The Effects of a Saffron Extract (affron ® ) on Menopausal Symptoms in Women during Perimenopause: A Randomised, Double-Blind, Placebo-Controlled Study

Objectives@#There is preliminary evidence suggesting saffron may effectively treat menopausal symptoms. The aim of this study was to examine the tolerability and efficacy of a standardised saffron extract (affron® ) on menopausal complaints in perimenopausal women. @*Methods@#In this 12-week, parallel-group, double-blind, randomised controlled trial, 86 perimenopausal women experiencing menopausal complaints received either a placebo or 14 mg of a saffron extract (affron® ), twice daily. Outcome measures included the Greene Climacteric Scale (GCS), Positive and Negative Affect Schedule (PANAS), and Short Form-36 Health Survey (SF-36). @*Results@#Based on data collected from 82 participants, saffron was associated with greater improvements in mood and psychological symptoms compared to the placebo. Results from the GCS revealed a significantly greater reduction in the GCS psychological score (P = 0.032), characterised by a 33% reduction in anxiety and a 32% reduction in depression scores from baseline to week 12. There was also a significantly greater reduction in the PANAS negative affect score (P = 0.043) compared to the placebo. However, compared to the placebo, saffron was not associated with greater improvements in vasomotor symptoms, somatic symptoms, or other quality of life measures. Saffron intake was well tolerated with no reported major adverse events. @*Conclusions@#The saffron extract, affron® , administered for 12 weeks at a dose of 14 mg twice daily was associated with greater improvements in psychological symptoms. Further studies in perimenopausal women presenting with varying severity of menopausal symptoms, using different doses of saffron will be useful to examine in future clinical trials.

The Effects of a Saffron Extract (affron ® ) on Menopausal Symptoms in Women during Perimenopause: A Randomised, Double-Blind, Placebo-Controlled Study

Objectives@#There is preliminary evidence suggesting saffron may effectively treat menopausal symptoms. The aim of this study was to examine the tolerability and efficacy of a standardised saffron extract (affron® ) on menopausal complaints in perimenopausal women. @*Methods@#In this 12-week, parallel-group, double-blind, randomised controlled trial, 86 perimenopausal women experiencing menopausal complaints received either a placebo or 14 mg of a saffron extract (affron® ), twice daily. Outcome measures included the Greene Climacteric Scale (GCS), Positive and Negative Affect Schedule (PANAS), and Short Form-36 Health Survey (SF-36). @*Results@#Based on data collected from 82 participants, saffron was associated with greater improvements in mood and psychological symptoms compared to the placebo. Results from the GCS revealed a significantly greater reduction in the GCS psychological score (P = 0.032), characterised by a 33% reduction in anxiety and a 32% reduction in depression scores from baseline to week 12. There was also a significantly greater reduction in the PANAS negative affect score (P = 0.043) compared to the placebo. However, compared to the placebo, saffron was not associated with greater improvements in vasomotor symptoms, somatic symptoms, or other quality of life measures. Saffron intake was well tolerated with no reported major adverse events. @*Conclusions@#The saffron extract, affron® , administered for 12 weeks at a dose of 14 mg twice daily was associated with greater improvements in psychological symptoms. Further studies in perimenopausal women presenting with varying severity of menopausal symptoms, using different doses of saffron will be useful to examine in future clinical trials.

Implementation and evaluation of a novel subspecialty society fellows robotic surgical course: the SGO minimally invasive academy surgical curriculum / 부인종양

Objective@#To evaluate the utility of a society-based robotic surgery training program for fellows in gynecologic oncology. @*Methods@#All participants underwent a 2-day robotic surgery training course between 2015–2017. The course included interactive didactic sessions with video, dry labs, and robotic cadaver labs. The labs encompassed a wide range of subject matter including troubleshooting, instrument variation, radical hysterectomies, and lymph node dissections.Participants completed a pre- and post-course survey using a 5-point Likert scale ranging from “not confident” to “extremely confident” on various measures. Statistical analysis was performed using SPSS Statistics v. 24. @*Results@#The response rate was high with 86% of the 70 participants completing the survey.Sixteen (26.7%) of these individuals were attending physicians and 44 (73.3%) were fellows.In general, there was a significant increase in confidence in more complex procedures and concepts such as radical hysterectomy (p=0.01), lymph node dissection (p=0.01), troubleshooting (p=0.001), and managing complications (p=0.004). Faculty comfort and practice patterns were cited as the primary reason (58.9%) for limitations during robotic procedures followed secondarily by surgical resources (34.0%). @*Conclusion@#In both gynecologic oncology fellows and attendings, this educational theorybased curriculum significantly improved confidence in the majority of procedures and concepts taught, emphasizing the value of hands-on skill labs.

