Portal Hypertension and Ascites Due to an Arterioportal Fistula: Sequela of a Remote Traumatic Liver Laceration

Arterioportal fistulas (APFs) are a group of vascular disorders, in which systemic arteries communicate with the portal circulation, presenting as a congenital syndrome or more commonly acquired from iatrogenic instrumentation or abdominal trauma. We report the case of a 58-year-old man who developed ascites without underlying risk factors for portal hypertension, which was attributed to an APF found on imaging, manifesting 43 years after sustaining a liver laceration. After angiographic embolization of the APF, the patient's ascites resolved completely. The prolonged latent period between the patient's abdominal trauma and eventual presentation with ascites highlights the need to consider vascular malformations in the differential diagnosis of unexplained noncirrhotic portal hypertension

Do preparticipation clinical exams reduce morbidity and mortality for athletes?

Though clinical preparticipation exams (PPE) are recommended by experts and required in most states, we found no medium- or better-quality evidence that demonstrates they reduce mortality or morbidity. PPEs detect only a very small percentage of cardiac abnormalities among athletes who subsequently die suddenly (strength of recommendation [SOR]: C, case series study). PPEs are also unable to accurately identify athletes with exercise-induced bronchospasm (SOR: C, small cross-sectional study) and are poorly predictive of which athletes are at increased risk of orthopedic injuries (SOR: C, cross-sectional study)

Does surgery relieve the pain of a herniated disc?

Patients with an acute episode of low back pain, radicular symptoms, and evidence of a herniated disc on imaging may experience short-term pain relief from discectomy if their symptoms haven�۪t improved after initial conservative therapy (strength of recommendation [SOR]: A, multiple randomized, controlled trials [RCTs]). Although surgery may enhance pain relief initially, no evidence supports a long-term benefit for surgery over conservative management (SOR: A, multiple RCTs)

What's the best treatment for sebaceous cysts?

Punch biopsy excision appears to be superior to traditional wide elliptical excision for the treatment of sebaceous cysts when intervention is necessary (strength of recommendation [SOR]: B, based on 1 small randomized study). No rigorous metho- dological studies have compared punch biopsy excision of sebaceous cysts with the minimal excision technique

A high-content, multiplexed screen in human breast cancer cells identifies profilin-1 inducers with anti-migratory activities

Profilin-1 (Pfn-1) is a ubiquitously expressed actin-binding protein that is essential for normal cell proliferation and migration. In breast cancer and several other adenocarcinomas, Pfn-1 expression is downregulated when compared to normal tissues. Previous studies from our laboratory have shown that genetically modulating Pfn-1 expression significantly impacts proliferation, migration, and invasion of breast cancer cells in vitro, and mammary tumor growth, dissemination, and metastatic colonization in vivo. Therefore, small molecules that can modulate Pfn-1 expression could have therapeutic potential in the treatment of metastatic breast cancer. The overall goal of this study was to perform a multiplexed phenotypic screen to identify compounds that inhibit cell motility through upregulation of Pfn-1. Screening of a test cassette of 1280 compounds with known biological activities on an Oris™ Pro 384 cell migration platform identified several agents that increased Pfn-1 expression greater than two-fold over vehicle controls and exerted anti-migratory effects in the absence of overt cytotoxicity in MDA-MB-231 human breast cancer cells. Concentration-response confirmation and orthogonal follow-up assays identified two bona fide inducers of Pfn-1, purvalanol and tyrphostin A9, that confirmed in single-cell motility assays and Western blot analyses. SiRNA-mediated knockdown of Pfn-1 abrogated the inhibitory effect of tyrphostin A9 on cell migration, suggesting Pfn-1 is mechanistically linked to tyrphostin A9's anti-migratory activity. The data illustrate the utility of the high-content cell motility assay to discover novel targeted anti-migratory agents by integrating functional phenotypic analyses with target-specific readouts in a single assay platform. © 2014 Joy et al

Are steroid injections effective for tenosynovitis of the hand?

