMARD monotherapy, however bDMARD and MTX combination therapy for all bDMARD classes was more efficacious (1B). Clinical and radiographic responses were high with treat-to-target strategies. Earlier improvement in signs and symptoms were seen with more intensive initial treatment strategies, but outcomes were similar upon addition of bDMARDs in patients with insufficient response to MTX. In general, radiographic progression was lower with bDMARD use, mainly due to initial treatment effects. Although patients may achieve bDMARD- and drug-free remission, maintenance of clinical responses was higher with bDMARD continuation (1B), but bDMARD dose reduction could be applied (1B). There was still no RCT data for bDMARD switching.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The systematic literature review confirms efficacy of biological DMARDs in RA. It addresses different treatment strategies with the potential for re… 10 [] ["Jackie L Nam", "Sofia Ramiro", "Cecile Gaujoux-Viala", "Kaoru Takase", "Mario Leon-Garcia", "Paul Emery", "Laure Gossec", "Robert Landewe", "Josef S Smolen", "Maya H Buch"] [""] [""] [""]
4 ["Gene profiling reveals specific molecular pathways in the pathogenesis of atherosclerosis and cardiovascular disease in antiphospholipid syndrome, systemic lupus erythematosus and antiphospholipid syndrome with lupus"] 10.1136/annrheumdis-2013-204600 http://dx.doi.org/10.1136/annrheumdis-2013-204600 2014-03-12T01:09:55Z ["Immunology", "General Biochemistry, Genetics and Molecular Biology", "Immunology and Allergy", "Rheumatology"] 47 31 ["0003-4967", "1468-2060"] Annals of the Rheumatic Diseases <jats:sec><jats:title>Objective</jats:title><jats:p>To identify shared and differential molecular pathways involved in the pathogenesis of atherosclerosis (AT) and cardiovascular disease (CVD) in systemic lupus erythematosus (SLE), primary antiphospholipid syndrome (APS) and APS associated with SLE (APS plus SLE).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>129 patients (42 APS, 31 APS plus SLE and 56 SLE) and 61 healthy donors were included. Microarray expression profiling was performed in monocytes. RT-PCR of selected genes and western blot were used to validate microarray data. Clinical and inflammatory parameters were also analysed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Compared with controls, 555, 1224 and 518 genes were differentially expressed in monocytes from SLE, APS plus SLE and APS patients, respectively. Approximately 25–30% of differentially expressed genes were related to AT and CVD. Each disease displayed a specific AT/CVD/Inflammation-related gene signature. Compared with SLE, APS showed alterations in mitochondria biogenesis and function and oxidative stress. Besides the interferon signature, found in APS plus SLE and SLE patients, various genes mediating atherosclerotic/inflammatory signalling were also differentially expressed in APS plus SLE. IgG-anticardiolipin (aCL) titres independently predicted both atherosclerotic and thrombosis in APS plus SLE. Moreover, a significant correlation of IgG-aCL titres with mRNA levels of certain inflammatory molecules in monocytes was further noticed. In vitro treatment of monocytes with IgG-aCL promoted an increase in the expression of the genes most significantly changed in APS plus SLE versus healthy donors.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Gene expression profiling allows the segregation of APS, APS plus SLE and SLE, with specific signatures explaining the pro-atherosclerotic and pro-thrombotic alterations in these highly related autoimmune diseases.</jats:p>… 11 [] ["Carlos Perez-Sanchez", "Nuria Barbarroja", "Sebastiano Messineo", "Patricia Ruiz-Limon", "Antonio Rodriguez-Ariza", "Yolanda Jimenez-Gomez", "Munther A Khamashta", "Eduardo Collantes-Estevez", "M\u00aa Jose Cuadrado", "M\u00aa Angeles Aguirre", "Chary Lopez-Pedrera"] [""] [""] [""]
9 ["Season and region of birth as risk factors for coeliac disease a key to the aetiology?"] 10.1136/archdischild-2015-310122 http://dx.doi.org/10.1136/archdischild-2015-310122 2016-08-16T01:13:27Z ["Pediatrics, Perinatology, and Child Health"] 39 11 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0–14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at &lt;2 years had an increased CD risk if born in spring while those diagnosed at 2–14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991–1996 had increased CD risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.</jats:p></jats:sec> 5 [] ["Fredinah Namatovu", "Marie Lindkvist", "Cecilia Olsson", "Anneli Ivarsson", "Olof Sandstr\u00f6m"] [""] [""] [""]
43 ["Thyroid scintigraphy differentiates subtypes of congenital hypothyroidism"] 10.1136/archdischild-2019-317665 http://dx.doi.org/10.1136/archdischild-2019-317665 2019-11-14T22:15:30Z ["Pediatrics, Perinatology, and Child Health"] 0 1 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Introduction</jats:title><jats:p>UK screening for congenital hypothyroidism (CH) is based on dried blood spot Thyroid Stimulating Hormone (TSH). Scintigraphy may identify CH subtypes classified as dysplasia, gland in situ (GIS) and ectopia, but is not performed in all centres. We retrospectively investigated the role of scintigraphy to identify CH subtypes in a single tertiary centre cohort.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Babies who screened positive for CH between 2007 and 2017 were studied (n=418 of 534 783). Scintigraphy outcomes were correlated with TSH and levothyroxine dose. GIS patients were analysed for 3-year outcomes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>303 patients started levothyroxine. Scintigraphy demonstrated three subtypes: GIS (n=139, 46%) ectopia (n=84, 28%) and dysplasia (n=80, 26%). Three-year follow up demonstrated permanence in 54% of 37 GIS cases.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Thyroid scintigraphy differentiates subtypes of CH and suggests a higher than expected proportion of patients with GIS and ectopia. CH is permanent in half of those with GIS.</jats:p></jats:sec> 6 [] ["Chris Worth", "Beverly Hird", "Lesley Tetlow", "Neville Wright", "Leena Patel", "Indraneel Banerjee"] [""] [""] [""]
45 ["Success of 4CMenB in preventing meningococcal disease: evidence from real-world experience"] 10.1136/archdischild-2019-318047 http://dx.doi.org/10.1136/archdischild-2019-318047 2020-02-06T22:15:25Z ["Pediatrics, Perinatology, and Child Health"] 0 1 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:p>Meningococcal disease remains one of the most feared infectious diseases worldwide because of its sudden onset, rapid progression and high case fatality rates, while survivors are often left with severe long-term sequelae. Young children have the highest incidence of invasive meningococcal disease (IMD), and nearly all cases in the UK, as in most of Europe and many other industrialised countries, are due to group B meningococci (MenB). The licensure of a broad-coverage, recombinant protein-based MenB vaccine (4CMenB) in 2013 was, therefore, heralded a major breakthrough in the fight against IMD. This vaccine was, however, licensed on immunogenicity and reactogenicity studies only, raising uncertainties about field effectiveness, long-term safety and antibody persistence. In 2015, the UK became the first country to implement 4CMenB into the national infant immunisation schedule and, since then, several countries have followed suit. Seven years after licensure, a wealth of real-world data has emerged to confirm 4CMenB effectiveness, along with large-scale safety data, duration of protection in different age groups, successful strategies to reduce vaccine reactogenicity, impact on carriage in adolescents and the potential for 4CMenB to protect against other meningococcal serogroups and against gonorrhoea. A number of questions, however, remain unanswered, including the investigation and management of vaccine-associated fever in infants, as well as disease severity and assessment of breakthrough cases in immunised children. Increasing use of 4CMenB will provide answers in due course. We now have vaccines against all the major serogroups causing IMD worldwide. Next-generation and combination vaccines against multiple serogroups look very promising.</jats:p> 4 [] ["Catherine Isitt", "Catherine A Cosgrove", "Mary Elizabeth Ramsay", "Shamez N Ladhani"] [""] [""] [""]
52 ["DEVELOPMENT AND ESTABLISHMENT OF A QUALITY-FRAMEWORK FOR THE LENA PROJECT"] 10.1136/archdischild-2015-310148.72 http://dx.doi.org/10.1136/archdischild-2015-310148.72 2015-12-15T08:07:33Z ["Pediatrics, Perinatology, and Child Health"] 0 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>The LENA (Labeling of Enalapril from Neonates up to Adolescents) project has been initiated to improve the healthcare of children with heart failure by an enalapril orodispersible mini-tablet. The LENA consortium combines academic clinical research centers, SMEs (small and medium-sized enterprises) and a patient/parent advocacy organization. The objective of the project requires to comply with respective GxP regulations like Good Manufacturing Practice (GMP), Good Clinical (Laboratory) Practice (GCP/“GCLP”1) and Good Vigilance Practice (GVP). The project team is comprised of sub-teams experienced in paediatric clinical practice, medicines development, clinical research and project management, but not all team members work in an appropriate quality framework. Aim: To establish a well-documented, efficient quality system applying a new approach for ensuring quality in all trial aspects by combining existing organization-related quality system elements of the project partners with newly developed SOPs and overarching, integrating trial-specific elements to ensure a reliable quality environment for the LENA Phase I clinical trial.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Based on the network-structure of the project organization, a strategy based on a team approach with joint responsibilities for the quality conduct of the project was pursuit, forming a QM Team consisting of the project leader, the leaders for pharmaceutical and clinical development and an external quality expert. The team compiled a quality manual and an organizational chart displaying the sub-teams and their responsibilities. Another responsibility of the team is the integration of existing SOPs and Work Instructions as well as the creation of procedures at the project level and furthermore the verification of appropriate qualification of all staff involved in the project through CVs, job descriptions and training records.</jats:p></jats:sec><jats:sec><jats:title>Resul… 7 [] ["Agnes M. Ciplea", "Karl Kleine", "Bj\u00f6rn B. Burckhardt", "Stephanie L\u00e4er", "J\u00f6rg Breitkreutz", "Lucie \u0160patenkov\u00e1", "Ingrid Klingmann"] [""] [""] [""]
