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991.
Katherine M. Iverson Rowena Mercado Sarah L. Carpenter Amy E. Street 《Journal of traumatic stress》2013,26(6):767-771
Experiences of abuse during childhood or military service may increase women veterans’ risk for intimate partner violence (IPV) victimization. This study examined the relative impact of 3 forms of interpersonal violence exposure (childhood physical abuse [CPA], childhood sexual abuse [CSA], and unwanted sexual experiences during military service) and demographic and military characteristics on past‐year IPV among women veterans. Participants were 160 female veteran patients at Veterans Afffairs hospitals in New England who completed a paper‐and‐pencil mail survey that included validated assessments of past‐year IPV and previous interpersonal violence exposures. Women who reported CSA were 3.06 times, 95% confidence interval (CI) [1.14, 8.23], more likely to report past‐year IPV relative to women who did not experience CSA. Similarly, women who reported unwanted sexual experiences during military service were 2.33 times, 95% CI [1.02, 5.35], more likely to report past‐year IPV compared to women who did not report such experiences. CPA was not associated with IPV risk. Having less education and having served in the Army (vs. other branches) were also associated with greater risk of experiencing IPV in the past year. Findings have implications for assisting at risk women veterans in reducing their risk for IPV through detection and intervention efforts. 相似文献
992.
Individuals with posttraumatic stress disorder (PTSD) experience elevated concerns about their capacity to control, and the consequences of, strong emotions that occur in response to trauma reminders. Anxiety is theorized to compromise attentional control (Eysenck, Derakshan, Santos, & Calvo, 2007). In turn, diminished attentional control may increase vulnerability to threat cues and emotional reactivity (Ehlers & Clark, 2001). Consequently, attentional control may play a role in the fear of emotions frequently experienced by individuals with PTSD. Study participants included 64 men and 64 women with a mean age of 37 years, 86% of whom were White, non‐Hispanic. Participants experienced an average of 7.68 types of traumatic events, most commonly including motor vehicle accidents and intimate partner violence. PTSD symptoms positively correlated with fear of emotions (r = .53) and negatively correlated with attentional control (r = ?.38). Attentional control was negatively correlated with fear emotions (r = ?.77) and partially mediated the link between PTSD and fear of emotions (R2 = .22). Given the findings regarding top‐down attentional control, these results have implications for cognitive and emotional processing theories of PTSD and emphasize the importance of clinical consideration of fear of emotions and attentional control in the treatment of PTSD. 相似文献
993.
Background
Inguinal hernias are a common cause of groin pain. Most hernias are detectable by clinical examination and many patients proceed to hernia repair on the basis of history and examination findings alone. However, a significant proportion of patients with symptoms suggestive of groin hernia are found to have a normal clinical examination. Several radiological techniques have been developed to solve the dilemma posed by occult inguinal hernias. No systematic review or meta-analysis has addressed this common clinical problem.Methods
A systematic review and meta-analysis were undertaken of relevant articles in Medline, Embase, and the Cochrane database. Studies were assessed using the QUADAS tool. Statistical analysis was undertaken.Results
We have shown in this meta-analysis that ultrasound has a sensitivity of 86 % and a specificity of 77 % in occult inguinal hernias. Computed tomography has a sensitivity of 80 % and a specificity of 65 %. Herniography has a sensitivity of 91 % and a specificity of 83 %.Conclusions
Based on this systematic review, herniography should be considered as the initial investigation for occult inguinal hernia where available. In centers where this is not available, ultrasound of the groin should be used with good clinical judgment. When there is still diagnostic uncertainty, further investigation with magnetic resonance imaging should be considered to exclude alternative pathology. 相似文献994.
Joseph Hardwicke Richard Thomson Amy Bamford Naiem Moiemen 《Burns : journal of the International Society for Burn Injuries》2013
Thermal imaging is a tool that can be used to determine burn depth. We have revisited the use of this technology in the assessment of burns and aim to establish if high resolution, real-time technology can be practically used in conjunction with clinical examination to determine burn depth. 11 patients with burns affecting upper and lower limbs and the anterior and posterior trunk were included in this study. Digital and thermal images were recorded at between 42 h and 5 days post burn. When compared to skin temperature, full thickness burns were significantly cooler (p < 0.001), as were deep partial thickness burns (p < 0.05). Superficial partial thickness burns were not significantly different in temperature than non-burnt skin (p > 0.05). Typically, full thickness burns were 2.3 °C cooler than non-burnt skin; deep partial thickness burns were 1.2 °C cooler than non-burnt skin; whilst superficial burns were only 0.1 °C cooler. Thermal imaging can correctly determine difference in burn depth. The thermal camera produces images of high resolution and is quick and easy to use. 相似文献
995.
