Dyad and group-based interventions in physical activity, diet, and weight loss: a systematic review of the evidence.

Studies show that interpersonal relations impact behavior change. Yet, a comprehensive review of their efficacy remains unclear. This systematic review examines the efficacy of dyadic and group-based studies that intervened on primary endpoints: diet, PA, and weight loss in adults and their networks. We searched five databases for eligible articles published from 1980 to present. Final inclusion and risk of bias were independently determined and agreed upon by two of the paper's co-authors. Nine dyads and twelve group-based studies were eligible. Of the studies, 36% (4/11) of PA studies, 60% (3/5) of diet studies and 57% (8/14) of studies with weight loss as primary outcomes, reported significant findings. Compared to dyadic interventions, a greater proportion of group-based interventions demonstrated efficacy in PA gain and weight loss as outcomes. Approximately 43% of studies demonstrated low to moderate methodological quality. This systematic review synthesized the evidence of dyadic and group studies that intervened on PA, diet, and weight in adults from the same network. Moderately-high risk of bias and lack of diverse representation restricts inferences around efficacy. High-quality rigorous research is needed to understand the efficacy of dyadic and group-based interventions in addressing these co-occurring endpoints of interest.

Carcinoma of unknown primary with gastrointestinal profile: immunohistochemistry and survival data for this favorable subset.

BACKGROUND: Carcinoma of unknown primary with a "gastrointestinal profile" is an emerging, favorable entity. Distinguishing this entity is of increasing significance given the progress in the treatment of colorectal cancer. PATIENTS AND METHODS: 74 carcinoma of unknown primary (CUP) patients with CDX2+ tumors were chosen from the databases at M.D. Anderson and Sarah Cannon Cancer Centers between 2004 and 2010. Data on clinical and pathological characteristics including therapy and survival were recorded. RESULTS: 20 patients had ascites on presentation; the predominant sites of metastases included liver (30 %), carcinomatosis (50 %), and nodes (51 %). Based on immunohistochemistry, 2 cohorts were created: Cohort 1-"consistent with lower GI profile" included 34 patients [CDX-2+, CK20+, CK7-] and Cohort 2-"probable lower GI profile" included 40 patients [CDX2+, irrespective of CK7/CK20 status]. Excluding 6 outliers, Cohorts 1 and 2 had 32 and 36 patients, respectively; their median survivals were 37 and 21 months, respectively. On multivariate Cox regression analysis, only liver metastases were found to negatively influence survival. CONCLUSIONS: Our retrospective study provides encouraging indications that CUP patients with gastrointestinal profiles benefit from site-specific therapy. We recommend all CUP patients, especially those with abdominal nodes, isolated carcinomatosis or liver metastases, to undergo optimal immunohistochemistry (IHC) to check for a gastrointestinal profile of CUP.

Are Caucasian-European men delaying fatherhood? Results of a 7 year observational study of infertile couples with male factor infertility.

This study was aimed at assessing presence and predictors of a trend towards more advanced paternal age at presentation in a cohort of 1283 Caucasian-European infertile couples with male factor infertility (MFI) over a short time frame. Multivariate linear regression analysis tested the association between predictors [namely, partners' age, length of infertility at first presentation, patients' comorbidities as scored with the Charlson Comorbidity Index (CCI) and educational status] and patient's age at presentation. Using anova, patient's age at presentation (F ratio: 2.43; p = 0.024) and patients' educational status (χ(2) trend: 142.38; p < 0.001) significantly increased over time. In contrast, length of infertility at first presentation, CCI and partners' age did not significantly change over time (all p ≥ 0.05). Linear regression analyses showed that CCI, educational status and year of presentation were not correlated with patients' age at presentation (all p ≥ 0.05), whereas partners' age (ß = 0.170; p < 0.001) and length of infertility (ß = 0.123; p = 0.004) were independent predictors of delayed fatherhood. These results showed a significant shift towards advanced paternal age, but a non-significant increase of maternal age at first presentation among Caucasian-European infertile couples with MFI over a short time frame.

[Bursitis with severe tendon and muscle necrosis on the lateral stifle area in cattle]. / Bursitis mit schwerwiegenden Sehnen- und Muskelnekrosen an der Aussenseite der Kniegelenke beim Rind.