55 ["MEDICATION USE IN NEONATAL INTENSIVE CARE UNITS ACROSS EUROPE"] 10.1136/archdischild-2015-310148.11 http://dx.doi.org/10.1136/archdischild-2015-310148.11 2015-12-15T08:07:33Z ["Pediatrics, Perinatology, and Child Health"] 0 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Objectives</jats:title><jats:p>This is the first Europe-wide study aiming to describe the medication use in Neonatal Intensive Care Units and to analyse the factors that might influence the prescription pattern.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A pan-European one day point-prevalence study was conducted in 2012 where all of the prescriptions for hospitalised neonates were recorded. A trade name, manufacturer, active pharmaceutical ingredients (API), strength, galenic form and route of administration were registered.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Altogether 2173 prescriptions were administered to 726 neonates from 21 countries, of whom 66% (477/726) were preterm, 12% (84/726) extremely preterm. There was inverse correlation between gestational age (GA) and median number of prescriptions per neonate (group median 2/IQR 1–4, extremely preterm 4/3–6, very preterm 3/2–5, late preterm 2/1–3, full-term 2/1–3). Median number of prescriptions per neonate was highest in the eastern region, among extremely preterm neonates (median=6.5/IQR 6–8.5). Highest prescription rate was for alimentary medicines (93/per 100 admissions), systemic antiinfectives (79/100) and medicines for blood (71/100). Antiinfectives were most frequently prescribed in the southern region (103/100). Multivitamins were most frequently used medications in most regions (western 74, southern 31, northern 31/100), except in eastern region (5/100). Most commonly prescribed API-s were multivitamins (32/100), caffeine (19/100), gentamicin (18/100), amino acids (18/100) and colecalciferol (15/100). Most frequently prescribed medications among extremely preterm neonates were caffeine (60/100), among very preterms multivitamins and caffeine (45 and 43/100), among late preterms multivitamins (44/100) and among full-terms phytomenadione (26/100) and gentamicin (24/100).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our study revealed the most c… 4 [] ["Inge Mesek", "Georgi Nellis", "Jana Lass", "Irja Lutsar"] [""] [""] [""]
68 ["Drug utilisation among Dutch adolescents: a pharmacy prescription records study"] 10.1136/archdischild-2017-314692 http://dx.doi.org/10.1136/archdischild-2017-314692 2018-06-01T16:16:30Z ["Pediatrics, Perinatology, and Child Health"] 12 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>Studies on adolescent drug use are scarce as most studies do not distinguish between children and adolescents. Therefore, we assessed overall drug use in adolescents.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective cohort study was conducted using pharmacy dispensing records from 62 community pharmacies in the Netherlands. Dispensing records of the previous 5 years were extracted for adolescents (12–18 years).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The study population consisted of 47 421 adolescents who collected at least one medication prescription during adolescence (mean age 15.5±1.8 years; 48.9% males). Half of them collected dermatologicals (46.2% males; 52.3% females), followed by drugs for the respiratory system (43.4% males; 40.3% females) and anti-infectives for systemic use (31.3% males; 39.1% females). The percentage of males using dermatologicals slightly increased, while the percentage of female users decreased with age. The most prescribed active ingredient was methylphenidate.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These insights into adolescent drug use help us to better understand adolescent healthcare use.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>Dutch trial register NTR5061.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0001-9059-1278"] ["Richelle C Kosse", "Ellen S Koster", "Tjalling W de Vries", "Marcel L Bouvy"] [""] [""] [""]
74 ["SELF-ADMINISTRATION OF IN-PATIENT MEDICATIONS: A PILOT STUDY IN CHILDREN WITH CYSTIC FIBROSIS"] 10.1136/archdischild-2016-311535.70 http://dx.doi.org/10.1136/archdischild-2016-311535.70 2016-08-18T07:07:30Z ["Pediatrics, Perinatology, and Child Health"] 1 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Introduction</jats:title><jats:p>Children with Cystic Fibrosis (CF) have complex medication regimens, where responsibility for administration usually lies with the parent/carer until the child is older and able to take over this role.1 On admission to hospital this role is usually undertaken by nurses, leaving patients/parents/carers feeling disempowered, and unprepared for discharge.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>All CF admissions to be offered the Self-Administration Of Medicines Scheme (SAM).</jats:p><jats:p>▸ Empower patients/parents/carers with responsibility of administering their own medications</jats:p><jats:p>▸ Reduce nursing time</jats:p><jats:p>▸ Educate patients/parents/carers about their medications</jats:p><jats:p>▸ Cost-saving by utilising Patients Own Medicines (PODs).</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A policy and training programme was developed and approved by the Trust's Medicines Management Board. This provided a framework for staff to use so that they may:</jats:p><jats:p>▸ Obtain consent</jats:p><jats:p>▸ Evaluate and re-use PODs</jats:p><jats:p>▸ Safely store and obtain supplies</jats:p><jats:p>▸ Continuously negotiate accountability for administration with patient/parent/carer.</jats:p><jats:p>The study was conducted over a 10 month period, where all families with CF admitted, were assessed for participation in SAM. The nursing teams acted as the primary assessors for SAM and any concerns were referred to the paediatric CF multidisciplinary team. To evaluate the pilot, families were given questionnaires to establish their views about the scheme. Nurses were asked to feedback if SAM decreased time for medication administration. To evaluate the associated cost-saving, data on PODs suitable for re-use was collected.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>159 children with CF were admitted to the ward, 95 (60%) were assessed to participate in the scheme and 64 (40%) of the… 7 [] ["Khola Khan", "Aoife Harrington", "Rupinder Pannu", "Sian Bentley", "Sukeshi Makhecha", "Nimla Pentayya", "Clare Pheasant"] [""] [""] [""]
98 ["Children with chronic health disorders travelling to the tropics: a prospective observational study"] 10.1136/archdischild-2015-309436 http://dx.doi.org/10.1136/archdischild-2015-309436 2016-06-11T04:55:23Z ["Pediatrics, Perinatology, and Child Health"] 19 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>The number of trips to the tropics taken by children with chronic health disorders (CHDs) is increasing.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All of the children with CHDs who attended two international vaccination centres in France before travelling to the tropics were included in a prospective, exposed/unexposed study. Each child was age-matched with two control children and followed for 1 month after returning from the tropics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Fifty-six children with CHDs and 107 control children were included. The children's median age was 6 years old (IQR 2–11). Of the study participants, 127/163 (78%) travelled to West Africa, mainly to visit relatives. The median duration of the stay was 42 days (IQR 31–55). The age of the children, the destination and the duration of the trip were similar between the two groups. Sickle cell disease (23/56) and asthma (16/56) were the most common CHDs. Overall, the children with CHDs experienced more clinical events than the control patients did (p&lt;0.05); however, there was no difference when chronic disease exacerbations were excluded (p=0.64) or when only the period abroad was considered (p=0.24). One child with a recent genetic diagnosis of atypical haemolytic uraemic syndrome died from a first disease exacerbation.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Health problems among children with CHDs travelling abroad are mainly related to chronic disease exacerbations, which mostly occur after the children return. Patients with diseases that require highly specialised care for an exacerbation should avoid travelling to resource-limited tropical countries.</jats:p></jats:sec> 12 [] ["Camille Ducrocq", "Julie Sommet", "Dora Levy", "Thanh-Van Trieu", "Fabrice Quercia", "Laurence Morin", "Xavier Belletre", "B\u00e9reng\u00e8re Koehl", "Frederic Sorge", "Corinne Alberti", "Loic de Pontual", "Albert Faye"] [""] [""] [""]
7 ["Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management"] 10.1136/gutjnl-2019-318404 http://dx.doi.org/10.1136/gutjnl-2019-318404 2019-08-19T15:35:18Z ["Gastroenterology"] 95 13 ["0017-5749", "1468-3288"] Gut <jats:p>Lactose is the main source of calories in milk, an essential nutriedigestion, patients with visceral hypersensitivity nt in infancy and a key part of the diet in populations that maintain the ability to digest this disaccharide in adulthood. Lactase deficiency (LD) is the failure to express the enzyme that hydrolyses lactose into galactose and glucose in the small intestine. The genetic mechanism of lactase persistence in adult Caucasians is mediated by a single C→T nucleotide polymorphism at the LCTbo −13’910 locus on chromosome-2. Lactose malabsorption (LM) refers to any cause of failure to digest and/or absorb lactose in the small intestine. This includes primary genetic and also secondary LD due to infection or other conditions that affect the mucosal integrity of the small bowel. Lactose intolerance (LI) is defined as the onset of abdominal symptoms such as abdominal pain, bloating and diarrhoea after lactose ingestion by an individual with LM. The likelihood of LI depends on the lactose dose, lactase expression and the intestinal microbiome. Independent of lactose digestion, patients with visceral hypersensitivity associated with anxiety or the Irritable Bowel Syndrome (IBS) are at increased risk of the condition. Diagnostic investigations available to diagnose LM and LI include genetic, endoscopic and physiological tests. The association between self-reported LI, objective findings and clinical outcome of dietary intervention is variable. Treatment of LI can include low-lactose diet, lactase supplementation and, potentially, colonic adaptation by prebiotics. The clinical outcome of these treatments is modest, because lactose is just one of a number of poorly absorbed carbohydrates which can cause symptoms by similar mechanisms.</jats:p> 4 ["http://orcid.org/0000-0002-8719-5175", "http://orcid.org/0000-0003-4394-5584"] ["Benjamin Misselwitz", "Matthias Butter", "Kristin Verbeke", "Mark R Fox"] [""] [""] [""]
35 ["Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis"] 10.1136/gutjnl-2020-321191 http://dx.doi.org/10.1136/gutjnl-2020-321191 2020-04-10T21:25:23Z ["Gastroenterology"] 0 2 ["0017-5749", "1468-3288"] Gut <jats:sec><jats:title>Objectives</jats:title><jats:p>National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95% CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95% CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95% CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated.</jats:p></jats:sec><jats:sec><… 6 ["http://orcid.org/0000-0003-4151-7180", "http://orcid.org/0000-0001-6371-4359"] ["Christopher J Black", "Elyse R Thakur", "Lesley A Houghton", "Eamonn M M Quigley", "Paul Moayyedi", "Alexander C Ford"] [""] [""] [""]
36 ["THE TOS2 STUDY: AN INTERNATIONAL MULTI-CENTRE AUDIT ASSESSING THE STANDARD OF NEUROLOGICAL EXAMINATION"] 10.1136/jnnp-2015-312379.1 http://dx.doi.org/10.1136/jnnp-2015-312379.1 2015-10-14T18:12:15Z [] 0 2 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:p>Having previously demonstrated that in-patients referred to neurology at two UK hospitals were not fully examined prior to referral, we designed an audit with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention.</jats:p><jats:p>In-patients referred to neurology over a 4 month period in the UK, Jordan, Sweden and the United Arab Emirates were asked whether they recalled examination with a Tendon hammer, Ophthalmoscope and Stethoscope since admission. Results were disseminated to local medical teams and data were collected for a further 4 months. Pre and post-intervention data were available for 11 centres with 407 and 391 patients in each arm. 264 patients (64.86%) recalled examination with a tendon hammer pre-intervention, which significantly improved to 298 (76.21%) (p&lt;0.001). 119 (29.24%) recollected ophthalmoscopy pre-intervention, which significantly improved to 149 (38.11%) (p=0.009). 321 (78.87%) recalled examination with a stethoscope pre-intervention, which significantly improved to 330 (84.4%) (p=0.045). Most patients were not fully examined prior to neurology referral, yet a simple assessment score and educational intervention can improve the standard of neurological examination. This is the largest and – to our knowledge – only study to assess the standard of neurological examination internationally. This has implications for national neurological educators.</jats:p> 10 [] ["JP Appleton", "A Ilinca", "AG Lindgren", "A Puschmann", "M Habahbeh", "K Siddiqui", "R DeSilva", "M Jones", "R Butterworth", "DJ Nicholl"] [""] [""] [""]
