An Advanced Surgical Dressing for High-risk Patients Undergoing Breast Cancer Surgery: a Case-control Study.

Oncological breast surgeries, classified as breast conserving surgery, oncoplastic surgery, and mastectomies (standard or with tissue sparing and reconstruction), are burdened with an overall complication rate up to 33%. Aquacel Ag Surgical is a combined hydrofiber-hydrocolloids dressing. The aim of this study is to evaluate the incidence of surgical site complications in patients presenting with three or more risk factors (or two, of which at least one classified as "high risk"), undergoing breast cancer surgery with/without reconstruction, comparing advanced (Aquacel Ag Surgical) with traditional dressing. METHODS: This is a retrospective, monocentric, case-control study based at the breast unit of the Città della Salute e della Scienza Hospital of Turin, Italy. Forty-two patients who underwent breast surgeries and met the inclusion criteria were enrolled, from February 1 to July 31, 2018. The primary endpoint was comparing the incidence of surgical site complications (skin alterations, infection, and wound dehiscence) in the two groups. The secondary endpoints were evaluating patient's quality of life, aesthetic outcomes, and compliance to the dressings. RESULTS: The distribution of risk factors at the baseline between the two groups was balanced, without statistically significant differences. Wound complications' incidence at 1 week was lower in the advanced dressing group (P = 0.015). On the bivariate descriptive analysis, advanced dressing proved to be easier to remove for the operator (P = 0.026). The aesthetic outcomes vouched for better scores in the advanced dressing group. CONCLUSION: In the presented study Aquacel Ag Surgical dressing reduces surgical site complications in the first week after surgery in patients affected by three or more risk factors (or two with at least one classified as "high risk").

Validation of SDM-Q-Doc Questionnaire to measure shared decision-making physician's perspective in oncology practice.

OBJECTIVE: The aim of this study was to analyze the psychometric properties of the Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) in a sample of medical oncologists who provide adjuvant treatment to patients with non-metastatic resected cancer and the correlations between the total SDM-Q-Doc score and physician satisfaction with the information provided. METHODS: Prospective, observational and multicenter study in which 32 medical oncologists and 520 patients were recruited. The psychometric properties, dimensionality, and factor structure of the SDM-Q-Doc were assessed. RESULTS: Exploratory factor analyses suggested that the most likely solution was two-dimensional, with two correlated factors: one factor regarding information and another one about treatment. Confirmatory factor analysis based on cross-validation showed that the fitted two-dimensional solution provided the best fit to the data. Reliability analyses revealed good accuracy for the derived scores, both total and sub-scale, with estimates ranging from 0.81 to 0.89. The results revealed significant correlations between the total SDM-Q-Doc score and physician satisfaction with the information provided (p < 0.01); between information sub-scale scores (factor 1) and satisfaction (p < 0.01), and between treatment sub-scale scores (factor 2) and satisfaction (p < 0.01). Medical oncologists of older age and those with more years of experience showed more interest in the patient preferences (p = 0.026 and p = 0.020, respectively). Patient age negatively correlated with SDM information (p < 0.01) and physicians appear to provide more information to young patients. CONCLUSION: SDM-Q-Doc showed good psychometric properties and could be a helpful tool that examines physician's perspective of SDM and as an indicator of quality and satisfaction in patients with cancer.

Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation.

BACKGROUND: In recent years there have been many developments in post-resuscitation care. We have investigated trends in patient characteristics and outcome following admission to UK critical care units following cardiopulmonary resuscitation (CPR) for the period 2004-2014. Our hypothesis is that there has been a reduction in risk-adjusted mortality during this period. METHODS: We undertook a prospectively defined, retrospective analysis of the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database (CMPD) for the period 1 January 2004 to 31 December 2014. Admissions, mechanically ventilated in the first 24 hours in the critical care unit and admitted following CPR, defined as the delivery of chest compressions in the 24 hours before admission, were identified. Case mix, withdrawal, outcome and activity were described annually for all admissions identified as post-cardiac arrest admissions, and separately for out-of-hospital cardiac arrest and in-hospital cardiac arrest. To assess whether in-hospital mortality had improved over time, hierarchical multivariate logistic regression models were constructed, with in-hospital mortality as the dependent variable, year of admission as the main exposure variable and intensive care unit (ICU) as a random effect. All analyses were repeated using only the data from those ICUs contributing data throughout the study period. RESULTS: During the period 2004-2014 survivors of cardiac arrest accounted for an increasing proportion of mechanically ventilated admissions to ICUs in the ICNARC CMPD (9.0 % in 2004 increasing to 12.2 % in 2014). Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during this period (OR 0.96 per year). Over this time, the ICU length of stay and time to treatment withdrawal has increased significantly. Re-analysis including only those 116 ICUs contributing data throughout the study period confirmed all the results of the primary analysis. CONCLUSIONS: Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during the period 2004-2014. Over the same period the ICU length of stay and time to treatment withdrawal has increased significantly.

