From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes

PURPOSE

While robotic-assisted hernia repair has increased the popularity of minimally invasive hernia surgery, selecting between the types of approaches is a challenge for both experts and novices alike. In this study, we compared a single surgeon's early experience transitioning from transabdominal hernia repair with sublay mesh in either the pre-peritoneal or retrorectus space (TA-SM) and enhanced-view totally extra-peritoneal (eTEP) ventral hernia repair in the peri-operative and long-term post-operative time periods.

METHODS

We conducted a retrospective review of 50 eTEP and 108 TA-SM procedures to collect demographics, intraoperative details, and 30-day and 1-year post-operative outcomes. Statistical analysis was performed utilizing Chi-square analysis, Fisher's test, and two sample t-tests with equal variances.

RESULTS

There were no significant differences in patient demographics or comorbidities. eTEP patients had larger defects (109.1 cm² vs. 31.8 cm², p = 0.043) and mesh used (432.8 cm² vs. 137.9 cm², p = 0.001). Operative times were equivalent (158.3 ± 90.6 min eTEP and 155.8 ± 65.2 min TA-SM, p = 0.84), but conversion to alternate procedure type was higher for the transabdominal approach (4% eTEP vs. 22% TA-SM, p < 0.05). Hospital stay was less in the eTEP cohort (1.3 days vs. 2.2 days, p < 0.05). Within 30 days, there were no significant differences in emergency visits or hospital readmissions. There was a greater propensity for eTEP patients to develop seromas (12.0% vs. 1.9%, p < 0.05). At 1 year, there was no statistically significant difference in recurrence rate (4.56% eTEP vs. 12.2% TA-SM, p = 0.28) respective to average time to recurrence (9.17 months eTEP vs. 11.05 months TA-SM).

CONCLUSION

The eTEP approach can be adopted safely and efficiently, and may have superior peri-operative outcomes including fewer conversions and reduced hospital stay.

Racial disparities after stoma construction in colorectal surgery

AIM

Racial disparities are under-recognized among patients undergoing colorectal surgery. The purpose of this study was to determine the complication rates and surgical outcomes stratified by race and ethnicity among patients undergoing colorectal surgery with intestinal stoma creation.

METHOD

The ACS NSQIP database from 2013 to 2016 was used. Colon, rectum and small bowel cases requiring intestinal stoma creation were selected. Both African-American and other groups of minority patients were compared with Caucasian patients using a complex multivariable analysis model. Primary outcomes of interest were complication rates, mortality and extended hospital length of stay.

RESULTS

The study included 38 088 admissions. After multivariable analysis, African-American patients still had a prolonged length of hospital stay and higher complication rates. Other minorities also had a prolonged length of hospital stay and higher complication rates.

CONCLUSIONS

Both African-American and other groups of minority patients requiring an ostomy suffer significantly higher postoperative complication rates and a prolonged hospital length of stay, even after comorbidity adjustment. Access to care, socioeconomic status and comorbid disease management are all important factors for minority patients who undergo colorectal surgery requiring intestinal stoma construction.

Factors associated with Tdap vaccination receipt during pregnancy: a cross-sectional study

OBJECTIVE

Pertussis morbidity and mortality disproportionately affect infants younger than 1 year, who constitute 70% of deaths from pertussis. In 2017, 43% of infants younger than 6 months diagnosed with pertussis were hospitalized. In 2012, the Advisory Committee on Immunization Practices recommended that all pregnant women should receive Tdap (tetanus-diphtheria-acellular pertussis) vaccine between 27- and 36-weeks gestation in an effort to reduce infant pertussis morbidity and mortality. However, Tdap vaccination rates among pregnant women remain far from robust. The aim of this study was to assess factors associated with maternal Tdap uptake to help providers identify best practices that can improve Tdap receipt and identify women at risk for not receiving this important vaccine.

STUDY DESIGN

A retrospective cross-sectional study.

METHODS

A review of prenatal and delivery records was performed on all maternal-infant dyads with infants older than 36 weeks gestation admitted to the term nursery at Albany Medical Center from January 1, 2016 to April 16, 2016. A chi-squared analysis using STATA®, version 14.1, was performed to determine if any variables were associated with Tdap uptake, with statistical significance defined as P < 0.05. Multivariate analysis was performed to identify the variables which had the greatest effect on Tdap receipt.

RESULTS

Tdap vaccine was received by 65.8% of pregnant women (n = 400) in the study; median gestational age of receipt was 30 weeks. Maternal influenza vaccine receipt, infant hepatitis B vaccine receipt, provider recommendation of Tdap vaccination, and on-site availability of Tdap vaccine were all positively associated with maternal Tdap receipt during pregnancy.