Massimo Lazzeri Alexander Haese Alexandre de la Taille Joan Palou Redorta Thomas McNicholas Giovanni Lughezzani Vincenzo Scattoni Vittorio Bini Massimo Freschi Amy Sussman Bijan Ghaleh Philippe Le Corvoisier Josep Alberola Bou Salvador Esquena Fernández Markus Graefen Giorgio Guazzoni 《European urology》2013
Background
Strategies to reduce prostate-specific antigen (PSA)–driven prostate cancer (PCa) overdiagnosis and overtreatment seem to be necessary.Objective
To test the accuracy of serum isoform [−2]proPSA (p2PSA) and its derivatives, percentage of p2PSA to free PSA (fPSA; %p2PSA) and the Prostate Health Index (PHI)—called index tests—in discriminating between patients with and without PCa.Design, setting, and participants
This was an observational, prospective cohort study of patients from five European urologic centers with a total PSA (tPSA) range of 2–10 ng/ml who were subjected to initial prostate biopsy for suspected PCa.Outcome measurements and statistical analysis
The primary end point was to evaluate the specificity, sensitivity, and diagnostic accuracy of index tests in determining the presence of PCa at prostate biopsy in comparison to tPSA, fPSA, and percentage of fPSA to tPSA (%fPSA) (standard tests) and the number of prostate biopsies that could be spared using these tests. Multivariable logistic regression models were complemented by predictive accuracy analysis and decision curve analysis.Results and limitations
Of >646 patients, PCa was diagnosed in 264 (40.1%). Median tPSA (5.7 vs 5.8 ng/ml; p = 0.942) and p2PSA (15.0 vs 14.7 pg/ml) did not differ between groups; conversely, median fPSA (0.7 vs 1 ng/ml; p < 0.001), %fPSA (0.14 vs 0.17; p < 0.001), %p2PSA (2.1 vs 1.6; p < 0.001), and PHI (48.2 vs 38; p < 0.001) did differ significantly between men with and without PCa. In multivariable logistic regression models, p2PSA, %p2PSA, and PHI significantly increased the accuracy of the base multivariable model by 6.4%, 5.6%, and 6.4%, respectively (all p < 0.001). At a PHI cut-off of 27.6, a total of 100 (15.5%) biopsies could have been avoided. The main limitation is that cases were selected on the basis of their initial tPSA values.Conclusions
In patients with a tPSA range of 2–10 ng/ml, %p2PSA and PHI are the strongest predictors of PCa at initial biopsy and are significantly more accurate than tPSA and %fPSA.Trial registration
The study is registered at http://www.controlled-trials.com, ref. ISRCTN04707454. 相似文献996.
997.
Pim J. M. Dings BSc MD Marloes A. G. Elferink MSc PhD Luc J. A. Strobbe MD PhD Johannes H. W. de Wilt MD PhD 《Annals of surgical oncology》2013,20(8):2607-2614
Background
The absolute number of involved axillary lymph nodes (LNs) is considered the most important prognostic factor in breast cancer. Over the last decade, several studies indicated that the lymph node ratio (LNR) might predict outcome better than the number of positive LNs. In this study we test the applicability of earlier published LNR cutoff values and study the prognostic value of the LNR on a nationwide level.Methods
A nationwide population-based study was performed, using data from the Netherlands Cancer Registry, including all women diagnosed with node-positive breast cancer between 1999 and 2005 (N = 25,315). Patients were divided into 3 LNR risk groups (low, ≤0.20; intermediate, 0.21–0.65; and high, >0.65). Kaplan–Meier survival analysis was performed. In order to evaluate whether LNR was associated with overall survival (OS), Cox proportional hazards modeling was used.Results
For the entire cohort, 5- and 10-year OS rates were 78 % and 62 %, respectively. The number of positive LNs correlated with OS (5-year OS 84 %, 72 %, and 55 % for patients with 1–3, 4–9, and 10 or more positive LNs, respectively, P < .001). LNR also correlated with OS (5-year OS 86 %, 75 %, and 54 % for low-, intermediate-, and high-risk groups, respectively, P < .001). In the multivariable analysis, the risk of death increased with increasing LNR (P < .001).Conclusions
The LNR has an important prognostic value in node-positive patients, independent of traditional clinicopathological factors. LNR should be added as an independent prognostic variable to the current staging system. 相似文献998.
