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Heart failure (HF) is a major cause of death and hospitalization worldwide. In particular, hospital readmission due to worsened HF occurs frequently after the onset of HF. However, the association of repeated hospital admission with clinical manifestations and outcomes is unclear. The aim of this study was to clarify the serial changes in presentation and clinical course of patients requiring repeated hospital admission due to worsened HF. Among 466,921 patients who were admitted and discharged between January 2010 and March 2018, with the main discharge diagnosis of HF, we studied 5,740 patients who were hospitalized 4 times or more, using the Diagnosis Procedure Combination database. We evaluated serial changes in continuous data using the Jonckheere trend test, and categorical data using the Cochran-Armitage trend test. The median age of the patients was 78 years, and 3,326 patients (58%) were male. Body mass index and Barthel Index decreased with increased numbers of admissions. Patients requiring respiratory support and hemodialysis increased, whereas patients undergoing intra-aortic balloon pumping decreased with increased numbers of admissions. The length of hospital stay was prolonged and the interval between hospitalizations was shortened with increased numbers of hospital admissions. The in-hospital mortality rate was 8.8% at the fourth admission. In conclusion, this is the first large-scale real-world study on the serial changes in characteristics and outcomes of HF patients requiring repeated hospitalization, suggesting that repeated hospitalization might adversely affect the general status of patients with HF and result in a vicious clinical cycle.

Background Torque teno virus-induced aseptic meningitis has not been documented, although torque teno virus infections still remain under consideration for etiological agents. This study identified a torque teno virus sequence using next generation sequencing and immunoglobulin M response to the torque teno virus antigen, therefore, that would be a comprehensive diagnosis for torque teno virus infection. Case presentation A 2-month-old Japanese boy was brought to our hospital because he was irritable, drowsy, and lethargic. He was admitted based on his test results which indicated the possibility of septic meningitis. He was started on treatment with high-dose antibiotics and steroids. On the third day of hospitalization, he became afebrile with improvement in his general status and was discharged on the sixth day. He had no developmental problems for up to 1 year after discharge. Metagenomic ribonucleic acid-Seq pathogen detection using next generation sequencing of a sample of his cerebrospinal fluid, which was collected at admission, revealed three short reads homologous to those in torque teno virus out of a total of 1,708,516 reads. This finding indicated that our patient was positive compared to the torque teno virus-negative cerebrospinal fluid samples (controls) from 13 other patients. The torque teno virus has been shown to have a whole genome sequence of 2810 nt by polymerase chain reaction. We prepared a recombinant GP2 antigen from torque teno virus and used it to study our patient’s anti-torque teno virus immune response. An anti-GP2 serum immunoglobulin M response was detected, providing further supportive evidence of torque teno virus infection. Conclusions This case speculates that torque teno virus-induced aseptic meningitis has a good course. New technologies like next generation sequencing can help in the identification of such cases, and an accumulation of future cases is expected.

The pathological diagnostics of cancer - based on the histological features - is today increasingly completed by molecular profiling at variable depth in an almost evident fashion. Predictive information should cover potential therapeutic targets and/or major resistance mechanisms the nature of which is subject of alteration during the course of the treatment. Mutational profiling recently became technically available by the analysis of circulating free DNA obtained following non-invasive peripheral blood or body fluid sampling. This "liquid biopsy" approach reflects the general status considering the actual tumor burden, irrespective of the intratumoral distribution and anatomical site. However, the dynamics of the liquid compartment relies on tissue-related processes reflected by histological variables. The amount and composition of free DNA seems to be influenced by many factors, including the stage and anatomical localization of the cancer, the relative mass of neoplastic subclones, the growth rate, the stromal and inflammatory component, the extent of tumor cell death and necrosis. The histopathological context should be considered also when analysis of cfDNA is about to replace repeated tumor sampling for molecular follow-up.

International audience; There exist many different human cancers, but regardless of the cancer type, an early diagnosis is a necessary condition for further optimal outcomes from the disease. Therefore, efficient specific and sensitive cancer biomarkers are urgently needed. This is especially true for the cancers depicting a silent progression, and those only diagnosed in an already metastatic state with a poor survival prognostic. After a rapid overview of the previous methods for cancer diagnosis, the outstanding characteristics of extracellular vesicles (EVs) will be presented, as new interesting candidates for early cancer diagnosis in human biofluid non-invasive liquid biopsy. The present review aims to give the state-of-the-art of the numerous searches of efficient EV-mediated cancer diagnosis. The corresponding literature quest was performed by means of an original approach, using a powerful Expernova Questel big data platform, which was specifically adapted for a literature search on EVs. The chosen collected scientific papers are presented in two parts, the first one drawing up a picture of the current general status of EV-mediated cancer diagnosis and the second one showing recent applications of such EV-mediated diagnosis for six important human-specific cancers, i.e., lung, breast, prostate, colorectal, ovary and pancreatic cancers. However, the promising perspective of finally succeeding in the worldwide quest for the much-needed early cancer diagnosis has to be moderated by the many remaining challenges left to solve before achieving the efficient clinical translation of the constantly increasing scientific knowledge.

Purpose This study was conducted to analyze the anxiety levels and attitudes of nursing students for the nursing profession during the COVID‐19 pandemic. Methods Data collection forms were sent online to nursing students of three different state or foundation universities in Turkey. In all, 456 individuals who answered the data collection forms were included in the study. Findings Study results revealed that the total average score for the “Attitude Scale for Nursing Profession” was 162 ± 15.6. The Professional characteristics subdimension score average was 80.64 ± 7.02. Furthermore, the state of choosing nursing profession subdimension score average was 50.05 ± 9.23, whereas the Attitude for the general status of nursing profession subdimension score average was 34.38 ± 2.97. Due to the pandemic, anxiety levels for the nursing profession were 4.86 ± 2.76 (between 0 and 10). It was determined that nursing students who studied in cities where the virus was very common had a more positive attitude toward the profession. Anxiety levels of nursing students studying in cities where the virus impact was moderate and in cities where the virus presence was quite common were higher (p > 0.05). Practical Implications It was found that nursing students had a positive and high‐level attitude toward the nursing profession. Furthermore, the results demonstrated that attitudes toward the nursing profession decreased significantly as anxiety increased.