CONCLUSION

Receipt of Tdap by pregnant women was highest in those who had received a provider recommendation about its benefits and who also received influenza vaccine during pregnancy. Because women who received the influenza vaccine themselves and also consented to have their infants receive the hepatitis B vaccine had significantly higher uptake rates, encouraging vaccines usage and combating vaccine hesitancy in general can improve Tdap uptake rates. A small, but statistically significant association with receipt of assisted reproductive technologies was also seen, meriting future research.

The effect of carob (Ceratonia siliqua) bean extract on male New Zealand White rabbit semen

<p>The carob tree (Ceratonia siliqua) grows naturally in the Mediterranean region. The empiric use of carob cures for their aphrodisiac properties is very common in Turkey. Thus, the experiment was conducted to determine the effects of carob bean extracts on some reproductive parameters in male New Zealand White rabbits. During the adaptation period (stage 1), 6-8 mo old rabbits were trained in semen collection for 30 d. At the beginning of the treatment period (stage 2), rabbits were assigned randomly to 2 groups of 8 animals each. For a period of 49 d (1 spermatogenesis duration), one group was treated with a daily oral dose (10 mL) of carob extract and the other group received the corresponding volume of tap water. Semen was collected weekly. Semen samples taken at week 1 and 7 were analysed separately. At the beginning of stage 2, no differences were observed in the volume and pH of the ejaculate, sperm concentration, percentage of motility, percentage of live spermatozoa, percentage of sperm plasma membrane integrity, plasma concentration of testosterone, and seminal plasma protein levels between the control and carob extract treated animals. Similarly, at the end of stage 2, there were no differences in the volume and pH of the ejaculate, motility percentage, the percentage of live spermatozoa, percentage of sperm plasma membrane integrity, and the seminal plasma protein levels between the control and the carob extract treated animals. However, sperm concentration (P&lt;0.05), plasma concentration of testosterone (P&lt;0.05), and percentage of change in spermatozoa concentration (P&lt;0.02) between groups were affected at the end of stage 2. The data suggested that the use of carob cures prepared by boiling carob fruit could have beneficial influences on sperm concentration in rabbits.</p>

Anti-vimentin Antibodies Present at the Time of Transplantation May Predict Early Development of Interstitial Fibrosis/Tubular Atrophy

BACKGROUND

Anti-vimentin (a cytoskeletal protein) autoantibodies in renal transplant recipients have been correlated with interstitial fibrosis/tubular atrophy (IFTA). In this study, we examine the association between pretransplantation anti-vimentin antibodies and the subsequent development of IFTA.

METHODS

Sera obtained before renal transplantation from 97 transplant recipients were analyzed for the presence of anti-vimentin antibodies via Luminex assays to determine the concentration of anti-vimentin antibodies. Results were correlated with findings of IFTA on biopsy as well as graft function and patient and graft survival.

RESULTS

In our patient population, 56 of 97 patients were diagnosed by biopsy with IFTA 2.9 (±2.1) years after renal transplantation. Patients with IFTA on biopsy had higher mean concentration of anti-vimentin antibodies when compared to patients without IFTA (32.2 μg/mL [3.97-269.12 μg/mL] vs 14.57 μg/mL [4.71-87.81 μg/mL]). The risk of developing IFTA with a concentration of anti-vimentin antibody >15 μg/mL before transplantation was 1.96 (95% CI = 1.38-2.79, P = .011). Patients with elevated anti-vimentin antibody concentrations (>15 μg/mL) at the time of transplantation also had a higher risk of developing IFTA (81.4% vs 41.2%; P < .05). In addition, graft function was worse at 1, 3, and 5 years posttransplantation in patients with elevated concentrations of pretransplantation anti-vimentin antibody. Although there were more graft losses in the IFTA groups (49.12% vs 25.64%, P = .021) and the IFTA patients loss their grafts earlier (4.3 years vs 3.6 years), there was no statistical difference in graft loss rates.

CONCLUSIONS

Pretransplantation anti-vimentin antibody concentrations >15 μg/mL may be a risk factor for IFTA.

It is not only the empty vials that go into the garbage can during chemotherapy drugs preparation: a cost analysis of unused chemotherapy drugs in cancer treatment

PURPOSE

Cancer therapy is a costly treatment. Costs of drugs used in cancer therapy are gradually increasing with the addition of new and expensive drugs. This fact imposes obligation on reasonable drug usage. Occasionally, all of the prescribed drugs are not used for various reasons, and a number of drugs can be left over. In this study, we aimed to calculate the costs of unused chemotherapeutic drugs in our oncology clinics.

METHODS

A total of 117 patients with 17 different types of cancer were administered 32 cancer therapy protocols during 2 months. After administration of ideal doses of the prescribed drugs calculated on an individual basis, the number of unused drug doses in the packages was recorded and the costs of the unused drugs were calculated based on current prices of the drugs.