In 21 animals, chronic swelling on the lateral aspect of the stifle also known as «perigonitis¼, «stable-syndrome¼ or «bursitis bicipitalis femoris¼ were evaluated. Ultrasonography showed increased fluid in the distal subtendinous bursa of the biceps femoris muscle and structural changes in the tendons, muscles, subcutis and fasciae. Soft tissue swelling and an irregular contour of the lateral tibial condyle were typical signs on radiographs. Macroscopic changes were found at the insertion of the biceps femoris muscle, the distal subtendinous bursa of the biceps femoris muscle, the lateral collateral ligament of the stifle, the origin of muscles on the lateral femoral condyle and the lateral tibial condyle. They mainly consisted of tendon and muscle tissue necrosis with granulation tissue. Histology revealed areas of coagulation necrosis in tendons and ligaments, in which occasionally Onchocerca spp. were seen. The severity of lesions correlated well with the clinical signs, which were associated with a poor prognosis in advanced cases.

Systematic extended and saturation prostate biopsy: when and how.

The increasing incidence of prostate cancer is manly due to the improvement of systematic transrectal ultrasound-guided prostate biopsy techniques. The objective of this review is to analyze the different approaches and the most common schemes used to perform prostate biopsy, the role of the anesthetic procedures, of the complementary imaging methods and the histological evaluation of the biopsy results. The actual indications to perform prostate biopsy have been also critically reviewed. We performed a review of the literature by searching Medline Database with the following key words: prostate cancer, diagnosis, trans-rectal ultrasound (TRUS), prostate biopsy, anaesthesia and prognosis. Prostate biopsy is always performed under transrectal ultrasound guidance with both transrectal and transperineal approach, with a minimal core number of 10. The extended protocols include lateral peripheral zone cores and cores from lesions found on palpation or imaging. Saturation biopsies should be performed only in case of repeat biopsies. The refinement of effective local anesthesia has allowed to increase the number of biopsies without important side effects. Complementary imaging methods might be adopted in order to reduce the number of unnecessary procedures .The histological issues related to the number and the location of cores are still matter of debate as important prognostic factors. According to international guidelines, the factors most involved in performing prostate biopsy still include suspicious digital rectal examination and PSA. Both the transrectal and the transperineal approach in prostatic biopsy are valid in term of detection rate and low incidence of side effects. The initial biopsy scheme in mainly extended, saturation biopsy has to be considered only in the repeat setting, with the eventual help of the complementary imaging methods. The histological issues has to be considered about patient's prognosis.

[Feed-related selenium poisoning in swine]. / Fütterungsbedingte Selen-Vergiftung beim Schwein.

The following case report describes a selenium toxicosis in a pig-fattening farm of two finisher groups. The diseased animals partly showed ataxia and paresis or intense lameness in connection with band-like ablation of the epidermis at the coronary band. Some of them suffered from alopecia. Foot-and-mouth disease and swine vesicular disease were excluded by serological tests. Dissection revealed a multifocal bilateral symmetric poliomyelomalacia. Histological changes in the claws ranged from severe cell-decay in the germinative layer to distinctive decay of the stratum corneum. Due to damage of the claw epidermis the corium was partly exposed. Feed analysis revealed 100-fold increased selenium content in the finishing premix from the feed mill and as a result 20- to 60-fold increased selenium values in feed samples from the farm-made finisher mixture. Selenium concentration in the blood of diseased animals was 4- to 10-fold higher than normal values, which confirmed the tentative diagnosis of a selenium toxicosis.

[Effects of high selenium intake on selenium status, liver function and claw health of fattening bulls]. / Einfluss einer hohen Selenzufuhr auf den Selenstatus, die Leberfunktion und auf die Klauenqualität von Maststieren.

The effects of three dietary selenium (Se) levels (0.15, 0.35 and 0.5 mg/kg dry matter (dm) and of two Se-compounds (sodium selenite and Se-yeast) on the Se-status, liver function and claw health were studied using 36 fattening bulls in a two-factorial feeding trial that lasted 16 weeks. The claw health was assessed macroscopically and microscopically. Compared to the two control diets containing 0.15 mg Se/kg dm, the intake of the diets containing 0.35 and 0.50 mg Se/kg dm significantly (P < 0.05) increased the Se-concentration in serum, hair, liver and skeletal muscle. Compared to sodium selenite the intake of Se-yeast resulted in significantly (P < 0.05) higher Se-concentration in serum, liver and hair. Concerning the claw horn quality, there was no significant difference between the different groups; the animals receiving organic Se tended to have a better histological score (P = 0.06) at the coronary band than the groups fed with sodium selenite. The serum vitamin E level decreased significantly (P < 0.05) with increasing Se-intake, which had no influence (P > 0.1) on growth and liver function parameters. With the exception of the decrease of the serum vitamin E level indicating an oxidative stress caused by a high Se-intake, no negative effects of dietary selenium exceeding recommended levels for 4 months were observed.

The content and composition of lipids in the digital cushion of the bovine claw with respect to age and location--a preliminary report.