42 ["Hyper-reflexia in Guillain-Barr\u00e9 syndrome: systematic review"] 10.1136/jnnp-2019-321890 http://dx.doi.org/10.1136/jnnp-2019-321890 2020-01-14T22:33:50Z ["Surgery", "Psychiatry and Mental health", "Clinical Neurology"] 43 1 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:p>Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barré syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.</jats:p> 3 ["http://orcid.org/0000-0002-8131-8912", "http://orcid.org/0000-0002-4716-8578"] ["Antonino Uncini", "Francesca Notturno", "Satoshi Kuwabara"] [""] [""] [""]
63 ["TM2-2\u2005Analysis of adverse events in the management of chronic headache by occipital nerve stimulation"] 10.1136/jnnp-2019-abn.41 http://dx.doi.org/10.1136/jnnp-2019-abn.41 2019-02-14T22:48:47Z ["Surgery", "Psychiatry and Mental health", "Clinical Neurology"] 0 0 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:sec><jats:title>Objectives</jats:title><jats:p>To analyse long-term adverse events of occipital nerve stimulation (ONS).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective open-label observational study.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>134 patients with refractory headaches implanted between 2007–2014 in a single specialised centre.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Information was collected on ONS device, implantable pulse generator (IPG) site and adverse event rates. The impact of implanter experience and the association between IPG site and adverse event rates was also explored.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean follow up was 46 months (6–108 months). A total of 139 adverse events were recorded in 75 patients (56%). A total of 59 additional surgeries were needed in 39 patients. A significant difference was seen in the rates of adverse events recorded between 2007–2010 and 2011–2014 (60.7% vs 42.6%, p=0.002). A significant reduction in ONS revision was seen over time (25.7% vs 5.9%, p=0.002). Analysis of adverse events with IPG site showed those with abdominal implants recorded higher adverse event rate that those with an IPG in the chest (65.8% vs 40.3%, p=0.004).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In specialist centres, adverse event rates of ONS can be much lower than reported in the literature. Our results suggest implanter experience and IPG site both have an effect on adverse event rate.</jats:p></jats:sec> 3 [] ["S Miller", "L Watkins", "M Matharu"] [""] [""] [""]
41 ["Therapeutic hypothermia in acute traumatic spinal cord injury"] 10.1136/jramc-2017-000792 http://dx.doi.org/10.1136/jramc-2017-000792 2017-10-13T00:25:27Z ["General Medicine"] 117 1 ["0035-8665", "2052-0468"] Journal of the Royal Army Medical Corps <jats:p>Therapeutic hypothermia is already widely acknowledged as an effective neuroprotective intervention, especially within the acute care setting in relation to conditions such as cardiac arrest and neonatal encephalopathy. Its multifactorial mechanisms of action, including lowering metabolic rate and reducing acute inflammatory cellular processes, ultimately provide protection for central nervous tissue from continuing injury following ischaemic or traumatic insult. Its clinical application within acute traumatic spinal cord injury would therefore seem very plausible, it having the potential to combat the pathophysiological secondary injury processes that can develop in the proceeding hours to days following the initial injury. As such it could offer invaluable assistance to lessen subsequent sensory, motor and autonomic dysfunction for an individual affected by this devastating condition. Yet research surrounding this intervention’s applicability in this field is somewhat lacking, the majority being experimental. Despite a recent resurgence of interest, which in turn has produced encouraging results, there is a real possibility that this potentially transformational intervention for treating traumatic spinal cord injury could remain an experimental therapy and never reach clinical implementation.</jats:p> 1 [] ["James Collis"] [""] [""] [""]
53 ["Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs"] 10.1136/vr.105296 http://dx.doi.org/10.1136/vr.105296 2019-10-29T21:28:27Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:sec><jats:title>Background</jats:title><jats:p>The aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Retrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>None of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Blood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.</jats:p></jats:sec> 9 ["http://orcid.org/0000-0002-2426-9296"] ["Nicolas Vallarino", "Steven Pil", "Nausikaa Devriendt", "Matan Or", "Eva Vandermeulen", "Gon\u00e7alo Serrano", "Dominique Paepe", "Tim Bosmans", "Hilde de Rooster"] [""] [""] [""]
75 ["Coming together to learn, discuss and support"] 10.1136/vr.m2361 http://dx.doi.org/10.1136/vr.m2361 2020-06-11T21:07:16Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p><jats:bold>Rachel Garty</jats:bold>, national president of the Farm Animal Veterinary Society and final-year vet student, introduces ‘Carpool Cases’ and highlights the importance of supporting the next generation of vets.</jats:p> 0 [""] [""] [""] [""] [""]
81 ["British Veterinary Association Annual General Meeting Belfast, September 21, 2017"] 10.1136/vr.j3847 http://dx.doi.org/10.1136/vr.j3847 2017-08-18T17:40:35Z [] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>The 2017 Annual General Meeting of the British Veterinary Association will be held at W5 at Odyssey, 2 Queen’s Quay, Belfast, Antrim, on Thursday, September 21, 2017, at 15.50.</jats:p> 1 [] ["D. Thorpe"] [""] [""] [""]
87 ["From teacher to trailblazer"] 10.1136/vr.k5185 http://dx.doi.org/10.1136/vr.k5185 2018-12-06T21:54:32Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p><jats:bold>Nalinika Obeyesekere</jats:bold> was recently awarded the World Small Animal Veterinary Association’s inaugural award for companion animal welfare in recognition of her contribution to raising standards of veterinary care in Sri Lanka.</jats:p> 0 [""] [""] [""] [""] [""]
92 ["Building confidence in independent practice"] 10.1136/vr.l619 http://dx.doi.org/10.1136/vr.l619 2019-02-08T10:40:35Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>Never short of an opinion, <jats:bold>Andrew Curwen</jats:bold> is bullish about the future of independent vet businesses. The chief executive serving XLVets tells Adele Waters why it’s time to start shouting about the benefits of collaboration.</jats:p> 0 [""] [""] [""] [""] [""]
100 ["Support and share our manifesto for animals, vets and public health"] 10.1136/vr.l6849 http://dx.doi.org/10.1136/vr.l6849 2019-12-05T21:35:15Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>With this month’s General Election fast approaching, BVA Public Affairs Manager <jats:bold>Helena Cotton</jats:bold> highlights the 10 pledges BVA has been encouraging all political parties to include in their manifestos.</jats:p> 0 [""] [""] [""] [""] [""]
47 ["Prescribing medical cannabis: ethical considerations for primary care providers"] 10.1136/medethics-2019-105759 http://dx.doi.org/10.1136/medethics-2019-105759 2019-12-18T22:15:30Z ["Health Policy", "Arts and Humanities (miscellaneous)", "Issues, ethics and legal aspects", "Health(social science)"] 27 1 ["0306-6800", "1473-4257"] Journal of Medical Ethics <jats:p>Medical cannabis is widely available in the USA and legalisation is likely to expand. Despite the increased accessibility and use of medical cannabis, physicians have significant knowledge gaps regarding evidence of clinical benefits and potential harms. We argue that primary care providers have an ethical obligation to develop competency to provide cannabis to appropriate patients. Furthermore, specific ethical considerations should guide the recommendation of medical cannabis. In many cases, these ethical considerations are extensions of well-established principles of beneficence and nonmaleficence, which indicate that providers should recommend cannabis only for conditions that have the strongest evidence base. Additionally, the contested status of cannabis in American culture raises specific issues related to shared decision-making and patient education, as well as continuing clinical education.</jats:p> 2 ["http://orcid.org/0000-0002-2282-9253"] ["Aaron Glickman", "Dominic Sisti"] [""] [""] [""]
8 ["Increased Incidence of Severe Gastrointestinal Events With First-Line Paclitaxel, Carboplatin, and Vorinostat Chemotherapy for Advanced-Stage Epithelial Ovarian, Primary Peritoneal, and Fallopian Tube Cancer"] 10.1097/igc.0b013e31828566f1 http://dx.doi.org/10.1097/igc.0b013e31828566f1 2013-02-02T09:45:07Z [] 37 13 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objectives</jats:title><jats:p>We sought to assess the response rate and toxicity of paclitaxel, carboplatin, andvorinostat primary induction therapy for the treatment of advanced-stage ovarian carcinoma.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients were treated with 6 cycles of weekly paclitaxel (80 mg/m<jats:sup>2</jats:sup>), carboplatin (6 times area under the curve), and vorinostat (200 mg) every 28 days according to an institutional review board–approved protocol. The subjects were eligible for response evaluation; in patients who achieved stable disease or better following the conclusion of primary induction chemotherapy, they were subsequently treated with a planned 12 cycles of paclitaxel (135 mg/m<jats:sup>2</jats:sup>) and vorinostat (400 mg) maintenance chemotherapy every 28 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eighteen patients received a combined 90 cycles (median, 6 cycles; range, 1–6 cycles) of primary induction chemotherapy. Of the 18 subjects, 7 demonstrated a complete response, and 2 subjects exhibited a partial response (a total response rate of 50.0%). Eight patients also received a combined total of 50 cycles (median, 5 cycles; range, 1–12 cycles) of consolidation therapy. Grade 3/4 neutropenia and thrombocytopenia were observed in 9 (56.3%) and 2 (12.5%) patients. One patient (6.3%) developed grade 3 anemia, and another (6.3%) manifested a grade 3 neuropathy. Remarkably, we observed a significant gastrointestinal event (eg, bowel anastomotic perforation) in 3 patients, which effectuated the study’s closure.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Because the current study was prematurely terminated, we cannot derive a conclusive assessment regarding the efficacy of this treatment. Nevertheless, the high incidence of severe gastrointestinal toxicity warrants further consideration when using vorinostat in the adjuvant setting for patients who have undergone a bowel res… 7 [] ["Alberto A. Mendivil", "John P. Micha", "John V. Brown", "Mark A. Rettenmaier", "Lisa N. Abaid", "Katrina L. Lopez", "Bram H. Goldstein"] [""] [""] [""]
