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Unlabelled♦BackgroundAlthough higher body mass index (BMI) is associated with better outcomes in hemodialysis patients, the relationship in peritoneal dialysis (PD) patients is less clear. We aimed to synthesize the results from all large and high-quality studies to examine whether underweight, overweight, or obesity is associated with any significantly different risk of death in peritoneal dialysis patients. ♦MethodsWe searched MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane CENTRAL, and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa Quality Assessment Scale. We meta-analyzed the results of the largest studies with no overlap in their data sources. ♦ResultsWe included 9 studies (n = 156,562) in the systematic review and 4 studies in the meta-analyses. When examined without stratifying studies by follow-up duration, the results of the studies were inconsistent. Hence, we pooled the study results stratified based upon their follow-up durations, as suggested by a large study, and observed that being underweight was associated with higher 1-year mortality but had no significant association with 2- and 3- to 5-year mortalities. In contrast, being overweight or obese was associated with lower 1-year mortality but it had no significant association with 2-, and 3- to 5-year mortalities. ♦ConclusionOver the short-term, being underweight was associated with higher mortality and being overweight or obese was associated with lower mortality. The associations of body mass with mortality were not significant over the long-term.

BackgroundPrevious studies have not shown a consistent link between body mass index (BMI) and outcomes such as mortality and kidney disease progression in non-dialysis-dependent chronic kidney disease (CKD) patients. Therefore, we aimed to complete a systematic review and meta-analysis study on this subject.MethodsWe searched MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL), and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa quality assessment scale. We meta-analyzed the results based on the BMI classification system by the WHO.ResultsWe included 10 studies (with a total sample size of 484,906) in the systematic review and 4 studies in the meta-analyses. The study results were generally heterogeneous. However, following reanalysis of the largest reported study and our meta-analyses, we observed that in stage 3-5 CKD, being underweight was associated with a higher risk of death while being overweight or obese class I was associated with a lower risk of death; however, obesity classes II and III were not associated with risk of death. In addition, reanalysis of the largest available study showed that a higher BMI was associated with an incrementally higher risk of kidney disease progression; however, this association was attenuated in our pooled results. For earlier stages of CKD, we could not complete meta-analyses as the studies were sparse and had heterogeneous BMI classifications and/or referent BMI groups.ConclusionAmong the group of patients with stage 3-5 CKD, we found a differential association between obesity classes I-III and mortality compared to the general population, indicating an obesity paradox in the CKD population.

Background: Despite the widespread teaching of evidence-based medicine (EBM) to medical students, the relevant literature has not been synthesized appropriately as to its value and effectiveness. Aim: To systematically review the literature regarding the impact of teaching EBM to medical students on their EBM knowledge, attitudes, skills and behaviors. Methods: MEDLINE, SCOPUS, Web of science, ERIC, CINAHL and Current Controlled Trials up to May 2011 were searched; backward and forward reference checking of included and relevant studies was also carried out. Two investigators independently extracted data and assessed the quality of the studies. Results: 10,111 potential studies were initially found, of which 27 were included in the review. Six studies examined the effect of clinically integrated methods, of which five had a low quality and the other one used no validated assessment tool. Twelve studies evaluated the effects of seminars, workshops and short courses, of which 11 had a low quality and the other one lacked a validated assessment tool. Six studies examined e-learning, of which five having a high or acceptable quality reported e-learning to be as effective as traditional teaching in improving knowledge, attitudes and skills. One robust study found problem-based learning less effective compared to usual teaching. Two studies with high or moderate quality linked multicomponent interventions to improved knowledge and attitudes. No included study assessed the long-term effects of the teaching of EBM. Conclusions: Our findings indicated that some EBM teaching strategies have the potential to improve knowledge, attitudes and skills in undergraduate medical students, but the evidenced base does not demonstrate superiority of one method. There is no evidence demonstrating transfer to clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: We have developed a helmet for trans-calvarial delivery of low-level, NIR light to the brain to assess the feasibility and effectiveness of low-level light therapy after moderate TBI. Methods: In this ongoing randomized controlled trial, we are enrolling adult subjects with in 72 hours of moderate TBI (GCS = 9-12 or GCS = 13-15 + abnormalCT). Subjects are randomized to treatment group (20 minutes of light therapy on 3 consecutive days immediately after enrollment) or control group (Sham treatment with the helmetwithout the light). All subjects undergo clinical assessments at baseline and after 2 weeks, 3 months, 6 months, and one year. Subjects also undergo MRI at baseline and after 2 weeks and 3 months. We obtain structural (T1, FLAIR, SWI, and Angiography), high-resolution DTI, resting-state functional MRI, cerebrovascular reactivity (CVR) imaging using hypercapniaBOLDMRI, and perfusion imaging using arterial spin labeling (ASL). Results: Of the 10 enrolled patients so far, 4 are still in the study while the rest were lost to follow-up. Light therapy did not lead to any adverse effects in any patient. The most common abnormalities were edema (3 subjects) and microhemorrhages (3 subjects). Angiography was normal in all subjects. There was abnormal CVR around left lentiform nucleus in one subject, with concordant abnormal perfusion in the same area. The Disability Rating Scale improved in one subject, while it did not change in any other subject. There was no change in the structural MRI findings from baseline to week 2 in any of the subjects. Conclusion: Our preliminary results, while the study population is still blinded, suggest that low-level light therapy is safe in patients with moderate traumatic brain injury. Assessment of the efficacy of low-level light therapy is pending further data collection and unblinded analysis of the data. [ABSTRACT FROM AUTHOR]

