Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors

BACKGROUND: Anastomotic leakage in colorectal surgery remains a major challenge because of its early and late consequences. STUDY DESIGN: To determine whether prevalence and risk factors for anastomotic leakage (AL) differed between right and left elective colectomy for cancer, we conducted univariate and multivariate analyses and compared 33 variables (15 preoperative, 18 intraoperative) culled prospectively for 520 right and 1,230 left colectomies, followed by immediate anastomosis in 1,750 adult patients with or without AL. RESULTS: The overall AL rate was 4% (71 of 1,750) and was significantly lower (p < 0.0001) for right (7 of 520=1.35%) than for left colectomy (64 of 1,230=5.20%). Overall mortality was 4.1% (68 of 1,750), and was not statistically different (p=0.50) between right (4.6%, 24 of 520) and left (3.6%, 44 of 1,230)) colectomy. In right colectomy, differences in associated mortality rates with (14.3%, 1 of 7) and without (4.5%, 23 of 513) AL were not statistically significant (p=0.28), but in left colectomy, associated mortality was statistically significantly higher (p < 0.006) with AL (10.9%, 7 of 64) than without it (3.2%, 37 of 1,166). Independent risk factors for AL were preoperative in right colectomy: loss of weight (> 10%), odds ratio (OR)=5.62, with 95% CI 1.06 to 29.8; and intraoperative in left colectomy: palliative resection (OR=2.12; 95% CI 1.06 to 4.23), "poor" colonic cleanliness (OR=2.4; 95% CI 1.34 to 4.28), proximal colorectal anastomosis (OR=1.34; 95% CI 1 to 1.8), and distal colorectal anastomosis (OR=3.91; 95% CI 1.64 to 9.81). CONCLUSIONS: In right colectomy for cancer, preoperative nutritive support leading to regain of lost weight could reduce postoperative morbidity. Concerning left colectomy, if colonic cleanliness is poor, intraoperative colonic lavage should be done. When poor colonic cleanliness is associated with palliative resection and low distal rectal anastomosis, a protective stoma should be considered.     

Persistence of Vaccine Hesitancy and Acceptance of the EU Covid Certificate Among French Students

Covid-19 vaccine hesitancy among young adults is a current public health issue that needs to be addressed considering the seasonally driven waves of disease and the administration of vaccine boosters. As a prevention measure, the EU Covid certificate had been implemented to increase vaccine uptake, but its application was controversial. Our study investigated students’ opinions and attitudes towards Covid-19 vaccination and the EU Covid certificate through a mixed-methods design. An 18-item questionnaire was administered to 200 students during a vaccination campaign in September 2021 at the University of Bordeaux, France. Simultaneously, 30 students attended a semi-structured interview. Collected data were analyzed separately then discussed together through a parallel and convergent approach. Results showed that vaccine hesitancy was high among students, mostly from fear of short-term side effects. However, respondents decided to get vaccinated to obtain the EU Covid certificate, even if they considered it as a violation of their freedom. Straightforward communication about Covid-19 vaccination did not reach students, although this was a strong expectation from governmental and health institutions. Findings suggest that key health personnel should provide evidence-based information about vaccines in efforts of building trust with young people.

     

