Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

Background  Advances in surgery have considerably lowered postoperative morbidity. However, infection remains a considerable morbidity factor. The aim of this review is to identify the potential benefit(s) of the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Methods  We searched PubMed, Scopus, Web of Science, and Cochrane library to identify randomized controlled trials (RCTs) that studied the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Results  Nine RCTs studying 733 patients were included in our review. The incidence of postoperative pneumonia, cholangitis, and any infections as well as the duration of postoperative hospital stay and length of antibiotic therapy were lower among patients receiving probiotics than in the control group [six RCTs, 355 patients, odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09–0.68; three RCTs, 209 patients, OR 0.18, 95% CI 0.05–0.57; seven RCTs, 514 patients, OR 0.26, 95% CI 0.12–0.55; five RCTs, 313 patients, OR −2.70, 95% CI −5.15 to −0.25; four RCTs, 250 patients, OR  −4.01, 95% CI −5.11 to −2.92, respectively], while the incidence of postoperative wound infection, urinary tract infection, intra-abdominal abscess, and mortality was not different between patients of the compared groups (six RCTs, 355 patients, OR 0.52, 95% CI 0.23–1.18; five RCTs, 313 patients, OR 0.44, 95% CI 0.04–5.54; four RCTs, 226 patients, OR 0.44, 95% CI  0.12–1.59; nine RCTs, 685 patients, OR 0.98, 95% CI 0.29–3.29, respectively). Conclusion  The use of probiotics/synbiotics may reduce postoperative infections after abdominal surgery. This is a promising infection-preventive measure that may decrease morbidity, length of antibiotic therapy, duration of hospital stay, and pressure for emergence of antimicrobial resistance. However, the results of this meta-analysis should be interpreted with caution due to the significant heterogeneity of the studies included.     

Experimentelle untersuchungen über die Beziehungen von Hypophysenhinterlappen und Ovarien

Ohne Zusammenfassung     

Association of demographic, clinical and treatment variables with quality of life of patients with epilepsy in Greece

PURPOSE: The aim was to study the influence of patients' age, frequency and type of seizures, disease duration, number of AEDs and use of benzodiazepines on the quality of life of patients with epilepsy. PATIENTS AND METHODS: We consecutively identified 223 patients with epilepsy who attended the epilepsy outpatient clinics at three university hospitals in Greece. Quality of life was evaluated by QOLIE-31. One-way analysis was used to assess the association of the studied factors and QOLIE-31 subscales. After checking for co-linearity, we performed multivariate stepwise linear regression analysis with all the variables that on univariate analysis showed a statistically significant effect on each subscale of QOLIE-31 to explore which of the studied factors affect independently on QOLIE-31 scores. RESULTS: Of a total of 223 patients, 118 (52.95%) were men; mean age was 35.18 +/- 13.22; mean duration of the disease was 13 years; 58 (26%) patients had generalized seizures, 93 (41.7%) had PS, and 72 (32.3%) of the patients had PsG; 85 (38.1%) were on polytherapy and 38 (17%) were taking benzodiazepines. Independent factors affecting QoL were: seizure frequency (Overall QoL P = 0.0001, Seizure worry and Emotional well-being P < 0.0001, Energy/fatigue and Social functioning P = 0.01); duration of the disease (Overall QoL and Energy/fatigue P = 0.01, Seizure worry P = 0.008, Cognitive functioning P < 0.0001); polytherapy only for the Emotional well-being P < 0.0001; and use of benzodiazepines (Overall QoL, Energy/fatigue, Social functioning P = 0.002, Cognitive functioning P < 0.0001). CONCLUSION: Our findings suggest that QoL in epileptic patients might be affected, in addition to the other established factors (high frequency of seizures and polytherapy), by the daily use of benzodiazepines as adjunctive therapy. Change of medical strategy concerning this medication may lead to improving the QoL of these patients.     

Endothelin system and atrial fibrillation post-cardiac surgery

Objective We investigated the relation between the endothelin system and atrial fibrillation. Background Endothelin has been implicated in the pathophysiology of atrial fibrillation, but the exact role of A- and B-receptors is unknown. Methods We obtained right atrial biopsies from patients in sinus rhythm and preserved left ventricular function, undergoing off-pump coronary artery bypass grafting. The expression of endothelin, A- and B-receptors was measured using real time reverse-transcribed polymerase chain reaction. Results We studied 52 patients (45 male, mean age 66 ± 1 years, mean ejection fraction 52 ± 1%). During a 5-day post-operative period, persistent atrial fibrillation occurred in 15 patients (28.8%). Endothelin mRNA expression was comparable in patients who subsequently developed atrial fibrillation and in those maintaining sinus rhythm. However, the former group displayed down-regulation of endothelin A- (by approximately 60%, p = 0.0059) and of B-receptors (by approximately 40%, p = 0.0084). The decreased endothelin A-receptor expression could predict atrial fibrillation occurrence (Wilks λ = 0.86, F = 6.16, p = 0.017). Conclusion Decreased endothelin A- and B-receptor expression is associated with atrial fibrillation after bypass surgery. Theofilos M. Kolettis and Zenon S. Kyriakides contributed equally to the study.     

