Mesothelial/monocytic incidental cardiac excrescence (MICE) is a very uncommon lesion. Diagnosis is incidental and may simulate thrombotic lesions. One of the hypotheses with regard to the etiology of this lesion is a previous cardiac procedure especially mitral valve repair or commissurotomy. Herein, we describe a MICE incidentally found in a patient who underwent mitral valve replacement, as a thrombotic lesion on the left atrial auricle. Histopathologic examination suggested MICE lesions and immunohistochemical stains confirmed it. 相似文献
To determine whether pregnant women receiving the Mothers and Babies group–based intervention exhibited greater depressive symptom reductions and fewer new cases of major depression than women receiving usual community-based services, and to examine whether groups run by paraprofessional home visitors and mental health professionals yielded similar depressive symptom reductions and prevention of major depression. Using a cluster-randomized design, 37 home visiting programs were randomized to usual home visiting, Mothers and Babies delivered via home visiting paraprofessionals, or Mothers and Babies delivered via mental health professionals. Baseline assessments were conducted prenatally with follow-up extending to 24 weeks postpartum. Eligibility criteria were ≥ 16 years old, ≤ 33 gestation upon referral, and Spanish/English speaking. Depressive symptoms at 24 weeks postpartum was the primary outcome. Eight hundred seventy-four women were enrolled. Neither intervention arm was superior to usual care in decreasing depressive symptoms across the sample (p = 0.401 home visiting paraprofessional vs. control; p = 0.430 mental health professional vs. control). Post hoc analyses suggest a positive intervention effect for women exhibiting mild depressive symptoms at baseline. We have evidence of non-inferiority, as the model-estimated mean difference in depressive symptoms between intervention arms (0.01 points, 95% CI: −0.79, 0.78) did not surpass our pre-specified margin of non-inferiority of two points. Although we did not find statistically significant differences between intervention and control arms, non-inferiority analyses found paraprofessional home visitors generated similar reductions in depressive symptoms as mental health professionals. Additionally, Mothers and Babies appears to reduce depressive symptoms among women with mild depressive symptoms when delivered by mental health professionals. This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444).
Mandibular radiolucencies are present in a variety of situations. These fall into developmental, metabolic, traumatic, infectious, and neoplastic categories. Differential diagnosis of these "lesions" is arrived at through signs, symptoms, history, radiographic presentation, and other diagnostic tools. This article presents the case of a 77-year-old man with an unusual radiographic presentation of the left posterior mandible. 相似文献
Adolescent problem behavior, including substance use, schoolmisconduct and delinquency, is a national concern. Implicitin the concept of middle school is the recognition that studentswho develop positive social bonds with their school are morelikely to perform well academically, and refrain from misconductand other antisocial behavior. However, little scientific attentionhas been given to the complex interactions between middle schoolstudents and the school environment. Prior to implementing amiddle school problem behavior prevention program we conducteda survey in the seven middle schools in one US school district.Out of 4668 grade 68 students enrolled, 4263 (91.3%)completed the survey. Studentschool bonding was positivelycorrelated with school adjustment (r = 0.49) and perceived schoolclimate (r = 0.77), but inversely correlated with problem behavior(r = 0.39 to 0.43). Problem behavior was significantlyhigher (P < 0.001) among males than females and among studentsin higher grades. Conversely, school bonding, climate and adjustmentwere significantly higher (P < 0.001) among females thanmales, but declined significantly from one grade to the next.The data support the conclusion that school bonding is associatedwith problem behavior. We describe the development of a multiple-componentintervention in middle schools designed to increase studentschoolbonding and prevent problem behavior. 相似文献
This study evaluated the effects of a school-based intervention on growth trajectories of smoking, drinking, and antisocial
behavior among early adolescents. Seven middle schools were randomized to intervention or comparison conditions and students
in two successive cohorts (n = 1484) provided five waves of data from sixth to ninth grade. The Going Places Program, included classroom curricula, parent
education, and school environment components. Latent growth curve analyses demonstrated significant treatment group effects,
including reducing increases in friends who smoke, outcome expectations for smoking, and smoking progression, but had non-significant
effects on drinking or antisocial behavior. The Going Places Program was effective in preventing increases in smoking progression,
but its efficacy as a more cross-cutting problem behavior preventive intervention was not confirmed. 相似文献
To assess the impact of focality and location of positive surgical margins (PSM) on long-term outcomes after radical prostatectomy (RP) for prostate cancer (PCa), including biochemical recurrence (BCR), metastasis and overall mortality.
Patients and Methods
From a total of 2796 cases of RP between 1993 and 2007 in our single hospital, 476 cases with PSMs were identified and included in this study. PSM location was categorized into apex, peripheral, and bladder neck. Survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze the impact of PSM focality and location status on oncologic survival.
Results
Of these 476 cases with PSMs, 335 (70.4%) cases were with single focal (sF) PSMs and 141 (29.6%) cases were with multifocal (mF) PSMs. Furthermore, 406 (85.3%) cases were found to have single location (sL) PSMs, and 70 (14.7%) cases were with multilocation (mL) PSMs. The median follow-up was 12.9 years. mF-PSMs and mL-PSMs showed significant impact on increased BCR risk on univariate analysis, and mL-PSMs remained significant on multivariate analysis (P = .048). Furthermore, the combination of multifocality and multilocation showed added prognostic value on predicting BCR-free survival, but not on metastasis-free survival or overall survival.
Conclusion
The presence of mF-PSMs and mL-PSMs, and especially the combination of both, demonstrated significant impact on BCR prognosis. Patients with apex sLsF-PSMs were less likely to have BCR when compared with all those with non-apex sLsF-PSMs. These results should be considered when evaluating patients for adjuvant therapy. 相似文献
BACKGROUND: The association between coeliac disease and type I diabetes mellitus has been evaluated in some previous studies, but its prevalence in Iranian diabetic patients remains unknown. AIM: To evaluate the prevalence of coeliac disease in patients with type I diabetes mellitus in Iran. PATIENTS: A total of 250 consecutive patients (102 male and 148 female) with type I diabetes mellitus. METHODS: Total serum immunoglobulin A level and immunoglobulin A endomysial antibody was measured for all patients. Endoscopy and biopsy of the duodenum were performed for immunoglobulin A endomysial antibody-positive patients and pathologic evaluation was done according to modified Marsh classification. RESULT: The mean age of the patients was 18.7 years (range: 2-55 years). Total serum immunoglobulin A was in the normal range for all patients. Immunoglobulin A endomysial antibody was positive in six (2.4%) patients (all of them were females; P = 0.04). Duodenal biopsy samples revealed grade I in two patients, grade II in three patients and grade IIIb in one patient (modified Marsh classification). Patients with coeliac disease and diabetes mellitus were older than patients with diabetes mellitus alone (mean age: 29.5 years versus 18.4 years; P < 0.001). There was a trend for longer duration of diabetes mellitus in coeliac patients than in patients without it (mean age: 17.3 years versus 12.5 years; P = 0.16). CONCLUSION: The prevalence of coeliac disease in Iranian patients with type I diabetes mellitus is relatively high (2.4%). Since almost half of the patients with coeliac disease are asymptomatic, all patients with type I diabetes mellitus should be screened for coeliac disease regardless of the presence of symptoms, at diagnosis of diabetes mellitus and with regular intervals in the follow up. 相似文献