10 ["Prognostic Impact of Parity in 493 Uterine Sarcoma Patients"] 10.1111/igc.0b013e3181aaa950 http://dx.doi.org/10.1111/igc.0b013e3181aaa950 2010-12-03T18:36:56Z ["Obstetrics and Gynaecology", "Oncology"] 28 11 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Introduction:</jats:title><jats:p>Nulliparity has been found to negatively affect prognosis among endometrial cancer patients. Few previous studies have examined the prognostic impact of parity in patients with uterine sarcomas.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>In the present nationwide, register-based study in Norway, we explore whether parity influences survival among 493 women diagnosed with malignant uterine sarcomas. Hazard ratios for total mortality were calculated in Cox proportional hazard regression analyses.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>The 5-year Kaplan-Meier survival rates for the 126 endometrial stromal sarcoma (ESS) patients, 249 leiomyosarcoma (LS) patients, and 118 carcinosarcoma (CS) patients were 74%, 68%, and 55%, respectively, but varied considerably by age at diagnosis and clinical stage. In the univariate analyses, nulliparous women had poorer prognosis than parous women among CS patients (<jats:italic>P</jats:italic> = 0.071, log-rank test) and ESS patients (<jats:italic>P</jats:italic> = 0.15). In analyses adjusted for clinical stage and age at diagnosis, nulliparity was associated with a worse outcome in ESS patients only (hazard ratio, 0.50; 95% confidence interval, 0.22-1.12; parous vs nulliparous women); a trend with increasing number of births was also observed, of borderline significance (<jats:italic>P</jats:italic> = 0.058). No independent prognostic impact of parity was found in LS or CS patients. However, a considerably higher proportion of nulliparous than parous CS patients was diagnosed with advanced-stage disease (<jats:italic>P</jats:italic> = 0.003).</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>Nulliparity seems to be associated with poorer prognosis in ESS patients; no independent prognostic impact of parity was seen among LS or CS patients. Further knowledge on underlying biological mechanisms may be valuable for improved treatment.</jats:p></jat… 4 [] ["Grethe Albrektsen", "Ivar Heuch", "Elisabeth Wik", "Helga B. Salvesen"] [""] [""] [""]
11 ["Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index"] 10.1097/igc.0000000000001097 http://dx.doi.org/10.1097/igc.0000000000001097 2017-08-01T21:01:48Z [] 28 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objective</jats:title><jats:p>The present study assessed the predictive value of age and Modified Frailty Index (mFI) on the management of primary epithelial ovarian cancer (EOC) patients aged 70 years or older (elderly).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective multicenter study selected elderly EOC patients treated between 2006 and 2014. Treatments were analyzed according to the following age group categories: (1) 70 to 75 years versus (2) older than 75 years, and mFI of less than 4 (low frailty) versus greater than or equal to 4 (high frailty).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seventy-eight patients were identified (40 in age group 1 and 38 in age group 2). The mFI was greater than or equal to 4 in 23 women. Median age of low frailty and high frailty was not significantly different (75.6 vs 75.3). Comorbidities were equally distributed according to age, whereas diabetes, hypertension, obesity, and chronic renal failure were more frequent in the high-frailty group. Performance status was different only according to mFI. Twenty percent of age group 1 versus 55.3% of age group 2 underwent none or only explorative surgical approach (<jats:italic>P</jats:italic> = 0.003), whereas surgical approaches were similar in the 2 frailty groups. The rate of postoperative complications was higher in high-frailty patients compared with low-frailty patients (23.5% vs 4.3%; <jats:italic>P</jats:italic> = 0.03). Chemotherapy was administered to all the patients, a monotherapy regimen to 50% of them. No differences in toxicity were registered, except more hospital recovery in the high-frailty cohort. Median survival time was in favor of younger patients (98 versus 30 months) and less-frailty patients (56 vs 27 months).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Elderly EOC patients can receive an adequate treatment, but patients who are older than 75 years can be undertreated, if not adequately selec… 8 [] ["Annamaria Ferrero", "Luca Fuso", "Elisa Tripodi", "Roberta Tana", "Alberto Daniele", "Valentina Zanfagnin", "Stefania Perotto", "Angiolo Gadducci"] [""] [""] [""]
12 ["Exploring the potential chemopreventative effect of aspirin and rofecoxib on hereditary nonpolyposis colorectal cancer\u2013like endometrial cancer cells in vitro through mechanisms involving apoptosis, the cell cycle, and mismatch repair gene expression"] 10.1111/j.1525-1438.2007.00867.x http://dx.doi.org/10.1111/j.1525-1438.2007.00867.x 2007-02-21T17:45:30Z [] 34 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Women in hereditary nonpolyposis colorectal cancer (HNPCC) families have up to a 71% lifetime risk for developing endometrial cancer (EC). This compares to the female lifetime risk for colorectal cancer (CRC) in HNPCC of 60%. The basis of HNPCC is an inherited mutation in a mismatch repair gene (MMR). Aspirin and COX2 inhibitors seem to have a chemoprotective effect on CRC in the general population and are the subject of prospective clinical studies in patients at high risk for CRC including HNPCC. There is no evidence that these agents have any protective effect against EC in the general population. This study investigated the effect of aspirin and a COX2 inhibitor (rofecoxib) on an HNPCC EC cell line model (Ishikawa) by assessing the effect on proliferation, apoptosis, the cell cycle, and MMR gene expression. Aspirin inhibits EC cell proliferation by inducing apoptosis and changes in the cell cycle. This effect is not mediated by changes in MMR gene (hMSH2) expression as assessed by quantitative reverse transcription–polymerase chain reaction. Rofecoxib inhibits EC cell proliferation; this did not appear to be mediated by induction of apoptosis, by alterations of the cell cycle, or by changes in MMR gene expression</jats:p> 5 [] ["N. J. Wood", "N. A. Quinton", "S. Burdall", "E. Sheridan", "S. R. Duffy"] [""] [""] [""]
29 ["Ovarian fibrosarcoma with long-term survival: A case report"] 10.1136/ijgc-00009577-200107000-00016 http://dx.doi.org/10.1136/ijgc-00009577-200107000-00016 2019-03-05T12:15:23Z ["Obstetrics and Gynaecology", "Oncology"] 0 3 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Abstract.</jats:title><jats:p>Huang Y-C, Hsu K-F, Chou C-Y, Dai Y-C, Tzeng C-C. Ovarian fibrosarcoma with long-term survival.</jats:p><jats:p>Primary ovarian fibrosarcoma is an exceedingly rare malignant ovarian stromal tumor which has a poor prognosis. We report here a 46-year-old woman who suffered from irregular vaginal bleeding for 2 months. She received hysterectomy and salpingo-oophorectomy due to a provisional diagnosis of uterine and ovarian tumors. At surgery, an 8-cm ovarian solid multilobular tumor was found. Frozen section examination revealed an ovarian fibrosarcoma. She then underwent staging procedures including intraperitoneal washing, cytology, and pelvic and para-aortic lymph node sampling. Final pathologic examination revealed that the tumor exhibited densely packed spindle cells in storiform configuration with obvious increased mitotic activity. In addition, the flow cytometric study showed marked elevated percentage of tumor cells in the S phase (13.1%). After surgery, the patient received six courses of combination chemotherapy with epirubicin, ifosfamide, and dacarbazine (DTIC). The patient stood the treatment well and is free from disease 6 years later.</jats:p></jats:sec> 5 [] ["Y.-C. Huang", "K.-F. Hsu", "C.-Y. Chou", "Y.-C. Dai", "C.-C. Tzeng"] [""] [""] [""]
38 ["A case of protrusion of an intraperitoneal chemotherapy catheter through rectum"] 10.1136/ijgc-00009577-200501000-00026 http://dx.doi.org/10.1136/ijgc-00009577-200501000-00026 2019-03-06T16:30:38Z ["Obstetrics and Gynaecology", "Oncology"] 0 1 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Bowel penetration of an intraperitoneal catheter occurred in a patient who had received a course of uncomplicated intraperitoneal chemotherapy for a persistent ovarian carcinoma. One month after the termination of chemotherapy, she presented with protrusion of a catheter through anus. At operation, the catheter was removed, the rectum was repaired primarily, and a cytoreductive surgery was performed.</jats:p> 5 [] ["Y. Bilsel", "E. Balik", "D. Bugra", "S. Yamaner", "A. Akyuz"] [""] [""] [""]
60 ["Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report"] 10.1136/ijgc-00009577-200303000-00026 http://dx.doi.org/10.1136/ijgc-00009577-200303000-00026 2019-03-06T09:50:37Z ["Obstetrics and Gynaecology", "Oncology"] 0 0 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD<jats:sub>4</jats:sub> counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD<jats:sub>4</jats:sub> count. She was given antiretroviral therapy and once the CD<jats:sub>4</jats:sub> count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum βHCG level and CD<jats:sub>4</jats:sub> count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.</jats:p> 2 [] ["M. Moodley", "J. Moodley"] [""] [""] [""]
62 ["The Selection of Time Interval Between Surgery and Adjuvant Therapy in Early Stage Cervical Cancer"] 10.1097/igc.0000000000001307 http://dx.doi.org/10.1097/igc.0000000000001307 2018-08-02T22:02:59Z ["Obstetrics and Gynaecology", "Oncology"] 21 0 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objectives</jats:title><jats:p>The optimal interval between surgery and adjuvant treatment has not yet been found in cervical cancer. And whether patients with different FIGO stage should choose different interval is unknown. The purpose of this study was to evaluate whether interval has a different effect on oncologic outcome for patients with different tumor stages.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a retrospective study of 226 cervical cancer patients who were treated by surgery and adjuvant therapy from May 2005 to August 2015. All patients were divided into 2 groups according to the interval of 5 weeks. Overall survival (OS) and disease-free survival (DFS) were compared between patients with interval shorter and longer than 5 weeks in the whole group and subgroups. Recurrence patterns were also analyzed. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival and distant metastasis-free survival for patients with stage IB2–IIA.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>For patients with stage IA2–IB1, the 5-year OS and DFS were similar between groups of short and long interval with also the comparable results of local and distant failure. For patients with IB2–IIA, both the OS and DFS in the short-interval group were higher than that in the long-interval group. Besides, the rates of local recurrence were found higher in the group of long interval compared with short interval. Multivariable analysis indicated that time interval was an independent predictor of DFS and local recurrence-free survival for patients with stage IB2–IIA.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In cervical cancer patients, time interval between surgery and adjuvant therapy may have different effects on the prognosis in different FIGO stages.</jats:p></jats:sec> 6 [] ["Kai-Yun You", "Xin-Hui Zhou", "Yan-Hui Jiang", "Zhuo-Fei Bi", "Yi-Min Liu", "Xing-Sheng Qiu"] [""] [""] [""]