A retrospective study on mesh repair alone vs. mesh repair plus pedicle flap for large incisional hernias.

OBJECTIVE: Our experience with the treatment of large incisional hernias (IH) was reviewed comparing mesh repair alone vs. mesh repair plus pedicle flaps. MATERIALS AND METHODS: A retrospective study was performed on patients treated between 2001 and 2005 that underwent component separation technique (CST) repair with polypropylene mesh alone or with polypropylene mesh and local "pedicle" dermal flaps. The primary outcome evaluated was the recurrence rate, secondary outcomes the complication rate, hospital stay and reoperation rate. RESULTS: Forty-eight patients were reviewed. Six patients (13%) developed an IH recurrence, two of them (4%) required secondary repair. CST combined with prosthetic mesh repair and pedicle flap was performed in 19 patients (39.6%) while CST combined with mesh repair alone in 29 patients (60.4%). The duration of surgery, hospitalization, postoperative complications as well as long-term results were similar. CONCLUSIONS: Dermal pedicled flaps obtained through deepithelization of redundant skin following corrections of large incisional hernias are a safe, relatively easy and effective technique that allows reliable soft tissue coverage of the abdominal submuscular mesh.

Comparison of anthropometric parameters as predictors of serum lipids in premenopausal women.

No single anthropometric parameter has yet been generally accepted as being superior to others in assessing the metabolic risk associated with abdominal obesity. To compare waist circumference (WC) with waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), regarding their association with serum lipids, we studied 166 women aged 20 to 48 yr; 53 were obese [body mass index (BMI) 30-39.9 Kg/m2], 50 were overweight (BMI 25-29.9 Kg/m2) and 63 normal weight (BMI 18.5-24.9 Kg/m2). Height, body weight, waist and hip circumferences, total serum cholesterol (Ch), low (LDL) and high density lipoprotein (HDL)-Ch and triglyceride (TG) concentrations were measured. The correlation coefficients between the concentration of serum lipid fractions and each anthropometric parameter did not differ significantly for any lipid variable when WC, WHR and WHtR were compared in the 166 women. The same applied for the obese and the overweight group, whereas in normal weight women there was significant association only between WC and LDL-Ch and between WHR and Ch/HDL-Ch ratio. Stepwise regression analysis showed that the proportion of variance in serum lipids did not change significantly when WHR or WHR+WHtR were added to WC into the regression model (18%, 18% and 18% for Ch; 13%, 18% and 18% for HDL-Ch; 18%, 18% and 12% for LDL-Ch; 35%, 35% and 37% for TG, respectively). These results indicate that WC is the main parameter associated with serum lipid levels and that the ratios studied do not provide additional substantial information in women who need weight management.

A case of Evans' syndrome in a patient with ulcerative colitis.

The case of a 37-year-old male diagnosed 16 years previously with ulcerative colitis, admitted on account of hemolytic anaemia and thrombocytopaenia that responded to immunosuppressive therapy, is reported. Despite various peculiarities discussed, this may be the first reported case of Evans' syndrome associated with ulcerative colitis.

A nonlinear congeneric model for continuous item responses.

This paper presents a unidimensional item response model intended for personality and attitude items that use a continuous response format. The model's starting point is the linear congeneric model for item scores, but it takes into account the bounded nature of the item responses and assumes that their conditional distributions for a fixed trait level are truncated normal. This assumption leads to nonlinear item-trait regressions and considerably modifies some aspects of the linear model. The linear model is considered as an approximation to the modified version, and an interval is defined in which the approximation is satisfactory. Procedures for estimating the item and subject parameters are described. The applicability of the model is illustrated using real data.

Fitting the Normal-Ogive Factor Analytic Model to Scores on Tests.

This article (a) describes how McDonald's nonlinear factor analytic approach to the normal ogive curve can be used to factor analyse total test scores, (b) discusses the conditions in which this model is more appropriate than the widely used linear model, and (c) illustrates the applicability of both models using an empirical example. The rationale for the described procedure is that the test scores are simple sums of binary item responses whose item characteristic curves are adequately represented by normal ogives. The results obtained in the empirical example are meaningful and informative, and agree with the results obtained at the item level.