Oligoanovulation with polycystic ovaries but not overt hyperandrogenism

OBJECTIVES: By requiring a minimum of two of three items [hyperandrogenism (HA), oligoanovulation (OA), and polycystic ovaries (PCO) at ultrasound], the Rotterdam definition recognizes four PCO syndrome (PCOS) phenotypes: HA+OA+PCO (full-blown syndrome), HA+OA (former National Institutes of Health definition), HA+PCO (ovulatory PCOS), and OA+PCO. However, the latter phenotype is controversial, and it is not known to what extent it shares similarities with the others. DESIGN: The study was a comparative analysis of hormonal, metabolic, and ultrasound parameters obtained from patients and controls that were consecutively included in a database. PATIENTS AND METHODS: Sixty-six patients having OA+PCO without hirsutism or elevated serum androstenedione and testosterone levels were compared with 118 normally cycling nonhyperandrogenic age-matched women without PCO (controls). These patients (phenotype D) were also compared with patients with HA+OA+PCO (phenotype A, n = 246), HA+OA (phenotype B, n = 27), and HA+PCO (phenotype C, n = 67). RESULTS: Patients with phenotype D had higher mean values of waist circumference and higher mean levels of serum testosterone, androstenedione, and LH than controls. Conversely, they had lower mean serum levels of FSH and SHBG (P < 0.05 for each parameter). Variance analysis disclosed significant group effects between the different patients' phenotypes for all parameters, except age, BMI, and FSH. After multiple comparisons with post hoc analysis, phenotype D had milder endocrine and metabolic abnormalities than phenotype A, although it did not differ from phenotype C, except for androgen data, by definition. Phenotypes A and B were statistically similar, except for the ultrasound data, by definition. CONCLUSION: Oligoanovulatory patients with PCO but without HA have mild endocrine and metabolic features of PCOS.     

Brain hydrodynamics study by phase-contrast magnetic resonance imaging and transcranial color doppler

PURPOSE: To evaluate the contributions of phase-contrast magnetic resonance (PCMR) and transcranial color Doppler (TCCD) imaging in the investigation of cerebral hydrodynamics. MATERIALS AND METHODS: A total of 13 healthy subjects were studied. Blood velocity measurements were performed with TCCD and gated PCMR imaging in major intracranial and extracranial arteries stages. Peak systolic velocity and end-diastolic velocity were extracted to establish correlations between TCCD and PCMR imaging. Cerebral blood flow (CBF) and intracranial volume change (IVC) during the cardiac cycle were calculated, taking into account cerebrospinal fluid (CSF) oscillations. RESULTS: Despite an underestimation of velocities with PCMR imaging, significant correlations were observed for velocity measurements between the two modalities in extracranial vessels, but were poorly correlated in intracranial vessels. PCMR data processing gave a mean CBF of 690+/-90 mL/minute. CONCLUSION: PCMR imaging provides complementary information to TCCD to assess various intracranial parameters such as instantaneous velocities, blood and CSF flow distributions, volume variation, or pressure regulation mechanisms during cardiac cycles.     

Cyanoacrylate embolization of experimental aneurysms

BACKGROUND AND PURPOSE: Cyanoacrylates are effective occlusive agents in neurovascular interventions. To study their potential to improve long-term results of endovascular treatment of aneurysms, we conducted experimental studies in canine aneurysm models. METHODS: Venous pouch carotid aneurysms were constructed in dogs. Results of coil embolization of lateral wall and bifurcation aneurysms were compared. A lateral wall model of embolization with gelatin sponges was used to study the effects of coating sponges with cyanoacrylate on angiographic results and neointima thickness at 3 and 12 weeks. These models were also used to investigate the control of endovascular cyanoacrylate deposition, alone or over a coil placed at the neck of the treated lesions. The results of endovascular cyanoacrylate embolization of bifurcation aneurysms were compared with those of coil embolization at 3 months. RESULTS: Bifurcation aneurysms treated with coils showed more frequent recurrences (P <.01) and thinner neointimas (P <.01) at 3 months than did lateral wall aneurysms. Cyanoacrylate-coated sponges improved angiographic results (P <.05) and led to thicker neointimas at 3 and 12 weeks (P <.05) as compared with uncoated sponges. Endovascular cyanoacrylate deposition with microcatheters led to stray emboli in all cases. Cyanoacrylate delivery was improved by a single coil positioned at the neck of the aneurysm, but parent vessel embolization still occurred in 25% of the animals. Cyanoacrylate embolization of bifurcation aneurysms improved angiographic results at 3 months as compared with coil embolization (P <.01). CONCLUSION: Cyanoacrylate embolization is currently difficult to control. It has the potential to decrease recurrences after endovacular treatment of aneurysms, but a safe method for endovascular delivery has yet to be developed.     