71 ["Phase III randomized pilot study comparing interferon \u03b1- 2b in combination with radiation therapy versus radiation therapy alone in patients with stage III-B carcinoma of the cervix"] 10.1136/ijgc-00009577-200303000-00011 http://dx.doi.org/10.1136/ijgc-00009577-200303000-00011 2019-03-06T14:50:37Z ["Obstetrics and Gynaecology", "Oncology"] 0 0 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>This randomized pilot study was designed to determine whether the addition of interferon α-2b to standard radiation therapy offered an advantage in loco-regional control and survival over radiation therapy alone in a homogeneous group of patients with stage IIIB carcinoma of the cervix. Thirty-six patients were treated with a combination of interferon α-2b plus radiation therapy, and 38 patients were treated with radiation therapy alone. Patients with evidence of ureteral obstruction were excluded from the study. Evaluation of loco-regional response was determined by pelvic examination, cervical cytology, biopsies and CT scans when indicated. Survival time was measured from initiation of treatment to date of death or last follow-up. Patient characteristics were comparable between both study arms. The objective complete response rate was 67% in the combined therapy group and 55% in the radiation alone group (<jats:italic>P</jats:italic> = 0.454). With a median follow-up of 17 months for all patients and 31 months for live patients, 50% of the combined group survived vs. 39.5% of the radiation alone group (<jats:italic>P</jats:italic> = 0.424). We conclude that the addition of interferon α-2b to standard radiation therapy did not significantly improve loco-regional response or survival, although such a trend was noted. We encourage the design of a larger randomized study with sufficient power to detect meaningful differences to prove whether the tendency observed in the present investigation holds any promise to improve the outcome of these patients.</jats:p> 14 [] ["R. Yazigi", "G. Aliste", "R. Torres", "A. M. Ciudad", "M. Cuevas", "J. Garrido", "S. Prado", "A. Sol\u00e1", "R. Castillo", "B. Cerda", "M. A. Cumsille", "M. Gonz\u00e1lez", "C. Navarro", "J. M. Reyes"] [""] [""] [""]
22 ["EGFR gene copy number as a predictive/biomarker for patients with non-small-cell lung cancer receiving tyrosine kinase inhibitor treatment: a systematic review and meta-analysis"] 10.1136/jim-2016-000252 http://dx.doi.org/10.1136/jim-2016-000252 2016-09-24T02:48:22Z [] 41 6 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:p>Epidermal growth factor receptor (<jats:italic>EGFR</jats:italic>) gene copy number has been proposed as a candidate biomarker for predicting treatment response to EGFR tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced non-small-cell lung cancer (NSCLC). MEDLINE, PubMed, Cochrane, and Google Scholar databases were searched until October 21, 2015 using the following search terms: lung neoplasms/lung cancer/non-small cell lung cancer/NSCLC, EGFR, gene amplification, copy number, erlotinib, gefitinib, tyrosine-kinase inhibitor/TKI, predictor. 17 studies were included in the analysis with a total of 2047 patients. The overall analysis found that increased <jats:italic>EGFR</jats:italic> gene copy number was associated with higher overall response rate (ORR), overall survival (OS) and progression-free survival (PFS; p values ≤0.008) compared with patients without a high <jats:italic>EGFR</jats:italic> gene copy number. Subgroup analysis found that in a population of patients who were primarily Caucasian, a higher <jats:italic>EGFR</jats:italic> gene copy number was also associated with increased ORR, OS, and PFS (p values ≤0.018). The results were similar in a population of Asian patients, except that a higher <jats:italic>EGFR</jats:italic> gene copy number was not associated with improved OS (p=0.248). Sensitivity analysis indicated that no one study overly influenced the results and that the findings are robust. The result of the analysis found that <jats:italic>EGFR</jats:italic> gene copy number was associated with increased OS and PFS, supporting the idea that <jats:italic>EGFR</jats:italic> gene copy number is a biomarker for response to EGFR-TKI therapy in patients with advanced NSCLC.</jats:p> 4 [] ["Xin Zhang", "Yiwen Zhang", "Hailing Tang", "Jianxing He"] [""] [""] [""]
85 ["ID: 129: PARTICULATE MATTER DISRUPTS ENDOTHELIAL CELL PERMEABILITY VIA GAP JUNCTION PROTEIN"] 10.1136/jim-2016-000120.124 http://dx.doi.org/10.1136/jim-2016-000120.124 2016-05-10T23:43:02Z [] 0 0 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:sec><jats:title>Introduction</jats:title><jats:p>Particulate matter (PM) is significantly associated with cardiopulmonary morbidity and mortality. We previously demonstrated that PM induces endothelial barrier disruption via reactive oxygen species (ROS)-dependent mechanisms. This study is focused on characterization of PM-regulated endothelial dysfunction via connexin43 (Cx43), a Gap junction protein. Gap junction is designated as intercellular channel which allows cells to communicate with each other, share nutrients, and transfer chemical or electrical signals, in turn, enables cells in a tissue to function in a coordinated manner.</jats:p></jats:sec><jats:sec><jats:title>Methods and Results</jats:title><jats:p>Cx43 protein levels were evaluated by western blotting, and band density quantified using MyImageAnalysis. Real-time PCR was conducted to determine Cx43 mRNA levels. Human pulmonary artery endothelial cell (EC) barrier function was measured using the electrical cell-substrate impedance sensing (ECIS) system (Applied Biophysics) that provides a readout of transendothelial electrical resistance (TER). PM sample (0.1–0.3 µm of aerodynamic diameter) was collected (April of 2005) from the Ft. McHenry Tunnel, Baltimore, MD using a high-volume cyclone collector. PM (100 µg/ml) induced time-dependent increases in EC Cx43 mRNA levels (∼5 fold increase at 4 hr) and protein expression which was attenuated by N-acetyl-cysteine (NAC, 5 mM, 1 hr pretreatment), an ROS scavenger. Unlike Cx43, Cx37, another connexin expressed in ECs, remained unaltered by PM challenge. In addition, EC pretreatment with a Cx43 inhibitor, connexin-mimetic peptide Gap27 (500 µM, 2 hr pretreatment), significantly attenuated PM-reduced TER reduction by 45%, suggesting a central role of Cx43 in PM-induced lung EC barrier integrity disruption and signal transduction.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results suggest Cx43 as a key and novel participant in PM-mediated signal transduction that resu… 4 [] ["X Wu", "X Xu", "JG Garcia", "T Wang"] [""] [""] [""]
76 ["O5A.1\u2005Definition of case management for return-to-work in the approach of workers with musculoskeletal disorders: an update using a scoping review"] 10.1136/oem-2019-epi.110 http://dx.doi.org/10.1136/oem-2019-epi.110 2020-05-08T06:57:14Z ["Public Health, Environmental and Occupational Health"] 0 0 ["1351-0711", "1470-7926"] Occupational and Environmental Medicine <jats:sec><jats:title>Purpose</jats:title><jats:p>We aim to identify the elements and functions that define the case management in the individual approach of workers with musculoskeletal disorders for return to work and to propose an updated definition.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Relevant articles were identified through a computerized search up to 1 December 2017 in the bibliographic databases PubMed, Web of Science, Scopus, Cochrane Library, IBECS, EMBASE, and LILACS. Language filter (English and Spanish) was included in the search. The inclusion criteria were working age population with musculoskeletal disorders, studies that described or evaluated case management interventions, and return to work interventions. Military personnel, and rheumatic and surgical pathologies were excluded. Independent pairs reviewed all cites and articles and extracted data, and narrative synthesis was carried out.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Our searches identified 1950 possible relevant articles, of which 27 were included for data extraction. Of these, 15 papers included definitions of case management, and 14 common elements were identified. Twenty two explained the role of case manager and in 18 a description of tasks was found. In 25 articles referral services were mentioned. The most common defining elements were ‘return to work intervention’, ‘multidisciplinary assessment’ and ‘interdisciplinary intervention’ (53.8%). The 40% of the articles emphasized the ’coordination’, ‘to influence multiple factors’ (33.3%) and ‘individual approach’ (26.7%). The tasks included ’to establish goals and plan the rehabilitation for return to work’ (50%), and ’supervise or coordinate return to work process and to offer/refer the employee to services/adaptations or therapeutic workplaces’ (36.4%) The most common offered services were mental health (64.0%), and rehabilitation (48.0%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Despite… 5 [] ["Merc\u00e8 Soler Font", "Jos\u00e9 Maria Ramada Rodilla", "Jos\u00e9 Maria Gonzalez", "Francisco Palencia Sanchez", "Consol Serra Pujadas"] [""] [""] [""]
72 ["Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and meta-analysis"] 10.1136/archdischild-2019-318207 http://dx.doi.org/10.1136/archdischild-2019-318207 2020-05-25T21:17:07Z ["Obstetrics and Gynaecology", "Pediatrics, Perinatology, and Child Health", "General Medicine"] 39 0 ["1359-2998", "1468-2052"] Archives of Disease in Childhood - Fetal and Neonatal Edition <jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate whether diffuse excessive high signal intensity (DEHSI) on term equivalent age MRI (TEA-MRI) predicts disability in preterm infants.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a systematic review and meta-analysis. Medline, EMBASE, Cochrane Library, EMCARE, Google Scholar and MedNar databases were searched in July 2019. Studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI were included. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was undertaken where data were available in a format suitable for pooling.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Neurodevelopmental outcomes ≥1 year of corrected age based on validated tools.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 15 studies (n=1832) were included, of which data from 9 studies were available for meta-analysis. The pooled estimate (n=7) for sensitivity of DEHSI in predicting cognitive/mental disability was 0.58 (95% CI 0.34 to 0.79) and for specificity was 0.46 (95% CI 0.20 to 0.74). The summary area under the receiver operating characteristics (ROC) curve was low at 0.54 (CI 0.50 to 0.58). A pooled diagnostic OR (DOR) of 1 indicated that DEHSI does not discriminate preterm infants with and without mental disability. The pooled estimate (n=8) for sensitivity of DEHSI in predicting cerebral palsy (CP) was 0.57 (95% CI 0.37 to 0.75) and for specificity was 0.41 (95% CI 0.24 to 0.62). The summary area under the ROC curve was low at 0.51 (CI 0.46 to 0.55). A pooled DOR of 1 indicated that DEHSI does not discriminate between preterm infants with and without CP.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>DEHSI on TEA-MRI did not predict future development of cognitive/mental disabilities or CP.</jats:p></jats:sec><jats:sec><jats:title>PROSPERO registration number</jats:title><jats:p>CRD4… 4 [] ["Chandra Prakash Rath", "Saumil Desai", "Shripada C Rao", "Sanjay Patole"] [""] [""] [""]
94 ["Shame-to-cynicism conversion in The Citadel and The House of God"] 10.1136/medhum-2020-011882 http://dx.doi.org/10.1136/medhum-2020-011882 2020-06-16T22:00:13Z ["Philosophy", "Pathology and Forensic Medicine"] 34 0 ["1468-215X", "1473-4265"] Medical Humanities <jats:p>This article considers the dynamics of shame and cynicism in A J Cronin’s <jats:italic>The Citadel</jats:italic> (1937) and Samuel Shem’s <jats:italic>The House of God</jats:italic> (1978). The protagonists of both novels are forced into shameful situations. Their response to these situations is increased cynicism. This results in a feedback loop: cynicism begets shame, which, in turn, causes more cynicism. Drawing on Bonnie Mann’s work on shame-to-power conversion, the article suggests that the novels stage a shame-to-cynicism conversion, which anticipates possible links between cynicism and shame in medical education. The overwhelming success of both novels in shaping the popular imaginary of healthcare professionals means that this dynamic, far from being isolated to the novels, might speak to shared concerns in the education scholarship.</jats:p> 1 ["http://orcid.org/0000-0003-0817-6898"] ["Arthur Rose"] [""] [""] [""]