Guidelines for planning and conducting high-quality research and testing on animals / 한국실험동물학회지

There are important scientific, legal and ethical reasons for optimising the quality of animal research and testing. Concerns about the reproducibility and translatability of animal studies are now being voiced not only by those opposed to animal use, but also by scientists themselves.Many of the attempts to improve reproducibility have, until recently, focused on ways in which the reporting of animal studies can be improved. Many reporting guidelines have been written. Better reporting cannot, however, improve the quality of work that has already been carried out - for this purpose better planning is required.Planning animal studies should involve close collaboration with the animal facility where the work is to be performed, from as early a stage as possible. In this way, weaknesses in the protocol will be detected and changes can be made before it is too late. Improved planning must focus on more than the “mathematical” elements of experimental design such as randomisation, blinding and statistical methods. This should include focus on practical details such as the standard of the facility, any need for education and training, and all the factors which can improve animal welfare.The PREPARE (Planning Research and Experimental Procedures on Animals: Recommendations for Excellence) checklist was developed to help scientists be more aware of all the issues which may affect their experiments. The checklist is supported by comprehensive webpages containing more information, with links to the latest resources that have been developed for each topic on the list.

Total knee arthroplasty following intramedullary tibial nailing

Methods@#This is a retrospective case series of patients who underwent TKA after IMN fixation of tibial fractures.Patient and case data, including need for hardware removal, staged vs non-staged procedures, operative time, and need for revision implants, were recorded. Postoperative data, including complications and revision, were recorded.Oxford Knee Score (OKS) was performed at follow-up. @*Results@#Nine patients were identified consisting of eight women and one man. Follow-up ranged from 0.8–13 years. Non-staged removal of the intramedullary hardware occurred in three cases that had increased operative lengths recorded. There were no complications related to wound healing or infection. No patients required revision.Two of the three patients who underwent non-staged TKA developed arthrofibrosis requiring manipulation. OKS scores in patients who underwent non-staged surgery were consistently low. @*Conclusions@#Conversion TKA after tibial IMN fixation can result in satisfying outcomes in many patients. However, intramedullary hardware presents challenges to TKA similar to more extensively studied conversion TKA scenarios.Removing hardware in either a staged or non-staged fashion results in increased resource utilization and imparts perioperative challenges with only theoretical benefits of one approach compared to the other. Increased stiffness may be associated with a non-staged approach to hardware removal and TKA. Several technical factors may permit component positioning without removal of hardware. Despite limitations, this is the first series to discuss this challenging clinical scenario and provides surgeons with technical guidance and data on operative outcomes.

Ingresos económicos en médicos peruanos según especialidad: Un análisis transversal de la ENSUSALUD 2015 / Economic income in peruvian physicians according to the specialty: A cross-sectional analysis of the ENSUSALUD 2015

RESUMEN Objetivos Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú. Materiales y métodos Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta. Resultados De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganar >S/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganar >S/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganar >S/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos. Conclusiones Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos.

ABSTRACT Objectives To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. Materials and methods : We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. Results Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. Conclusions Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.

Clinical care for sexual assault survivors: the use of a multimedia training tool

Introduction: Sexual assault rises as a global public health in conflict-affected populations where chaos prevails and gender based violence becomes as a strategy of war. The health effects of sexual violence include unwanted pregnancy, unsafe abortion, sexually transmitted infections [STIs], physical and psychological trauma, and social stigma. Training health care providers [HCPs] has been prioritized by humanitarian actors globally to improve the quality clinical care to survivors of sexual violence. However, few studies have evaluated the effectiveness of training interventions in refugee and post-conflict settings. Methods: A four to five days "training of trainers" [ToT] was provided to relevant community health workers, nurses, midwives, doctors and other relevant field workers working in conflict-affected environments in Jordan, Turkey, Syria and Lebanon using the "Clinical care for sexual assault survivors [CCSAS] multimedia training tool" developed by International Rescue Committee [IRC]

Results: Overall, six ToTs took place; they included general practitioners, obstetrician/gynecologists, pediatricians, psychologist, forensic physicians, nurses, social workers, midwifes, and program officers. In Jordan, 50 participants [two groups of 25] have completed the training; the group improved by 142% on average at post-test in knowledge and attitudes to care for survivors [25% on average of correct answers at pretest, 60.5% on average at posttest]. A second ToT in Jordan included 22 participants who have improved by 57.6% on average [50.3% vs. 79.3%]. The third ToT in Turkey included 13 participants who have improved by 47% on average [38.5% vs. 56%]. A forth ToT took place in Lebanon where 19 participants have improved by 62.5% on average [56% vs. 91%]. The fifth ToT in Syria, included 18 participants who have improved by 46.2% on average [52% vs. 76%]. And the sixth ToT took place in Turkey where nine participants have improved by 82.6% on average [46% on vs. 84%]

Discussion: All participants have successfully completed the training and showed improvement at the posttests. However, key challenges and limitations identified included logistics at the preparation and recruitment stages, language barrier and differences in cultural or religious views. Key barriers to quality care identified included poor or lack of access to services, lack of trained staff, lack of privacy and confidentiality and lack of essential resources and treatment including emergency contraception and HIV post-exposure prophylaxis [PEP] as well as unclear referral mechanism. Action plans were developed by participants to address these barriers and follow-up to evaluate progress was planned

