Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs

Study Objective

We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions.

Effect of extracorporeal shockwave lithotripsy on serum prostate specific antigen concentration

PURPOSE: We investigated the effect of extracorporeal shockwave lithotripsy (SWL) on the serum prostate specific antigen (PSA) concentration. PATIENTS AND METHODS: A total of 22 male patients with a mean age of 52.9 years (range 37-67 years) were treated with SWL for distal ureteral calculi close to the ureteral orifice. Serum samples were drawn for measurement of PSA values just before (PSA-1) and 45 minutes (PSA-2) and 7 days (PSA-3) after the session. None of the patients had urinary tract infection or any abnormal finding on digital rectal examination. The SWL sessions were performed with the Wolf piezoelectric 2300 lithotripter that has a therapeutic focus of 3 x 11 mm. The mean number of shockwaves per patient was 2204. Student's t-test was used for statistical analysis. At 1 year, all patients completed a questionnaire concerning recent diagnosis of prostate cancer. RESULTS: The mean total PSA concentration before SWL was 3.13 ng/mL and rose to 3.91 ng/mL 45 minutes after the session. The mean PSA-3 value was 3.76 ng/mL. The mean free PSA values were 0.80, 0.83, and 0.77 ng/mL, respectively. The difference between PSA-1 and PSA-2 was statistically significant; all of the other differences were not significant. None of the patients reported prostate cancer at 1 year. CONCLUSION: Shockwave lithotripsy affects prostate epithelial cells and may cause a minor rise in total serum PSA values. However, this rise does seem to impair the value of PSA in patients with undiagnosed prostate cancer.     

In vitro, ex vivo, and in vivo methodological approaches for studying therapeutic targets of osteoporosis and degenerative joint diseases: how biomarkers can assist?

Although our approach to the clinical management of osteoporosis (OP) and degenerative joint diseases (DJD)-major causes of disability and morbidity in the elderly-has greatly advanced in the past decades, curative treatments that could bring ultimate solutions have yet to be found or developed. Effective and timely development of candidate drugs is a critical function of the availability of sensitive and accurate methodological arsenal enabling the recognition and quantification of pharmacodynamic effects. The established concept that both OP and DJD arise from an imbalance in processes of tissue formation and degradation draws attention to need of establishing in vitro, ex vivo, and in vivo experimental settings, which allow obtaining insights into the mechanisms driving increased bone and cartilage degradation at cellular, organ, and organism levels. When addressing changes in bone or cartilage turnover at the organ or organism level, monitoring tools adequately reflecting the outcome of tissue homeostasis become particularly critical. In this context, bioassays targeting the quantification of various degradation and formation products of bone and cartilage matrix elements represent a useful approach. In this review, a comprehensive overview of widely used and recently established in vitro, ex vivo, and in vivo set-ups is provided, which in many cases effectively take advantage of the potentials of biomarkers. In addition to describing and discussing the advantages and limitations of each assay and their methods of evaluation, we added experimental and clinical data illustrating the utility of biomarkers for these methodological approaches.     

Preventing the transfer of Streptococcus mutans from primary molars to permanent first molars using chlorhexidine

PURPOSE: The purpose of this study was to determine if the application of 1% chlorhexidine-containing wax on primary molars during the period of eruption of the first permanent molars could prevent the transfer of certain oral flora, namely Streptococcus mutans, to the permanent molars. METHODS: Fourteen children with a mean age of 6.5 years (7 males and 7 females) were assigned into two groups: a chlorhexidine group (n=9) in which 1% chlorhexidine-containing wax was painted on primary molars on one side of the mouth; and a placebo wax group (n=5) in which a similar wax, but without chlorhexidine, was painted on primary molars on the other side of the mouth. Baseline saliva samples and pooled plaque samples from the primary molars on both sides of the dentition were obtained from the two treatment groups. Following treatment, plaque samples from the occlusal fissures of the first permanent molars on both sides of the dentition were obtained. The levels of S.mutans and other members of the oral flora on the treated sides (chlorhexidine or placebo) were compared with those on the untreated sides. RESULTS: The results showed that the proportions of S.mutans to S.sanguinis were significantly lower in the chlorhexidine-treated sides compared to the untreated (P=0.04) and in the chlorhexidine-treated patients compared to placebo (P=0.029). CONCLUSIONS: Since lower mutans to sanguinis ratios have been associated with lower caries experience, treating primary molars with 1% chlorhexidine wax during eruption of permanent first molars may be a simple means for shifting the fissure flora of the permanent molars towards a more favorable balance.     

Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study

BackgroundThe implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis.ObjectiveThe objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19.MethodsA prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children’s Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest.ResultsFrom March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88% for the training data and 89% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0%), sensitivity was low (10.6%).ConclusionsLoss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level—using machine learning–based random forest classification—reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19.     

External ventricular drainage for acute obstructive hydrocephalus developing following spontaneous intracerebral haemorrhages

There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). In this open, prospective study, we investigated the clinical courses, radiological findings and outcome scores of 47 consecutive patients who were admitted to our clinic with spontaneous ICH. Hydrocephalus developed in 6 (12.8%) of the 47 patients, and EVD was applied in these 6 cases. In one of the 6 patients, the lesion was additionally excised due to the large cerebellar haematoma. Intraventricular haemorrhage was more common in patients developing hydrocephalus (83.3% vs. 29.3% in patients without hydrocephalus; p<0.05) and the lesions of all the patients were in the proximity of the ventricular system. Hospital mortality and functional outcome were not significantly different between patients with and without hydrocephalus. Our results shown that acute obstructive hydrocephalus should be anticipated if haematoma is near the ventricle or if it is opening to the ventricle. EVD is a life-saving and effective procedure that should be performed in patients who develop hydrocephalus following spontaneous intracerebral haemorrhage. Received: 20 July 2001 / Accepted in revised form: 30 January 2002     