13 ["Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation"] 10.1136/emermed-2012-201737 http://dx.doi.org/10.1136/emermed-2012-201737 2013-03-29T00:49:44Z ["Critical Care and Intensive Care Medicine", "Emergency Medicine", "General Medicine"] 19 10 ["1472-0205", "1472-0213"] Emergency Medicine Journal <jats:sec><jats:title>Objectives</jats:title><jats:p>Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinee's answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbach's α) and its ability to discriminate between the different groups (ANOVA followed by Tukey's post hoc test).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbach's α=0.80). Statistically significant differences were found between the groups (F<jats:sub>0.271</jats:sub>=21.07; p&lt;0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p&lt;0.001), students and experts (p&lt;0.001), and residents and experts (p=0.017).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise.</jats:p></jats:sec> 5 [] ["Caroline Boulouffe", "Bruno Doucet", "Xavier Muschart", "Bernard Charlin", "Dominique Vanpee"] [""] [""] [""]
59 ["Diagnosis and management of acute ischaemic stroke"] 10.1136/practneurol-2020-002557 http://dx.doi.org/10.1136/practneurol-2020-002557 2020-06-07T21:19:36Z ["Clinical Neurology", "General Medicine"] 130 0 ["1474-7758", "1474-7766"] Practical Neurology <jats:p>Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.</jats:p> 4 ["http://orcid.org/0000-0002-4226-7681", "http://orcid.org/0000-0001-9535-022X"] ["Robert Hurford", "Alakendu Sekhar", "Tom A T Hughes", "Keith W Muir"] [""] [""] [""]
34 ["Pneumothorax after acupuncture"] 10.1136/bcr-2018-228770 http://dx.doi.org/10.1136/bcr-2018-228770 2019-06-12T11:35:13Z [] 16 2 ["1757-790X"] BMJ Case Reports <jats:p>Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.</jats:p> 4 ["http://orcid.org/0000-0003-3408-0515"] ["Sofia Costa Corado", "Margarida Gra\u00e7a Santos", "Lu\u00edsa Quaresma", "Jos\u00e9 Rodrigues Baltazar"] [""] [""] [""]
44 ["Adult intussusception secondary to diverticular disease"] 10.1136/bcr-2018-226678 http://dx.doi.org/10.1136/bcr-2018-226678 2018-11-09T07:25:40Z [] 9 1 ["1757-790X"] BMJ Case Reports <jats:p>Intussusception is the invagination of a proximal segment of bowel into the lumen of an adjacent distal segment. It is a common condition in the paediatric age group although it rarely occurs in adults. Organic lesions in the bowel wall are the primary cause of adult intussusceptions with malignant neoplasms being the most common. However, we present a rare case of a 92-year-old man diagnosed with an intussusception of the sigmoid-rectal colon secondary to a diverticular stricture.</jats:p> 4 ["http://orcid.org/0000-0003-0461-0861"] ["Habib Syed", "Labib Syed", "Umesh Parampalli", "Mokhtar Uheba"] [""] [""] [""]
50 ["Mediastinal cystic teratoma masquerading as a hydatid cyst"] 10.1136/bcr-2020-234755 http://dx.doi.org/10.1136/bcr-2020-234755 2020-06-30T06:17:26Z [] 8 0 ["1757-790X"] BMJ Case Reports <jats:p>A case is presented in which a preoperatively diagnosed hydatid cyst was found to be a mature cystic teratoma on pathological examination. Diagnostic dilemmas surrounding each disease are discussed.</jats:p> 4 [] ["David Williams", "Fang Zhou", "Max Grovenburg", "Mikhail Vaynblat"] [""] [""] [""]
51 ["A challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma"] 10.1136/bcr-2018-226168 http://dx.doi.org/10.1136/bcr-2018-226168 2019-07-09T10:09:12Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.</jats:p> 5 ["http://orcid.org/0000-0002-9143-8942"] ["Alexander Yao", "Haroon Saeed", "Gavin Udall", "Vivek Kaushik", "Lip Wai Lee"] [""] [""] [""]
73 ["Synchronous recurrence of concurrent colon adenocarcinoma and dedifferentiated liposarcoma"] 10.1136/bcr-2018-228868 http://dx.doi.org/10.1136/bcr-2018-228868 2019-05-14T11:54:19Z [] 19 0 ["1757-790X"] BMJ Case Reports <jats:p>A 62-year-old man presented with concurrent sigmoid colon adenocarcinoma and small bowel mesenteric dedifferentiated liposarcoma. Following surgical resection of the colon cancer, complete excision of the mesenteric sarcoma and adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy, the patient demonstrated no radiological evidence of disease for more than 2 years. The patient then developed synchronous recurrence of both cancers: the colon cancer metastasised to the liver and a pelvic lymph node, and the liposarcoma recurred in the original location. The patient underwent additional chemotherapy with complete response of the metastatic colon cancer and stable disease for the liposarcoma. The recurrent mesenteric tumour was subsequently resected. Although concurrent cancers have been reported, this unique case of synchronous recurrence raises interesting hypotheses regarding host–tumour interaction and immune surveillance.</jats:p> 7 ["http://orcid.org/0000-0001-8440-1271"] ["Eric E Jung", "F Scott Heinemann", "Colt A Egelston", "Jennifer Wang", "Raphael E Pollock", "Peter P Lee", "William W Tseng"] [""] [""] [""]
80 ["Odontogenic myxomas: what is the ideal treatment?"] 10.1136/bcr-2018-228540 http://dx.doi.org/10.1136/bcr-2018-228540 2019-05-22T11:16:59Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.</jats:p> 2 [] ["Milad Tavakoli", "Raymond Williamson"] [""] [""] [""]
89 ["Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP)"] 10.1136/bcr-2019-232359 http://dx.doi.org/10.1136/bcr-2019-232359 2020-03-13T09:15:12Z [] 18 0 ["1757-790X"] BMJ Case Reports <jats:p>An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.</jats:p> 3 [] ["Ayad Shafiq", "Roxane Hillier", "Richard Hearn"] [""] [""] [""]
90 ["Junctional bradycardia caused by ciguatera intoxication"] 10.1136/bcr-2019-229354 http://dx.doi.org/10.1136/bcr-2019-229354 2019-05-31T12:15:32Z [] 9 0 ["1757-790X"] BMJ Case Reports <jats:p>Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.</jats:p> 4 ["http://orcid.org/0000-0001-6099-0948"] ["Rajendra Raman", "Sarah Coppes", "Tessa Hellingman", "Casper Lacl\u00e9"] [""] [""] [""]
19 ["Clinical significance of the circle of Willis in intracranial atherosclerotic stenosis"] 10.1136/neurintsurg-2014-011439 http://dx.doi.org/10.1136/neurintsurg-2014-011439 2014-12-10T04:09:30Z [] 19 6 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Introduction</jats:title><jats:p>The effectiveness of a scoring system based on the circle of Willis for evaluations of collateral circulation was studied in patients with intracranial atherosclerotic stenosis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Eighty-three patients who underwent medical or endovascular treatment for symptomatic and severe intracranial atherosclerotic stenosis were enrolled in the study. Clinical profiles, status of the circle of Willis (poor and good integrity group), and clinical outcomes were analyzed. Primary endpoints were: (1) symptomatic ischemic or hemorrhagic stroke within 30 days; and (2) recurrent transient ischemic attack or ischemic stroke beyond 30 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The estimated rates of the primary endpoint at 1 and 2 years after treatment were 8.5% and 11.4% in the medical group and 7.0% and 9.7% in the endovascular group, respectively. A primary endpoint event after medical treatment was only identified in patients with poor integrity of the circle of Willis (p=0.059). In patients with poor integrity of the circle of Willis, previous antiplatelet medication before initial presentation (p=0.026) and hypertension (p=0.006) were more prevalent. During the follow-up period, complete arterial occlusion was identified in 9 patients. The circle of Willis score of the patients with complete arterial occlusion was 1.33±1.52 in the fatal stroke group (n=3) and 3.20±1.64 in the asymptomatic group (n=6, p=0.099).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>If patients have poor integrity of the circle of Willis, the risk of recurrent stroke may be increased. Such patients appear to be good candidates for endovascular treatment.</jats:p></jats:sec> 6 [] ["Kang Min Kim", "Hyun-Seung Kang", "Woong Jae Lee", "Young Dae Cho", "Jeong Eun Kim", "Moon Hee Han"] [""] [""] [""]
30 ["Inter-rater reliability of published flow diversion occlusion scales"] 10.1136/neurintsurg-2015-012193 http://dx.doi.org/10.1136/neurintsurg-2015-012193 2016-01-20T23:04:34Z ["Surgery", "Clinical Neurology", "General Medicine"] 14 3 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>With increasing use of flow-diverting stents for the treatment of intracranial aneurysms, standardized methods and a common language to evaluate angiographic outcomes are needed. Multiple grading scales have been developed for this purpose but none has been widely adopted.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To analyze these scales to determine interobserver reliability.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Four independent assessors scored the intraprocedural angiograms of patients who underwent flow-diverting stent deployment for an intracranial saccular or fusiform aneurysm at our institution between October 2012 and June 2015. Angiographic outcome immediately after flow-diverting stent deployment was scored using three grading scales (Kamran–Byrne (KB), Simple Measurement of Aneurysm Residual after Treatment (SMART), and O'Kelley, Krings, Marotta (OKM)). Statistical analysis was performed using Light's κ for multiple raters (κ), Kendall's coefficient of concordance (W), and intraclass correlation (ICC).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included the angiograms of 50 consecutive patients (mean age 58 years, range 30–79) who underwent flow-diverting stent deployment for an intracranial aneurysm (40 saccular, 10 fusiform). Six aneurysms were located in the posterior circulation. The inter-rater reliability was typically poor or fair: SMART aneurysm filling (κ=0.30, W=0.36, ICC=0.12), SMART parent vessel stenosis (κ=0.07, W=0.33, ICC=0.12), KB axis I (κ=0.24, W=0.50, ICC=0.25), KB axis II (κ=0.07, W=0.30, ICC=0.06), OKM aneurysm filling (κ=0.23, W=0.45, ICC=0.13), OKM contrast stasis (κ=0.36,W=0.71, ICC=0.54).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Existing flow-diverting stent grading scales have low inter-rater reliability for most categories.</jats:p></jats:sec> 5 [] ["Marcus D Mazur", "Philipp Taussky", "Lubdha M Shah", "Blair Winegar", "Min S Park"] [""] [""] [""]
27 ["Guideline review: British Society of Gastroenterology/UK-PBC Primary Biliary Cholangitis treatment and management guidelines"] 10.1136/flgastro-2018-101109 http://dx.doi.org/10.1136/flgastro-2018-101109 2019-01-09T22:19:25Z [] 11 4 ["2041-4137", "2041-4145"] Frontline Gastroenterology <jats:p>New guidelines have been produced for the management of primary biliary cholangitis, an infrequent but nonetheless important autoimmune liver disease. We provide a succient commentary and overview of the key features of disease management that arise from these recent guideline recommendations, with a focus on therapy with licensed agents (ursodeoxycholic acid and obeticholic acid) as well as personalised management of disease complications and associated symptoms.</jats:p> 2 ["http://orcid.org/0000-0002-6054-569X"] ["Jorn C Goet", "Gideon M Hirschfield"] [""] [""] [""]
25 ["Using Q-methodology to guide the implementation of new healthcare policies"] 10.1136/bmjqs-2017-007380 http://dx.doi.org/10.1136/bmjqs-2017-007380 2018-04-12T16:20:06Z [] 25 5 ["2044-5415", "2044-5423"] BMJ Quality & Safety <jats:p>There are many challenges in the development, implementation and evaluation of healthcare policy. One challenge is understanding how different stakeholders view a particular policy and what impact these views may have during implementation. Q-methodology is one approach that can be used to help policy makers and researchers actively engage with those who are important in policy implementation, and anticipate their responses. Q-methodology combines qualitative and quantitative research methods to systematically explore and describe the range of viewpoints about a topic. Participants are required to rank a set of predefined statements relating to the topic, according to their own viewpoint. Factor analytic techniques then identify people who are like-minded in the way they view the topic and enable areas of consensus and divergence in viewpoint to be clearly defined. This mapping of viewpoints allows those working in policy implementation to anticipate likely barriers and levers in implementing new policies.</jats:p> 5 ["http://orcid.org/0000-0002-5418-0495", "http://orcid.org/0000-0001-8721-8026"] ["Sarah Alderson", "Robbie Foy", "Louise Bryant", "Shenaz Ahmed", "Allan House"] [""] [""] [""]