Purpose: Treatment of hypertension has recently shown remarkable advances. It is quite important to survey the current general status of blood pressure (BP) and recent changes to verify whether peo...

This study aimed to assess the masticatory efficiency in patients with a removable dental prosthesis, presenting different systemic, oral and prosthetic states while chewing different foods. The study was conducted on a convenient sample of patients aged 45 and above, with removable prostheses in at least one jaw. Patients were asked to chew samples of digestive biscuits, apple, and carrot, until the sensation of swallowing. The recorded masticatory function parameters were: chewing time, the number of mastication cycles, mean masticatory cycle duration, and chewing frequency. We found out that the masticatory functional parameters registered statistically significant differences according to the chewed food (e.g., generally the highest values were recorded for carrot and lowest for apple), most likely this being in relation to food’s consistency, wetting, and adherence. High positive correlations were found between the chewing time and the number of mastication cycles for all three foods taken into consideration. Higher values for chewing time and number of mastication cycles were found for all foods in patients with complete dentures and overdentures, and while chewing carrot in patients with altered general status and of advanced age. Therefore, it that it takes a different time and number of mastication cycles to complete chewing, in relation to individual and food characteristics, to the systemic, oral and prosthetic patient’s status. The residual teeth number and the type of prosthetic rehabilitation favor the adaptation and improvement of masticatory parameters and can have marker value for masticatory efficiency.

The ever increasing applications of bioinformatics in providing effective interpretation of large and complex biological data require expertise in the use of sophisticated computational tools and advanced statistical tests, skills that are mostly lacking in the Sudanese research community. This can be attributed to paucity in the development and promotion of bioinformatics, lack of senior bioinformaticians, and the general status quo of inadequate research funding in Sudan. In this paper, we describe the challenges that have encountered the development of bioinformatics as a discipline in Sudan. Additionally, we highlight on specific actions that may help develop and promote its education and training. The paper takes the National University Biomedical Research Institute (NUBRI) as an example of an institute that has tackled many of these challenges and strives to drive powerful efforts in the development of bioinformatics in the country., Author summary Bioinformatics is gaining recognition globally and in Sudan as an important subdiscipline of biological sciences, one that enables researchers to efficiently interpret complex biological data. A limited number of Sudanese academic institutions have acknowledged this field despite its increasingly recognized importance. The development of bioinformatics in the country requires interdisciplinary collaborations involving experts in life sciences, research methodology, healthcare, computer, and data sciences. This can be achieved through designing educational programs and workshops alongside proposing and establishing effective collaborative research projects. In this context, we comprehensively discussed the present state of bioinformatics in Sudan, the challenges faced, as well as the efforts exerted by academic institutions including NUBRI, to upgrade infrastructure and establish local and international collaborations.

In Japan, the era of thrombectomy for acute stroke started when the Merci retriever was approved in 2010 and the Penumbra system in 2011. New-generation Penumbra catheters (MAX series) and stent retrievers were introduced in 2013 and 2014, respectively. The aim of this study was to clarify the general status and trends in endovascular reperfusion therapy for stroke in Japan from 2010 to 2014. We extracted a total of 3705 patients (72.1 ± 12.2 years, 1482 women) from a nationwide study of patients receiving any neuroendovascular treatment, the Japanese Registry of NeuroEndovascular Therapy 3. Reperfusion therapy resulted in a successful reperfusion rate of 59%, and 31% of patients achieved a favorable outcome at 30 days of onset. The frequency of Merci-including procedures increased to 52% in the first half of 2011, but conversely decreased to 1% in the second half of 2014. The frequency of Penumbra-including procedures increased from 18% in the second half of 2011 to 67% in the first half of 2014, decreasing to 38% in the second half of 2014. The reperfusion rate and 30-day clinical outcomes remained almost unchanged until June 2013, and started to improve thereafter, coincident with the introduction and spread of newer-generation devices. The rate of successful reperfusion reached 71-76%, and 36-38% of patients achieved a favorable outcome in 2014. After multivariate adjustment for preprocedure variables, the calendar period from 2013 to 2014 was significantly associated with improvement in reperfusion rates and clinical outcomes.

Complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have dramatically changed the prognosis of patients with pseudomyxoma peritonei (PMP). However, recurrences can still occur and no consensus has been reached regarding their optimal treatments. This study aimed to analyze the patterns of recurrence after CCRS plus HIPEC for PMP and potential subsequent treatments of these lesions.Between 1992 and 2014, patients who had relapsed after treatment of PMP were selected from a prospective database of 251 patients who had undergone CCRS plus HIPEC with a curative intent.After a median follow-up of 85 months, 66 patients (26%) had relapsed with a median free interval of 25 months. The first recurrence was mostly located in the peritoneum, isolated in 50 patients (76%) and associated with extraperitoneal disease in 6 patients. Curatively intended treatment of the relapse, combining surgery and chemotherapy was achievable in 76% of the patients, leading to a 5-year overall survival (OS) rate of 83% from the date of treatment of the first recurrence. In contrast, the 5-year OS rate was only 27% (p 0.001) for patients treated with non-curative therapy. An isolated peritoneal recurrence was predictive of greater amenability to curative therapy and a better prognosis.After CCRS plus HIPEC, serosal recurrences were more common than their distant counterparts. Distant relapses' emergence has raised the question of their optimal treatments. Very long-term survival can be obtained after further treatment of recurrent PMP for patients with limited disease and good general status.

International audience; Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5-7years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients.

