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This case reminds clinicians that abdominal pregnancy remains a differential diagnosis for painful fetal movements.BACKGROUND To examine the tumor characteristics, treatments and survival outcomes of prostate cancer (PCa) patients with a prostate-specific antigen (PSA) level 20 ng/ml. The multivariate Cox regression model revealed that overall mortality was associated with age, marital status, race, Gleason grade, M stage and treatment approach. CONCLUSIONS In conclusion, PCa patients with a PSA level less then 4 ng/ml have more favorable tumor characteristics at diagnosis and receive more benefit from active treatment. However, those patients with advanced TNM stage and high Gleason grade should be paid more attention in clinical application.BACKGROUND Data linking labor pain and postpartum depression are emerging. Robust, prospective evaluations of this relationship while factoring other important variables are lacking. We assessed perinatal pain and other factors predicting postpartum depression (PPD) symptoms. METHODS Third trimester women, stratified by a priori plan to receive or avoid labor epidural analgesia, were longitudinally followed from the prenatal period through labor and delivery, until 6 weeks and 3 months postpartum. Electronic pain data was collected hourly during labor in real time, capturing pain unpleasantness, intensity, pain management satisfaction, and expectations. Prenatal and postpartum data included anxiety, depression, the Brief Pain Inventory (BPI), pain catastrophizing, resiliency, and perceived social support and stress. The primary outcome was Edinburgh Postnatal Depression Score (EPDS) as a marker of PPD symptoms. The primary pain variable of interest was labor pain emotional valence (unpleasantness burden, areaven though satisfaction and expectations regarding labor pain management were met or exceeded. These data support the concept that labor and acute postpartum pain influences both acute and long-term PPD symptoms, although additional data are needed to assess how analgesia preference interacts with these relationships.BACKGROUND Evidence regarding health effects of tobacco cessation during pregnancy is mainly restricted to cigarette while water pipe is the preferred method of tobacco smoking among women in the Middle-East. The present study aimed to assess the effects of cessation of water pipe during pregnancy on birth anthropometric measures in the south of Iran. METHODS Data on 1120 singleton pregnancies (response rate = 93.4%) from a population-based prospective cohort study in suburban communities in Bandar Abbas city was used. Based on water pipe smoking status, the study subjects were categorized into 1) those who never smoke water pipe (never smoker); 2) those who stopped water pipe during pregnancy and resumed it postpartum (quitters); 3) those who continued smoking water pipe during their pregnancy (always smokers). The Generalized Linear Models (GLMs) were utilized for the analyses. selleckchem RESULTS Compared to never smokers, quitting water pipe in pregnancy decreased mean birthweight of infants by 99.30 g (β-99.30, 95%CI-204.35,-5.75) and an additional decrease of 37.83 g occurred in infants of always smokers (β-137.13;95%CI- 262.21,-12.05). Means of birth length did not significantly differ among the three water pipe groups. Means of head circumference, however, significantly increased by 0.79 cm in infants of always smokers (β079,95%CI0.13,1.45). CONCLUSION Quitting water pipe during pregnancy had positive effects on infant growth, especially birth weight. Awareness campaigns about health benefits of quitting water pipe during routine prenatal checkups and integration of active follow-up visits into prenatal care protocols for smoking mothers are provided.BACKGROUND Contrast-induced nephropathy (CIN) following a percutaneous coronary intervention (PCI) is the third most common cause of acute kidney injury (AKI) worldwide. Patients who require hemodialysis secondary to CIN have an elevated mortality rate as high as 55%. The current definition of CIN is based on an elevation of creatinine and decrease in urinary output. Creatinine typically increases 48 h after the contrast exposure, which delays the diagnosis and treatment of CIN. The neutrophil gelatinase associated lipocalin (NGAL) has emerged as a sensitive and specific biomarker of renal injury. Limited data exists about the effectiveness of NGAL to predict CIN in high-risk patients with acute coronary syndrome (ACS) that underwent PCI. The primary aim of this study was to determine the association of serum NGAL levels and the need for hemodialysis after PCI. METHODS This is a prospective, observational study. NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 h of hospitaafter contrast exposure predicts the development of acute kidney injury requiring hemodialysis.BACKGROUND Although a number of studies have found that income mobility associated with an elevated risk of mental disorders, existing research does not provide sufficient evidence of how exactly individuals' experience of income mobility per se affects their risk of mental health outcomes. This present study aimed to explore roles of baseline income, follow-up income, and income mobility in the development of mental disorders using an intra-generational, longitudinal follow-up study. METHODS We used data from the Montreal South-West Longitudinal Catchment Area Study. A total of 1117 participants with complete information both on income and past 12-month diagnoses of mental disorders were selected for this study. Diagonal Reference Models were used to simultaneously examine roles of income at baseline, income at follow-up, and income mobility in mental disorders during a 4-year follow-up. RESULTS Both baseline and follow-up income were important predictors for any mental disorder and major depression among males and females. Those with low income had a higher risk of any mental disorders and major depression. No evidence was found to support an association between income mobility (neither downwards nor upwards) and mental disorders. Marital status was uniquely associated with any mental disorder among males. Having a pre-existing diagnosis of any mental disorder at origin was associated with any mental disorder and major depression at the end of the 4-year follow-up. CONCLUSIONS This study first simultaneously examined roles of income at baseline, at follow-up, and mobility in mental disorders among a large-scale intra-generational community-based study. This present study provides additional evidence on how income is associated with an individuals' likelihood of mental disorders.BACKGROUND Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. METHODS We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. RESULTS Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0-4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. CONCLUSION Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. TRIAL REGISTRATION ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery.BACKGROUND Aciduria caused by urinary excretion of acidic metabolic wastes produced in daily life is known to be augmented in patients with chronic kidney disease (CKD). To evaluate the reno-protective effect of oral alkalizing agents for the improvement of metabolic acidosis and neutralization of intratubular pH in the patients with mild stages of CKD. Also, to identify reno-protective surrogate markers in the serum and urine that can closely associate the effect of urine alkalization. METHODS In this single-centered, open-labeled, randomized cohort study, patients with CKD stages G2, G3a and G3b, who visited and were treated at Tohoku University Hospital during the enrollment period were registered. We administered sodium bicarbonate or sodium-potassium citrate as the oral alkalinizing agents. A total of 150 patients with CKD will be randomly allocated into the following three groups sodium bicarbonate, sodium-potassium citrate and standard therapy group without any alkalinizing agents. The data of performaoral alkalizing agents in the patients with early stages of CKD, furthermore they could address any new surrogate biomarkers that can be useful from early stage CKD. TRIAL REGISTRATION Registered Report Identifier UMIN000010059 and jRCT021180043. The trial registration number; 150. Date of registration; 2013/02/26.BACKGROUND Early detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients. METHOD A retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cut-off values were determined using Youden's index. RESULTS Detecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI 0.656-0.840, power = 0.997) and 0.740 (95% CI 0.647-0.833, power = 0.996), respectively. Cut-off values of CHr 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients. CONCLUSION CHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.
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