3 ["Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium"] 10.1136/bmjopen-2014-006141 http://dx.doi.org/10.1136/bmjopen-2014-006141 2014-10-08T06:07:47Z [] 0 53 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate whether associations of smoking with depression and anxiety are likely to be causal, using a Mendelian randomisation approach.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Mendelian randomisation meta-analyses using a genetic variant (rs16969968/rs1051730) as a proxy for smoking heaviness, and observational meta-analyses of the associations of smoking status and smoking heaviness with depression, anxiety and psychological distress.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Current, former and never smokers of European ancestry aged ≥16 years from 25 studies in the Consortium for Causal Analysis Research in Tobacco and Alcohol (CARTA).</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measures</jats:title><jats:p>Binary definitions of depression, anxiety and psychological distress assessed by clinical interview, symptom scales or self-reported recall of clinician diagnosis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The analytic sample included up to 58 176 never smokers, 37 428 former smokers and 32 028 current smokers (total N=127 632). In observational analyses, current smokers had 1.85 times greater odds of depression (95% CI 1.65 to 2.07), 1.71 times greater odds of anxiety (95% CI 1.54 to 1.90) and 1.69 times greater odds of psychological distress (95% CI 1.56 to 1.83) than never smokers. Former smokers also had greater odds of depression, anxiety and psychological distress than never smokers. There was evidence for positive associations of smoking heaviness with depression, anxiety and psychological distress (ORs per cigarette per day: 1.03 (95% CI 1.02 to 1.04), 1.03 (95% CI 1.02 to 1.04) and 1.02 (95% CI 1.02 to 1.03) respectively). In Mendelian randomisation analyses, there was no strong evidence that the minor allele of rs16969968/rs1051730 was associated with depression (OR=1.00, 95% CI 0.95 to 1.05), anxiety (OR=1.02, 95% CI 0.97 to 1.07) or psycho… 62 [] ["Amy E Taylor", "Meg E Fluharty", "Johan H Bj\u00f8rngaard", "Maiken Elvestad Gabrielsen", "Frank Skorpen", "Riccardo E Marioni", "Archie Campbell", "Jorgen Engmann", "Saira Saeed Mirza", "Anu Loukola", "Tiina Laatikainen", "Timo Partonen", "Marika Kaakinen", "Francesca Ducci", "Alana Cavadino", "Lise Lotte N Husemoen", "Tarunveer Singh Ahluwalia", "Rikke Kart Jacobsen", "Tea Skaaby", "Jeanette Frost Ebstrup", "Erik Lykke Mortensen", "Camelia C Minica", "Jacqueline M Vink", "Gonneke Willemsen", "Pedro Marques-Vidal", "Caroline E Dale", "Antoinette Amuzu", "Lucy T Lennon", "Jari Lahti", "Aarno Palotie", "Katri R\u00e4ikk\u00f6nen", "Andrew Wong", "Lavinia Paternoster", "Angelita Pui-Yee Wong", "L John Horwood", "Michael Murphy", "Elaine C Johnstone", "Martin A Kennedy", "Zdenka Pausova", "Tom\u00e1\u0161 Paus", "Yoav Ben-Shlomo", "Ellen A Nohr", "Diana Kuh", "Mika Kivimaki", "Johan G Eriksson", "Richard W Morris", "Juan P Casas", "Martin Preisig", "Dorret I Boomsma", "Allan Linneberg", "Chris Power", "Elina Hypp\u00f6nen", "Juha Veijola", "Marjo-Riitta Jarvelin", "Tellervo Korhonen", "Henning Tiemeier", "Meena Kumari", "David J Porteous", "Caroline Hayward", "P\u00e5l R Romundstad", "George Davey Smith", "Marcus R Munaf\u00f2"] [""] [""] [""]
5 ["How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial"] 10.1136/bmjopen-2015-010581 http://dx.doi.org/10.1136/bmjopen-2015-010581 2016-09-13T01:49:12Z ["General Medicine"] 0 19 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p&lt;0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>HF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>ISRCTN42520374.</jats:p></jats:sec> 10 [] ["Patricia O'Campo", "Vicky Stergiopoulos", "Pam Nir", "Matthew Levy", "Vachan Misir", "Antony Chum", "Bouchra Arbach", "Rosane Nisenbaum", "Matthew J To", "Stephen W Hwang"] [""] [""] [""]
6 ["What\u2019s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland"] 10.1136/bmjopen-2017-018023 http://dx.doi.org/10.1136/bmjopen-2017-018023 2017-10-16T22:16:03Z [] 0 19 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Irish publicly funded hospitals and residential institutions.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extremely severe symptoms of depression, anxiety and stress were evident in 7.2%, 6.1% and 9.5% of participants (Depression, Anxiety, Stress Scale 21). Symptoms of distress, depression, anxiety and stress were significantly higher and levels of well-being were significantly lower in trainees compared with consultants, and this was not accounted for by differences in sociodemographic variables. Self-stigma was present in 68.4%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The work hours of doctors working in Irish hospitals were in excess of European Working Time Directive’s requirements. Just over half of hospital doctors in Ireland had positive well-being. Compared with international e… 5 [] ["Bl\u00e1naid Hayes", "Lucia Prihodova", "Gillian Walsh", "Frank Doyle", "Sally Doherty"] [""] [""] [""]
23 ["What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study"] 10.1136/bmjopen-2017-019627 http://dx.doi.org/10.1136/bmjopen-2017-019627 2018-01-23T09:51:02Z ["General Medicine"] 0 5 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>We investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services. Each was invited to provide up to 5 years of data and total number of taskings during the same period.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Patients with hypotensive trauma (systolic blood pressure &lt;90 mm Hg or absent radial pulse) attended by a doctor.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>The primary outcome was the number of patients with hypotensive trauma given prehospital fluids. Secondary outcomes were types and volumes of fluids. These data were combined with published data to estimate potential national eligibility for PHBP.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 29 037 taskings, 729 (2.5%) were for patients with hypotensive trauma attended by a physician. Half were aged 21–50 years; 73.4% were male. A total of 537 out of 729 (73.7%) were given fluids. Five hundred and ten patients were given a single type of fluid; 27 received &gt;1 type. The most common fluid was 0.9% saline, given to 486/537 (90.5%) of patients who received fluids, at a median volume of 750 (IQR 300–1500) mL. Three per cent of patients received PHBP. Estimated projections for patients eligible for PHBP at these 11 services and in the whole UK were 313 and 794 patients per year, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><ja… 8 [] ["David N Naumann", "James M Hancox", "James Raitt", "Iain M Smith", "Nicholas Crombie", "Heidi Doughty", "Gavin D Perkins", "Mark J Midwinter"] [""] [""] [""]
26 ["Relationship between estimated cardiovascular disease risk and insulin resistance in a black African population living with HIV: a cross-sectional study from Cameroon"] 10.1136/bmjopen-2017-016835 http://dx.doi.org/10.1136/bmjopen-2017-016835 2017-08-11T20:25:24Z [] 0 4 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>Cardiovascular disease (CVD) and metabolic diseases are growing concerns among patients with HIV infection as a consequence of the improving survival of this population. We aimed to assess the relationship between CVD risk and insulin resistance in a group of black African individuals with HIV infection.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This cross-sectional study involved patients with HIV infection aged 30–74 years and followed up at the Yaoundé Central Hospital, Cameroon. Absolute CVD risk was calculated using the Framingham and the DAD CVD risk equations while the HOMA-IR index was used to assess insulin resistance (index ≥2.1).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 452 patients (361 women; 80%) were screened. The mean age was 44.4 years and most of the respondents were on antiretroviral therapy (88.5%). The median 5-year cardiovascular risk was 0.7% (25th−75th percentiles: 0.2–2.0) and 0.6% (0.3–1.3) according to the Framingham and DAD equations respectively. Of all participants, 47.3% were insulin resistant. The Framingham equation derived absolute CVD risk was significantly associated with insulin resistance; while no linear association was found using the DAD equation.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The relationship between cardiovascular risk and insulin resistance in black African patients with HIV infection seems to depend on the cardiovascular risk equation used.</jats:p></jats:sec> 13 ["http://orcid.org/0000-0001-8018-6279", "http://orcid.org/0000-0001-6155-235X"] ["Steve Raoul Noumegni", "Jean Joel Bigna", "Vicky Jocelyne Ama Moor epse Nkegoum", "Jobert Richie Nansseu", "Felix K Assah", "Ahmadou Musa Jingi", "Magellan Guewo-Fokeng", "Steve Leumi", "Jean-Claude Katte", "Mesmin Y Dehayem", "Liliane Mfeukeu Kuate", "Andre Pascal Kengne", "Eugene Sobngwi"] [""] [""] [""]
31 ["Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset"] 10.1136/bmjopen-2018-026396 http://dx.doi.org/10.1136/bmjopen-2018-026396 2019-05-02T08:39:22Z ["General Medicine"] 50 3 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Open cohort study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>A representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p&lt;0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p&lt;0.05), antibiotic (30.7% vs 23.4%, p&lt;0.05) and antiviral (34.2% vs 13.5%, p&lt;0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation r… 3 ["http://orcid.org/0000-0001-6998-6419", "http://orcid.org/0000-0002-7153-2878", "http://orcid.org/0000-0002-9018-0361"] ["Carla De Oliveira Bernardo", "David Gonzalez-Chica", "Nigel Stocks"] [""] [""] [""]
66 ["Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study"] 10.1136/bmjopen-2019-032678 http://dx.doi.org/10.1136/bmjopen-2019-032678 2019-12-03T15:46:41Z ["General Medicine"] 29 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>In 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>An explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Six ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme.</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measures</jats:title><jats:p>(1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL &lt;1000 copies/mL); (2) association between patient characteristics and ‘not tested’ was assessed using log binomial regression and (3) qualitative codes on implementation challenges.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of ‘not being tested’ for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges.</jats:p></jats:sec><jats:sec><jats… 8 [] ["Khine Khine Thinn", "Pruthu Thekkur", "Nang Thu Thu Kyaw", "Nyein Su Aye", "Tin Maung Zaw", "Pyae Soan", "San Hone", "Htun Nyunt Oo"] [""] [""] [""]