Aim To clarify the status of minimally invasive gynecologic surgery (MIGS) in the Asia/Oceania region. Methods Survey questionnaires were sent out to the representative of AOFOG countries. They consisted of questions on the general status of MIGS, the clinical indication of MIGS, cost coverage, company support, training and certification for MIGS, patient preference for MIGS and requirements for the AOFOG. Results Developmental stage of MIGS in this region was roughly divided into three categories: fully developed countries, countries in the developmental stage and countries in the rudimentary stage. Clinical indication of MIGS and training opportunity of young doctors were correlated with the developmental stage. Conclusion Support by AOFOG should be considered according to the developmental stage of each country. Collecting updated information on MIGS in each member country is important to provide adequate support.

The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcomes of children with erythroderma (also known as exfoliative dermatitis) in hospital dermatology departments in Lome, Togo. This retrospective descriptive study examined the records of patients aged 0 to 15 years who were treated for erythroderma in dermatology departments in Lome from January 1997 to December 2016. The study included 28 patients, with a mean age of 6.3 ± 5 years. The mean duration of progression of erythroderma before the consultation was 39.2 days. Pruritus was present in 60 % of the children, fever in 13.3 %, and impairment of general status in 3.3 %. Among the children aged 3 months and older, 84.2 % had dry squamous erythrodermic dermatosis, and among those younger than 3 months, 15.8 %. Among those with erythrodermic dermatosis, atopic dermatitis (70.6 %) was the most frequent dermatosis. No cause was found in 32.1 % cases. Course and outcome were favorable in 53.3 % of cases; one child died, and the rate of loss to follow-up was 43.3 %. Erythroderma is a rare disease in children in hospital dermatology departments in Lome. Erythrodermic dermatosis, particularly atopic eczema, remains the most frequent cause.

Background: Physical activity enhances quality of life and body image in obese. Behavioural changes are useful tools to increase life conditions of this population. Aim: To evaluate the physical activity level of candidates to bariatric surgery and its relation with quality of life and body image, when patients are encouraged weekly by personal trainers. ) Method: This is a prospective, interventional and longitudinal study with quantitative analysis. Patients were divided into two groups, control (n=28) and interventional (n= 10). Both groups received physical activity and nutritional recommendations and psychological support. Were used the SF36 and Body Shape questionnaires to assess physical activity level and body image and pedometers to count weekly steps. Patients were followed during 12 weeks. ) Results: Were found significant difference in the domains physical activity (p=0.019), pain (p=0.0001) and health general status (p=0.021). No significant difference in body weight (p=0.095) was noted. Conclusion: When assisted by personal trainers, obese patients can change behavior, increase health quality and physical activity levels and experience less pain. Increase in physical activity, when well structured can benefit these patients.

Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operator’s level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providers’ clinical judgment for individual patients, and they may need to be modified based on the medical team’s level of experience and the availability of local resources.

International audience; AimIn the presence of large bowel obstruction, the choice of treatment is determined by the patient's general status, the tumour characteristics and the perceived risk of caecal perforation. This study was designed to evaluate the predictive factors of impending caecal perforation, and also investigated the use of caecal volumetry. MethodFrom January 2011 to June 2016, patients with obstructive distal colon cancer undergoing emergency laparotomy, for whom a pretreatment CT scan was available, were included in this retrospective, case-control, two-centre study. Two patient groups were defined: patients with and without impending caecal perforation. The primary end-point of the study was a determination of predictive factors for caecal perforation. ResultsA total of 72 patients (45 men, 62.5%) were included. Univariate analysis revealed that the presence of pericaecal fluid (P9cm (P=0.002) and a caecal diameter at the ileocaecal junction >7.5cm (P=0.001) were associated with impending caecal perforation. In multivariate analysis, only caecal volume >400cm(3) (P=0.001) was correlated with the risk of impending caecal perforation. ConclusionCaecal volumetry is an easy and useful tool to predict impending caecal perforation in patients with large bowel obstruction.

Patients with advanced haematological malignancies in non-curative settings suffer from complex physical symptoms and psychosocial distress, comparable to patients with solid tumour entities. Nevertheless, numerous problems at the interface between haematology and palliative home care have been described. From January 2011 until October 2014, we performed a retrospective, multicenter analysis of all patients with haematological malignancies (ICD 10: C81-C95) being treated by the respective specialized palliative home care (SAPV) team. Three SAPV teams were surveyed. Disease entity, physical symptoms, psychosocial distress, number of hospital admissions, therapeutic interventions and other items were analysed descriptively. Of 3,955 SAPV patients, 1.8% (n = 73) suffered from haematological malignancies. Main problems were deterioration of general condition, pain or psychological problems. Thirty-seven percent developed new symptoms during SAPV, mainly pain, psychological distress or deterioration of general status. In 33%, patients were referred to hospital, mainly due to deterioration of general condition or pain. Seventy percent died within 3 months after beginning SAPV care; 83% died at home or in a nursing home. Patients suffering from advanced haematological malignancies were statistically underrepresented in SAPV, and SAPV was installed rather at the very last days of life. By far, more patients were able to die outside a hospital as compared to reference cohorts of haematological patients not being treated in SAPV. The spectrum of documented problems is comparable to other patient cohorts being treated in SAPV; therefore, the options and benefits of palliative home care should be incorporated in palliative haematological treatment concepts more vigorously and consequently.

Sarcoidosis is a rare, systemic disease that is characterized by the formation of granulomas in various organs, including the skin. As the etiology remains unknown, the treatment of sarcoidosis is challenging. We present a 47-year-old female patient with progressive, multi-organ sarcoidosis who had a complete clinical improvement of the skin lesions, a moderate reduction in pulmonary opacities on chest X-ray, a marked subjective improvement in general status and pulmonary efficiency and a marked reduction in serum angiotensin-converting enzyme and soluble interleukin-2 receptor after 6 months of therapy with fumaric acid esters. The present case and similar reports in the literature highlight the probable efficacy of fumaric acid esters in the treatment of sarcoidosis and other non-infectious, granulomatous diseases.

