Credibility, readability and content analysis of treatment recommendations for adolescents with nonspecific back pain published on consumer websites.

BACKGROUND: Parents may seek out health information online when their adolescent has nonspecific back pain to better understand treatment options. Such information directed towards consumers has not been previously analysed. METHODS: A descriptive cross-sectional content analysis was performed to describe the treatments recommended on consumer websites for nonspecific back pain in adolescents. The credibility and readability of the websites were also assessed. Systematic Google searches were completed in five countries, and relevant content from eligible web pages was analysed. An a priori codebook with 34 treatment-related codes was developed. Nine additional codes were inductively created during analysis. Credibility was assessed using the JAMA benchmark. Readability was assessed via the Flesch Kincaid Grade Level. RESULTS: Of 245 web pages, 48 were deemed eligible and analysed. Of 43 treatment codes, 37 were present in at least one web page. The five most frequently identified codes were See the doctor/get a diagnosis (found on 85% of web pages), Ergonomics/posture/biomechanics (52%), Reassurance (48%), Physiotherapy (48%) and Non-prescription pharmaceuticals/supplements (46%). Only 21% of the web pages met all four JAMA benchmark criteria, and 15% cited at least one recent or high-quality source. The median Flesch Kincaid Grade Level score was 9.0 (range 3.5-12.9). CONCLUSIONS: Parents of adolescents with nonspecific back pain may find that treatment recommendations published online are numerous and varied, with visits to the doctor encouraged. The credibility scores of these web pages are generally low, while the median reading level may be too high for the general population. SIGNIFICANCE STATEMENT: This analysis reveals that public-facing websites with recommendations for treating adolescent nonspecific back pain do not cite the most recent, high-quality research. Although web pages correctly encourage physical activity and exercise over surgery and prescription medications, they do not reflect the psychologically informed or interdisciplinary care emphasized in recently published treatment recommendations. Clinicians must be aware that caregivers of their adolescent patients with nonspecific back pain may be exposed to online messages that encourage them to keep seeking a diagnosis.

The muscles of the infrapubic abdominal wall of a 6-month-old Crocodylus niloticus (Reptilia: Crocodylia).

The muscles of the infrapubic abdominal wall of crocodilians play an important role in their ventilatory mechanism. Yet the anatomy and homology of these muscles is poorly understood. To gain new insights into the anatomy of the crocodilian infrapubic abdominal wall, we dissected a specimen of Crocodylus niloticus. Origin and insertion of the muscles, as well as their arrangement relative to each other was examined in great detail. The findings were compared with those of other crocodilian taxa to detect potential variability of the muscles of interest. The homology of the muscles was studied by comparing the muscles of the crocodilian infrapubic abdominal wall with those of other diapsids. In Crocodylus niloticus, the infrapubic abdominal wall consists of four muscles: Musculus truncocaudalis, M. ischiotruncus, and Mm. rectus abdominis externus and internus. The arrangement of the muscles of the infrapubic abdominal wall of Crocodylus niloticus is consistent with that found in most other crocodilian taxa. In some crocodilian taxa, an additional muscle, M. ischiopubis, is found. In the remaining diapsids, only M. rectus abdominis is present. The crocodilian M. truncocaudalis, M. ischiotruncus and, if present, M. ischiopubis appear to be derivates of M. rectus abdominis; the development of those might be related to the evolution of the unique crocodilian ventilatory mechanism.

Large area smoothing of surfaces by ion bombardment: fundamentals and applications.

Ion beam erosion can be used as a process for achieving surface smoothing at microscopic length scales and for the preparation of ultrasmooth surfaces, as an alternative to nanostructuring of various surfaces via self-organization. This requires that in the evolution of the surface topography different relaxation mechanisms dominate over the roughening, and smoothing of initially rough surfaces can occur. This contribution focuses on the basic mechanisms as well as potential applications of surface smoothing using low energy ion beams. In the first part, the fundamentals for the smoothing of III/V semiconductors, Si and quartz glass surfaces using low energy ion beams (ion energy: ≤2000 eV) are reviewed using examples. The topography evolution of these surfaces with respect to different process parameters (ion energy, ion incidence angle, erosion time, sample rotation) has been investigated. On the basis of the time evolution of different roughness parameters, the relevant surface relaxation mechanisms responsible for surface smoothing are discussed. In this context, physical constraints as regards the effectiveness of surface smoothing by direct ion bombardment will also be addressed and furthermore ion beam assisted smoothing techniques are introduced. In the second application-orientated part, recent technological developments related to ion beam assisted smoothing of optically relevant surfaces are summarized. It will be demonstrated that smoothing by direct ion bombardment in combination with the use of sacrificial smoothing layers and the utilization of appropriate broad beam ion sources enables the polishing of various technologically important surfaces down to 0.1 nm root mean square roughness level, showing great promise for large area surface processing. Specific examples are given for ion beam smoothing of different optical surfaces, especially for substrates used for advanced optical applications (e.g., in x-ray optics and components for extreme ultraviolet lithography).

