The majority of endometrial and cervical cancers present with abnormal vaginal bleeding but only a small proportion of women suffering from vaginal bleeding actually have such a cancer. A simple, ...operator‐independent and accurate test to correctly identify women presenting with abnormal bleeding as a consequence of endometrial or cervical cancer is urgently required. We have recently developed and validated the WID‐qEC test, which assesses DNA methylation of ZSCAN12 and GYPC via real‐time PCR, to triage women with symptoms suggestive of endometrial cancer using ThinPrep‐based liquid cytology samples. Here, we investigated whether the WID‐qEC test can additionally identify women with cervical cancer. Moreover, we evaluate the test's applicability in a SurePath‐based hospital‐cohort by comparing its ability to detect endometrial and cervical cancer to cytology. In a set of 23 cervical cancer cases and 28 matched controls the receiver operating characteristic (ROC) area under the curve (AUC) is 0.99 (95% confidence interval CI: 0.97‐1.00) with a sensitivity and specificity of 100% and 92.9%, respectively. Amongst the hospital‐cohort (n = 330), the ROC AUC is 0.99 (95% CI: 0.98‐1) with a sensitivity and specificity of 100% and 82.5% for the WID‐qEC test, respectively, and 33.3% and 96.9% for cytology (considering PAP IV/V as positive). Our data suggest that the WID‐qEC test detects both endometrial and cervical cancer with high accuracy.
What's new?
While abnormal vaginal bleeding is a presenting symptom of endometrial and cervical cancers, only a small proportion of women who present with vaginal bleeding have endometrial or cervical cancer. Currently, the tests used to triage women with abnormal bleeding, such as ultrasound or cytology, are subjective and have modest accuracy. Here, the authors demonstrate that a real‐time PCR‐based test, which assesses DNA methylation at three gene regions using a cervical or vaginal sample, is able to identify 100% of women who have cervical or endometrial cancer with a high specificity (>80%), irrespective of the sample collection system.
BACKGROUND: Retrospective cohort study to evaluate differences in outcome when embryo transfer was performed either on day 2–3 (cleavage stage, CS-group) or on day 4–5 (blastocyst stage, BS-group). ...METHODS: A total of 1259 consecutive cycles yielding 500 live born babies performed at a single centre in Bregenz, Austria, were included. Main outcome measures were implantation and (multiple) pregnancy rates and neonatal outcome including birth defects. RESULTS: Total Pregnancy rate was 44% vs 28% (P<0.001) and the total ‘take home baby rate’ was 37% vs 22% in the BS-group and the CS-group, respectively. Rate of multiple gestations (34% vs 17%, P=0.001) was significantly higher among the BS-group, resulting in a higher rate of preterm deliveries <36 weeks (26% vs 17%, P=0.045). Female factor causing infertility (40% vs 21%, P<0.001) was significantly higher among the BS-group. For the CS-group, rate of singleton pregnancies (83% vs 66%, P=0.001) and idiopathic cause of infertility (34% vs 22%, P=0.012) were significantly higher. No statistically significant differences were found in sex, Caesarean section rate, Apgar score and umbilical artery pH-values, total mean birth weight, admission rate to intensive care unit, days of hospitalization and number of minor and major birth defects. CONCLUSIONS: Our data suggest that blastocyst transfer may lead to a higher pregnancy rate with an overall better take-home baby rate (THBR) at the cost of higher rates of multiples and preterm deliveries.