Medical waste is a special category of waste with potential health and environment risks. The present study aimed to explore the current status of medical waste management in western China. Seventy-four healthcare facilities were selected to assess the general status of medical waste management based upon a designed questionnaire survey. The surveyed results showed that the quantities of average medical waste generation were 0.79, 0.59 and 0.61 kg bed−1 day−1 in tertiary, secondary and primary hospitals, respectively. The incomplete segregation of domestic and medical waste generated a higher quantity of medical waste in primary hospitals (0.61 kg bed−1 day−1) than that in secondary hospitals. Furthermore, the effective implementation of the medical waste management system depended on national regulations, occupational safety, internal policies and administration and the qualifications and competence of the directors of the waste management department in the healthcare facilities. Therefore, sufficient training programmes and protective measures should be provided by healthcare facilities to all relevant personnel and adequate financial support and effective administrative monitoring should be performed by local authorities.

Aim To evaluate the contribution of CT scanning to the management of patients with severe acute exacerbation of colitis (SAC) complicating inflammatory bowel disease (IBD), in particular, its contribution to surgical decision making. Method All patients who were admitted to our institution for SAC complicating IBD, were divided into Group A (surgical treatment) and B (medical treatment). Admission CT scan results were compared between the 2 groups. Results From 2006 to 2015, 54 patients (26 males, median age= 39 (17-71) years) presented with SAC were divided into Group A (n=41, 76%) and B (n=13, 24%). Surgical patients in Group A were more frequently with altered general status (50% vs 17%; p=0.01). Physical exam, Lichtiger score, endoscopic and laboratory results were similar between the 2 groups. There was no significant difference in CT scans between the 2 groups with respect to extension of the colitis (pan-colitis in 54% and 69%, respectively, p=0.35), median colonic thickness (10 [4-16] vs 8 [6-11] mm, p=0.15), target enhancement (88% vs 77%, p=0.38) and occurrence of toxic megacolon (2% vs 0%). Conclusion Admission CT scanning is not helpful in surgical decision making in SAC. This article is protected by copyright. All rights reserved.

Introduction: Advanced cases of uterine carcinomas with parametrial and fornix infiltration often cause massive genital bleeding, with severe anemia, fast deterioration, and a high risk of death for patients; women with advanced uterine cancer (UC) and genital massive bleeding were treated using an endovascular therapy in local anesthesia. Methods: Ten women with advanced UC and genital massive bleeding were hospitalized for a high risk of immediate death; after blood transfusions and resuscitation therapy, the patients were submitted to an experimental nanopharmacologic endovascular therapy in local anesthesia. Results: On average, the total operative time for the procedure was 38.6 minutes, the intrasurgical blood loss was of 37 mL, the postoperative analgesic request for 48 hours was just for 3 patients (all dismissed in the second day after pelvic artery embolization), the hemoglobin level at dismissal was of 6.5 g/L, and the duration of hospital stay was 1.4 days. All patients well tolerated the procedure, with no linked complications; clinical check was at the 10th and 30th days after dismissal, with no further recurrent genital bleeding in the follow-up course stopped at the visit in the 60th day. Conclusions: Genital bleeding in advanced UC is a serious complication because it causes deterioration of the patient9s general status and has a worse prognosis. The pelvic uterine embolization according to our endovascular nanopharmacologic methods is bloodless, less traumatic, and faster than a surgical procedure. Even if it requires experience in intervention radiology, it enables the continuation of external radiotherapy without delay and can replace laparotomic or laparoscopic treatment.

Serum creatinine (SCr) and Cockcroft-Gault creatinine clearance (CG CrCL) are used to estimate glomerular filtration rate (GFR). Other markers have been proposed including serum cystatin C (cysC) and the Modification of Diet in Renal Disease (MDRD) study equation. We have compared the diagnostic performances of SCr, cysC, CG CrCL, and the MDRD equation in 144 cancer patients. For reference we used either the measured or the predicted carboplatin clearance, which is around the GFR+25 mL/min. CysC was more sensitive than SCr (70.1% vs 13.4%) but was not very specific (61% for a cut-off =0.95 mL). CysC values were higher in 40 cancer patients vs 40 healthy controls with a similar and normal mean CG CrCL (1.08 vs 0.71 mg/L; p

BACKGROUND Acute lower respiratory tract diseases are an important cause of mortality in children in resource-limited settings. In the absence of pulse oximetry, clinicians rely on clinical signs to detect hypoxaemia. OBJECTIVE To assess the diagnostic value of clinical signs of hypoxaemia in children aged 2 months to 5 years with acute lower respiratory tract disease. METHODS Seventy children with a history of cough and signs of respiratory distress were enrolled. Three experienced physicians recorded clinical signs and oxygen saturation by pulse oximetry. Hypoxaemia was defined as oxygen saturation

A 14-year-old adolescent presented with a prolonged fever, abnormal liver function, anaemia, thrombocytopaenia, but a good general status. Diagnosis of hemophagocytic lymphohistiocytosis (HLH) was suspected, in spite of the initial indolent course. Secondary causes were excluded, but no specific mutation indicative of primary HLH was found. The patient started with specific therapy, but progressed with reactivations and later with persistently active disease. Haematopoietic stem cell transplantation was not successful and the adolescent died 7 months after diagnosis.

Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.

