Websterbeebe5997

PURPOSE Cosmetic outcomes and rate of implant loss are poorly characterized among breast cancer patients with previous breast augmentation (BA) who undergo breast-conservation therapy (BCT). Here we determine capsular contracture and implant loss frequency after BCT among patients receiving contemporary whole-breast radiotherapy (WBRT). METHODS AND MATERIALS Breast cancer patients with a prior history of breast augmentation presenting to our institution from January 2006 to January 2017 who elected BCT were included. 71 breast cancers in 70 patients with a history of BA electing BCT were retrospectively identified. Clinicopathologic, treatment, and outcome variables were examined. WBRT included conventional and hypofractionated schedules with and without a boost. Rates of implant loss as well as cosmetic outcomes among patients who did and did not develop a new/worse contracture based on physician assessment were compared. RESULTS 54.9% of patients received radiation using hypofractionated whole-breast tangents; 81.7% received a boost. 18/71 cases (25.4%) developed a new/worse contracture after BCT with a mean follow-up of 1.9 years. 9/71 cases (12.7%) were referred to a plastic surgeon for revisional surgery. There were no implant-loss cases. On univariate analysis, implant location, time from implant placement to diagnosis, radiation therapy (RT) type, RT boost, body mass index, and tumor size were not associated with new/worse contracture. Of 12 patients with existing contracture, only 2 developed worsening contracture. Physician assessment of cosmetic outcome following BCT was noted to be excellent or good for 87.4% of patients. CONCLUSIONS BCT for breast cancer patients with prior history of BA has a low risk of implant loss. Hypofractionated RT does not adversely affect implant outcomes. Patients should be counseled regarding risk for capsular contracture, but the majority have good/excellent outcome; BA does not represent a contraindication to BCT. Diagnosing and treating elite and Olympic athletes with exercise-induced bronchoconstriction has been well established. However, a subset of elite and Olympic athletes with exercise-induced bronchoconstriction experience symptoms of breathlessness due to lack of adherence, improper medications, and/or generalized breathing dysfunction. A short review of traditional treatment plans for elite and Olympic athletes is presented along with the challenges of adherence, managing dysfunctional breathing, and measuring and treating mental skills deficits that may impact breathing. Elite and Olympic athletes may not respond to traditional treatment for exercise-induced bronchospasm, and we present some of the reasons why the athletes fail to respond. Furthermore, we present information on how to detect and treat elite and Olympic athletes with difficult-to-treat asthma. As part of this review we developed a flow diagram for medical providers to identify the reasons for lack of response to traditional treatment plans for exercise-induced bronchoconstriction with options for other treatment modalities. BACKGROUND Bacillus Calmette-Guérin (BCG) vaccine is a live attenuated bacterial vaccine derived from Mycobacterium bovis, which is mostly administered to neonates in regions where tuberculosis is endemic. Adverse reactions after BCG vaccination are rare; however, immunocompromised individuals and in particular patients with primary immunodeficiencies (PIDs) are prone to develop vaccine-derived complications. OBJECTIVE To systematically review demographic, clinical, immunologic, and genetic data of PIDs that present with BCG vaccine complications. Moreover, we performed a meta-analysis aiming to determine the BCG-vaccine complications rate for patients with PID. METHODS We conducted electronic searches on Embase, Web of Science, PubMed, and Scopus (1966 to September 2018) introducing terms related to PIDs, BCG vaccination, and BCG vaccine complications. Studies with human subjects with confirmed PID, BCG vaccination history, and vaccine-associated complications (VACs) were included. RESULTS A total of 46 PIDs associated with BCG-VAC were identified. Severe combined immunodeficiency was the most common (466 cases) and also showed the highest BCG-related mortality. Most BCG infection cases in patients with PID were reported from Iran (n = 219 [18.8%]). The overall frequency of BCG-VAC in the included 1691 PID cases was 41.5% (95% CI, 29.9-53.2; I2 = 98.3%), based on the results of the random-effect method used in this meta-analysis. Patients with Mendelian susceptibility to mycobacterial diseases had the highest frequency of BCG-VACs with a pooled frequency of 90.6% (95% CI, 79.7-1.0; I2 = 81.1%). CONCLUSIONS Several PID entities are susceptible to BCG-VACs. Systemic neonatal PID screening programs may help to prevent a substantial amount of BCG vaccination complications. BACKGROUND The positive rate and pattern of penicillin skin testing (PST) has been reported to be decreasing and changing. Previous studies differ in which penicillin component is the dominant component in positive PST. OBJECTIVE This study was conducted to characterize past and current PST patterns to determine if different determinants in PST have changed overtime. METHODS A retrospective review of electronic medical records (January 2001-December 2017) was performed for patients who underwent PST. Data was divided into four cohorts to see if trends occurred overtime. The cohorts were divided as follows Cohort 12001-2005, Cohort 2 2006-2010, Cohort 3 2011-2015, and Cohort 4 2016-2017. RESULTS 30,883 patients underwent PST with the following breakdowns per cohort Cohort 1- 6,536, Cohort 2- 10,372, Cohort 3- 10,640, Cohort 4- 3,335. 