Recognition memory for emotional and neutral faces: an event-related potential study

This study examined emotional influences on the hypothesized event-related potential (ERP) correlates of familiarity and recollection (Experiment 1) and the states of awareness (Experiment 2) accompanying recognition memory for faces differing in facial affect. Participants made gender judgments to positive, negative, and neutral faces at study and were in the test phase instructed to discriminate between studied and nonstudied faces. Whereas old-new discrimination was unaffected by facial expression, negative faces were recollected to a greater extent than both positive and neutral faces as reflected in the parietal ERP old-new effect and in the proportion of remember judgments. Moreover, emotion-specific modulations were observed in frontally recorded ERPs elicited by correctly rejected new faces that concurred with a more liberal response criterion for emotional as compared to neutral faces. Taken together, the results are consistent with the view that processes promoting recollection are facilitated for negative events and that emotion may affect recognition performance by influencing criterion setting mediated by the prefrontal cortex.     

Quantification of host–microbe interactions by automated fluorescence microscopy

We describe an automated fluorescence microscopy-based assay that quantifies the invasion of mammalian cells by intracellular pathogens. Pathogens associated with host cell surfaces, intracellular pathogens and mammalian cells are directly counted based on their specific fluorescent labeling. Such approach utilizes automated image acquisition and processing, and is thus ideally suited for high-throughput analyses. This method was validated using Listeria monocytogenes as a model intracellular pathogen.     

Regional differences in the effect of the combined treatment of WAY 100635 and fluoxetine: an in vivo microdialysis study

We studied the changes in extracellular serotonin (5-HT) levels in the frontal cortex (FC) and ventral hippocampus (vHi) in conscious rats, induced by the combined administration of a highly selective 5-HT_1A receptor antagonist, WAY 100635 (0.1 mg/kg, i.v.), and fluoxetine (1 mg/kg, i.p.), a selective 5-HT reuptake inhibitor (SSRI). In the two brain areas studied, no change in extracellular 5-HT concentrations was observed following fluoxetine administration over the 210 min post-injection period. However, in animals co-administered with [WAY 100635 + fluoxetine], the maximal increase in 5-HT levels in the FC was to 215% of the respective basal value (100%), while no significant change in 5-HT was observed in dialysates from the vHi. Furthermore, the [norfluoxetine]-to-[fluoxetine] ratio in the FC was significantly higher than in the hippocampus as measured in homogenates of animals treated with either fluoxetine alone or a prior administration of WAY 100635. Thus, WAY 100635 made the fluoxetine short-lasting effect apparent in the FC, but not by interfering with pharmacokinetic parameters of fluoxetine. Taken together, our data suggest the possibility, that either 5HT-_1A autoreceptor sensitivity or uptake carrier density or higher [metabolite]-to-[parent drug] ratios in the FC than in the hippocampus may be involved in regional specific responses to SSRIs.     

Deletion of astroglial connexins weakens the blood-brain barrier

Astrocytes, the most prominent glial cell type in the brain, send specialized processes named endfeet, which enwrap blood vessels and express a large molecular repertoire dedicated to the physiology of the vascular system. One of the most striking properties of astrocyte endfeet is their enrichment in gap junction protein connexins 43 and 30 (Cx43 and Cx30) allowing for direct intercellular trafficking of ions and small signaling molecules through perivascular astroglial networks. The contribution of astroglial connexins to the physiology of the brain vascular system has never been addressed. Here, we show that Cx43 and Cx30 expression at the level of perivascular endfeet starts from postnatal days 2 and 12 and is fully mature at postnatal days 15 and 20, respectively, indicating that astroglial perivascular connectivity occurs and develops during postnatal blood-brain barrier (BBB) maturation. We demonstrate that mice lacking Cx30 and Cx43 in GFAP (glial fibrillary acidic protein)-positive cells display astrocyte endfeet edema and a partial loss of the astroglial water channel aquaporin-4 and β-dystroglycan, a transmembrane receptor anchoring astrocyte endfeet to the perivascular basal lamina. Furthermore, the absence of astroglial connexins weakens the BBB, which opens upon increased hydrostatic vascular pressure and shear stress. These results demonstrate that astroglial connexins are necessary to maintain BBB integrity.