Échographie des fractures de stress

Accurate assessment of bones is essential in every musculoskeletal US examination. Several articles reported the US appearance of SF of knees, legs, ankles and feet. The US hallmarks of a SF at this level are: (1) local soft tissues oedema; (2) hypoechoic thickening of the periosteum; (3) hyperaemia located into the soft tissues, periosteum and frequently inside the bone cortex; (4) normal appearance of other local structures. The US diagnosis of a SF necessitates a careful correlation with clinical findings, since US appearance although suggestive is aspecific. If US indicate a SF, an attending attitude including rest and avoidance of charge and clinical follow-up can be proposed in most patients. If the patient does not improve or in case presenting a discrepancy between US and clinical findings a MRI examination must be obtained.     

The prognostic role of fatigue,depression and anxiety on postoperative outcomes after pancreatectomy for pancreatic cancer. A prospective observational study (FAT-PRO study)

ObjectivesThis study aims to assess the prevalence of preoperative fatigue, depression and anxiety among patients undergoing pancreatic surgery for pancreatic cancer (PC), and possible relationship with postoperative outcomes.MethodsProspective data from 162 consecutive patients undergoing pancreatectomy for PC at a third-level referral centers for pancreatic surgery were collected. All patients preoperatively completed four questionnaires assessing depression (PHQ-9), anxiety (STAI-Y2), chronic illness fatigue (FACIT-F) and cancer therapy fatigue (FACT-G).ResultsForty patients (25%) where in the first quartile for chronic illness (FACIT-F ≤34) and/or cancer therapy (FACT-G ≤78) fatigue, 26 patients (16%) met the criteria for major depression (PHQ-9 ≥10) and 34 patients (21%) had anxiety symptoms (STAI-Y2 ≥40). Cancer therapy fatigue was significantly associated with higher rates of morbidity (70% vs 49%), major morbidity (Clavien-Dindo ≥3) (28% vs 11%), post-pancreatectomy hemorrhage (18% vs 4%), pulmonary complications (20% vs 9%) and mortality (8% vs null) (all P ≤ 0.01). Major depression was associated with higher rates of post-pancreatectomy hemorrhage and readmission (23% vs 5%). Multivariable logistic regression analysis of preoperative factors confirmed diabetes (OR 2.71, 95%CI 1.01–7.20; P = 0.04), ASA score ≥3 (OR 4.12, 95%CI 1.52–11.21; P < 0.01) and cancer therapy fatigue (OR 2.95, 95%CI 1.01–8.74; P = 0.04) to be independent predictors of major morbidity.ConclusionsHigher levels of fatigue (in particular cancer therapy fatigue) strongly correlates with worse postoperative outcomes.     

Predictors of fatigue in obstructive sleep apnea

Objective  The objective of this study was to determine potential inflammatory predictors of fatigue in obstructive sleep apnea (OSA). Materials and methods  Fifty-six women and men untreated OSA patients had their sleep monitored with polysomnography. Fatigue was assessed by the Multidimensional Fatigue Symptom Inventory-Short Form. Depressed mood was assessed by the Center for Epidemiologic Studies-Depression Scale. Blood was drawn to assess circulating levels of Interleukin-6 (IL-6) and soluble tumor necrosis factor receptor I (sTNF-RI). Age, gender, body mass index (BMI), blood pressure, OSA severity, depressed mood, and inflammatory biomarkers were entered into a hierarchical multiple linear regression analysis predicting self-reported fatigue. Results  Approximately 42% of the patients reported significant amounts of fatigue. Higher BMI (p = 0.014), greater depressed mood (p = 0.004), and higher sTNF-RI levels (p = 0.033) were independent predictors of fatigue in the final model (full model R ² = .571; p = .003). Age, gender, blood pressure and apnea severity were unrelated to fatigue. Conclusion  The findings suggest that in addition to depressed mood, fatigue in OSA may be associated with increased body weight and elevated levels of the proinflammatory cytokine receptor sTNF-RI. The findings support a linkage between the widely reported fatigue in OSA and a sleep-related component of inflammation.     