BACKGROUND: Families play a vital role in the recovery of patients admitted to Intensive Care Units. They can help patients to adapt themselves to the crisis and feel more satisfied.OBJECTIVE: In this study, we examined the patients’ and families’ satisfaction with the current visiting policies in Cardiac Intensive Care Units in the largest Cardiovascular Medical and Research Center of Iran.METHOD: This research used a cross-sectional design with a simple random sampling. To do so, 303 patients admitted to those Cardiac Intensive Care Units and their families responded to a two-part questionnaire between September 2014 and March 2015. The inclusion criteria for patients were aged between 18 and 85, acceptable general status to respond to the questions of the questionnaire, and having one of the cardiac diseases symptoms. Intention to attend was the only inclusion criterion for the family members.RESULTS: The results showed that 167(55.1%) of the participants were dissatisfied with the limited visiting policies of the Cardiac Intensive Care Units, while the satisfaction rate was 43(14.2%). The remaining participants (30.7%) were slightly satisfied with the visiting policies in Cardiac Intensive Care Units.CONCLUSIONS: Patient-centered care is an expectation among patients and their families in the Cardiac Intensive Care Units. It seems that a change in visiting policies is necessary.

The authors explored the associations between subthalamic nucleus deep brain stimulation (STN-DBS) and anxiety in Parkinson's disease (PD) patients. Recent research suggests that anxiety may be one of the earliest manifestations of PD; however, the lack of a dopamine-medication control group is a major limitation of these studies. Authors paired a group of 31 bilateral STN-DBS PD patients (STN-DBS group) with 31 dopamine-medicated PD patients (Medication-control group) and used various psychological assessment scales for group evaluations. These were completed 1 month preoperatively, and 3 weeks, 5 weeks, 2 months, 4 months, 7 months, and 13 months postoperatively. As compared with the Medication group, the STN-DBS group improved in motor functioning and general status after 1 week Stimulator Power-On; State-Anxiety improved significantly at 1 week and 1 month after Stimulator Power-On, but was not significant at the subsequent time-points. Anxiety scores remained stable before 3rd-month Stimulator Power-On, but got worse after that time. In the STN-DBS group, S-AI was positively related to motor symptoms and life quality preoperatively and 4 months postoperatively, but, in the Medication group, this correlation existed throughout the study. PD-related anxiety decreased in STN-DBS patients because of the improvement in motor function for a short time; however, as the voltages and pulse-widths grew higher with time, the PD-related anxiety became worse.

The purpose of this study was to explore the effects of cumulus cells on vitreous cryopreservation of human mature oocytes and clinical pregnancy outcomes. The study was divided into group A (cumulus cells were removed from the oocytes before freezing) containing 24 participants and 193 oocytes and group B (cumulus cells were retained with the oocytes before freezing) containing 26 participants and 240 oocytes. Based on no significant differences in age, duration of infertility, infertile causes, and number of retrieved oocytes between both groups when oocytes were retrieved from infertile women, we found that the survival rate of post thaw oocytes (88% vs 58%), cleavage rate (80% vs 56%), and high-quality embryo rate (75% vs 59%) were significantly higher in group B than in group A. Under the conditions that there were no significant differences between the 2 groups in the general status of the participants undergoing embryo transfer, the embryo implantation rate (37% vs 15%) and the clinical pregnancy rate (50% vs 17%) were significantly higher in group B than in group A, all with Ps.05. We conclude that the retention of cumulus cells can improve the developmental competence of vitrified-thawed human mature oocytes and clinical pregnancy outcomes.

Existing questionnaires on personal views of one's own cognitive functioning are either unduly long, restrict their focus on memory, and/or capture complaints rather than the general status quo. A brief 9-item questionnaire was developed, assessing metacognition with two subscales covering metamemory and metaconcentration.The questionnaire was tested in a sample of healthy women (n = 228) aged 70-93 years, during two face-to-face interviews with an interval of 6 months.Subscales were confirmed to have factorial validity. While objective cognitive test performance did not predict self-reported everyday functioning, metamemory and metaconcentration accounted for a substantial amount of its variance. The newly developed instrument was shown to be predominantly characterized by latent trait variance components.The presented questionnaire is advantageous for the assessment of metacognition as it is brief and easily applicable. Since metacognition is highly relevant for sustained independence in old age, the questionnaire is suitable to capture important determining factors in research on aging phenomena and processes.

Summary Objectives To analyze the diagnostic and therapeutic aspects of isolated gastric outlet obstruction secondary to corrosive ingestion. Patients and methods Retrospective chart review of eight patients who developed gastric stricture following corrosive ingestion and were treated in the Digestive and General Surgery Service of Yopougon Teaching Hospital in Abidjan from 1991 to 2009. Results Six men and two women (mean age of 34.3 [range 21 to 48 years]) had isolated gastric outlet obstruction following accidental ( n = 2) or suicidal ( n = 6) acid ingestion. Two patients sought hospital medical attention two days after ingestion, whereas six patients came to hospital with a mean delay of 60.8 days (range 12 and 96 days). Patients sought medical attention for poor general status ( n = 6), postprandial vomiting ( n = 4), early satiety ( n = 2) and retrosternal pain ( n = 2). Two patients, who presented early to hospital, underwent upper gastrointestinal tract endoscopy the day after admission and then received a feeding jejunostomy whereas the esogastroduodenal barium swallow and feeding jejunostomy were performed after a mean delay of 2 days (range 1 and 3 days) and 3 days (range 1 and 5 days), respectively. The findings at upper endoscopy and barium swallow were: microgastria ( n = 2), midgastric stricture ( n = 1), antropyloric stricture ( n = 4) and gastric body stricture ( n = 1). One patient died preoperatively as the result of severe nutritional depletion. A follow-up endoscopy and barium swallow were performed respectively 21 and 35 days later. Definitive surgery was performed after a mean delay of 85 days (range 74 to 123 days) in the remaining seven patients. Gastric lesions were managed by total gastrectomy with Roux-en-Y esophagojejunostomy ( n = 2), partial gastrectomy with gastrojejunostomy ( n = 2) or simple gastrojejunostomy ( n = 3). During the mean follow-up period of 4 years (range 1 to 7 years), all patients were free of symptoms. Conclusion Isolated corrosive gastric stricture is relatively rare. Surgery tailored according to the extent of gastric stricture provides excellent results.

