Medicine
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Observational Study
Reference interval for the disc-macula distance to disc diameter ratio in a large population of healthy Japanese adults: A prospective, observational study.
This study presents the calculated reference interval for the disc-to-macula distance to disc diameter ratio (DM:DD) based on a large population of healthy Japanese adults. A total of 308 consecutive, healthy Japanese adults were examined in this prospective observational study. Eighteen subjects were also excluded because of poor quality of the fundus photograph of one or both eyes; 290 (161 men and 129 women) were included in this study. ⋯ The data did not fit a normal distribution (P < .001, Kolmogorov-Smirnov test). The estimated reference interval for DM:DD corresponding to the 2.5th and 97.5th percentiles was 2.12 to 4.18. Using a nonparametric approach, the reference interval for DM:DD of a large population of healthy Japanese adults was calculated to be 2.12 to 4.18, regardless of age or sex.
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Observational Study
Epigastric symptoms of gallbladder dyskinesia mistaken for functional dyspepsia: Retrospective observational study.
Functional dyspepsia (FD) is a constellation of epigastric symptoms originating in the gastroduodenal region without organic and metabolic cause. However, similar confounding symptoms can also appear in patients with gallbladder (GB) dyskinesia. Therefore, symptoms of GB dyskinesia may be mistaken for FD. ⋯ In 4 of the 7 patients with GB dyskinesia, FD symptoms disappeared as GB function normalized. As a result, GB dyskinesia was the cause of the symptoms in 4 of 18 patients with FD symptoms compatible with the Rome IV criteria. It is necessary to evaluate GB function in patients with refractory FD symptoms because the symptoms can be caused by GB dyskinesia.
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Observational Study
Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors: A database study.
Two hypotheses were offered for the effect of shorter hospital stays on mortality after hip fracture surgery: worsening the quality of care and shifting death occurrence to postacute settings. We tested whether the risk of hospital death after hip fracture surgery differed across years when postoperative stays shortened, and whether care factors moderated the association. Analysis of acute hospital discharge abstracts for subgroups defined by hospital type, bed capacity, surgical volume, and admission time.153,917 patients 65 years or older surgically treated for first hip fracture. ⋯ In large lower volume community hospitals, the 2012 risk was 56% lower for weekend admissions, OR = 0.44 (95%CI: 0.26-0.75), compared to 2004. The risk of hospital death after hip fracture surgery decreased only in large community hospitals, despite universal shortening of hospital stays. This supports the concern of worsening the quality of hip fracture care due to shorter stays.
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Recognition of the close relationship of nonalcoholic fatty liver disease (NAFLD) with diabetes mellitus 2, obesity, metabolic syndrome, and cardiovascular disease has stimulated growing interest in NAFLD as a public health problem. Serum alanine aminotransferase (ALT) has been proposed as a marker of NAFLD, but levels are within the range currently considered "normal" in a large proportion of NAFLD subjects. The aim of the study was to determine the diagnostic accuracy of serum ALT for identifying individuals with NAFLD, using 3-Tesla (T) magnetic resonance spectroscopy (H-MRS). ⋯ Optimal serum ALT cut-off to predict NAFLD was 23 IU/L (area under receiver-operating characteristic curve: 0.93; sensitivity: 0.94; specificity: 0.72). This study shows that serum ALT is a sensitive and accurate biomarker of NAFLD if the "normal" ALT value is revised and established at a lower level. An ALT threshold of 23 IU/L identified 94% of individuals with NAFLD in the present series, using 3-T H-MRS for liver triglyceride quantification.
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Observational Study
Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy.
Controversy remains over whether random cervical biopsies and endocervical curettage (ECC) should be used in women with positive screening but negative colposcopy. Our paper aims to determine the indications for random biopsies and ECC among these screened positive women. Three thousand two hundred thirteen women with any positive screening test result but negative colposcopy, who received random 4-quadrant biopsies, were pooled from 17 population-based cervical cancer screening studies done in China from 1999 to 2008. ⋯ If random biopsies were only taken without ECC, 9.3% of CIN2+ and 18.5% of CIN3+ would have been missed. For women with any positive screening but negative colposcopy, in areas with good cytological infrastructure, it was necessary to perform random biopsies plus ECC on those with cytological ASC-US/LSIL and positive HR-HPV, AGC, ASC-H, or HSIL+. In contrast, those with other results should be followed up.