The use of economic evaluation in CAM: an introductory framework

Background  

For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities.     

Development of a heart failure filter for Medline: an objective approach using evidence-based clinical practice guidelines as an alternative to hand searching

Background  

Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this evidence.     

Experiences of using an interactive audience response system in lectures

Background  

Lectures are good for presenting information and providing explanations, but because they lack active participation they have been neglected.     

Action ethical dilemmas in surgery: an interview study of practicing surgeons

Background  

The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice.     

Copula based prediction models: an application to an aortic regurgitation study

Background:  

An important issue in prediction modeling of multivariate data is the measure of dependence structure. The use of Pearson's correlation as a dependence measure has several pitfalls and hence application of regression prediction models based on this correlation may not be an appropriate methodology. As an alternative, a copula based methodology for prediction modeling and an algorithm to simulate data are proposed.     

Dog saliva – an important source of dog allergens

Background

Allergy to dog (Canis familiaris) is a worldwide common cause of asthma and allergic rhinitis. However, dander extract in routine diagnostics is not an optimal predictor of IgE‐mediated dog allergy. Our objective was to evaluate saliva as an allergen source for improved diagnostics of allergy to dog.

Methods

IgE‐binding proteins in dog saliva and dander extract were analysed by immunoblot and mass spectrometry (LC‐MS/MS) using pooled or individual sera from dog‐allergic patients (n = 13). Sera from 59 patients IgE positive to dander and 55 patients IgE negative to dander but with symptoms to dog were analysed for IgE against saliva and dander by ELISA. Basophil stimulation with dog saliva and dander extract was measured by flow cytometry among three dog‐allergic patients. Additionally, IgE‐binding protein profiles of saliva from different breeds were investigated by immunoblot.

Results

Greater number and diversity of IgE‐binding proteins was found in saliva compared to dander extract and varied among dog breeds. In saliva, Can f 1, 2, 3 and 6 were identified but also four new saliva allergen candidates. The majority of the 59 dog dander–positive sera (n = 44) were IgE positive to dog saliva. Among patients IgE negative to dander, but with symptoms to dog, 20% were IgE positive to saliva. The biological activity of saliva was confirmed by basophil degranulation.

Conclusions

Dog saliva is an allergen source for improved diagnostics of dog allergy. The IgE‐binding protein profile of saliva from different dogs varies.

     

Experts' attitudes towards medical futility: an empirical survey from Japan

Background  

The current debate about medical futility is mostly driven by theoretical and personal perspectives and there is a lack of empirical data to document experts and public attitudes towards medical futility.     

An evaluation of the hypolipidemic effect of an extract of Hibiscus Sabdariffa leaves in hyperlipidemic Indians: a double blind,placebo controlled trial

Background  

Hibiscus sabdariffa is used regularly in folk medicine to treat various conditions.     

A preliminary report of an educational intervention in practice management

Background  

Practice management education continues to evolve, and little information exists regarding its curriculum design and effectiveness for resident education. We report the results of an exploratory study of a practice management curriculum for primary care residents.     

Assessment of knowledge retention and the value of proctored ultrasound exams after the introduction of an emergency ultrasound curriculum

Background  

Optimal training required for proficiency in bedside ultrasound is unknown. In addition, the value of proctored training is often assumed but has never been quantified.     

Morphological spectrum of renal cell carcinoma,unclassified: an analysis of 136 cases

Aims

Renal cell carcinoma, unclassified (RCCU) is a category that includes a morphologically and biologically heterogeneous group of tumours that are unable to be diagnosed as other well‐defined entities. We aim to describe the morphological findings of tumours within this category and to determine the most frequent morphological features leading to classification difficulty.

Methods and results

One hundred and thirty‐six cases of RCCU were examined. Patients ranged in age from 23 to 87 years. Seventy‐seven patients were men and 59 were women. International Society of Urological Pathology (ISUP) grade was most commonly 3 (n = 66), followed by 2 (n = 42) and 4 (n = 28). Tumour size ranged from 0.6 to 24.9 cm. The American Joint Committee on Cancer (AJCC) pathological T categories included pT1a (n = 50), pT1b (n = 14), pT2a (n = 7), pT2b (n = 4), pT3a (n = 50) and pT4 (n = 9). Forty‐four cases included lymph node(s), 41% of which (n = 18) had metastases. Tumours were assessed for a variety of histological features and assigned to the following morphological groups: predominantly oncocytoma/chromophobe RCC‐like; clear cell RCC‐like; papillary RCC‐like; collecting duct‐like; and pure sarcomatoid differentiation. The majority of the oncocytoma/chromophobe and clear cell RCC‐like phenotypes were low stage (pT1 or pT2). The papillary RCC‐like, collecting duct‐like and pure sarcomatoid phenotypes were mainly high stage (pT3 or pT4).

