Breath sound distribution images of patients with pneumonia and pleural effusion

OBJECTIVE: To determine whether breath sound distribution maps can differentiate between patients with pneumonia or pleural effusion versus healthy controls. METHODS: We recorded breath sounds from 20 patients conventionally diagnosed as having pleural effusion, 20 patients conventionally diagnosed as having pneumonia, and 60 healthy controls, of whom 20 served as a learning sample. All subjects were examined with a computer-based multi-sensor breath sound mapping device that records, analyzes, and displays a dynamic map of breath sound distribution. The physicians who interpreted the breath sound images were first trained in identifying common characteristics of the images from the learning sample of normals. Then the images from the 40 patients and the 40 controls were interpreted as either normal or abnormal. RESULTS: In the normal images, the left and right lung images developed synchronously and had similar size, shape, and intensity. The sensitivity and specificity of blinded differentiation between normal and abnormal images when the physician interpreter did not know the patient's workup were 82.5% and 80%, respectively. The sensitivity and specificity of blinded detection of normal and abnormal images when the interpreter did know the patient' workup were 90% and 88%, respectively. CONCLUSIONS: Computerized dynamic imaging of breath sounds is a sensitive and specific tool for distinguishing pneumonia or pleural effusion from normal lungs. The role of computerized breath sound analysis for diagnosis and monitoring of lung diseases needs further evaluation.     

Influence of Probiotics Administration Before Liver Resection in Patients with Liver Disease: A Randomized Controlled Trial

World Journal of Surgery - By inhibiting the growth of pathogenic bacteria and modulating the local intestinal immune system, probiotics may reduce bacterial translocation and systemic...     

Disclosure of Funding Sources and Conflicts of Interest in Phase III Surgical Trials: Survey of Ten General Surgery Journals

Background

Discussions regarding disclosure of funding sources and conflicts of interest (COI) in published peer-reviewed journal articles are becoming increasingly more common and intense. The aim of the present study was to examine whether randomized controlled trials (RCTs) published in leading surgery journals report funding sources and COI.

Methods

All articles reporting randomized controlled phase III trials published January 2005 through December 2010 were chosen for review from ten international journals. We evaluated the number of disclosed funding sources and COI, and the factors associated with such disclosures.

Results

From a review of 657 RCT from the ten journals, we discovered that presence or absence of a funding source and COI was disclosed by 47 % (309) and 25.1 % (165), respectively. Most articles in “International Committee of Medical Journal Editors (ICMJE)-affiliated journals” did not disclose COI. Disclosure of funding was associated with a journal impact factor >3 (51.7 vs 41.6 %; p < 0.01), statistician/epidemiologist involvement (64.2 vs 43.7 %; p < 0.001), publication after 2008 (52.9 vs 41.1 %; p < 0.01), and the journal being ICMJE-affiliated (49.3 vs 40 %; p < 0.05). Conflict of interest disclosure was associated with publication after 2008 (38.7 vs 11.3 %; p < 0.001), and with the journal not being affiliated with ICMJE (36.9 vs 21.3 %; p < 0.001).

Conclusions

Of the published studies we investigated, over half did not disclose funding sources (i.e., whether or not there was a funding source), and almost three quarters did not disclose whether COI existed. Our findings suggest the need to adopt best current practices regarding disclosure of competing interests to fulfill responsibilities to readers and, ultimately, to patients.     

Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

Objective

To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management.

Methods

We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick’s classification.

Results

Before TMT, thrombus level was staged I for 1 (7 %), II for 10 (72 %) and III (21 %) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1–5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43 %) patients had a measurable decrease, 6 (43 %) had no change, and 2 (14 %) had an increase in the thrombus. One patient (7 %) had a downstage of thrombus level, 12 (85 %) had stable thrombi, and 1 (7 %) had an upstage. Regarding primary tumor, 7 (50 %), 5 (36 %) and 2 (14 %) patients had a decrease, stabilization and an increase in tumor size, respectively.

Conclusion

Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.     

Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff

ObjectivesTo analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication.Methods and materialsClinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant.ResultsMedian age at diagnosis was 60 years (19–91). Tumor size was smaller than 4 cm in 665 (68.3%) cases and larger than 4 cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4 cm (P = 0.0001) and for tumors>4 cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR<60 ml/min (P = 0.0001), tumor size≥4 cm (P = 0.0001), and older age at diagnosis (P = 0.0001).ConclusionsThe renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff.     

Proximal myofascial pain in patients with distal complex regional pain syndrome of the upper limb

BackgroundPatients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases.AimsTo evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers’ tenderness and allodynia are associated with CRPS.MethodsA case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test.ResultsThe prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ² = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ² = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ² = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls.ConclusionThere is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.     