Quantitative gait analysis has revealed that a large proportion of horses in training, perceived as free from lameness by their owners, show movement asymmetries of equal magnitude to horses with ...mild clinical lameness. Whether these movement asymmetries are related to orthopaedic pain and/or pathology has yet to be further investigated. Therefore, the objective of this study was to determine whether movement asymmetries in riding horses in training are affected by anti-inflammatory treatment with meloxicam. In a crossover design, horses were treated with meloxicam or placebo for four days respectively, with a 14-16 day washout period between treatments. Objective movement analysis utilising body mounted accelerometers was performed on a hard and a soft surface before and on day four of each treatment. A trial mean was calculated for the differences between the two vertical displacement minima and maxima of head (HDmin, HDmax) and pelvis (PDmin, PDmax) per stride. Horses (n = 66) with trial mean asymmetries greater than 6 mm for HDmin or HDmax, or more than 3 mm for PDmin or PDmax, at baseline were included. The difference before and after each treatment in the measured movement asymmetry was assessed with linear mixed models. Treatment with meloxicam did not significantly affect the movement asymmetry in any of the models applied (all p>0.30). These results raise new questions: are the movement asymmetries in riding horses in training simply expressions of biological variation or are they related to pain/dysfunction that is non-responsive to meloxicam treatment?
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
During orthopaedic assessment of lame horses, a head nod is commonly present in both primary forelimb and hindlimb lame horses. Additional motion metrics that could assist clinicians in ...correctly differentiating between these two scenarios would be of great clinical value.
Objectives
The primary objective of this study was to examine whether withers movement asymmetry can be used in a clinical setting to distinguish primary forelimb lameness from compensatory head movement asymmetry due to primary hindlimb lameness.
Study design
Retrospective, multicentre study.
Methods
Movement asymmetry of head, withers and pelvis was measured using multi‐camera optical motion capture, as part of routine lameness investigations at four European equine hospitals. Vertical movement asymmetry parameters from 317 horses trotting in a straight line were compared before and after successful diagnostic analgesia of a single limb. Descriptive statistics, t‐tests and linear models were used to analyse the data.
Results
In forelimb lame horses, 80%–81% showed head and withers asymmetry both indicating lameness in the same forelimb. In hindlimb lame horses, 69%–72% showed head asymmetry ipsilateral to the lame hindlimb and withers asymmetry diagonal to the lame hindlimb, thus, head and withers asymmetry indicated lameness in different forelimbs. A large (>15 mm) compensatory head nod was seen in 28%–31% of the hindlimb lame horses. In 89%–92% of these, head and withers asymmetry indicated lameness in different forelimbs. Withers asymmetry decreased linearly with reduced head or pelvic asymmetry for both forelimb and hindlimb lame horses.
Main limitations
Compensatory strategies were evaluated on group level to identify common patterns, potentially ignoring uncommon individual strategies.
Conclusions
Withers vertical movement asymmetry metrics can be useful in helping to locate the primary lame limb during quantitative lameness assessment. Head and withers movement asymmetry parameters generally indicate the same forelimb in forelimb lame horses, but different forelimbs in hindlimb lame horses.
Zusammenfassung
Hintergrund
Während der orthopädischen Untersuchung lahmer Pferde tritt häufig bei primär lahmenden Vorder‐ und Hintergliedmaßen ein Kopfnicken auf. Zusätzliche Bewegungsmetriken, die den Kliniker bei der korrekten Unterscheidung dieser beiden Szenarien unterstützen könnten, wären von großem klinischem Wert.
Ziele
Das Hauptziel dieser Studie war zu untersuchen, ob die Asymmetrie der Widerristbewegung in einer klinischen Umgebung verwendet werden kann, um zwischen primärer Vordergliedmaßen‐Lahmheit und kompensatorischer Kopfasymmetrie aufgrund primärer Hintergliedmaßen‐Lahmheit zu unterscheiden.
Studiendesign
Retrospektive, multizentrische Studie.
Methoden
Die Bewegungsasymmetrie von Kopf, Widerrist und Becken wurde mithilfe einer Mehrkamera‐Optikbewegungserfassung im Rahmen von Routine‐Untersuchungen von Lahmheiten an vier europäischen Pferdekliniken gemessen. Vertikale Bewegungsasymmetrieparameter von 317 Pferden, die auf der Geraden trabten, wurden vor und nach erfolgreicher diagnostischer Anästhesie einer einzelnen Gliedmaße verglichen. Deskriptive Statistiken, t‐Tests und lineare Modelle wurden zur Analyse der Daten verwendet.