Conclusions

Renal cell carcinoma, unclassified is a term that encompasses tumours with a variety of morphological features and a wide biological spectrum. The most common source of diagnostic difficulty was tumours composed of predominantly eosinophilic cells.     

Unusual MRI findings in an immunocompetent patient with EBV encephalitis: a case report

Blackground  

It is well-known that Epstein-Barr virus (EBV) can affect the central nervous system (CNS).     

Medical informatics in an undergraduate curriculum: a qualitative study

Background  

There is strong support for educating physicians in medical informatics, and the benefits of such education have been clearly identified. Despite this, North American medical schools do not routinely provide education in medical informatics.     

Endoscopic removal of a suprasellar arachnoid cyst: an anatomical study with special reference to skull base

Background  

Suprasellar arachnoid cysts are rare entities in adults, representing 10% of all cysts. Endoscopic treatment is now preferred for this pathology, allowing a new anatomical approach to skull base structures.     

Azithromycin in Chronic Fatigue Syndrome (CFS), an analysis of clinical data

Background  

CFS is a clinical state with defined symptoms, but undefined cause. The patients may show a chronic state of immune activation and treatment with an antibiotic in this subgroup has been suggested.     

B lymphocyte subsets and outcomes in patients with an initial diagnosis of transient hypogammaglobulinemia of infancy

Purpose

Transient hypogammaglobulinemia of infancy (THI ) is a common immunodeficiency, but definitive diagnosis can only be made retrospectively. While the pathogenesis is still unknown, abnormalities have been reported in the B cell compartment. In this study, we analysed the B cell subsets of patients with an initial THI diagnosis (n = 20) and compared them with those of healthy age‐matched Turkish children (n = 72).

Methods

Flow cytometric analyses of the B subsets were performed by staining with anti‐CD 27‐PE , anti‐CD 19‐PerCP , anti‐IgD‐FITC and anti‐IgM‐APC antibodies.

Results

During a median follow‐up of 6.6 years, 13 patients whose IgG levels had normalized before they reached four years of age were diagnosed with definitive THI . The memory subsets of these patients were lower but not statistically different from the healthy controls (HC ). The remaining seven patients had prolonged hypogammaglobulinemia after the age of four and had significantly lower memory B cell subsets compared to the HC . On follow‐up, these patients had not experienced recurrent infections or autoimmunity. Re‐evaluation of patients’ B cell subsets six years later showed that the memory B cell ratios had increased to levels comparable to HC , despite the patients still having mildly low IgG levels.

Conclusion

Patients with prolonged hypogammaglobulinemia had lower levels of memory B cells despite having a similar clinical course to patients who had been diagnosed with definitive THI . This subgroup of putative THI patients poses a diagnostic and classification dilemma. Our results suggested that these patients’ memory B cells and IgG levels may recover over time.

     

The coracoclavicular ligaments: an anatomic study

Purpose  

The treatment for the acromioclavicular joint dislocations has focused on anatomic restoration of the coracoclavicular ligaments. We reviewed the detailed anatomy of trapezoid ligaments and conoid ligaments using cadavers.     

Excavated pulmonary nodules: an unusual clinical presentation of lung metastasis in two cases

Background  

Excavated pulmonary metastasis are rare. We present two cases of excavated pulmonary nodules proved to be metastases from osteosarcoma and gallblader lymphoma.     

FTO gene variation and measures of body mass in an African population

Background  

Variation in the fat mass and obesity associated (FTO) gene has been reproducibly associated with body mass index (BMI) and obesity in populations of White European origin. Data from Asians and African-Americans is less conclusive.     

Improvement of Sidestream Dark Field Imaging with an Image Acquisition Stabilizer

Background  

In the present study we developed, evaluated in volunteers, and clinically validated an image acquisition stabilizer (IAS) for Sidestream Dark Field (SDF) imaging.