Symptômes reliés au diagnostic du trouble de personnalité limite à l’adolescence : une recension systématique de la littérature

The diagnosis of borderline personality disorder (BPD) in adolescence is controversial among some researchers and clinicians. For many, the symptoms presented in young people with BPD resemble normal functioning in adolescence. The diagnosis is then delayed in adulthood, postponing the treatment. The aim of this systematic review of the literature is to investigate the symptoms that can differentiate an adolescent population with BPD from one with another diagnosis and/or without any psychiatric issues. In all, 17 studies out of the 4789 titles initially identified met the inclusion criteria and were analyzed. This systematic review considers diverse symptoms: internalized and externalized disorders, suicide, mentalization errors, maladaptive schemas and comorbid diagnoses. Several symptoms significantly differentiated adolescents with BPD from three control groups teenagers: non-psychiatric, with another personality disorder and with another diagnosis. Finally, a pattern of symptoms could also be observed between suicidal adolescents with BPD and suicidal youth without it.     

Bridges between Nervous and Immune Systems: Their Disconnection and Clinical Consequences

Nervous and immune systems are connected by several mutual links, thus constituting a diffuse functional network in the body. In particular, neurohormones, neuropeptides, and cytokines represent the major mediators of the so-called psychoneuroendocrinoimmune axis. In this review, special emphasis is placed on certain pathologies characterized by a disconnection of the existing bridges between nervous and immune systems. For instance, spinal cord injury (SCI) is a clinical condition in which loss of neurons and very poor axon growth represent the main features. The role played by infiltrating and resident immunocompetent cells is still debated in SCI. However, to enhance axon growth in SCI, current therapeutic attempts are based on the stimulation of the immune response within the central nervous system, thus triggering either cell-mediated or humoral immune responsiveness.     

人工智能辅助软件可提升疲劳状态下放射科规培医师对肺结节的检测效能

目的:探讨在人工智能(AI)肺结节检测软件的辅助下能否提升疲劳状态的放射科规培医师对肺结节的检测效能。方法:搜集182例患者的1 mm薄层胸部CT图像,有一位放射科规培医师分别在3种模式下进行阅片:正常状态下独立阅片(A组)、疲劳状态下(即一天日常工作满8小时以上)独立阅片(B组)、疲劳状态下使用AI软件辅助阅片(C组),三种阅片模式均间隔洗脱期(2周),分别记录每次阅片时检出结节的位置、大小和数目。将3次肺结节检出结果与金标准(由2位从事胸部影像诊断超过8年的中级医师结合AI筛查结果分别作出诊断,再由1位从事胸部影像诊断超过15年的高级医师最终审核确定)进行比较,计算敏感度和(患者)人均假阳性(误诊)结节数来评价3种模式的检测效能。结果:经金标准确认1281个肺结节,A组检出真阳性结节592个、假阳结节297个,敏感度46.21%,人均误诊结节数为1.63;B组检出真阳性结节517个、假阳结节225个,敏感度40.36%,人均误诊结节数为1.24;C组检出真阳性结节995个、假阳结节165个,敏感度77.67%,人均误诊结节数为0.91。B组的敏感度和人均误诊结节数均较A组降低,差异均有统计学意义(P<0.05);C组的敏感度较B组提高,且人均误诊结节数降低,差异均有统计学意义(P<0.05);C组的敏感度较A组提高,人均误诊结节数降低,差异均有统计学意义(P<0.05)。结论:疲劳显著降低了放射科规培医师对肺结节的检测效能,但在AI软件辅助下能明显提高疲劳状态下放射科规培医师对肺结节的检出效能,甚至超过其正常状态下的水平。     

Changes in exertion-related symptoms in adults and youth who have sustained a sport-related concussion