The pads of the bovine digital cushion, which serves as a shock absorber, have specific anatomical structures to cope with the substantial forces acting within the claw. To gain more information on the lipid composition and content of the pads, horn shoes from 12 slaughtered heifers and cows were removed and different samples of the pads excised with a scalpel. Pad lipids were extracted and the fatty acid composition determined by gas chromatography. Fat from perirenal and subcutaneous adipose tissues served as a comparison. Overall, this fat contained a higher quantity of extracted lipids than that of the claw pads and did not differ between heifers and cows. In contrast, lipid content in the pads was significantly higher in the cows than in the heifers. In both groups, the lipid content of the middle and abaxial pads, which are situated directly under the distal phalanx, was lower than in the pads of the other locations. The lipids in all pads contained >77% monounsaturated fatty acids (MUFA), differing sharply from the adipose tissue with values <51%. Among the polyunsaturated fatty acids (PUFA) a significantly higher proportion of arachidonic acid (AA) was found in the heifer pads than in those of the cows, whereas the proportion of AA was similar in the adipose tissue of all animals. The proportion of AA in the pad lipids also varied between the defined locations with the highest proportion found in locations that showed the lowest lipid content and was related to the age of the animal.

[Interactive educational DVD on hoof protection, horseshoeing and diseases of the hoof]. / Interaktives Lehrmittel Huf: Schutz, Beschlag und Erkrankungen.

Good cooperation between farrier, veterinarian and horse owner is an important prerequisite for optimal support of the horse with regards to shoeing and hoof health. The introduction of a joint educational aid aims to improve the level of education of both veterinarians and farriers. The interactive, multimedia approach represents an innovative new dimension in instruction techniques, predominantly provided through images and videos. The contents of the new teaching aid will focus on detailed anatomy of the foot and distal limb, as well as currently accepted shoeing practices and techniques and pathologic conditions of the hoof and foot.

Microlaparoscopy in sex reassignment surgery.

Sex reassignment (male to female surgery) is a standard operation which is aimed at constructing female genitalia and obtaining a cosmetic and functional result that is similar to that of a normal female subject. The ideal surgical procedure has not yet been described, but the various techniques which have been proposed in the literature are similar. The most cumbersome maneuver of the procedure is that of creating a neovaginal cavity inside the perineum. This step is generally carried out by means of blunt dissection between the rectal wall and the prostate, but most of the surgery is blindly performed without visual control. In these conditions, the risk of rectal injury is high, and may lead to severe intraoperative complications. Microlaparoscopy allows for a direct observation of the perineal dissection from inside the peritoneal cavity, thus avoiding risk of rectal injury. The technique is simple to perform, is non-invasive, and only 15 minutes are added to the operation.

The bovine digital cushion--a descriptive anatomical study.

The properties of the suspensory and supporting structures of the bovine claw are of particular importance in the pathogenesis of claw lesions since both must function optimally to prevent soft tissue compression and trauma. An essential component is the shock-absorbing digital cushion situated under the distal phalanx. The sound claws of 54 slaughtered cows were dissected. The digital cushion consisted of three parallel pads--axial, middle and abaxial--that ran longitudinally from the heel and underneath the distal phalanx with numerous transverse finger-shaped branches that connected the axial and abaxial pads cranial to the flexor process of the distal phalanx. The middle fat pad frequently ended just at the apical end of the flexor process of the distal phalanx, which may result in an inferior cushioning effect under the distal phalanx and increase the likelihood of ulcers. There were differences in the structure of the digital cushion with age and loose connective tissue in heifers' pads was first replaced by fat which, after the third lactation, was gradually supplanted by collagenous connective tissue.

Suspensory structures and supporting tissues of the third phalanx of cows and their relevance to the development of typical sole ulcers (Rusterholz ulcers).

The mural suspensory apparatus of third phalanx and its supportive heel cushion were examined in 19 cows with an ulcer at the 'typical' site (Rusterholz ulcer) to gain information on the pathogenesis of sole and heel ulcers. The claws of 17 healthy controls were used for comparison. The left hind claws, frozen at -20 degrees C, were sectioned in one longitudinal and four transverse planes with a band saw. The thickness of the subcutaneous tissue, the corium and the extent of displacement of the third phalanx were measured at defined sites on these sections. In addition, the suspensory apparatus, the tissue layer connecting the third phalanx to the dorsal wall of the horn capsule, was examined histologically. There was a direct relationship between the displacement of the third phalanx and ulceration of the sole or heel; in all the ulcerated claws the third phalanx had dropped and the corium and the subcutis under the bone were thinner than in the controls. The supportive cushions of the cows with ulcers contained less fat tissue. There was no histological evidence of damage to the epidermis or the corioepidermal junction in the ulcerated claws nor were the lamellae elongated. Similarly, there were no morphological changes in the connective tissue layer, the submural dermis.