88 ["Systematic review and meta-analysis of prognostic factors of acute exacerbation of idiopathic pulmonary fibrosis"] 10.1136/bmjopen-2019-035420 http://dx.doi.org/10.1136/bmjopen-2019-035420 2020-06-16T06:15:18Z ["General Medicine"] 89 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>To clarify prognostic factors of acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A systematic review and meta-analysis.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>Medline, Embase and Science Citation Index Expanded were searched from 2002 through 1 March 2019.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies</jats:title><jats:p>The review included primary studies addressing the association between the outcomes such as all-cause mortality of AE of IPF and its potential prognostic factors, which were designated as any clinical information related to the outcomes.</jats:p></jats:sec><jats:sec><jats:title>Data extraction and synthesis</jats:title><jats:p>Two reviewers extracted relevant data independently and assessed risk of bias. Univariate results were pooled using a random-effect model if at least three studies were available. Prognostic factors were determined based on significant and consistent results on both univariate and multivariate analyses in the majority of studies.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Out of a total of 6763 articles retrieved, 37 were eligible and 31 potential prognostic factors for all-cause mortality were selected. Each study was subject to certain methodological shortcomings. The following five factors were statistically significant by a meta-analysis of univariate results, which was confirmed by multivariate analysis, that is, Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR 1.10, 1.01 to 1.19), partial pressure of arterial oxygen to fraction of inspired oxygen (PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub>) ratio (ORs 0.99 in two studies and HRs 0.31 and 0.99 in two studies, respectively), lactate dehydrogenase (LDH) (HRs 1.002, 1.003, 1.01 and 1.02), white blood cell (WBC) count (OR 1.38, 1.04 to 1.83) and oxygen therapy bef… 2 ["http://orcid.org/0000-0001-5623-1279"] ["Hiroyuki Kamiya", "Ogee Mer Panlaqui"] [""] [""] [""]
95 ["Another look at what teachers and students think about interprofessional learning as a shared experience in Iran: a qualitative research"] 10.1136/bmjopen-2017-020015 http://dx.doi.org/10.1136/bmjopen-2017-020015 2018-10-31T06:05:15Z ["General Medicine"] 39 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To explore experiences of interprofessional learning (IPL), and how faculty and students might want to participate in IPL opportunities as a form of shared learning.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Qualitative study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Ministry of Health and Medical Education which is accountable for rendering service to the public, providing healthcare needs and improving the quality of medical education was established in Iran in 1985, to integrate medical education with healthcare services.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>A sample of six faculty members and seven students, purposively sampled for demographic characteristics and their experience regarding shared learning.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A descriptive qualitative study using thematic analysis of content was conducted. Data were obtained using semistructured interviews and then analysed thematically. Data collection and analysis were concurrent.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Three categories were identified: the role of prologues in IPL, the role of structured IPL, and the role of context and structure in such a system for learning, representing seven subcategories.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The findings indicate that experiences of learning with different professionals are complex, and these experiences shape their present and future workplace relations. Matching the existing educational context and structure with IPL and providing planned interaction and reflection among professionals are necessary to support IPL.</jats:p></jats:sec> 2 [] ["Soleiman Ahmady", "Mahboobeh Khabaz Mafinejad"] [""] [""] [""]
37 ["Palliative care research centre's move into social media: constructing a framework for ethical research, a consensus paper"] 10.1136/bmjspcare-2015-000889 http://dx.doi.org/10.1136/bmjspcare-2015-000889 2016-01-29T03:54:13Z ["Medicine (miscellaneous)", "Oncology(nursing)", "Medical\u2013Surgical", "General Medicine"] 13 2 ["2045-435X", "2045-4368"] BMJ Supportive & Palliative Care <jats:sec><jats:title>Background</jats:title><jats:p>Social media (SM) have altered the way we live and, for many, the way we die. The information available on even the rarest conditions is vast. Free from restrictions of mobility, time and distance, SM provides a space for people to share experiences of illness, death and dying, and potentially benefit from the emotional and practical support of others n similar positions. The communications that take place in these spaces also create large amounts of ‘data’ which, for any research centre, cannot be ignored. However, for a palliative care research centre the use of this ‘data’ comes with specific ethical dilemmas.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This paper details the process that we, as a research, went through in constructing a set of ethical guidelines by which to work. This involved conducting two consensus days; one with researchers from within the centre, and one with the inclusion of external researchers with a specific interest in SM.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The primary themes that emerged from the consensus meetings includes; SM as a public or private space; the status of open and closed groups; the use of historical data; recruiting participants and obtaining informed consent and problems of anonymity associated with dissemination.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These are the themes that this paper will focus on prior to setting out the guidelines that we subsequently constructed.</jats:p></jats:sec> 12 [] ["Noreen Hopewell-Kelly", "Jessica Baillie", "Stephanie Sivell", "Emily Harrop", "Anna Bowyer", "Sophia Taylor", "Kristen Thomas", "Alisha Newman", "Hayley Prout", "Anthony Byrne", "Mark Taubert", "Annmarie Nelson"] [""] [""] [""]
58 ["Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands"] 10.1136/bmjdrc-2019-000767 http://dx.doi.org/10.1136/bmjdrc-2019-000767 2020-01-08T10:45:11Z [] 0 0 ["2052-4897"] BMJ Open Diabetes Research & Care <jats:sec><jats:title>Rationale and objectives</jats:title><jats:p>Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patients only received BIGUs, 19.1% of all patients started on BIGUs but switched to BIGU +SU. 13.5% of patients with T2DM initiated insulins, on average 532 days (almost 18 months) after the index date.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings showed that in the Netherlands, medication treatment in patients with T2DM is mainly consistent with the clinical guidelines in the Netherlands during the study period.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0003-2775-7276", "http://orcid.org/0000-0002-2957-5436"] ["Jan Maurik van den Heuvel", "Niloufar Farzan", "Mandy van Hoek", "Anke-Hilse Maitland-van der Zee", "Fariba Ahmadizar"] [""] [""] [""]
56 ["High-grade astrocytoma with ventricular invasion in a dog"] 10.1136/vetreccr-2019-000958 http://dx.doi.org/10.1136/vetreccr-2019-000958 2019-12-03T10:42:48Z ["General Veterinary"] 22 0 ["2052-6121"] Veterinary Record Case Reports <jats:p>A 13-year-old female German Shepherd dog was euthanised and submitted to necropsy after a 7-month history of prolonged recumbency and vocalisation. Gross anatomical changes consisted of a well-demarcated, 3.5×1.5 cm, soft red mass that effaced the right lateral ventricle and compressed the adjacent neuroparenchyma. Histologically, elongate neoplastic cells with astrocytic morphology were arranged in short bundles and streams supported by a neuropil-like stroma. Neoplastic cells were immunopositive for glial fibrillar acidic protein (GFAP) and oligodendrocyte transcription factor 2 (Olig2), and immunonegative for e-cadherin and pancytokeratin. Histological and immunohistochemical features were consistent with a high-grade astrocytoma with ventricular invasion, a rare feature of astrocytic tumours in dogs.</jats:p> 5 ["http://orcid.org/0000-0002-7128-8756"] ["Rayane Chitolina Pupin", "Daniel R Rissi", "Danilo Carloto Gomes", "Amanda Gimelli", "Mariana Isa Poci Palumbo"] [""] [""] [""]
54 ["PO 8417\u2005RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY"] 10.1136/bmjgh-2019-edc.89 http://dx.doi.org/10.1136/bmjgh-2019-edc.89 2019-04-24T15:32:16Z [] 0 0 ["2059-7908"] BMJ Global Health <jats:sec><jats:title>Background</jats:title><jats:p>Despite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (P<jats:sub>trend</jats:sub> &lt;0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (P<jats:sub>trend</jats:sub>=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p&lt;0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) &lt;18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early dea… 5 [] ["Moses Ngari", "Osman Abdullahi", "Deche Sanga", "Geoffrey Katana", "Annie Willetts"] [""] [""] [""]
46 ["Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study"] 10.1136/bmjsrh-2018-200278 http://dx.doi.org/10.1136/bmjsrh-2018-200278 2019-08-17T21:25:18Z [] 25 1 ["2515-1991", "2515-2009"] BMJ Sexual & Reproductive Health <jats:sec><jats:title>Introduction</jats:title><jats:p>In October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Self-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0003-0044-5635"] ["Rebecca Elizabeth Finch", "Kevin McGeechan", "Anne Johnstone", "Sharon Cameron"] [""] [""] [""]
93 ["Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution"] 10.1136/wjps-2018-000009 http://dx.doi.org/10.1136/wjps-2018-000009 2019-06-05T21:11:19Z [] 15 0 ["2516-5410"] World Journal of Pediatric Surgery <jats:sec><jats:title>Purpose</jats:title><jats:p>An early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifty-eight ovarian masses (55 episodes) in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed. The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The median age of these 55 episodes was 10.5 years old (range 1.0–23.0). Thirty-three patients presented with abdominal pain. Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically (50 benign and 8 malignant). Torsion was identified in 15 cases (25.9%) at operation. The torsion masses were all benign, and 8 ovaries (53.3%) were successfully preserved. Comparing the torsion cases with the non-torsion cases, only the white cell count was significantly higher in the torsion cases (p=0.0133) and in the patients presented with abdominal pain (p=0.0068). The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.</jats:p></jats:sec> 13 [] ["Koshiro Sugita", "Takafumi Kawano", "Mukai Motoi", "Toshihiro Muraji", "Shun Onishi", "Tomoe Moriguchi", "Koji Yamada", "Waka Yamada", "Ryuta Masuya", "Seiro Machigashira", "Kazuhiko Nakame", "Tatsuru Kaji", "Satoshi Ieiri"] [""] [""] [""]
97 ["Sex, gender or occupational psychology: what matters most to preventing heat-related illnesses and improving outcomes for women in ground close combat?"] 10.1136/bmjmilitary-2020-001480 http://dx.doi.org/10.1136/bmjmilitary-2020-001480 2020-04-28T07:44:52Z [] 0 0 ["2633-3767", "2633-3775"] BMJ Military Health <jats:p>Since the advent of women in ground close combat (WGCC) roles, the impact on women of the attendant risk of heat stress and heat illness has been considered. Much emphasis has been placed on sex differences in thermal physiology. This article considers the application of evidence of sex-associated thermoregulatory variation to the occupational and environmental setting of WGCC, and weighs the relative importance of physiological differences arising from biological sex, and behaviour associated with gender normatives. Quantifying the risk of heat illness to WGCC should draw on data from their real-world occupational context.</jats:p> 4 ["http://orcid.org/0000-0002-6248-6400"] ["Robert M Gifford", "N Taylor", "M Stacey", "D R Woods"] [""] [""] [""]

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