Purpose: A novel atlas-based software called Anatom-e (Anatom-e Systems, Houston TX) has a deformable anatomic template of brain structures. This atlas of white matter tracts can be aligned with the MRI data of a patient to illustrate white matter pathways and injury pattern. In this study, we describe this approach in a cohort of acute head trauma patients. Materials and Methods: In an IRB approved prospective pilot study, 4 subjects (mean age 50 - 17 yrs) with acute head trauma gave written informed consent for acquisition of MRI. The MRI (T1, Flair, DWI, and SWI) were performed on 3-T scanners (Siemens Healthcare, Germany). De-identified images were imported to Anatom-e. The MR images were manually aligned over the template of the Anatom-e in axial, coronal, sagittal planes. For all subjects, deformable anatomic template was well aligned with MRI sequence. The tractography and functional circuit options were selected from software for visualization of white matter tracts. Results: Spatial relationship of the white matter tracts systems including projection tracts (e.g. corticospinal tract), association tracts (e.g. arcuate fasciculus), and commissural tracts (e.g. corpus callosum) were easily visualized in 3D volumetric plane with Anatom-e. Various projection tracts were demonstrated collecting projections from many areas of cortex to brainstem and were also easily visualized. The trajectories of the acute fasciculus, superior and inferior longitudinal fasciculus were well demonstrated with Anatom-e software. The forceps minor, rostrum, body, & forceps major of corpus callosum were also easily appreciated. The software depicts the 3D relationship of white matter tracts and other brain structures or lesions. Conclusions: White matter tracts were easily illustrated with deformable anatomic template of Anatom-e software by using routine MRI sequences. Anatom-e can also predict the sets of signs and symptoms that can be expected from a morphologic map of the injury pattern. As such, the software can be used in the clinical settings and teaching purposes. [ABSTRACT FROM AUTHOR]

Unlabelled: ♦, Background: Although higher body mass index (BMI) is associated with better outcomes in hemodialysis patients, the relationship in peritoneal dialysis (PD) patients is less clear. We aimed to synthesize the results from all large and high-quality studies to examine whether underweight, overweight, or obesity is associated with any significantly different risk of death in peritoneal dialysis patients. ♦, Methods: We searched MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane CENTRAL, and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa Quality Assessment Scale. We meta-analyzed the results of the largest studies with no overlap in their data sources. ♦, Results: We included 9 studies (n = 156,562) in the systematic review and 4 studies in the meta-analyses. When examined without stratifying studies by follow-up duration, the results of the studies were inconsistent. Hence, we pooled the study results stratified based upon their follow-up durations, as suggested by a large study, and observed that being underweight was associated with higher 1-year mortality but had no significant association with 2- and 3- to 5-year mortalities. In contrast, being overweight or obese was associated with lower 1-year mortality but it had no significant association with 2-, and 3- to 5-year mortalities. ♦, Conclusion: Over the short-term, being underweight was associated with higher mortality and being overweight or obese was associated with lower mortality. The associations of body mass with mortality were not significant over the long-term., (Copyright © 2016 International Society for Peritoneal Dialysis.)