Toward an accelerated adoption of data-driven findings in medicine

Medicine, Health Care and Philosophy - To accelerate the adoption of a new method with a high potential to replace or extend an existing, presumably less accurate, medical scoring system,...     

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Epididymal anomalies and patent processus vaginalis are frequently found in boys with cryptorchidism or hydrocele. We conducted this study to evaluate the association between epididymal anomalies and testicular location or patent processus vaginalis in boys with undescended testis or hydrocele. Children undergoing surgery with undescended testis (group A, 136 boys and 162 testes) or communicating hydrocele (group B, 93 boys and 96 testes) were included. Testicular locations and epididymal anomalies were investigated prospectively. An anomalous epididymis was defined as anomalies of epididymal fusion that consisted of loss of continuity between the testis, the epididymis, and the long looping epididymis. The epididymis was considered normal when a normal, firm attachment between the testis, the caput, and the cauda epididymis was present. The mean ages of groups A and B were 24.6 ± 19.7 (range, 8–52 months) and 31.4 ± 20.6 months (range, 10–59 months). The incidence of epididymal anomalies was significantly higher in group A than that in group B (65.4 % vs. 13.5 %, P < 0.001). The incidence of epididymal anomalies in boys with undescended testis was significantly different according to testis location. Epididymal anomalies were observed in 100 %, 91.4 %, and 39.3 % of cases when the testis was located in the abdomen, inguinal canal, and distal to the external inguinal ring, respectively (P < 0.001). We conclude that epididymal anomalies were more frequent in boys with undescended testis than in boys with hydrocele, and that these anomalies were more frequent when undescended testis was at a higher level. These results suggest that testicular location is associated with epididymal anomalies rather than patent processus vaginalis.     

Intraoperative computerized navigation for flapless implant surgery and immediate loading in the edentulous mandible

Computerized navigation surgery has evolved to facilitate minimally invasive procedures, the gold standard of surgery today. While flapless implant surgery may be clinically beneficial, it has generally been perceived as a blind procedure limited to straightforward cases that do not pose a risk of cortical plate perforation. The objective of this report is to describe a protocol for flapless implant placement in a completely edentulous mandible using computerized navigation surgery. The Image Guided Implantology system (IGI, DenX Advanced Dental Systems) is described. The IGI system provides real-time imaging of the dental drill and transforms flapless implant surgery into a fully monitored procedure. The highly accurate intraoperative navigation enables precise transfer of the detailed presurgical implant plan to the patient. This is particularly valuable in edentulous jaws lacking any indication of the dental arch. The accurate positioning of the implants, based on the presurgical digital plan, allows fabrication of a provisional fixed prosthesis before the implant surgery for immediate postoperative loading. This innovative protocol can enhance prosthodontic-driven placement of implants in a fully monitored flapless surgery.     

Cholesterol lowering in the older population: time for reassessment?

Hypercholesterolaemia is an established major risk factor for coronary heart disease (CHD) in the general population. In the vast majority of studies that focused on this particular age group and carefully eliminated other confounding factors such as co-morbid conditions, hypercholesterolaemia was a risk factor for CHD in the older population. Because the prevalence of CHD increases with advancing age, studies that consider not only the relative risk attributed to cholesterol but also the absolute numbers of people affected, show hypercholesterolaemia to be an even stronger risk factor in the elderly. Large primary and secondary prevention studies of HMG-CoA reductase inhibitors (statins) in the elderly have shown a reduction in major coronary events similar to that observed in the younger age group. The role of hypercholesterolaemia as a risk factor for stroke is less clear, and a major limitation is the heterogeneous nature of the disease. Nevertheless, most studies that evaluated non-haemorrhagic strokes separately showed a positive association with cholesterol levels, and statin therapy is effective in preventing stroke. These data provide a rationale for treating older hypercholesterolaemic people with statins, not only to prevent CHD, but also to prevent stroke.     

Spatiotemporal effects of microsaccades on population activity in the visual cortex of monkeys during fixation

During visual fixation, the eyes make fast involuntary miniature movements known as microsaccades (MSs). When MSs are executed they displace the visual image over the retina and can generate neural modulation along the visual pathway. However, the effects of MSs on neural activity have substantial variability and are not fully understood. By utilizing voltage-sensitive dye imaging, we imaged the spatiotemporal patterns induced by MSs in V1 and V2 areas of behaving monkeys while they were fixating and presented with visual stimuli. We then investigated the neuronal modulation dynamics, induced by MSs, under different visual stimulation. MSs induced monophasic or biphasic neural responses depending on stimulus size. These neural responses were accompanied by different spatiotemporal patterns of synchronization. Finally, we show that a local patch of population response evoked by a small stimulus was clearly shifted over the V1 retinotopic map after each MS. Our results demonstrate the lack of visual stability in V1 following MSs and help clarify the substantial variability reported for MSs effects on neuronal responses. The observed neural effects suggest that MSs are associated with a continuum of neuronal responses in V1 area reflecting diverse spatiotemporal dynamics.     

Differential lateralization of hippocampal connectivity reflects features of recent context and ongoing demands: An examination of immediate post‐task activity

Neuroimaging studies have shown that task demands affect connectivity patterns in the human brain not only during task performance but also during subsequent rest periods. Our goal was to determine whether ongoing connectivity patterns during rest contain information about both the current rest state, as well as the recently terminated task. Our experimental design consisted of two types of active tasks that were followed by two types of low‐demand rest states. Using this design, we examined whether hippocampal functional connectivity during wakeful rest reflects both features of a recently terminated task and those of the current resting‐state condition. We identified four types of networks: (i) one whose connectivity with the hippocampus was determined only by features of a recently terminated task, (ii) one whose connectivity was determined only by features of the current resting‐state, (iii) one whose connectivity reflected aspects of both the recently terminated task and ongoing resting‐state features, and (iv) one whose connectivity with the hippocampus was strong, but not affected by any external factor. The left and right hippocampi played distinct roles in these networks. These findings suggest that ongoing hippocampal connectivity networks mediate information integration across multiple temporal scales, with hippocampal laterality moderating these connectivity patterns. Hum Brain Mapp 36:519–537, 2015. © 2014 Wiley Periodicals, Inc.