Validation of the Mayo Adhesive Probability score as a predictor of adherent perinephric fat and outcomes in open partial nephrectomy

BackgroundAdherent perinephric fat (APF) contributes to surgical complexity and can be associated with adverse perioperative outcomes for partial nephrectomy (PN). The Mayo Adhesive Probability (MAP) score accurately predicts the presence of APF during robotic-assisted partial nephrectomy (RAPN). Our primary aim is to validate MAP score as a predictor of APF in open partial nephrectomy (OPNx).MethodsWe reviewed 105 consecutive OPNx (100 patients) performed by a single surgeon with intraoperative determination of APF. We evaluated the ability of the MAP score to discriminate between those with APF and those without APF by estimating the area under the receiver operating characteristic curve (AUROCC). The association of perioperative outcomes with APF was evaluated as well.ResultsForty-three patients [49%; 95% confidence interval (CI), 39–59%] had intraoperative identification of APF. The MAP score had excellent ability to predict APF in OPNx (AUROCC, 0.82; 95% CI, 0.74–0.92). APF was observed in 6% of patients with a MAP score of 0-1, 27% with score 2, 52% with score 3, 75% with score 4, and 90% with score 5. The presence of APF was associated with longer operative times (P=0.004) and higher estimated blood loss (EBL) (P=0.003). Although not statistically significant, our study did suggest that APF may be associated with postoperative complications and prolonged length of stay (LOS) (>3 days).ConclusionsMAP score accurately predicts the presence of APF in patients undergoing OPNx. APF is associated with longer operative time and higher blood loss in OPNx.     

Debunking Lesbian Bed Death: Using Coarsened Exact Matching to Compare Sexual Practices and Satisfaction of Lesbian and Heterosexual Women

Archives of Sexual Behavior - The current study examined the prevalence and correlates of over 50 sexual practices in a national survey of heterosexual and lesbian women in relationships. Coarsened...     

Communication Patterns Among Male Couples with Open and Monogamous Agreements

Archives of Sexual Behavior - Male couples in open relationships tend to have as equally fulfilling relationships as monogamous male couples; however, less is known about communication differences...     

Efficacy of intracytoplasmic sperm injection using intentionally cryopreserved epididymal spermatozoa

Microsurgical epididymal sperm aspiration was a great advancein the therapy of patients with non-recon-structable, obstructiveazoospermia, most notably congenital bilateral absence of thevas deferens. Using conventional in-vitro fertilization, pregnancieswere rarely achieved because the rate of oocyte fertilizationwas extremely poor. However, the use of retrieved spermatozoain conjunction with intracytoplasmic sperm injection (ICSI)has dramatically increased the likelihood of embryo formation.Typically, sperm and oocyte harvesting are performed simultaneously.We have investigated whether frozen-thawed spermatozoa workas well as fresh spermatozoa. When we had concluded from ourown population of patients (groups I and II) that they did,we adopted a policy of aspirating spermatozoa, primarily cryopreservingthem and using them for ICSI at a later date. We found the fertilizationrates of this latter cohort of patients (group III) to be excellent(37% per oocyte), and the ongoing pregnancy rate is quite satisfactory(40 % per couple, 29% per cycle). We offer this approach asan alternative to the traditional scheme because it markedlyeases the burden of partner scheduling on both the couple andthe clinicians involved. In addition, assurance of the availabilityof male partner spermatozoa can be attained prior to beginningovulation induction.     

Generalized pharmacokinetic modeling for drugs with nonlinear binding: I. Theoretical framework

The following integrodifferential equation is proposed as the basis for a generalized treatment of pharmacokinetic systems in which nonlinear binding occurs $$\phi '(c_u )c'_u = - q(c_u ) + g*c_u + f$$ where c_u≡unbound plasma drug concentration, f≡drug input rate,'indicates the derivative of a function, and * indicates the convolution operation: (g* c_u)(t)=∫ ₀ ^t g(t?u)c_udu.Possible physical interpretations of the functions q, g and f are: q (c_u)≡ rate at which drug leaves the sampling compartment, g * c_u ≡ rate at which drug returns to the sampling compartment from the peripheral system (tissues that are kinetically distinct from the sampling compartment), and φ(c_u) ≡ amount of drug in the sampling compartment. The approach assumes that drug binding is sufficiently rapid that it may be treated as an equilibrium process. It may be applied to systems in which nonlinear binding occurs within the sampling compartment, i.e., in the systemic circulation or in tissues to which drug is rapidly distributed. The proposed relationship is a generalization of most existing models for drugs with nonlinear binding. It can serve as a general theoretical framework for such models or as the basis for “model-independent” methods for analyzing the pharmacokinetics of drugs with nonlinear binding. Computer programs for the numerical solution of the integrodifferential equation are presented. Methods for pharmacokinetic system characterization, prediction and bioavailability are presented and demonstrated.     

Multi-cultural health provision

It has almost become a cliché now that the changes the NHS is currently undergoing are the most far reaching since its inception in 1948. Some say that the NHS and Community Care Act represents the greatest opportunity for improvement: Rosemary Gillespie looks at the means to better the NHS's poor record on provision for ethnic minorities.     

A STUDY OF POSTDIAGNOSIS BREAST CANCER CONCERNS FOR WOMEN LIVING IN RURAL AND REMOTE QUEENSLAND. PART I: PERSONAL CONCERNS

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women's expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant's absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.