Association of infiltrating lobular carcinoma with positive surgical margins after breast-conservation therapy.

OBJECTIVE: To determine whether infiltrating lobular carcinoma (ILC) is associated with high positive-margin rates for single-stage lumpectomy procedures, and to define clinical, mammographic, or histologic characteristics of ILC that might influence the positive-margin rate, thereby affecting treatment decisions. SUMMARY BACKGROUND DATA: Infiltrating lobular cancer represents approximately 10% of all invasive breast carcinomas and is often poorly defined on gross examination. METHODS: A group of 47 patients with biopsy-proven ILC undergoing breast-conservation therapy (BCT) at the University of Virginia Health Sciences Center between 1975 and 1999 was compared with a group of 150 patients with infiltrating ductal cancer undergoing BCT during the same time period. The pathology of the lumpectomy specimen was reviewed for each patient to confirm surgical margin status. Office and surgical notes as well as mammography reports were examined to determine whether the lesions were deemed palpable before and during surgery. Patients were stratified according to age, family history, tumor size, tumor location, and histologic features of the tumor. RESULTS: The incidence of positive margins was greater in the ILC group compared with the infiltrating ductal cancer group. Patient age, family history, and preoperative palpability of the tumor did not correlate with surgical margin status. Of the mammographic features identified, including spiculated mass, calcifications, architectural distortion, and other densities, only architectural distortion predicted positive surgical margin status. Tumor grade, tumor size, lymph node status, and receptor status were not predictive of surgical margin status. CONCLUSIONS: For patients with ILC, BCT is feasible, but these patients are at high risk of tumor-positive resection margins (51% incidence) after the initial resection. Only the mammographic finding of architectural distortion was identified as a preoperative marker reliably identifying a subgroup of ILC patients at especially high risk for a positive surgical margin. For all patients with ILC considering BCT, careful counseling about the potential need for a second procedure to treat the positive margin should be included in the treatment discussion.

Apparent ipsilateral decrease in breast size at mammography: a sign of infiltrating lobular carcinoma.

PURPOSE: To assess if infiltrating lobular carcinoma (ILC) is associated with an ipsilateral mammographic decrease in breast size. MATERIALS AND METHODS: Mammographic change in size was evaluated by measuring the distance from the nipple to the pectoralis major muscle on the mediolateral oblique view of the diagnostic mammogram and on a preceding mammogram in 30 patients with ILC. Clinical, mammographic, and histopathologic findings were retrospectively reviewed. RESULTS: Five patients (17%) had an ipsilateral decrease in mammographic size. No patients noticed a physical decrease in breast size. Patients with an ipsilateral decrease in mammographic size most commonly had breast thickening at examination (four of five patients [80%], P < .001) and either a focal asymmetry density (three of five patients [60%]) or architectural distortion (one of five patients [20%]) at mammography; those patients with no change in size most commonly had a palpable mass (six of 25 patients [24%]) or normal findings (19 of 25 patients [76%]) and a mass (13 of 25 patients [52%]) at mammography. The mean tumor size was 66 mm for those with an ipsilateral size decrease and 16 mm for those with no size decrease (P < .001). At histologic analysis, tumors associated with an ipsilateral decrease in mammographic size had more diffuse involvement of the breast, and discrete masses were not seen. CONCLUSION: An apparent decrease in mammographic size may help identify cases of ILC, especially when associated with thickening at clinical examination and focal asymmetric density at mammography.

The Histologic Spectrum of Apocrine Lesions of the Breast

Apocrine proliferations most often are metaplasia as a component offibrocystic change. However, the appearance of apocrine metaplasia within various breast lesions, such as papillomas, ductal adenomas, and sclerosing adenosis, may complicate their diagnosis. Distinguishing benign from malignant apocrine proliferations can be problematic owing to the nuclear characteristics of apocrine cells. In this article, we characterize the spectrum of apocrine proliferations in the breast ranging from benign to malignant and attempt to clarify the difficult lesions that are intermediate between hyperplasia and ductal carcinoma in situ.

