Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors.

Purpose: Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery.

Patients And Methods: Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery.

Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist.

Background: The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.

Three Tesla MRI for the diagnosis of meniscal and anterior cruciate ligament pathology: a comparison to arthroscopic findings.

Aim: To assess the accuracy of 3T magnetic resonance imaging (MRI) in the evaluation of meniscal and anterior cruciate ligament (ACL) injury.

Materials And Methods: Sixty-one consecutive patients were identified who were referred for evaluation of suspected intra-articular pathology with a 3T MRI and who, subsequently, underwent an arthroscopic procedure of the knee were included for the study. Two musculoskeletal radiologists interpreted the images.

Near-surface wetland sediments as a source of arsenic release to ground water in Asia.

Tens of millions of people in south and southeast Asia routinely consume ground water that has unsafe arsenic levels. Arsenic is naturally derived from eroded Himalayan sediments, and is believed to enter solution following reductive release from solid phases under anaerobic conditions. However, the processes governing aqueous concentrations and locations of arsenic release to pore water remain unresolved, limiting our ability to predict arsenic concentrations spatially (between wells) and temporally (future concentrations) and to assess the impact of human activities on the arsenic problem.

Intravesical oxybutynin for children with poorly compliant neurogenic bladder: a systematic review.

Purpose: Children with neurogenic bladder and poor bladder compliance are usually treated with bladder catheterization and oral anticholinergic medication. They may become nonresponders to the drug or present with severe side effects. We evaluated the effectiveness and tolerability of intravesical oxybutynin in children with poorly compliant neurogenic bladder.

Metal ion substrate inhibition of ferrochelatase.

Ferrochelatase catalyzes the insertion of ferrous iron into protoporphyrin IX to form heme. Robust kinetic analyses of the reaction mechanism are complicated by the instability of ferrous iron in aqueous solution, particularly at alkaline pH values. At pH 7.

Surveillance search techniques identified the need to update systematic reviews.

Objective: This article reports on literature surveillance methods to identify new evidence eligible for updating systematic reviews.

Study Design And Setting: Five surveillance search approaches are tested in the context of identifying studies that would signal major or invalidating new evidence for existing systematic reviews of health care interventions. Recall for each search approach was assessed as proportion of a composite yield of relevant studies across all search approaches that were identified by that approach.

No consensus exists on search reporting methods for systematic reviews.

Objectives: The reporting of the search methods used in systematic reviews has implications for how systematic reviews are critically appraised, their reproducibility and how easily they may be updated. The objective of this paper was to identify validated or evaluated search reporting instruments used in reporting systematic review searches and to compare reported and recommended searching practices.

Study Design And Setting: This cohort study was a systematic review.

Does fumagillin control the recently detected invasive parasite Nosema ceranae in western honey bees (Apis mellifera)?

Western honey bee (Apis mellifera) colonies in Nova Scotia, Canada were sampled in spring and late summer 2007 to evaluate efficacy of fumagillin dicyclohexylammonium (hereafter, fumagillin) against Nosema ceranae. Colonies treated with fumagillin in September 2006 (n=94) had significantly lower Nosema intensity in spring 2007 than did colonies that received no treatment (n=51), but by late summer 2007 no difference existed between groups. Molecular sequencing of 15 infected colonies identified N.

Systematic reviews can be produced and published faster.

Objective: As part of a larger project on updating systematic reviews, we studied the currency of reviews at the time of publication to determine typical and achievable times to publication for systematic reviews published in journals, Health Technology Assessment technical reports or Cochrane Collaboration reviews, and examined differences in publication speed between these document types.

Study Design And Setting: A cohort of systematic reviews of treatment interventions originally published between 1995 and 2005 and indexed in ACP Journal Club was assembled. Dates of search, manuscript submission, acceptance, publication and indexing in MEDLINE were extracted.

Selective serotonin reuptake inhibitors for unipolar depression: a systematic review of classic long-term randomized controlled trials.

Background: Selective serotonin reuptake inhibitors are increasingly used in the long-term treatment of depression. Much of the supporting evidence about the effects of these drugs comes from discontinuation trials, a variant of randomized controlled trials whose design is problematic to interpret. We conducted a systematic review to examine the efficacy and acceptability of long-term therapy with selective serotonin reuptake inhibitors relative to placebo in the treatment of unipolar depression.

Few systematic reviews exist documenting the extent of bias: a systematic review.

Objective: To summarize the evidence concerning bias and confounding in conducting systematic reviews (SRs).

Study Design And Setting: Literature was identified through searching the Cochrane Library, MEDLINE, PsycINFO until November 2006, and the authors' files. Studies were included if they were SRs of bias that can occur while conducting a SR.