Conclusion:The CCSAS multimedia training tool showed an initial positive impact and has demonstrated effectiveness in promoting compassion and competence among trained HCPs and improving quality of clinical care for sexual assault survivors in such humanitarian settings. On-going technical and psychosocial support, long-term behavior change interventions, supply chain management, monitoring and evaluation, and interventions to raise awareness and identify survivors of sexual assault are needed in addition to the training to ensure quality clinical care is delivered to sexual assault survivors

Silymarin and hepatoprotection / 中南大学学报(医学版)

OBJECTIVE@#To determine the hepatoprotective effect of silymarin with Chang cell cultures. Specifically, to investigate the antioxidant properties of silymarin and its protective function in reducing pro-apoptotic markers.@*METHODS@#Intracellular free radical levels were assessed with dichlorofluorescein (DCF) fluorescence after exposing cells to an oxidative stress of 400 μmol/L H2O2 for 20 min. Levels of cellular ATP and bax expression were examined to evaluate the protective effects of silymarin.@*RESULTS@#Silymarin significantly reduced the DCF fluorescence signal. Cell viability, assessed by the MTT assay, showed that silymarin enhanced the cell growth. Drug treatment was also associated with enhanced ATP levels, and reduced Bax and protein mRNA levels.@*CONCLUSION@#Silymarin can function as a hepatoprotectant against free radical damage due to oxidative stress. The protective nature extends to reducing levels of pro-apoptotic Bax protein. Silymarin may be a useful adjuvant for the treatment of specific liver diseases.

Skeletal imaging of Gorllin's syndrome

To report a case of a patient with many of the common manifestations of Gorlin's syndrome, a rare inherited condition. A 26-year-old female with longstanding left hip pain was referred for bone scintigraphy to find the cause of pain. The findings on bone scintigraphy as well as prior radiographic studies illustrated many of the defining features of Gorlin's syndrome, i.e. jaw keratocysts, falcine calcifications, short and deformed ribs, Sprengel deformity and a sclerotic bone lesion. The past medical history also revealed dermatologic, cardiac and gynecological findings related to the syndrome. Our case highlights the multisystemic involvement of Gorlin's syndrome, based particularly on the skeletal findings. Practicing physicians, including imaging specialists, should be familiar with these findings to reach the diagnosis

Survey of faecal parasites in patients from western Kenys

Fecal specimens were collected from patients complaining of diarrhea and abdominal or epigastric discomfort at two hospitals. Information obtained by questionnaires completed at the time of specimens collection included demographic and clinical data. The specimens were preserved in 10% formalin and polyvinyl alcohol [PVA] and examined as wet mounts as well as stained with Wheatley's trichrome, Weber, modified acid-fast and hot safranin stains. A total of 100 patients was examined, parasites were detected in 30 of them. The most common organism identified was Cryptosporidium parvum in specimens of five patients, followed by Entamoeba histolytica/E. Dispar in four patients. The recently described "emerging parasites" were detected. Helminth eggs were found in two patients only. HIV status was not known for most of the patients and the parasites commonly proliferated in the immunocompromised individuals were not frequently found

Alteraciones del tejido conectivo subepitelial durante la carcinogénesis experimental: estudio estereológico / Stereological assessment of changes in subepitelial stroma during experimental carcinogenesis

El propósito de este estudio fué el de obtener información cuantitativa de los cambios del estroma subepitelial durante la carcinogénesis química experimental El carcinógeno DMBA fué aplicado localmente tres veces por semana durante cuatro semanas a la mucosa bucal (bolsa) y la palatina de veinte hamsters dorados machos, de cuatro a seis semanas de edad. A otros seis animales se les aplicó parafina líquida en sitios análogos, y diez animales no recibieron tratamiento. A las seis y doce semanas de iniciado el experimento, se tomaron muestras de tejido de paladar y mucosa bucal para microscopía de luz y electrónica, a cinco animales tratados con DMBA, a cinco no tratados y a tres tratados con parafina líquida. A las 21 semanas, la mucosa bucal de los animales tratados con dDMBA, mostró displasia epitelial o carcinoma escamocelular; la mucosa palatina no mostró cambios malignos o premalignos. Se tomaron fotomicrografías a un aumetno final de x14,210 de las secciones obtenidas de los bloques seleccionados al azar. Para calcular la densidad de volumen de colágeno, substancia intercelular, células del estroma y vasos sanguíneos, se aplicó la técnica de conteo de puntos. El analizador de imágenes proporcionó la densidad de volumen de las células del estroma y vasos sanguíneos. A las 6 y 12 semanas, la mucosa bucal tratada con DMBA mostró una disminución significativa de colágeno, un aumento significativo de substancia intercelular y un ligero aumento de vasos sanguíneos. A las 12 semanas hubo también un aumento significativo de las células del estroma. La mucosa palatina tratada con el carcinógeno no mostró cambios significativos en el estroma.