Background: Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by identifying the various elements included in the definitions and how they vary across the literature, determining how these definitions affect the methodological components therein, and proposing a definition that appropriately encompasses all of the appropriate elements. Methods:We searched PubMed to retrieve all studies and case reports on PMPS, and we analyzed definitions of PMPS, inclusion/exclusion criteria, and methods of measuring PMPS. Results:Twenty-three studies were included in this review. We identified 7 independent domains for defining PMPS: surgical breast procedure, neuropathic nature, pain of at least moderate intensity, protracted duration, frequent symptoms, appropriate location of the symptoms and exacerbation with movement. These domains were used with varying frequency. Inclusion/exclusion criteria and methods for assessing PMPS also varied markedly. Conclusion:To prevent future discrepancies in both the clinical and research settings, we propose a new and complete definition based on the results of our review: PMPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50% of the time; and may be exacerbated by movements of the shoulder girdle.Contexte : Le syndrome douloureux post-mastectomie (SDPM) est une complication fréquente de la chirurgie mammaire. Actuellement, il n'existe aucune définition unique de cette douleur chronique. Le but de la présente revue était donc d'élaborer une définition consensuelle du SDPM en dégageant les différents éléments défini-toires, en observant leur variation dans les différentes sources, en déterminant comment ces variations influent sur la méthodologie utilisée, puis en proposant une défi-nition qui met correctement en relation tous les éléments pertinents. Méthodes : Nous avons cherché dans PubMed toutes les études et études de cas sur le SDPM. Nous avons ensuite analysé les définitions du syndrome, ses critères d'inclusion et d'exclusion et ses méthodes d'évaluation.Résultats : La présente revue repose sur 23 études. Nous avons mis en évidence 7 élé-ments indépendants servant à définir le SDPM : l'intervention de chirurgie mammaire, la nature neuropathique de la douleur, la présence d'une douleur au minimum d'intensité modérée, la persistance des symptômes, leur fréquence élevée, leur localisation ainsi que leur exacerbation due au mouvement. La prise en compte de ces éléments dans les diffé-rentes définitions était variable; des variations importantes ont aussi été observées dans les critères d'inclusion et d'exclusion ainsi que dans les méthodes d'évaluation. Conclusion :Pour prévenir les différences conceptuelles, autant dans les milieux c...

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Rapid isothermal amplification methods have recently been introduced, and some of these methods offer significant advantages over PCR. The objective of this study was to develop a rapid and sensitive multiplex loop-mediated isothermal amplification (M-LAMP) assay for the detection of respiratory syncytial virus subgroups A and B (RSV A and B). We designed six primers each for the matrix gene of RSV A and the polymerase gene of RSV B and developed an M-LAMP assay by using a commercially available master mix and a real-time fluorometer (Genie II; Optigene, United Kingdom) that displays real-time amplification, time to positivity, and amplicon annealing temperature (T m ). The M-LAMP was evaluated against PCR by testing 275 nasopharyngeal (NP) specimens. The final optimized M-LAMP assay had a mean amplification time of 14.2 min (compared with 90 to 120 min for PCR) and had an analytical sensitivity of 1 genome equivalent (ge) for both RSV A and B. Using PCR as a comparator, M-LAMP had a sensitivity of 100% (81/81) and specificity of 100% (194/ 194). We also evaluated a 3-to 10-min specimen processing method involving vortexing with glass beads and heating to 98°C in M-swab medium (Copan Italia, Brescia, Italy) and found that this rapid processing method allowed detection of 37/41 (90.2%) of positives when we used extracted nucleic acid. In summary, the M-LAMP assay had excellent sensitivity and specificity for detecting RSV A and B in NP specimens and, when coupled with a rapid specimen preparation method, could provide a specimen-to-result diagnosis time of 30 min. Over the past 15 years there has seen a shift away from traditional testing methods for respiratory viruses, such as culture and antigen detection, and toward more sensitive nucleic acid amplification tests (NAAT) (1, 2). PCR amplification has provided diagnostic laboratories with sensitive and specific tools to detect a variety of respiratory viruses, and molecular testing has been widely adopted by clinical laboratories around the world (3-5). PCR testing, however, has some disadvantages, as these tests can be cumbersome, labor-intensive, require a thermal cycler, and require on average 2 to 3 h to obtain results. Isothermal amplification methods were first introduced in the 1990s and included transcription-mediated amplification (TMA), nucleic acid sequence-based amplification (NASBA), and strand displacement amplification (SDA). Following the introduction of these methods, 12 additional isothermal amplification formats have been developed (see recent reviews by Wu and Tang [4] and Niemz et al.[6]). Some of these newer amplification methods have been used to detect respiratory viruses, some are amenable to multiplex formats, and others can yield a result in 25 min (7-13).Respiratory syncytial virus (RSV) is a major cause of both upper and lower respiratory tract infections (LRTI) in both the young and the elderly (14-16). RSV is the single most important cause of bronchiolitis or LRTI in infants under the age of 2 years that results in emergency roo...