Yes. Steroid injections are an effective first-line therapy for flexor tenosynovitis of the hand, with a number needed to treat [NNT] of 2.3 for injection of steroids and lidocaine (strength of recommendation [SOR]: B, based on 1 prospective RCT and low- quality studies). Injection into the tendon sheath may not be critical to a successful outcome (SOR: B, based on 1 prospective uncontrolled trial)

Fiber-Flux Diffusion Density for White Matter Tracts Analysis: Application to Mild Anomalies Localization in Contact Sports Players

We present the concept of fiber-flux density for locally quantifying white matter (WM) fiber bundles. By combining scalar diffusivity measures (e.g., fractional anisotropy) with fiber-flux measurements, we define new local descriptors called Fiber-Flux Diffusion Density (FFDD) vectors. Applying each descriptor throughout fiber bundles allows along-tract coupling of a specific diffusion measure with geometrical properties, such as fiber orientation and coherence. A key step in the proposed framework is the construction of an FFDD dissimilarity measure for sub-voxel alignment of fiber bundles, based on the fast marching method (FMM). The obtained aligned WM tract-profiles enable meaningful inter-subject comparisons and group-wise statistical analysis. We demonstrate our method using two different datasets of contact sports players. Along-tract pairwise comparison as well as group-wise analysis, with respect to non-player healthy controls, reveal significant and spatially-consistent FFDD anomalies. Comparing our method with along-tract FA analysis shows improved sensitivity to subtle structural anomalies in football players over standard FA measurements

What is the best beta-blocker for systolic heart failure?

Q: What is the best beta-blocker for systolic heart failure? Evidence-based answer: Three beta-blockers--carvedilol, metoprolol succinate, and bisoprolol--reduce mortality equally (by about 30% over one year) in patients with Class III or IV systolic heart failure. Insufficient evidence exists comparing equipotent doses of these medications head-to-head to recommend any one over the others (strength of recommendation [SOR]: A, systematic review/meta-analysis)

Inactivation of Surrogate Coronaviruses on Hard Surfaces by Healthcare Germicides

The SARS coronavirus (SARS-CoV) was identified as the cause of severe acute respiratory syndrome (SARS) following the worldwide 2003 outbreak. The spread of SARS in healthcare settings and the presence of SARS CoV nucleic acids on hospital surfaces in outbreak settings suggest that surfaces could potentially play a role in the spread of SARS in healthcare environments. Disinfection of hospital surfaces may interrupt virus transmission, but there are little data on the effectiveness of germicides commonly used in healthcare against corona viruses on surfaces. The goal of this research was to test the efficacy of six standard healthcare germicides for inactivation of surrogate corona viruses on environmental surfaces. The germicides tested were (1) Steris Vesphene® IIse Non-sterile Disinfectant Cleaner (9.09% o-phenylphenol, 7.66% p-tertiary amylphenol), (2) 70% ethanol, (3) chlorine bleach (6.0% sodium hypochlorite), (4) Cidex® OPA (ortho-phthalaldehyde), (5) Purell® Instant Hand Sanitizer (62% ethanol), (6) Clorox® Anywhere Hand Sanitizing Spray (71% ethanol). These were tested for virucidal activity against two surrogate coronaviruses, Mouse Hepatitis Virus (MHV) and Transmissible Gastroenteritis Virus (TGEV). MHV and TGEV were dried onto stainless steel surfaces, exposed to a germicide at its use dilution for one-minute contact time, and assayed for infectivity in cell culture. For TGEV, log[10] infectivity reductions were: 70% ethanol=3.2; phenolic=2.0; Cidex OPA=2.3; 1:100 chlorine bleach=0.35; 62% ethanol=4.0; and 71% ethanol=3.5. For MHV, they were: 70% ethanol=3.9; phenolic,=1.3; Cidex OPA=1.7; 1:100 chlorine bleach=0.62; 62% ethanol=2.7; and 71% ethanol=2.0. Of the healthcare germicides tested, only the ethanol effectively reduced infectivity of the two coronaviruses by >3 log[10] after an exposure time of one minute. Cidex OPA was somewhat effective, with >2 log[10] reduction, and 1:100 chlorine bleach was ineffective, with <1 log[10] reduction. MHV and TGEV were reduced to a similar extent (within 0.5 log[10]) by the germicide tested. The results of this study suggest the need for care in choosing effective germicides against viruses like SARS CoV.Master of Science in Public Healt

The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant

Nearly all medical schools incorporate some form of professional medical oath into their graduation ceremo- nies. The oldest and most popular of these oaths is the Hippocratic Oath, composed more than 2,400 years ago. In modern times, especially during the twentieth century, the Hippocratic Oath has had its content changed and its authorship challenged. This article discusses the history of the Hippocratic Oath from its traditional form to its modern adaptations. Additionally, this article seeks to explain the Hippocratic Oath’s endurance despite these challenges, based upon the historical importance of Hippocrates and the Hippocratic tradition in Western medicine.