RESULTS

The cumulative cost of the unused drugs calculated for all patients was US dollars (USD) 6406.93, and average cost of the drug per capita was USD 54.76. Minimal and maximal unused drug costs per drug were USD 0.29 for 5-fluorouracil, and USD 247.12 for bevacizumab, respectively. Minimal increase in drug costs per recipe was USD 0.50 for a prescription containing cyclophosphamide and 5-fluorouracil, while the total cost of bevacizumab plus irinotecan combination increased tremendously to USD 309.12. Among chemotherapeutic protocols the cheapest one was AC (adriamycin, cyclophosphamide) with USD 4.77, while the most expensive one (USD 116.02) was FOLFIRI-B (5-fluorouracil, calcium folinate, irinotecan, and bevacizumab).

CONCLUSION

The important financial burden of unused drugs goes unrecognized among routine chemotherapeutic applications. In order to be able to avoid this extravagance, drug industry, prescribing physicians, and practice nurses must assume important roles.

Frequency of comorbid illnesses in cancer patients in Turkey

PURPOSE

Comorbidities in cancer patients can adversely affect the management and outcome of their primary illnesses at all levels from diagnosis to therapy. We sought to examine comorbid conditions of cancer patients, treated at 4 university hospitals, each representing a different geographic location in Turkey.

METHODS

A total of 769 consecutive cancer patients presenting to outpatient clinics were recruited between November 2007 and May 2008. The patients filled in a questionnaire on comorbidities. Based on the questionnaire, Charlson Comorbidity Index (CCI( was calculated.

RESULTS

The patient median age was 55 years (range 21-87) and 456 (59.3%) were female. Breast (36.5%), colorectal (21.4%) and lung cancers (13.9%) were the 3 most frequent malignancies. Of the patients, 59.3% had at least one comorbid disease and 46.3% were using at least one medication daily. The most frequent comorbidities were hypertension (25.3%), diabetes mellitus (13.1%) and peptic ulcer (7.7%). Increasing age positively correlated with the extent of comorbidities (r=0.30, p<0.001), number of medications (r=0.32, p<0.001) and the CCI (r=0.20, p<0.001).

CONCLUSION

It is crucial to remember that comorbid illnesses are not rare and many patients are treated for conditions unrelated to their cancer, which potentially may affect various stages of their clinical management.

Frequency of co-morbid illnesses in cancer patients in Turkey

e20717

Background: Co-morbidities in cancer patients can adversely affect the management of their primary illnesses at multiple levels from diagnosis to therapy. We saught to examine co-morbid conditions in cancer patients treated at 3 university hospitals in Turkey representing three different geographic locations. Methods: A total of 622 consecutive cancer patients presenting to outpatient clinics were recruited to the study from November 2007 to May 2008. Each patient answered a questionnaire consisting of questions on co-morbidities and drugs taken. Based on the questionnaire, Charlson Comorbidity Index (CCI) was calculated. Results: Their median age was 55 years (minimum-maximum: 21–87) and 376 (62%) were female. Breast cancer (39%), colon and rectum (19%) and lung cancer (14%) were the 3 most frequent cancers. Of the patients, 60% had at least 1 co-morbid disease and 49% were using at least one medication daily. The most frequent comorbid diseases were hypertension (25%), other cardiovascular disorders (15%) and diabetes mellitus (13%). Incidence of comorbid diseases were increasing by age; 65% in patients between 60–69 years and 76% in patients older than 70 (r=0.25, p<0.001). Similarly, of those over 70 years, 65% was on at least 1 medication (r=0.29, p<0,001). CCI scores were calculated as 0 in (71%), 1 (23%) and 2 (5%) and it also worsened by increasing age (r=0.15, p<0.001). Conclusions: It is crucial to remember that co-morbid illnesses are not infrequent and many patients take medications for conditions unrelated to their cancer, which potentially may affect multiple stages of clinical management.

No significant financial relationships to disclose.

Effects of subclinical bovine leukemia virus infection on some production parameters in a dairy farm in southern Turkey

Some production parameters of seropositive cows (age, first calving age, 305 day mature equivalent last milk yield production, lifetime mature equivalent milk yield production, lifetime total milk production, lifetime total milking period, lifetime monthly milk production, lifetime daily milk production, lifetime total days of milking, number of inseminations per pregnancy (for last pregnancy), number of calves and calving interval (for last pregnancy)) were analysed in the current study. The study population was clinically healthy Holstein cows from a commercial dairy herd in southern Turkey. Of 109 animals, 65 cows were seropositive by ELISA and the prevalence of bovine leukemia virus (BLV) infection was 59.6%. The prevalence of seropositive cows in 2nd (62.8%), 3rd (64.7%), 4th (61.5%), and 5th (66.6 %) lactations was slightly higher than that of cows in 1st (52.6%) lactations. No statistical differences were observed between BLV seronegative and seropositive cows for production and reproduction parameters analysed in this study (P > 0.05).