Resultate
Bei Pferden, die auf der Vorderextremität lahmten, zeigten 80%–81% eine Asymmetrie von Kopf und Widerrist, die beide auf eine Lahmheit in derselben Vordergliedmaße hinwiesen. Bei Pferden mit einer Lahmheit der Hinterextremität zeigten 69%–72% eine Kopfasymmetrie ipsilateral zur lahmenden Hintergliedmaße und eine Widerristasymmetrie diagonal zur lahmenden Hintergliedmaße, wobei Kopf‐ und Widerristasymmetrie auf eine Lahmheit in verschiedenen Vordergliedmaßen hinwiesen. Eine große (>|15| mm) kompensatorische Kopfbewegung wurde bei 28%–31% der Pferde mit einer Hinterextremitätslahmheit beobachtet. Bei 89%–92% dieser Pferde wiesen Kopf‐ und Widerristasymmetrie auf Lahmheit in verschiedenen Vordergliedmaßen hin. Die Widerristasymmetrie nahm linear mit reduzierter Kopf‐ oder Beckenasymmetrie bei sowohl Vorder‐ als auch Hinterextremitätslahmheiten ab.
Wichtigste Einschränkungen
Kompensatorische Bewegungsabläufe wurden auf Gruppenebene bewertet, um gemeinsame Muster zu identifizieren, wodurch potenziell ungewöhnliche individuelle Strategien ignoriert werden könnten.
Zusammenfassung
Metriken zur vertikalen Bewegungsasymmetrie des Widerrists können dabei helfen, die primäre lahme Gliedmaße bei der quantitativen Lahmheitsuntersuchung zu lokalisieren. Die Bewegungsasymmetrieparameter von Kopf und Widerrist weisen in der Regel bei einer Lahmheit der Vorderextremität auf diesselbe Vordergliedmaße hin, aber bei Pferden mit einer Lahmheit der Hinterextremität auf verschiedene Vordergliedmaße.
Patients with de novo restless legs syndrome present a unique type of central sensitization accompanied by tactile hypoesthesia. Somatosensory changes were reversed by dopaminergic treatment.
Pain ...and other sensory signs in patients with restless legs syndrome (RLS) are still poorly understood, as most investigations focus on motor system dysfunctions. This study aimed to investigate somatosensory changes in patients with primary RLS and the restoration of somatosensory function by guideline-based treatment. Forty previously untreated RLS patients were investigated unilaterally over hand and foot using quantitative sensory testing (QST) and were compared with 40 age- and gender-matched healthy subjects. The predominant finding in RLS patients was 3- to 4-fold increase of sensitivity to pinprick stimuli in both extremities (hand: P<.05; foot: P<.001), a sensory pathway involved in withdrawal reflexes. Pinprick hyperalgesia was not paralleled by dynamic mechanical allodynia. Additional significant sensory changes were tactile hypoesthesia in both extremities (hand: P<.05; foot P<.01) and dysesthesia to non-noxious cold stimuli (paradoxical heat sensation), which was present in the foot in an unusually high proportion (14 of 40 patients; P<.01). In 8 patients, follow-up QST 2 to 20 months after treatment with l-DOPA (L-3,4-dihydroxyphenylalanine) revealed a significant reduction of pinprick hyperalgesia (−60%, P<.001), improved tactile detection (+50%, P<.05), and disappearance of paradoxical heat sensation in half of the patients. QST suggested a type of spinal or supraspinal central sensitization differing from neuropathic pain or human experimental models of central sensitization by the absence of dynamic mechanical allodynia. Reversal of pinprick hyperalgesia by l-DOPA may be explained by impaired descending inhibitory dopaminergic control on spinal nociceptive neurons. Restoration of tactile sensitivity and paradoxical heat sensations suggest that they were functional disturbances resulting from central disinhibition.
