Neoadjuvant Therapy and Anastomotic Leak After Tumor-Specific Mesorectal Excision for Rectal Cancer

Purpose  This study was designed to evaluate whether neoadjuvant therapy is a risk factor for anastomotic leakage after rectal cancer surgery. Methods  A retrospective review of 220 patients who underwent tumor-specific mesorectal excision for rectal cancer from 2000 to 2005 was performed. Risk factors for leak were identified by using a multivariable regression model. Results  A total of 54 patients received neoadjuvant chemoradiation therapy and surgery, whereas 166 received surgery alone. No difference in clinically significant leaks was observed between the two groups (5.6 vs. 6.6 percent, P = 1). A diverting ileostomy was performed in 26.4 percent of patients who received neoadjuvant therapy compared with 9.7 percent for surgery alone (P = 0.0021). Neoadjuvant patients were more likely to have ultralow anastomoses (17.6 vs. 2.5 percent, P < 0.0001). On multivariate analysis, smoking (odds ratio, 6.37 (1.8, 22.2), P = 0.004), difficult anastomosis (odds ratio, 7.66 (1.8, 31.5), P = 0.0048), and low level of anastomosis (≤4 cm from the verge; odds ratio, 5.28 (1.05, 26.6), P = 0.044) were independently associated with anastomotic leakage. Conclusions  Significant predictors of anastomotic leak include smoking, difficult anastomosis, and level of anastomosis (≤4 cm). Neoadjuvant chemoradiation therapy was not found to be significantly associated with leakage after tumor-specific mesorectal excision for rectal cancer. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.     

Maximum bite force following unilateral implant‐supported prosthetic treatment: within‐subject comparison to opposite dentate side

Bite force is a significant component of chewing and masticatory function. The literature lacks studies that compare bite force values of implant‐supported fixed bridges to natural dentition within same subjects. The objective of the study was to assess maximum occlusal bite force (MBF) among patients with an implant‐supported fixed prosthesis and compare it to their opposite dentate side and also to determine the effect of gender, age and Body Mass Index (BMI) on maximum occlusal bite force. Forty patients (20 males and 20 females, mean age = 42·7 ± 9·6 years) with an implant‐supported fixed prosthetic rehabilitation on one side and dentate on the other side were recruited into this study. Participants' MBF were measured bilaterally at the first molar region using a digital hydraulic occlusal force gauge (GM10). The measurements were repeated three times (with 45 s intervals between times) for each side, and the highest value of the bite force (MBF) was recorded for each side. The mean MBF was 577·9 N at the implant‐supported prosthesis side and 595·1 N at the dentate side. The average MBF was higher at the dentulous side (P < 0·05). Maximum occlusal bite force was higher in males and participants with higher weight and height. However, BMI was not significantly related to MBF values. Maximum occlusal bite force values at the dentate side were slightly (3%) but significantly higher than MBF at implant‐supported prosthesis side. Males, taller patients and patients with higher weights had higher MBF values. Body mass index was not significantly related to MBF values.     

Endothelial glycocalyx on brain endothelial cells is lost in experimental cerebral malaria

We hypothesized that the glycocalyx, which is important for endothelial integrity, is lost in severe malaria. C57BL/6 mice were infected with Plasmodium berghei ANKA, resulting in cerebral malaria, or P. chabaudi AS, resulting in uncomplicated malaria. We visualized the glycocalyx with transmission electron microscopy and measured circulating glycosaminoglycans by dot blot and ELISA. The glycocalyx was degraded in brain vasculature in cerebral and to a lesser degree uncomplicated malaria. It was affected on both intact and apoptotic endothelial cells. Circulating glycosaminoglycan levels suggested that glycocalyx disruption preceded cerebral manifestations. The contribution of this loss to pathogenesis should be studied further.     

Impact of the LSVT on vowel articulation and coarticulation in Parkinson’s disease

The purpose of this study was to investigate the impact of the Lee Silverman Voice Treatment (LSVT®) on vowel articulation and consonant–vowel (C–V) coarticulation in dysarthric speakers with Parkinson’s disease (PD). Nine Quebec French speakers diagnosed with idiopathic PD underwent the LSVT®. Speech characteristics were compared before and after treatment. Vowel articulation was measured using acoustic vowel space and calculated with the first (F1) and second formant (F2) of the vowels /i/, /u/ and /a/. C–V coarticulation was measured using locus equations, an acoustic metric based on the F2 transitions within vowels in relation to the preceding consonant. The relationship between these variables, speech loudness and vowel duration was also analysed. Results showed that vowel contrast increased in F1/F2 acoustic space after administration of the LSVT®. This improvement was associated with the gain in speech loudness and longer vowel duration. C–V coarticulation patterns between consonant contexts showed greater distinctiveness after the treatment. This improvement was associated with the gain in speech loudness only. These results support the conclusions of previous studies investigating the relationship between the LSVT®, speech loudness and articulation in PD. These results expand clinical understanding of the treatment and indicate that loud speech changes C–V coarticulation patterns. Clinical applications and theoretical considerations are discussed.     

Research Review: A new perspective on attention-deficit/hyperactivity disorder: emotion dysregulation and trait models

Attention-deficit/hyperactivity disorder (ADHD) is a common example of developmental psychopathology that might be able to be better understood by taking an emotion regulation perspective. As discussed herein, emotion regulation is understood to consist of two component processes, emotion (e.g., positive and negative emotionality) and regulation (e.g., effortful and reactive forms of control), which interact with one another at the behavioral level. Review of work to date suggests that the heterogeneous behavioral category of ADHD may encompass two distinct kinds of inputs: inattentive ADHD symptoms may be primarily associated with breakdowns in the regulation side, whereas hyperactivity-impulsive ADHD symptoms may be associated with breakdowns in the emotionality side. It is argued that breakdowns in control may be a signature for ADHD specifically, while increased negative emotionality may serve as non-specific risk factors for disruptive behavior disorders, explaining their comorbidity. Increased understanding of the interrelations and interactions of component emotion regulation processes may elucidate developmental, sex, and neural mechanisms of ADHD and associated comorbid disruptive disorders.     

Effect of nickel on the mineralization of hydrocarbons by indigenous microbiota in Kuwait soils

Assessment of nickel contents in soil samples in Kuwait indicated only a minor difference in concentration in hydrocarbon‐contaminated (86 mg kg^–1 soil) and non‐contaminated soils (84 mg kg^–1 soil). The potential inhibitory effects of nickel on the number of hydrocarbon degraders, and hydrocarbon utilization were investigated over a wide range of nickel concentrations to span concentrations observed in the soil. Nickel addition, as nickel sulphate, to soil samples reduced the number of hydrocarbon degraders in all samples by a wide range (15–96%) depending on concentration and the hydrocarbon substrate utilized. Similarly, the metabolic activities were affected as observed in mineralization (3–60%) of soils amended with various concentrations of nickel. The inhibitive effects of nickel on hexadecane and crude oil utilization were minimal but were significantly higher with naphthalene (P < 0.05) in both hydrocarbon‐contaminated and non‐contaminated soils. Polarographic determination of hydrocarbons induced oxygen uptake rate demonstrated the tendency of nickel to significantly inhibit (P < 0.05) the oxidation of polyaromatic hydrocarbons compared to aliphatic hydrocarbons. (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)