Matrix metalloproteinase and aggrecanase generated aggrecan fragments: implications for the diagnostics and therapeutics of destructive joint diseases

The degradation of extracellular matrix (ECM) components of articular cartilage is a hallmark of joint‐destructive diseases like osteoarthritis (OA) and rheumatoid arthritis (RA). A major component of the ECM is aggrecan, a proteoglycan, which is among the first matrix components to be degraded by the action of catabolic enzymes, increasingly expressed and activated during the inflammatory responses accompanying the aforementioned joint‐diseases. The two main families of enzymes are Matrix Metalloproteinases (MMPs) and aggrecanases, which both contribute to the degradation of the ECM, although their relative importance may vary between matrix components. Understanding the process of aggrecan degradation has crucial implications for improving the early diagnosis and monitoring of destructive joint‐diseases, as well as the therapeutic responses to disease‐modifying agents with potential chondroprotective effects. In the present review, we wish to provide an update on the emerging knowledge in the field obtained from ex vivo cartilage explants subjected to catabolic enzymes relevant for the pathogenesis of osteoarthritis (OA), as well as from synovial fluid of OA patients. In addition, we discuss the present status of specific immunochemical biomarker assays that were recently introduced to serve as diagnostic tools and emerging concepts of pharmacological interventions targeting the inhibition of aggrecan destruction, with the ultimate aim of decreasing the epidemiological burden of OA and rheumatoid arthritis (RA). Drug Dev Res 68:1–13, 2007. © 2007 Wiley‐Liss, Inc.     

Chlorhexidine Gluconate: An Ideal Scolicidal Agent in the Treatment of Intraperitoneal Hydatidosis?

Hydatid disease is a parasitic disease that is treated primarily by surgery. The most important complication of surgical treatment is spillage of the contents of the cyst, leading to secondary dissemination. In this study, the effect of chlorhexidine gluconate (Chx-Glu) was investigated in the treatment of experimental intraperitoneal hydatidosis (IPH). IPH was reproduced in 100 Wistar albino rats by inoculation with 1 ml of a suspension contained approximately 1500 viable protoscolices of Echinococcus granulosus following determination of scolicidal activity of chlorhexidine gluconate in vitro. Five minutes after protoscolex inoculation, 5 ml of the scolicidal solution was instilled into the peritoneal cavity: 0.9% NaCl (control group), 4.0% Chx-Glu, 0.4% Chx-Glu, and 0.04% Chx-Glu. After 6 months of follow-up, the rats were sacrificed, and the number of isolated cysts, peroperative and postoperative deaths, and toxicity were evaluated. Cyst formation did not occur in any of the Chx-Glu groups compared to the control group (p < 0.05), whereas it was detected in all of the control rats. In addition, to 4.0% Chx-Glu was found to be more toxic and to cause a high mortality rate compared to the 0.4% and 0.04% Chx-Glu groups and the control group (p < 0.05). Chx-Glu 0.04% was found to be the most potent, nontoxic agent; it is easily available, inexpensive, and highly potent in a short period of time at the low concentration. Chx-Glu 0.04% can be used safely in the treatment of intraperitoneal hydatidosis and hydatid cyst.     

Personal resources, coping self-efficacy, and quake exposure as predictors of psychological distress following the 1999 earthquake in Turkey

This study examined the predictive power of personal resources (i.e., self-esteem, optimism, and perceived control), severity of earthquake experience (i.e., material and human loss and perceived threat), and coping self-efficacy (CSE) on general distress, intrusion, and avoidance symptoms among the survivors of the 1999 Marmara earthquake in Turkey. Specifically, we expected that CSE would mediate the links between personal resources, severity of earthquake experience, and distress. Survivors (N = 336) filled out various measures of earthquake exposure, personal resources, CSE, and distress. Results of the path analyses indicated that personal resources, earthquake experiences, CSE, and gender have direct effects on intrusion and general distress. Personal resources had also an indirect effect on general distress mediated by CSE. Findings were discussed considering the implications for conservation of resources model and social cognitive theory as well as for interventions following natural disasters.     

The Comparison of PRISM and PIM scoring systems for mortality risk in infantile intensive care

Scoring systems that predict the risk of mortality for children in an intensive care unit (ICU) are needed for the evaluation of the effectiveness of pediatric intensive care. The Pediatric Risk of Mortality (PRISM) and the Pediatric Index of Mortality (PIM) scores have been developed to predict mortality among children in the ICU. The purpose of this study was to evaluate whether these systems are effective and population-independent. PRISM and PIM scores were calculated prospectively during a 1-year period solely on 105 non-surgical infants admitted to the ICU. Statistical analysis was performed to assess the performance of the scoring systems. There were 29 (27.6 per cent) deaths and 76 (72.4 per cent) survivors. SMR and Z scores for PIM and PRISM signified higher mortality and poor performance. Prediction of mortality by the scoring systems appeared to be underestimated in almost all risk groups. The Hosmer and Lemeshow test showed a satisfactory overall calibration of both scoring systems. Although ROC analysis showed a poor discriminatory function of both scores, a marginally acceptable performance for PIM was observed. The ROC curve also showed an acceptable performance for PIM, for patients with pre-existent chronic disorder. Although care must be taken not to overstate the importance of our results, we believe that when revised according to the characteristics of the population, PIM may perform well in predicting the mortality risk for infants in the ICU, especially in countries where the mortality rate is relatively high and pre-existent chronic disorders are more common.