Several centers are now performing allogeneic hematopoietic stem cell transplantation (HSCT) in the World Health Organization Eastern Mediterranean Region (EMRO) but the availability is still limited due to high cost and the need for multi-disciplinary team and an advanced laboratory support. Special issues including compatible donor availability, potential for alternate donor programs, differences in pattern of disease, pre-HSCT general status particularly for patients with BM failure, high sero-positivity for CMV, Hepatitis B and C infection and specific observations about GVHD with its relation to genetically homogeneous community are discussed. A total of 17 HSCT programs (performing five or more HSCTs annually) exist in nine countries of the EM region. Only six programs are currently reporting to EBMT or IBMTR. A total of 7617 HSCTs including 5701 allogeneic HSCTs have been performed. Due to low HSCT team density (1.5583 teams/10 million inhabitants versus 14.4333 in Europe) and very low HSCT team distribution (0.2729 teams/10,000 sq km area versus

This study investigated the adult adjustment of a statewide random sample of 737 young adults with learning disabilities, 59 labeled behaviorally disordered, and 142 labeled mentally disabled, all graduates of special education resource teacher programs. Results are reported in terms of (a) general status information, such as marital status and living arrangements; (b) information about those competitively employed, such as wages, hours worked per week, and percentage of living expenses paid; and (c) comparison of competitively employed versus unemployed individuals, in terms of high school vocational training and work experiences. Information is also provided on postsecondary education and overall “successful” adult adjustment. Data are compared across disability groups and across gender, where relevant.

Although several centers are now performing allogeneic hematopoietic SCT (HSCT) in the Eastern Mediterranean (EM) region, the availability is still limited. Special issues including compatible donor availability and potential for alternative donor programs are discussed. In comparison to Europe and North America, differences in patterns of diseases and pre-HSCT general status, particularly for patients with BM failure, are described. Other differences including high sero-positivity for CMV, hepatitis B and C infection, and specific observations about GVHD and its relation to genetically homogeneous communities are also discussed. We report that a total of 17 HSCT programs (performing five or more HSCTs annually) exist in 9 countries of the EM region. Only six programs are currently reporting to European Group for Blood and Marrow Transplantation or Center for International Blood and Marrow Transplantation Research. A total of 7617 HSCTs have been performed by these programs including 5701 allogeneic HSCTs. The area has low-HSCT team density (1.56 teams per 10 million inhabitants vs 14.43 in Europe) and very low-HSCT team distribution (0.27 teams per 10 000 sq km area vs

This paper reviews the several different factors that must be considered during the development of assays for high throughput screening (HTS) or in vitro diagnostic (IVD) applications. The reader is introduced to the terminology used in assay development as well as the statistical approaches for evaluating the data. The review is intended to serve as a tutorial to biotechnology, pharmaceutical and clinical professionals, the academic researcher, as well as a guide for established investigators of HTS and IVD. This review is not a comprehensive treatise in its scope or content, but is meant to introduce the reader to key concepts of assay development. Elementary mathematical and statistical tools for designing robust assays and data management are described. While certain design concepts overlap HTS and IVDs, others are more pertinent to one or the other topic. An overview of the regulatory requirements for IVDs is included in the context of the United States Food and Drug Administration. Quality concepts and high content screening are also briefly described. The review does not focus upon any particular assay technology nor does it provide detailed laboratory procedures on specific assays. The references cited are not exhaustive, but meant to steer the reader toward a general status report of the various technologies discussed. The information presented in this review is not intended to replace the judgment of the experienced laboratory scientist. However, this review should assist the scientific professional in executing well designed assays and being aware of design considerations.

We report a severe alcoholic hepatitis (SAH) patient with an extremely high WBC count, high serum bilirubin and low prothrombin time (PT) successfully treated with granulocytapheresis. After neutrophil-elastase inhibitor failed to reduce WBC count, methylprednisolone pulse therapy was performed. However, WBC count continued to be elevated to 97,190/microl (neutrophils 97.0%) despite improvement of total bilirubin and PT. After 5 sessions of granulocytapheresis and ulinastatin administration, increased serum IL-6, IL-8, neutrophil-elastase and WBC count gradually decreased. We could conclude that granulocytapheresis and ulinastatin can be very effective in reducing cytokines and neutrophil-elastase, and in improving the general status of SAH patients.

Although many studies have been published on the risk factors and therapies for endogenous fungal endophthalmitis (EFE), only a few have been published on the relationship between the stage of EFE at the initial examination and the prognosis. Thus, the purpose of this study was to determine the relation between the stage of EFE at the initial examination and the prognosis.A total of 103 eyes of 58 patients (40 men, 18 women) with EFE, examined over a 20-year period (1984-2004), were studied. The severity of the EFE at the initial examination was classified into four stages. In addition, the type of fungus, general status, initial and final visual acuity, findings of the anterior and posterior segments, latent fungal infection, duration from initial symptoms to initial visit, history of intravenous hyperalimentation (IVH), results of the Candida Detection System, and beta-D-glucan levels were analyzed.More than 95% of the patients had some type of underlying disorder. Candida albicans was detected initially in the blood in 40 patients. The stage of the EFE advanced as the time from the initial symptoms to the beginning of therapy increased. The final visual acuity was significantly correlated with the stage of EFE at the initial examination. In 20 of 21 patients, blood beta-D-glucan was positive, and 42 patients (90%) were receiving IVH.Because the stage of EFE advanced with the time between the initial symptoms and the beginning of therapy, and because of the high correlation between the stage of EFE and the final visual acuity, it is very important that treatment be begun as soon as possible. Thus, in patients with visual symptoms and susceptible to opportunistic infections, an early consultation with an ophthalmologist is highly recommended.