Implementing a Test of Underlying Normality for Censored Variables.

This article describes the implementation of a standard Pearson chi-square statistic to test the null hypothesis of bivariate normality for the latent variables in the Type 1 censored model and discussed the need for such test. The behavior of the statistic is assessed by means of a series of simulation studies and illustrated by means of an empirical example. The limitations of the test are also discussed.

[Fever of unknown origin in patients infected with the human immunodeficiency virus]. / Fiebre de origen desconocido en pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND: To describe the clinical features and the final diagnosis of patients infected with human immunodeficiency virus who presented fever of unknown origin. METHODS: Retrospective study, from November 1989 to January 1994, of all patients infected with HIV who had fever of unknown origin and who were admitted to a community hospital in a Mediterranean area in Alicante (Spain). Fever of unknown origin was defined as fever exceeding 38.3 degrees C lasting for at least three weeks with no diagnosis in the first three days of hospitalization after fulfilling clinical exam, three blood cultures, acid-fast bacilli stain in sputum and chest-X-ray. RESULTS: Of a cohort of 231 patients, 27 (12%) were evaluated because of fever of unknown origin during their follow-up. Patients' mean age was 31 years (interval, 22-75) and intravenous drug use (81%) was the most common risk factor for HIV infection. A total of 31 episodes of fever of unknown origin were reviewed. Twenty-three (74%) episodes occurred in patients with less than 200 CD4 lymphocytes/mm3. A final diagnosis of fever of unknown origin was achieved in 24 (77%) episodes: visceral leishmaniasis (n = 11), tuberculosis (n = 9), non-Hodgkin's lymphoma (n = 1), CNS toxoplasmosis (n = 1), cryptococcal meningitis (n = 1) and drug adverse reaction (n = 1). CONCLUSIONS: HIV-infected patients with fever of unknown origin very often show severe immunodeficiency. Cryptococcal antigen testing should be carried out in the initial evaluation of fever of unknown origin in HIV-infected patients. In our area, 64% of episodes of fever of unknown origin were caused by visceral leishmaniasis or tuberculosis.

Calibration of Invariant Item Parameters in a Continuous Item Response Model Using the Extended Lisrel Measurement Submodel.

This article attempts to study the utility of Sorbom's (1974) Confirmatory Factor Analysis (CFA) with mean structures model, to estimate invariant difficulty and discrimination item parameters on a personality scale. A set of items from the Social Worry Scale, belonging to the "Anxious Thoughts Inventory" (Wells, 1994) are administered using a continuous response format. The general sample is split into two groups according to gender and an invariant CFA model with mean structures is fitted simultaneously in both groups. The results suggest that both the format and the model may be of interest for personality scales.

Cosmic ray and solar particle investigations over the South polar regions of the sun.

Observations of galactic cosmic radiation and anomalous component nuclei with charged particle sensors on the Ulysses spacecraft showed that heliospheric magnetic field structure over the south solar pole does not permit substantially more direct access to the local interstellar cosmic ray spectrum than is possible in the equatorial zone. Fluxes of galactic cosmic rays and the anomalous component increased as a result of latitude gradients by less than 50% from the equator to -80 degrees . Thus, the modulated cosmic ray nucleon, electron, and anomalous component fluxes are nearly spherically symmetric in the inner solar system. The cosmic rays and the anomalous nuclear component underwent a continuous, -26 day recurrent modulation to -80.2 degrees , whereas all recurring magnetic field compressions and recurring streams in the solar wind disappeared above approximately 55 degrees S latitude.

Effectiveness of autologous blood transfusion in patients undergoing radical hysterectomy.

Autologous blood transfusion (ABT) is a safe and useful procedure in patients undergoing elective surgery, but it has not been recommended for radical hysterectomy with pelvic lymphadenectomy. We retrospectively evaluated the results of an ABT programme in 146 consecutive women undergoing radical hysterectomy and pelvic lymphadenectomy for cervical carcinoma at our institution. Forty women underwent autologous blood transfusion after predeposit; 23 underwent preoperative normovolemic haemodilution; 38 were eligible but could not receive autologous blood transfusion for logistic reasons; 45 were excluded for medical reasons. 126 units of blood were collected, of which 100 (80%) were reinfused. The donation procedure was well-tolerated and no transfusion reaction was observed. Homologous blood transfusion was needed in 13% of patients receiving predeposit or haemodilution (8/63), in 42% of patients that were eligible but not receiving autologous blood transfusion (16/(38), and in 71% of non-eligible patients (32/45). The total number of units of homologous blood required for transfusion was lower in patients undergoing predeposit or haemodilution (14) than in those included in the observation arm (43). Autologous blood transfusion is a safe practice which greatly reduces the need for homologous blood transfusion, and radical hysterectomy with pelvic lymphadenectomy represents an adequate indication for this procedure, as the majority of deposited blood is actually reinfused.