Role of cyclin kinase inhibitor p21 in systemic autoimmunity.

The cyclin kinase inhibitor protein p21 affects multiple processes relevant to the immune system, including cell cycle progression, replicative senescence, hemopoietic stem cell quiescence, and apoptosis. Therefore, malfunction of this protein may be a contributor to the pathogenesis of systemic autoimmunity. Here, we report that mixed background p21-deficient 129/Sv x C57BL/6 mice showed increased in vitro and in vivo T cell cycling and activation, moderate hypergammaglobulinemia and, at low penetrance, anti-chromatin autoantibodies. Homeostatic anti-self MHC/peptide ligand-induced proliferation of p21-deficient T cells was also enhanced. However, lymphoid organ enlargement was very mild, presumably due to increased apoptosis of the rapidly dividing cells. Moreover, the older p21-deficient mice had kidney pathology representing a similar, but slightly more advanced, state than that seen in the control mice. The timing and severity of the above serologic, cellular, and histologic manifestations in p21-deficient mice were unaffected by gender. Thus, p21 deficiency significantly enhances T cell activation and homeostatic proliferation, and can induce mild autoimmune manifestations at a low incidence without gender bias, but does not in itself generate the full spectrum of lupus-like disease.

Comparison of single preoperative oral rufloxacin versus perioperative ciprofloxacin as prophylactic agents in transurethral surgery.

The aim of this prospective clinical trial was to compare the efficacy of rufloxacin, a once-daily fluoroquinolone administered as a single pre-operative dose versus the perioperative prophylaxis with ciprofloxacin in transurethral surgery. Two hundred and two patients undergoing transurethral resection of bladder tumors (132) or transurethral resection of the prostate (70) were selected for the study between January 1997 and June 1998. Patients were randomized to two treatment groups. Group A received a single oral 200 mg dose of rufloxacin three hours before surgery and group B was administered oral ciprofloxacin 250 mg bid until catheter removal. The two treatment groups were homogeneous with respect to patient characteristics. One hundred and seventy-three patients (89 rufloxacin and 84 ciprofloxacin) were assessed and 29 were excluded from the statistical analysis. The incidence of postoperative infection was similar in both treatment groups (5.7% rufloxacin, 4.7% ciprofloxacin). On the other hand, single-dose pre-operative prophylaxis with rufloxacin significantly reduced the cost of antibiotic prophylaxis. Results of the present study show that single dose oral rufloxacin may be used in routine clinical practice as a preoperative prophylactic antibiotic due to its low cost, its documented efficacy and its simple once daily dosage regimen.

[Repeated ultrasound-guided transrectal prostate biopsy in patients with negative histologic test]. / Il campionamento bioptico prostatico transrettale ecoguidato iterativo in pazienti con esame istologico negativo.

The screening programs for prostate cancer will affect a number increasing of patients over 50 years with consequence rising the bioptic demand. Nevertheless the istopathologic results are negatives for carcinoma in the most part of patients. It's evident that a part of carcinomas are lost at biopsy. Two hundred four patients where submitted at second bioptic session after a maximum of 12 months. Our results show a percent probability of positive findings in 12%. In 75% cancer diagnosed in that second session had clinically significance. Prostate specific antigen (PSA) value, in our study, is the most positive predictive parameter for prostate cancer at second biopsy. Patients with PSA > 10 ng/ml have a risk 7 times greater of having a prostatic cancer respect to patients with PSA < 10 ng/ml. PSA density, PSA velocity and the presence of ipoecoic areas previously biopsied, aren't risk factors for detection of prostate cancer at second bioptic session.

[Complications of multiple transrectal ultrasound-guided biopsy of the prostate]. / Complicanze del campionamento bioptico multiplo prostatico transrettale.

The screening programs for prostate cancer will affect a number increasing of patients over 50 years with consequence rising the bioptic demand. For these reason it's important to know the real morbidity correlate with these widespread diagnostic method that will know a larger use in the future. Our study involve 1.467 patients with median age of 66.7 years (range 45-93). Forty-five were diabetics, 80 took a chronic anti-aggregant salicylic therapy, 25 took a chronic coumarolic anticoagulation therapy, 54 had a recent history of prostatitis. Our major complication rate was 0.7% of patients requesting hospital admission and care. An intermediate category of complications was considered, with complication rate of 6.9% and indication for out-patient treatment. Minor complication rate was 76% without need of therapy. In spite of high number of biopsies per patient, our major complication rate is similar of that demonstrate from other authors. In conclusion, whole complication rate is high, but the incidence of major complications is very low. The complications that need out-patient treatment are limited and acceptable.