We report here the case of a young Chinese woman with cryptic miliary tuberculosis associated with acute hepatitis, pancytopenia, biological disseminated intravascular coagulation (DIC), and hyponatremia. Following the introduction of a classic tuberculostatic treatment, her general status quickly improved. After an extensive review of the literature, this is, to the best of our knowledge, the first case of cryptogenic miliary tuberculosis with all its cumulative complications.

Autoimmune neurological disorders are very common. Health-related quality-of-life measures, obtained through a patient-oriented tool (a self-administered questionnaire), are now considered essential in the evaluation of therapies, especially for pathologies that may affect patients' general status. We reviewed the most common autoimmune neurological disorders and their treatment, and we report on our experience on intravenous immunoglobulin (IVIG) administration and the relationship between IVIG and health-related quality of life. Generally, IVIG administration is effective in the most common autoimmune neurological diseases. Concerning the relationship between IVIG treatment and health-related quality of life, our results reveal an improvement of physical aspects of patients' health-related quality of life after IVIG administration. Conversely, the comparison of mental scores between the evaluation at baseline and the evaluation at follow-up exhibited no difference. Although the use of IVIG is effective for autoimmune neurological disorders, there are no commonly accepted protocols for the use of IVIG treatment. Further controlled studies on IVIG, including quality-of-life assessments, are necessary to develop needed evidence on the use of IVIG in clinical practice.

To describe the ocular features of a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) due to a homozygous G1443A mutation in the thymidine-phosphorylase gene. A case report with extensive ophthalmological investigation over a 9-year period, until death at age 38 years. Measures used included standard ophthalmological examination, visual field examination and optical coherence tomography (OCT). Ptosis and external ophthalmoplegia progressively worsened during the follow-up, as did the neurological and general status. Corneal and optic disc alterations were also observed at the last visit. Glaucomatous changes of the optic disc were confirmed by the visual field examination and OCT. In addition to previously described alterations such as ptosis and external ophthalmoplegia, MNGIE may be associated with glaucomatous-like optic neuropathy.

The burn unit establishment in a Vietnamese military hospital (1970 to 1971) is an example of the management of burns under conditions of limited resources. The problems encountered and methods used in their solution are still relevant. This is the first (and possibly still the only) instance of such clinical use of topical Sulfamylon (mafenide) aqueous spray as the sole pregraft antibacterial agent for patients with deep partial-thickness and full-thickness burns (and associated injuries). The mafenide spray open treatment resulted in a bacteriostatic film permitting eschars to remain uninfected while more superficial burns healed and general status improved, enabling delayed grafting to be effective. Use of operating rooms, supplies, and personnel was minimized. The study group contained 211 patients; 86 (approximately 40%) had burns that exceeded 20% body surface area, and 26 (approximately 12%) had burns that exceeded 40% body surface area. As the procedures became fully established, all of the last 110 patients of this series survived. Only 17 deaths occurred in the total series; none were attributed to infection.

With this issue we launch the fourth volume of our journal since its name change to Cognitive Behaviour Therapy. At this point we thought it would be worth reflecting on the general status of cogni...

Endoscopic third ventriculostomy (ETV) is an established treatment for hydrocephalus. Most studies focus on success rate, and complications are insufficiently documented. The aim of this study was to perform a systematic review of ETV complications.A Medline search discovered 34 series of ETV with detailed complications reports (17 series involving exclusively pediatric patient populations, 6 series involving exclusively adults, and 11 series involving mixed adult and pediatric populations).The analysis included 2985 ETVs performed in 2884 patients. The cause of hydrocephalus was aqueductal stenosis in 29.3% of patients, tumor in 37.6%, meningomyelocele in 7.6%, cysts in 2.6%, cerebellar infarct in 0.9%, Dandy-Walker malformation in 0.6%, and Chiari malformation Type I in 0.4%; 7.4% of the patients had posthemorrhagic hydrocephalus, 1.8% had postinfectious hydrocephalus, and 1.2% had normal pressure hydrocephalus. Hydrocephalus was due to other causes in 1.3% of cases and the cause was not reported in 9.8%. The overall complication rate was 8.5%. The rate of permanent morbidity was 2.38%; the rate of permanent neurological complications was 1.44% (hemiparesis, gaze palsy, memory disorders, altered consciousness), and the rate of permanent hormonal morbidity was 0.94% (diabetes insipidus, weight gain, precocious puberty). The rate of intraoperative hemorrhage rate was 3.7%; the rate of severe intraoperative hemorrhage was 0.6% (including a 0.21% rate of basilar rupture). The rate for intraoperative neural injury (thalamic, forniceal, hypothalamic, and midbrain injuries) was 0.24%. Central nervous system infections occurred in 1.81% of cases, CSF leak in 1.61%, and postoperative intracranial hematomas in 0.81% of cases. The early postoperative mortality rate was 0.21% (6 patients died; 2 of sepsis and 4 of hemorrhage). Another 2 children suffered delayed "sudden death" (one after 25 months and the other after 60 months), caused by acute hydrocephalus due to stoma occlusion. There were no significant differences between series involving pediatric or adult patient populations or series with fewer than 100 or more than 100 patients. All reported deaths were in series involving more than 100 patients.Endoscopic third ventriculostomy can be regarded as a low-complication procedure, with an overall complication rate of 8.5%, permanent morbidity rate of 2.4%, mortality rate of 0.21%, and delayed "sudden death" rate of 0.07%.

Immediate open reduction with internal fixation was performed on 66 open fractures (54 patients) of the long bones in the upper or lower extremity, including one clavicle. Using the classification system of Gustilo, there were 13 (20%) type I, 30 (45%) type II, 11 (16%) type IIIA, six (9%) type IIIB, and six (9%) type IIIC soft tissue injuries. Thirty-two patients had associated major multiple trauma. Eighty-eight percent of the patients had good functional results using a modification of Katenjian's criteria. There were three late deep infections (4.5%), all at the sites of type III fractures. The nonunions occurred in four open fractures (6.1%). We conclude that, if a complete and timely debridement can be accomplished, immediate internal fixation of open fractures allows for improvement in ultimate function and a decrease in mortality in patients with multiple trauma. This procedure should be performed in selected patients who have type III open fractures, with careful attention to the general status of the patient and the severity of the soft tissue wound at the fracture site.