Angiosarcoma arising in a bone infarct.

A primary angiosarcoma of the femur arose in continuity with a bone infarct in a 74-year-old man. The tumor, resected by amputation, had pleomorphic polygonal and spindle cells in solid and cystic patterns with focal vasoformative features. The immunohistochemical stains CD31, CD34, factor VIII-related antigen, and Ulex europeus corroborated the endothelial differentiation of the tumor. The patient died after developing pulmonary metastases. This is the oldest reported patient with a well-documented angiosarcoma associated with a bone infarct.

Postnatal conditioning for spreading cortical depression in the rat brain.

The cerebral cortex of anaesthetised 2- to 12-day-old rats was superfused with artificial cerebrospinal fluid containing 100 mM acetate substituted for chloride to condition the brain for spreading depression (SD). After such superfusion, the earliest SD-like events were found at day 9 and full blown SD at day 10, whereas in the unconditioned brain the first SD occurred between days 12 and 15. Acetate conditioning of the cerebral cortex may be used to unmask neuronal and glial properties that are hidden in early stages of development.

Second opinions in surgical pathology.

When to obtain opinions in anatomic pathology is a complex issue. The authors discuss the cognitive process of morphologic interpretation, the influence of expertise on the need for a second opinion, the role of ego, and the impact of economic factors on the patterns of consultation.

Recommendations for the reporting of resected prostate carcinomas.

The Association of Directors of Anatomic and Surgical Pathology has developed recommendations for the surgical pathology reporting of common malignant tumors. The recommendations for resected prostate carcinomas are reported herein.

Initiation of spreading depression can be blocked by transcortical polarization of rat cerebral cortex.

Spreading depression (SD) was elicited in urethane anesthetized rats by pricking the cortical gray matter with a needle. The SDs were monitored by recording changes of direct current (DC) potentials and changes of extracellular potassium concentrations ([K+]e). Simultaneous recordings were made at cortical depths of 400 microns and 1200 microns by an array of two double-barrelled electrodes, one served to measure DC the other contained an ion-sensitive resin. An additional DC microelectrode was inserted in the gray matter near the point of SD elicitation at a depth of about 400 microns. An epicortical Ag-AgCl wire electrode surrounding the recording site and a remote Ag-AgCl electrode penetrating the cortex in the contralateral hemisphere were used for polarizing DC currents. These currents were applied 5 min before elicitation of SD by a needle prick and were sustained for a period ending 3 min after SD. Cathodic polarization of cortical surface with intensities of 30 microA and higher blocked the SD completely. Lower intensities of polarizing currents (10 or 20 microA) had no effect. After ending polarizations normal SDs could be elicited. The polarizing and restitution effects were replicable in the same animal. The results suggest that longer lasting DC polarization of the cortex blocks initiation of SD but not propagation.

Fine-needle aspiration cytology of spindle-cell argyrophilic mucin-producing carcinoma of the breast.

An unusual breast carcinoma with prominent spindle cells, intracytoplasmic mucin, and argyrophilia in an 82-yr-old woman was sampled preoperatively by fine-needle aspiration (FNA). The smears contained highly cellular sheets and fragments of uniform spindle cells with abundant vacuolated cytoplasm. The cells were mucicarmine positive and contained many cytoplasmic argyrophilic granules. The findings were confirmed by histologic examination of the excised tumor, which was also studied with a panel of immunohistochemical stains. A review of the literature indicated that spindle-cell argyrophilic mucin-producing carcinoma (SCAMPC) of the breast is a very rare neoplasm presenting primarily in elderly patients. The FNA cytologic features seem to be unique and should allow distinction from other primary breast lesions.

Aggressive angiomyxoma in males. A report of four cases.

Aggressive angiomyxoma (AAM) is a rare, locally infiltrative but nonmetastasizing tumor of the pelvic and perineal soft tissues that occurs almost exclusively in adult females. The authors describe four cases of AAM in adult males that arose in the scrotum. There was some histologic variation among the tumors. One case was focally hypercellular around the blood vessels, two were more densely cellular throughout, and one had cystic degeneration. Three of the tumors were widely infiltrative, and one of the four tumors recurred locally. The clinicopathologic features of these cases are similar to those of AAM occurring in females. In either sex, AAM should be distinguished from benign myxoid tumors with a low risk of local recurrence and fully malignant myxoid tumors with distant metastatic potential.