ObjectivesTo identify the symptoms responsible for cessation of exercise testing and evaluate changes in post-concussion symptom scores on the Post-Concussion Symptom Scale (PCSS) from the Sport-Concussion Assessment Tool (SCAT5) immediately, 1–4 h, and 6–12 h following completion of the Buffalo Concussion Treadmill Test (BCTT) in youth and adults who have sustained a sport-related concussion.DesignProspective case-series.MethodsIndividuals who were diagnosed with a sport-related concussion and self-reported difficulties with exertion were referred to perform an exertional treadmill test. Individuals were recruited from a university sports medicine clinic. Change in PCSS symptom severity scores were operationally defined as a change ≥4 points.ResultsForty-five individuals aged 13–57 years consented to participate. A total of 14/24 (58.3%) female and 13/21 (61.9%) male participants reported an increase in symptom severity scores immediately following the BCTT. At 1–4 h, 5/10 (50.0%) males and 5/14 (35.7%) females who completed the PCSS had elevated symptom severity scores compared to pre-exertion. Only 24.2% (3/17 males and 5/16 females) of participants completing the PCSS at 6–12 h reported increased symptom severity scores.ConclusionExertional testing is an important component of a multifaceted assessment following concussion; however, previous research evaluating symptom responses to exertion is limited. This study provides evidence to suggest individuals who experience an exacerbation of concussion-associated symptoms after exertion are likely to return to pre-exertion levels within the same day. Future research monitoring symptoms following exertion and throughout recovery should be performed in tandem with physiological measures to better understand the source of symptoms.     

The interaction of acute physical fatigue with three traditional functional performance tests and the reactive balance test

ObjectivesTo assess the impact of acute physical fatigue on traditional and neurocognitive functional performance tests in recreational athletes.Designrandomized counterbalanced cross-over study, pre-post designSettinglaboratoryParticipantsTwenty recreational athletes (age = 24 ± 3 years)Main outcome measuresWe evaluated fatigue impairments following a 30 s all-out effort in three traditional and one neurocognitive functional performance test. The traditional functional performance tests encompassed the single leg hop for distance (SLH), countermovement jump (CMJ) and Y-balance test (YBT). The neurocognitive functional performance test encompassed the reactive balance test (RBT). A 30 s modified Wingate was used to induce acute physical fatigue.ResultsAcute physical fatigue was successfully induced as indicated by a significant increase in heart rate, systolic blood pressure, blood lactate levels and rating of perceived exertion (p < 0.001). Acute physical fatigue induced significant decreases in RBT accuracy (p = 0.004) and SLH performance (p < 0.001). YBT, CMJ and RBT visuomotor reaction time remained unaffected by acute physical fatigue.ConclusionsAcute physical fatigue impairs SLH performance and decreases accuracy in the RBT. YBT and CMJ performance remained unaffected by acute physical fatigue. Clinicians should be aware of this divergent neurocognitive functional impairments caused by one all-out effort to allow well-informed selection of functional performance tests.     

Factors associated with menopausal symptom severity in middle-aged Brazilian women from the Brazilian Western Amazon

Objective

To determine the frequency and severity of menopausal symptoms and associated factors in middle-aged Brazilian women.

Methods

A cross-sectional study was carried out involving 1415 women aged 35–65 years attended at the Outpatient unit of the Clinicas Hospital of Rio Branco, Acre state, Brazil. The Menopause Rating Scale (MRS) was used to assess the severity of menopause symptoms. The Stata 10 statistical package was used for all data analysis whereas Pearson's x² nonparametric association test was used for bivariate analysis, adopting a level of statistical significance of 5%. On the multivariate analysis, independent variables positively associated with the dependent model were retained in the final model (p < 0.005).

Results

Overall, 54.1% of participants were premenopausal, 10.1% perimenopausal, and 35.8% postmenopausal. Irritability was the most frequent symptom (78.3%), followed by joint and muscular discomfort (74.8%), and anxiety (72.7%). Mean total MRS score was 15.6 + 8.8 (median 15). After adjusting for confounding factors, the logistic regression analysis found low educational level (OR:1.53; [95% CI:1.21–1.95]; p < 0.001); self-perceived poor/very poor health (OR:4.48; [95% CI: 3.53–5.69]; p < 0.001), and menopausal transition phase (OR:1.73; [95% CI:1.18–2.53]; p = 0.005) to be statistically significantly associated with more severe menopausal symptoms.

Conclusion

Among Brazilian women, atypical symptoms of the menopause were the most frequently reported. Severe menopausal symptoms were more likely in women with low educational level, self-perceived poor health and at the menopausal transition phase.