Pathogenic Gram-negative bacteria use type III secretion (T3S) to inject effector proteins into the host cell to create appropriate conditions for infection and intracellular replication. Chlamydia spp. are believed to use T3S to infect their host cell, and the translocator proteins are an essential component of this system. Chlamydia pneumoniae contains genes encoding two sets of translocator proteins; CopB and CopD, and CopB2 and CopD2. In this study, we identified novel interactions between CopD and three type III secretion proteins; namely, CopN, CdsN, and CdsF. We identified a CopD putative chaperone binding motif, PxLxxP, within the N-terminal region (CopD amino acids 120–125), which was necessary for interaction with its putative chaperone LcrH_1. Using size exclusion chromatography, we showed that CopD and LcrH_1 formed higher order structures in solution with CopD and LcrH_1 binding in a ratio of 1∶1, which is unique for T3SS translocator proteins. Lastly, we showed that antibodies to CopD reduced C. pneumoniae infectivity by >95%. Collectively, this data suggests that CopD plays a critical role in pathogenesis and likely functions as a hydrophobic translocator of the type III secretion system in Chlamydia pneumoniae.

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Background: Current guidelines for randomized controlled trial reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature. Methods: This is a systematic review of plastic surgery randomized controlled trials published within the past 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, nonpharmaceutical randomized controlled trials, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizon, was extracted. Results: The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, or a follow-up duration range, or were not reported at all. Although most studies (85.4 percent) reported a standardized time horizon, the majority (85.4 percent) failed to provide a valid justification to support their selection of time horizon. Conclusions: Clinical investigators failed to justify their choice of time horizon in the majority of published randomized controlled trials. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency.

Background Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is difficult due to variation in outcome reporting. Objectives The authors sought to identify a comprehensive list of outcomes and outcome measures in reduction mammaplasty. Methods A comprehensive computerized search was performed. Included studies were randomized or nonrandomized controlled trials involving at least 100 cases of female breast hypertrophy and patients of all ages who underwent 1 or more defined reduction mammaplasty technique. Outcomes and outcome measures were extracted and tabulated. Results A total 106 articles were eligible for inclusion; 57 unique outcomes and 16 outcome measures were identified. Frequency of patient-reported and author-reported outcomes were 44% and 88%, respectively. Postoperative complications were the most frequently reported outcome (82.2%). Quality-of-life outcomes were accounted for in 37.7% of studies. Outcome measures were either condition-specific or generic; frequencies were as low as 1% and as high as 5.6%. Five scales were formally assessed in the breast reduction populations. Clinical measures were defined in 15.1% of studies. Conclusions There is marked heterogeneity in reporting of outcomes and outcome measures in the literature. A standardized outcome set is needed to compare outcomes of various reduction mammaplasty techniques. Level of Evidence: 4