To investigate characteristics of the foveal pit and the foveal avascular zone (FAZ) in patients with Alport syndrome (AS), a rare monogenetic disease due to mutations in genes encoding for collagen ...type IV.
Twenty-eight eyes of nine patients with AS, and five autosomal-recessive carriers and 15 eyes from 15 age-similar healthy control subjects were examined using optical coherence tomography (OCT) and OCT-angiography (OCT-A). Foveal configuration and FAZ measures including the FAZ area, circularity, and vessel density in the central 1° and 3° were correlated.
Foveal hypoplasia was found in 10 eyes from seven patients with either genotype. In contrast, a staircase foveopathy was found in seven eyes of four X-linked AS patients. The average FAZ area did not differ significantly between AS patients and control subjects (mean ± SD 0.24 ± 0.24 mm2 vs. 0.21 ± 0.09 mm2; P = 0.64). Five eyes showed absence or severe anomalies of the FAZ with crossing macular capillaries that was linked to the degree of foveal hypoplasia on OCT images leading to a significant inverse correlation of FAZ area and foveal thickness (r = -0.88; P < 0.001). In contrary, female patients with X-linked mutations exhibited a significantly greater FAZ area (0.48 ± 0.30 mm2 vs. 0.21 ± 0.09 mm2; P = 0.007), in line with OCT findings of a staircase foveopathy.
The foveal phenotypic spectrum in AS ranges from foveal hypoplasia and absence of a FAZ to staircase foveopathy with an enlarged FAZ. Because the development of the FAZ and foveal pit are closely related, these findings suggest an important role for collagen type IV in foveal development and maturation.
Long-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC ...3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke.
Data were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale, respectively. Multivariable logistic and linear regression analyses were performed.
Between 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4% of FC were older than 55 years, 70.1% were women and 67.5% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5%) and the privilege (70.0%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4%). Median overall self-rated burden was 30 (IQR: 0-50; range 0-100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner.
The majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver.
The study was registered at "German Clinical Trial Register": DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011696.
Pressure sores in geriatric patients represent a challenge for all disciplines involved in the treatment process; however, the prerequisite for successful treatment is the elaboration of an ...interdisciplinary treatment concept. The treatment goals should be adapted to the individual needs of the patients including the life situation, general condition and local findings. In addition to general basic operative techniques, such as wound cleansing and conditioning, plastic and reconstructive surgery provides a wide range of highly specialized operative techniques for the treatment of these patients by which a definitive defect coverage can be achieved. The aim of this article is to raise awareness for these complex and highly specialized procedures for all disciplines participating in the treatment in order to improve the interdisciplinary cooperation and ultimately the quality of treatment.
Zusammenfassung
Der Dekubitus bei geriatrischen Patienten stellt eine Herausforderung für alle an der Behandlung beteiligten Disziplinen dar. Voraussetzung für eine erfolgreiche Therapie ist die ...Erarbeitung eines interdisziplinären Behandlungskonzeptes. Hierbei gilt es, das Therapieziel an die Lebenssituation und den Allgemeinzustand sowie den Lokalbefund des Patienten anzupassen. Neben allgemeinen, operativen Grundtechniken beispielsweise zu Wundsäuberung und -konditionierung gibt es in der rekonstruktiven plastischen Chirurgie hochspezialisierte Operationstechniken, durch die eine definitive Defektdeckung erzielt werden kann. Ziel der Arbeit ist es, durch die Darstellung dieser komplexen und hochspezifischen Operationen und Therapiekonzepte das Verständnis der an der Behandlung beteiligten Fachbereiche für diese zu erhöhen, um so die interdisziplinäre Zusammenarbeit und letztendlich die Behandlungsqualität zu verbessern.
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