Contamination of drinking water resources in the Mekong delta floodplains: arsenic and other trace metals pose serious health risks to population.

This study presents a transnational groundwater survey of the 62,000 km(2) Mekong delta floodplain (Southern Vietnam and bordering Cambodia) and assesses human health risks associated with elevated concentrations of dissolved toxic elements. The lower Mekong delta generally features saline groundwater. However, where groundwater salinity is <1 g L(-)(1) Total Dissolved Solids (TDS), the rural population started exploiting shallow groundwater as drinking water in replacement of microbially contaminated surface water.

Dual role of Cbl links critical events in BCR endocytosis.

Receptor endocytosis down-regulates ligand-induced signaling in a timely manner and depends on cytoskeletal remodeling. In B lymphocytes, internalization of B cell receptors (BCRs) is also critical to antigen presentation. However, the mechanisms underlying BCR endocytosis are not fully understood.

When and how to update systematic reviews.

Background: Systematic reviews are most helpful if they are up-to-date. We did a systematic review of strategies and methods describing when and how to update systematic reviews.

Objectives: To identify, describe and assess strategies and methods addressing: 1) when to update systematic reviews and 2) how to update systematic reviews.

Arsenic in hair and nails of individuals exposed to arsenic-rich groundwaters in Kandal province, Cambodia.

The health implications of the consumption of high arsenic groundwater in Bangladesh and West Bengal are well-documented, however, little is known about the level of arsenic exposure elsewhere in Southeast Asia, where widespread exploitation of groundwater resources is less well established. We measured the arsenic concentrations of nail and hair samples collected from residents of Kandal province, Cambodia, an area recently identified to host arsenic-rich groundwaters, in order to evaluate the extent of arsenic exposure. Nail and hair arsenic concentrations ranged from 0.

Effectiveness and safety of vitamin D in relation to bone health.

Objectives: To review and synthesize the literature in the following areas: the association of specific circulating 25(OH)D concentrations with bone health outcomes in children, women of reproductive age, postmenopausal women and elderly men; the effect of dietary intakes (foods fortified with vitamin D and/or vitamin D supplementation) and sun exposure on serum 25(OH)D; the effect of vitamin D on bone mineral density (BMD) and fracture or fall risk; and the identification of potential harms of vitamin D above current reference intakes.

Data Sources: MEDLINE(R) (1966-June Week 3 2006); Embase (2002-2006 Week 25); CINAHL (1982-June Week 4, 2006); AMED (1985 to June 2006); Biological Abstracts (1990-February 2005); and the Cochrane Central Register of Controlled Trials (2nd Quarter 2006).

Review Methods: Two independent reviewers completed a multi-level process of screening the literature to identify eligible studies (title and abstract, followed by full text review, and categorization of study design per key question).

Comfort and confidence levels of health care professionals providing pediatric palliative care in the intensive care unit.

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care.

A systematic review identified few methods and strategies describing when and how to update systematic reviews.

Objective: Systematic reviews (SRs) are convenient summaries of evidence for health care practitioners. They form a basis for clinical practice guidelines and suggest directions for new research. SRs are most helpful if they are current; however, most of them are not being updated.

Low density lipoprotein from patients with Type 2 diabetes increases expression of monocyte matrix metalloproteinase and ADAM metalloproteinase genes.

Aims: Type 2 diabetes is characterised by increased plasma concentrations of pro-inflammatory cytokines [such as tumour necrosis factor - alpha; TNF-alpha] and soluble forms of adhesion molecules involved in leukocyte - endothelial interactions. These molecules are synthesised as transmembrane proteins and the plasma soluble forms are generated by ectodomain cleavage from the cell surface by members of the ADAM [adisintegrin and metalloproteinase] proteinase family. We hypothesised that plasma low density lipoprotein [LDL] from subjects with Type 2 diabetes would influence in vitro monocytic ADAM and matrix metalloproteinase [MMP] gene expression differently compared to control LDL.

How quickly do systematic reviews go out of date? A survival analysis.

Background: Systematic reviews are often advocated as the best source of evidence to guide clinical decisions and health care policy, yet we know little about the extent to which they require updating.

Objective: To estimate the average time to changes in evidence that are sufficiently important to warrant updating systematic reviews.

Design: Survival analysis of 100 quantitative systematic reviews.

Mitochondrial DNA haplogroups and type 2 diabetes: a study of 897 cases and 1010 controls.

Mitochondria play a central role in the secretion of insulin by pancreatic beta-cells, and pathogenic mutations of mitochondrial DNA (mtDNA) can cause diabetes. The aetiology of type 2 diabetes has a strong genetic component, raising the possibility that genetic variants of mtDNA alter the risk of developing the disorder. Recent studies have produced conflicting results.