A program to measure new energetic particle nuclear interaction cross sections.

The Transport Collaboration, consisting of researchers from institutions in France, Germany, Italy and the USA, has established a program to make new measurements of nuclear interaction cross sections for heavy projectiles (Z > or = 2) in targets of liquid H2, He and heavier materials. Such cross sections directly affect calculations of galactic and solar cosmic ray transport through matter and are needed for accurate radiation hazard assessment. To date, the collaboration has obtained data using the LBL Bevalac HISS facility with 20 projectiles from 4He to 58Ni in the energy range 393-910 MeV/nucleon. Preliminary results from the analysis of these data are presented here and compared to other measurements and to cross section prediction formulae.

[Evaluation of the effectiveness of personalized and frequent dietetic counseling in the treatment of obesity]. / Evaluación de la efectividad del consejo dietético personalizado y frecuente en el tratamiento de la obesidad.

OBJECTIVE: To evaluate the effectiveness of a nursing intervention (personal and ongoing dietary counselling) on the treatment of obese patients. DESIGN: A quasi-experimental intervention study (prospective, randomized, with a control group and non-blind). SETTING: At the Primary Care level: carried out in two General Medical practices in the city of Valls. PATIENTS AND METHODS: A total of 64 obese patients (Body Mass Index > 27) who had not carried out any hypocaloric dieting in the previous 30 days were included in the study. The patients were drawn from both practices. In a random manner, 32 were assigned to the control group and 32 to the intervention group. There were 7 losses: people who did not attend all the appointments. INTERVENTIONS: A standard diet was distributed to the intervention group. They had a fortnightly appointment in the nursing station, where their data were recorded and they received personal dietary counselling. The control group patients were only handed and explained the diet; and given appointments at 2 and 4 months in order to check their weight. MAIN MEASUREMENTS AND RESULTS: The average weight loss at 2 months was 3.9 kg in the intervention group and 2.2 kg in the control group (SD p < 0.05). At four months, the weight loss was 2.9 kg in the control group and 4.5 kg in the intervention group (no SD). CONCLUSIONS: Given the scant difference between the weight losses observed in both groups, the conclusion is that, although they are effective, the efficiency of these types of intervention is low. The resources required are excessive, considering that at the end a weight loss at 2 months of little relevance and at 4 months of no significance, in comparison with the control group, is obtained.

Energetic Charged-Particle Phenomena in the Jovian Magnetosphere: First Results from the Ulysses COSPIN Collaboration.

The Ulysses spacecraft made the first exploration of the region of Jupiter's magnetosphere at high Jovigraphic latitudes ( approximately 37 degrees south) on the dusk side and reached higher magnetic latitudes ( approximately 49 degrees north) on the day side than any previous mission to Jupiter. The cosmic and solar particle investigations (COSPIN) instrumentation achieved a remarkably well integrated set of observations of energetic charged particles in the energy ranges of approximately 1 to 170 megaelectron volts for electrons and 0.3 to 20 megaelectron volts for protons and heavier nuclei. The new findings include (i) an apparent polar cap region in the northern hemisphere in which energetic charged particles following Jovian magnetic field lines may have direct access to the interplanetary medium, (ii) high-energy electron bursts (rise times approximately 17 megaelectron volts) on the dusk side that are apparently associated with field-aligned currents and radio burst emissions, (iii) persistence of the global 10-hour relativistic electron "clock" phenomenon throughout Jupiter's magnetosphere, (iv) on the basis of charged-particle measurements, apparent dragging of magnetic field lines at large radii in the dusk sector toward the tail, and (v) consistent outflow of megaelectron volt electrons and large-scale departures from corotation for nucleons.

[Spinocellular epithelioma. Risk factors in the occurrence of metastasis. Study of 650 cases]. / Epitelioma espinocelular. Factores de riesgo en la aparición de metástasis. Estudio de 650 casos.

An evaluation is made of the clinical and histological parameters of 650 cases of spinocellular epitheliomas. The statistical study shows metastasis to be related to tumor location, tumor size, Broder's grading and acantholysis.