One day surgery--defined by the fact that the patient enters the clinic in the morning and returns at home late in the afternoon--requires the observation of a whole of criteria which are absolutely necessary to guarantee the highest security as possible. At first an outstanding collaboration with the anesthetist is mandatory. Material conditions of its practice should'nt be neglected. Rooms and medical staff have to be appropriate. Indications of its performance are large but depend of the experience of the surgeon. Limits are ruled by the general status of the patient and also by his social conditions and his surroundings, not to forget an excellent collaboration with the general practitioner. Economic advantages seem obvious but have to be calculated. It is above all necessary to persuade the public hospital administrations and the social Security structures, of the interest and the advantages of one day surgery.

The lymphocyte response to mitogens is frequently used as a screening method for monitoring general immunocompetence. In practice, however, the technique is potemtially misleading. The results presented here suggest that temporal variation in lymphocyte response is the norm. Considerable variation in response to phytohemagglutinin was found for several dogs tested over different time periods. The response for any individual dog also fluctuated whether testing was at 2-week intervals, daily, or even every 4 h. This temporal variation remained whether seperated lymphocytes or whole blood was cultured and when the results were expressed on a per lymphocyte basis. This suggests that there is a real difference in the response capability of individual lymphocytes. Factors affecting the numbers of leukocytes and the proportions of different types of lymphocytes in the peripheral blood are suggested as a possible source of the variation. Because of the inherent variation in lymphocyte responsiveness, it is necessary to test at different intervals to obtain an accurate indication of the general status of an individual's immunocompetence and to determine the time of peak response capability for that individual.

Percutaneous transhepatic cholangiography using a very thin needle has been performed in 885 patients with a variety of underlying hepatic, biliary, and pancreatic disorders. The procedure was successful in 99% of the patients with dilated intrahepatic bile ducts and in 85% of those with non-dilated ducts. Complications which required surgical intervention occurred only in two cases (0.2%). In patients with obstructive jaundice, external bile drainage was performed immediately after visualization of the bile duct. Percutaneous transhepatic cholangiography is an extremely useful and safe method for investigating disorders of the biliary tract, for localizing the cause of obstructive jaundice, and for reducing the degree of jaundice and improving the general status of patients with obstructive jaundice.

Ninety-four patients with T2 NO, N1a, N1b, MO were treated with primary radiotherapy (RT) because of old age or poor general conditions. In 32 patients (34 %), younger in age and in better general conditions, Halsted radical mastectomy could be performed 5–8 months from starting RT; surgery was not done at random, but decided case by case on the basis of a good response to RT and an improvement of general status. Relapse was documented in 42 patients. Relapse rate was 50 % in the group treated with RT alone (high incidence of breast recurrences) and 33 % in the group operated on after RT. Distant metastases had the same incidence in the 2 groups, with a median free interval of 14 months. Overall disease-free survival rates at 5 to 10 years were 46 % and 35 %, respectively; these results are not particularly different from the data of historical series of T2 breast cancer treated with surgery alone. The patients operated on after RT had a significantly better survival, but the results were clearly influenced by the selection of patients. For the future, a safe policy could be a conservative combined treatment consisting of tumorectomy followed by curative RT; adjuvant medical therapy could be scheduled for high-risk patients (N1b).

Medical jurisprudence and particularly malpractice by the physician have becomes the subject of increasing concern and scholarly interest. The approach of other civilizations to the physician's liability has been previously explored. This inquiry will seek a comprehensive understanding of the liability imposed upon the physician in Jewish law.First, to provide the proper context, the general status and role of medicine and the physician in Jewish law will be briefly considered. Then, the situations in which a physician is obligated to treat or to refrain from treating patients will be explored. Assuming the physician has agreed to treat the patient, the various standards of conduct—due care, negligence, gross negligence, battery, unauthorized practice—and the liability that attaches in each will be outlined. Then, the special liability of a physician in cases of a patient's death will be analyzed. Thereafter, the effect of a patient's waiver of any claim for damages against the doctor will be considered. Finally, the overall approach adopted by Jewish law to the problem of physician's liability will be evaluated.

During the process of ‘maturation’ of the fetal skin, detachment of the layer of vernix caseosa takes place from the fetal epidermis into the amniotic fluid, in the course of the last weeks of pregnancy. This results in: (a) a change of the cytological image of the amniotic fluid followed by a considerable increase in the proportion of the keratinized epidermic cells, (b) a simultaneous increase in the turbidity of the amniotic fluid and (c) a parallel increase in the quantity of sediment which remains after centrifugation of the amniotic fluid. The data presented in this paper, measured in 87 samples of amniotic fluid from normal, eutrophic, uncomplicated pregnancies, indicate the difference between the values of the various parameters before and after the main detachment of the vernix caseosa. Since the fetal skin is the organ reflecting most accurately the general status of the fetal maturity at the end of pregnancy, we consider that an overall examination of findings from the amniotic fluid indicating the condition of the fetal skin supplies us with reliable results for making a prenatal prediction of the maturity status of the fetus.

Our study is a comparison of treatments used for 97 patients with pyonephrosis. The patients were divided into 3 groups: 1) cases in which a primary nephrectomy was done, 2) cases in which nephrectomy was secondary to drainage through a nephrostomy and 3) cases in which nephrectomy was secondary to drainage through a translumbar percutaneous puncture with an Ingram catheter indwelling.Patients in whom nephrostomy and puncture were used had the highest percentage of complications, while primary nephrectomy produced the best results. Therefore, we believe that primary nephrectomy is the procedure of choice, using drainage through a puncture only when the general status of the patient does not permit primary nephrectomy.