329 patients (1.0%) had a positive PST (≥ 3x3 wheal) with 110 in Cohort 1, 130 in Cohort 2, 67 in Cohort 3, and 22 in Cohort 4. 170 patients(0.5%) were positive with a ≥5x5 wheal r adoption into standard protocol for routine PST should be considered. Although nebulized corticosteroids (NebCS) are a key treatment option for young children with asthma or viral-induced wheezing (VIW), there are no uniform recommendations on their best use. This systematic review aims to clarify the role of NebCS in children aged ≤5 years for the management of acute asthma exacerbations, asthma maintenance therapy and for the treatment of VIW. Electronic databases were used to identify relevant English language articles with no date restrictions. Studies reporting efficacy data in children aged ≤5 years, with a double-blind, placebo- or open-controlled, randomized design, and inclusion of ≥40 participants (no lower patient limit for VIW) were included. Ten articles on asthma exacerbation, 9 on asthma maintenance, and 7 on VIW were identified. Results showed NebCS to be at least as efficacious as oral corticosteroids in the emergency room (ER) for the management of mild-to-moderate asthma exacerbations. In asthma maintenance, nebulized budesonide, the agent of focus in all trials analyzed, significantly reduced the risk of further asthma exacerbations compared with placebo, cromolyn sodium, and montelukast. Intermittent NebCS treatment of VIW was as effective as continuous daily treatment. In summary, NebCS are effective and well tolerated in patients aged ≤5 years for the management of acute and chronic asthma. PURPOSE Fear of cancer recurrence (FCR) is a paramount concern among ovarian cancer survivors. Evidence shows that cancer survivors living in regional or rural areas have higher psychological morbidity; however, no known studies have explored how ovarian cancer survivors living in small urban and rural areas cope with FCR. METHODS In this qualitative descriptive study, a semi-structured questioning process was developed in accordance with Carver et al.'s conceptualization of coping. Focus groups or 11 telephone interviews were used to collect data from a convenience sample of ovarian cancer survivors. Participants completed a demographic form and the Fear of Cancer Recurrence Inventory, and clinical information was extracted from hospital charts. RESULTS The average age of participants (n = 15) was 62.8 years (Range 51-76 years) and the average time since diagnosis was 2.7 years (Range 1-19 years). Most women had elevated levels of FCR. Five themes for coping were expressed by all women 1) health care provider support; 2) knowing, trusting, and prioritizing self; 3) finding what works; 4) uniqueness and belonging; and 5) redirecting thoughts and actions. One additional theme was expressed by most women (n = 11) 6) preparing for the future. CONCLUSION Fear of cancer recurrence was a concern for most ovarian cancer survivors who used a variety of ways to cope. Results can be used to guide nurses' discussions with post-treatment ovarian cancer survivors or be used to inform refinement and development of resources to assist ovarian cancer survivors living in small urban and rural settings to cope with FCR. PURPOSE Sleep quality was considered a priority concern facing pregnant women. L-Mimosine supplier Conventional wisdom argues that good sleep quality benefits pregnant women and their fetuses. The aim of this study is to assess the effects of a specific exercise program on the　sleep quality in pregnant women. METHODS Searches were executed in seven databases since their inceptions until February 28, 2019, for randomized controlled trials evaluating the effects of an exercise program on the sleep quality and insomnia in pregnant women. A random-effects model was applied for meta-analysis, and odds ratio, mean differences (MDs), and 95% confidence intervals (CIs) are shown as parts of outcomes. RESULTS Seven studies were included for meta-analysis. Compared with their not-exercising counterparts, analyses showed that regularly exercising women had significantly enhanced sleep quality, with an odds ratio of 6.21 (95% CI, 2.02-19.11;p = .001; I2 = 80.2%), with a standardized MD of -0.93 (95% CI, -1.19 to -0.67; p less then .001; I2 = 30.0%). However, exercising women showed no significant insomnia improvement, with an standardized MD of -2.85 (95% CI, -7.67 to 1.98; p = .250; I2 = 97.0%), relative to their not-exercising counterparts. CONCLUSION This research indicated that exercise has a positive impact on the sleep quality of pregnant women. Despite the aforementioned positive impact on sleep quality, the present study did not find evidence to support that exercise may also improve insomnia for pregnant women. V.Surgical indications for trapeziometacarpal (TMC) total joint replacement for thumb basal joint osteoarthritis (OA) are increasing. However, complications following this procedure are not insignificant. To avoid complications, preoperative planning with measurement of trapezium height is indicated to ensure a cup is not implanted in the trapezium if its height is less than 8 millimeters. The objective of our study was to analyze a series of preoperative radiographs of patients managed by trapeziectomy and suspensionplasty in our department, and to assess the possibility of a surgical alternative-total joint replacement-based on the trapezium's height. We also wanted to determine whether radiological height was influenced by the radiological progression of the thumb OA. A single-center retrospective study based on available medical records was conducted. The patients included had TMC OA refractory to conservative treatment and were managed surgically by trapeziectomy and suspensionplasty between 2012 and 2018.