Maartje A. J. van den Broek MD Celien P. H. Vreuls MD Ali Winstanley MD Rob L. H. Jansen MD PhD Annemarie A. van Bijnen BSc Simon A. W. G. Dello MD Marc H. Bemelmans MD PhD Cornelis H. C. Dejong MD PhD Ann Driessen MD PhD Steven W. M. Olde Damink MD PhD MSc 《Annals of surgical oncology》2013,20(5):1462-1469
Background
A considerable number of patients develop sinusoidal obstruction syndrome (SOS) after oxaliplatin-based chemotherapy for colorectal liver metastases (CLMs). SOS is associated with adverse outcomes after major hepatectomy. Hyaluronic acid (HA) is a marker of hepatic sinusoidal endothelial cell function and may serve as an accurate marker of SOS. This study aimed to assess the value of systemic HA levels and fractional extraction (FE) of HA by the splanchnic area and liver as markers of SOS after oxaliplatin-based chemotherapy for CLMs.Methods
Forty patients were studied. The presence of SOS was assessed histopathologically. Blood samples from the radial artery and portal and hepatic veins were collected. HA levels were determined by ELISA and the FE of HA was estimated.Results
SOS was present in 23 patients, 11 of whom demonstrated moderate or severe SOS. Preoperative HA levels were significantly higher in patients with moderate or severe SOS (group B, n = 11) compared to patients with no or mild SOS (group A, n = 29) (51.6 ± 10.2 ng/mL vs. 32.1 ± 3.5 ng/mL, p = 0.030). A cutoff HA level of 44.1 ng/mL yielded a sensitivity of 67 % and specificity of 83 % for detection of SOS. The positive predictive value was 50 % and the negative predictive value 91 %. Both groups exhibited a similar FE of HA by the splanchnic area (?7.9 ± 8.5 % in Group A vs. 7.3 ± 3.6 % in Group B, p = 0.422) and liver (?10.7 ± 6.2 % in Group A vs. 4.6 ± 2.3 % in Group B, p = 0.265).Conclusions
Systemic HA levels can be used to detect patients at risk of SOS after oxaliplatin-based chemotherapy for CLMs. Additional investigations into the presence of SOS are indicated in patients with elevated HA levels. 相似文献999.
Ye-Xin Koh MBBS MRCS Aik-Yong Chok MBBS MRCS Hui-Li Zheng BSc Chuen-Seng Tan BSc MSc PhD Pierce K. H. Chow MBBS FRCS PhD Wai-Keong Wong MBBS FRCS Brian K. P. Goh MBBS MMed MSc FRCS 《Annals of surgical oncology》2013,20(11):3549-3560
Background
This study is a systematic review and meta-analysis that compares the short- and long-term outcomes of laparoscopic gastric resection (LR) versus open gastric resection (OR) for gastric gastrointestinal stromal tumors (GISTs).Methods
Comparative studies reporting the outcomes of LR and OR for GIST were reviewed.Results
A total of 11 nonrandomized studies reviewed 765 patients: 381 LR and 384 OR. A higher proportion of high-risk tumors and gastrectomies were in the OR compared with LR (odds ratio, 3.348; 95 % CI, 1.248–8.983; p = .016) and (odds ratio, .169; 95 % CI, .090–.315; p < .001), respectively. Intraoperative blood loss was significantly lower in the LR group [weighted mean difference (WMD), ?86.508 ml; 95 % CI, ?141.184 to ?31.831 ml; p < .002]. The LR group was associated with a significantly lower risk of minor complications (odds ratio, .517; 95 % CI, .277–.965; p = .038), a decreased postoperative hospital stay (WMD, ?3.421 days; 95 % CI, ?4.737 to ?2.104 days; p < .001), a shorter time to first flatus (WMD, ?1.395 days; 95 % CI, ?1.655 to ?1.135 days; p < .001), and shorter time for resumption of oral intake (WMD, ?1.887 days; 95 % CI, ?2.785 to ?.989 days; p < .001). There was no statistically significant difference between the two groups with regard to operation time (WMD, 5.731 min; 95 % CI, ?15.354–26.815 min; p = .594), rate of major complications (odds ratio, .631; 95 % CI, .202–1.969; p = .428), margin positivity (odds ratio, .501; 95 % CI, .157–1.603; p = .244), local recurrence rate (odds ratio, .629; 95 % CI, .208–1.903; p = .412), recurrence-free survival (RFS) (odds ratio, 1.28; 95 % CI, .705–2.325; p = .417), and overall survival (OS) (odds ratio, 1.879; 95 % CI, .591–5.979; p = .285).Conclusions
LR results in superior short-term postoperative outcomes without compromising oncological safety and long-term oncological outcomes compared with OR. 相似文献1000.
Myung-Han Hyun Chung-Ho Lee BSc Ye-Ji Kwon BSc Sung-Il Cho MD You-Jin Jang MD PhD Dong-Hoon Kim MD PhD Jong-Han Kim MD PhD Seong-Heum Park MD PhD Young-Jae Mok MD PhD Sung-Soo Park MD PhD 《Annals of surgical oncology》2013,20(4):1258-1265