Protective role of ascorbic acid on subacute sperm toxicity in male New Zealand white rabbits treated with endosulfan

The ameliorating effect of oral ascorbic acid (AA) was evaluated against changes in sperm parameters in New Zealand White (NZW) rabbits treated with endosulfan. Rabbits (6 to 8 months old) were divided into four groups of six animals each. Rabbits in TRT-I served as control and received corn oil by oral gavage for 6 weeks. Rabbits in TRT-II received endosulfan (1 mg/kg bw per day) in corn oil. TRT-III group received oral corn oil daily and ascorbic acid (AA; 20 mg/kg bw) every other day for 6 weeks. TRT-IV group received the same amounts of endosulfan and AA. Endosulfan alone significantly reduced the sperm count and motility and increased the presence of sperm with morphologic problems. AA treatment showed significant amelioration when coupled with endosulfan. Ameliorations were up to control levels in all cases except for sperm motility. The data suggested that AA has beneficial influences in neutralizing the toxic effects of endosulfan in the spermatologic parameters of NZW males.

Correlation of seminal parameters with serum lipid profile and sex hormones

The phospholipids and fatty acid composition of sperm are altered under the influence of serum lipids on impaired seminal parameters in infertile men. We studied the correlation of the serum lipid profile and sex hormone results of a group of infertile men with sperm characteristics of 18 infertile men. Semen samples were collected and analyzed. Serum fasted and post-meal glucose levels, insulin, total cholesterol, HDL, LDL, VLDL, triglyceride, FSH, LH, and testosterone measurements were performed. The increased serum VLDL, total triglyceride, and testosterone values were significantly correlated with decreased sperm motility. Serum FSH values were also inversely correlated with normal sperm morphology. The increased VLDL impaired seminal parameters; additionally, increased triglycerides may have deleterious effects on spermatogenesis. Deterioration is related with increased serum VLDL and triglyceride levels.

Adhesion between Nanoscale Rough Surfaces

In this investigation, the adhesion between particles and plates with root-mean-square, rms, surface roughness of 0.17-10.5 nm was measured by atomic force microscopy. Measurements obtained with particles both larger and smaller than the surface asperities are presented. Results indicate adhesion force decreases sharply with increasing surface roughness in the nanometer scale (<2 nm), followed by a gradual and slow decrease with further increase in roughness. Existing models were found to significantly underestimate adhesion force. Hence, a new model based on a geometry that considers both the height and breadth of asperities yielding an increased asperity radius compared to previous approaches, as detailed in Part I of this series, is applied using both van der Waals and elastic deformation/work of adhesion based approaches. For the system studied in this investigation, the adhesion forces predicted by the proposed model are considerably more accurate than those predicted by past models. Copyright 2000 Academic Press.

Adhesion between Nanoscale Rough Surfaces

Nanoscale surface roughness strongly affects the adhesion force between surfaces. In this investigation, a model that more accurately describes the size of an asperity based on the measurable parameters of root-mean-square (rms) roughness and the distance between the asperities is derived. The radius of the asperity from the proposed model is much larger than the radius used in previous approaches, considering the same surface with nanoscale roughness. Using the proposed geometry and previously suggested models, this paper elucidates the contributions from contact and noncontact interactions of a particle adhered to a surface with nanoscale roughness (approximately less than 20 nm rms). For most surfaces considered, the contact interaction of the asperity and the adhering particle are found to dominate the interaction. In the second paper of this series, the proposed model is compared to the experimentally determined force of adhesion in systems with nanoscale roughness. Copyright 2000 Academic Press.

New steroidal alkaloids from the roots of buxus sempervirens

Phytochemical studies on an EtOH-soluble extract of the roots of Buxus sempervirens of Turkish origin have resulted in the isolation of three new steroidal alkaloids, (+)-semperviraminol (1), (+)-buxamine F (2), and (+)-17-oxocycloprotobuxine (3), along with two known steroidal alkaloids, (+)-buxoxybenzamine (4) and (+)-buxapapillinine (5). The structures of 1-3 were elucidated with the aid of spectroscopic studies. Compounds 4 and 5 exhibited phytotoxic activity against Lemna minor.

New steroidal alkaloids from the roots of buxus sempervirens

Phytochemical studies on an EtOH-soluble extract of the roots of Buxus sempervirens of Turkish origin have resulted in the isolation of three new steroidal alkaloids, (+)-semperviraminol (1), (+)-buxamine F (2), and (+)-17-oxocycloprotobuxine (3), along with two known steroidal alkaloids, (+)-buxoxybenzamine (4) and (+)-buxapapillinine (5). The structures of 1-3 were elucidated with the aid of spectroscopic studies. Compounds 4 and 5 exhibited phytotoxic activity against Lemna minor.