The absolute chronology of Boker Tachtit (Israel) and implications for the Middle to Upper Paleolithic transition in the Levant

The Initial Upper Paleolithic (IUP) is a crucial lithic assemblage type in the archaeology of southwest Asia because it marks a dramatic shift in hominin populations accompanied by technological changes in material culture. This phase is conventionally divided into two chronocultural phases based on the Boker Tachtit site, central Negev, Israel. While lithic technologies at Boker Tachtit are well defined, showing continuity from one phase to another, the absolute chronology is poorly resolved because the radiocarbon method used had a large uncertainty. Nevertheless, Boker Tachtit is considered to be the origin of the succeeding Early Upper Paleolithic Ahmarian tradition that dates in the Negev to ∼42,000 y ago (42 ka). Here, we provide ¹⁴C and optically stimulated luminescence dates obtained from a recent excavation of Boker Tachtit. The new dates show that the early phase at Boker Tachtit, the Emirian, dates to 50 through 49 ka, while the late phase dates to 47.3 ka and ends by 44.3 ka. These results show that the IUP started in the Levant during the final stages of the Late Middle Paleolithic some 50,000 y ago. The later IUP phase in the Negev chronologically overlaps with the Early Upper Paleolithic Ahmarian of the Mediterranean woodland region between 47 and 44 ka. We conclude that Boker Tachtit is the earliest manifestation of the IUP in Eurasia. The study shows that distinguishing the chronology of the IUP from the Late Middle Paleolithic, as well as from the Early Upper Paleolithic, is much more complex than previously thought.

The spread of modern humans from Africa into Eurasia is certainly one of the most important events in human history (1–3). The appearance of Homo sapiens at the transition between the Middle Paleolithic (MP) and the Upper Paleolithic (UP) periods corresponds with the demise of Neanderthals in Europe and west Asia (4). This demographic process, known in the literature as the “Recent African Origin” (5), has undergone refinements since it was first introduced (6). Today, this dispersal event is thought to be a multifaceted process that involved several events and genetic admixture between H. sapiens and Neanderthals (7–12).Recognizing demographic changes in the archaeological record is not always straightforward, mainly because of a lack of human fossils. Still, transformations in material culture are often conceived as a reliable indicator for demographic change (13, 14). In the Levant, as in Europe, such changes occurred during the transition from the MP to the UP, namely, the replacement of Levallois technology by blade technologies and the introduction of systematically produced tools on bone and antler (15–18). The nature and timing of the MP to UP transition has been investigated for almost a century (18–24). While the characteristics of the material culture changes are more or less defined, the absolute chronology and the origins of the transitional industries are under debate (25–30).One of the major reasons for this uncertainty is the fact that many of the key sites with supposedly “transitional” lithic industries in the south Levant, such as Emireh and el-Wad caves, were excavated in the beginning of the 20th century and their stratigraphies are challenging (24). An important exception is the site of Boker Tachtit in the Negev Highlands, Israel, that comprises a series of intact stratigraphic layers with refitted lithic assemblages, which are separated by sterile sediments (31, 32). Here, we report the results of an excavation at Boker Tachtit and in particular the chronology based on radiocarbon and optically stimulated luminescence (OSL) dates.Boker Tachtit is located in the Wadi Zin basin in the central Negev region, Israel (Fig. 1). The site was discovered and excavated by A. Marks in the framework of the Central Negev Project (31). The excavation revealed well-preserved archaeological horizons (Levels 1 through 4 from the bottom up) composed of flint artifacts, a few hammer stones, and charcoal pieces, including the presence of a hearth feature in Level 1. Comprehensive lithic studies enabled technological reconstructions of the lithic industries at the site as well as spatial aspects of these occupations (32–34). The refitting study demonstrated a technological continuity from the lowermost Level 1 to the uppermost Level 4 and indicated on-site flint knapping. This later point is additionally supported by a study of the microflints from Marks’ excavation section D (35). Marks conceived Boker Tachtit as an MP to UP transitional site bearing two consecutive cultural phases: the Emirian (Levels 1 through 3), which he associated with the MP, and the Initial UP (IUP) (Level 4), which was predominantly UP (28). Later studies by Kuhn that included sites in the north Levant redefined the IUP and incorporated the Emirian into this phase (16). In this paper, we follow Kuhn''s definition for the IUP.Open in a separate windowFig. 1.Location of Boker Tachtit and other sites mentioned in the text.The original chronology of Boker Tachtit was based on five radiocarbon dates using the ¹⁴C decay counting method (31). Four samples (GY-3642, SMU-184, SMU-580, and SMU-259) were from Level 1 and one sample (SMU-579) from Level 4. Two samples were of infinite ages (GY-3642, >33,000 BC; SMU-184, >43,620 BC), and one (SMU-579, 33,105 ± 4,100 BC) appeared to be an outlier. Another (SMU-580, 44,330 ± 9,050 BC) had an extremely wide uncertainty range of 9,000 y. The only supposedly reliable date (SMU-259, 44,980 ± 2,420 BC) was used to set the chronology of the site to ∼47 ka BP. The latter date was perceived by Marks and many others to reflect the age of the MP to UP transition in the Levant (1, 13). The few samples analyzed and the large uncertainties are related to the methodology used and probably also to the quality of the charred material analyzed.More recent MP to UP chronological studies based on radiocarbon dating of charred material and marine shells from new and old excavations at other sites have initiated a debate about the chronology of the transition, and the age of Boker Tachtit was suggested to be too old compared with northern Levantine sites (25, 27, 29, 30, 36). The problems lie in the disparities in the documented timing of the transition. While these differences may reflect a time lag in the transition between Boker Tachtit and the northern Levantine sites, problems with the quality of dated material or their context should not be overlooked (i.e., stratigraphic provenience and/or diagenesis) (e.g., refs. 25, 29, 30).