Assessment of overactive bladder symptoms among women with successful pessary placement

Introduction and hypothesis

The causal association between pelvic organ prolapse (POP) and overactive bladder (OAB) symptoms is supported by several theories. The aim of this study is to assess any changes in OAB symptoms among women with POP and OAB after successful pessary placement.

Methods

During the study period, all women with symptomatic POP stage II or greater and OAB symptoms were offered the solution of either a ring or a Gellhorn pessary. All patients were asked to complete a 3-day micturition/incontinence diary. Objective evaluation endpoints at baseline and at 6 weeks included: change in the mean number of micturitions/24 h, change in the mean volume voided per micturition/24 h, and change in the number of urinary incontinence episodes. Subjective evaluation of the urgency, frequency, and nocturia symptoms was carried out using the score change of the questions 3, 5, and 2 of the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) respectively.

Results

Seventy-four women were included in the study. A statistically significant decrease (?28.3%; p < 0.001) of the mean number of micturitions/24 h with a significant increase (37%; p < 0.001) in the mean voided volume per micturition/24 h was observed. The total urine volume/24 h remained unchanged. The number of urinary incontinence episodes was significantly increased 6 weeks after pessary placement (p < 0.001). De novo stress urinary incontinence (SUI) was reported by 16.7% of the initially stress continent women.

Conclusions

Women with coexisting POP and OAB symptoms may experience a significant improvement in micturition frequency and in urgency and frequency symptoms after successful pessary fitting.

     

Life before death: identifying preparatory grief through the development of a new measurement in advanced cancer patients (PGAC)

Goals of work This paper describes the development of a self-rating scale to measure preparatory grief in advanced cancer patients.Patients and methods The Preparatory Grief in Advanced Cancer patients (PGAC) instrument incorporates seven multi-items scales. The final sample consisted of 200 patients. The questionnaire was completed at baseline and 3 days later with a cross-validation sample of 100 patients.Main results The average time required to complete the questionnaire was 9 min. All scales met the minimum standards of reliability (Cronbachs alpha coefficient >0.70). The test–retest reliability in terms of Spearman-rho coefficient was also satisfactory (p<0.05). Validity was demonstrated by content validity, factor analysis, convergence and discriminative validity, inter-scales correlations, concurrent validity with the Hospital Anxiety and Depression Scale (HADS) and known-group validity with the Eastern Cooperative Oncology Group (ECOG) performance status.Conclusions The PGAC is a reliable and valid measure for the assessment of anticipatory grief in patients with advanced stage cancer.     

Frequency of operative trauma to anal sphincters: evaluation with endoanal ultrasound.

Sphincter trauma after anorectal surgery is usually asymptomatic. Frequency of trauma cannot be established with the clinical examination only. The frequency of operative sphincter defects and their correlation with disorders of continence was evaluated with the endoanal ultrasound. This study includes 123 subjects who had undergone anorectal surgery in the past and were examined with endoanal ultrasound for various indications such as continence disorders, recurrent fistula, idiopathic perineal pain, or simple postoperative follow-up. No subjects had isolated external anal sphincter defects.Nineteen of 123 patients (15%) had minor or major continence disorders, 55 patients (45%) had no sphincter defects, 42 (34%) had only internal anal sphincter (IAS) defects, and 26 (21%) had simultaneously external and internal anal sphincter (EAS) defects. The incidence of IAS and EAS trauma after Milligan-Morgan hemorrhoidectomy was 1/18 (5.5%) and 0/18 respectively; after fistula repair, 24/42 (57%) and 12/42 (29%); and after anal dilatation, 13/17 (76%) and 4/17 (24%). Sixteen of 26 patients (62%) with EAS trauma and 51/68 patients (75%) with IAS trauma did not report any disorders of continence. In patients with two or more operations, the frequency of IAS trauma was 74%, 30% for EAS trauma, and 26% for continence disorders.     

Temporal multiplexing with adaptive optics for simultaneous vision

We present and test a methodology for generating simultaneous vision with a deformable mirror that changed shape at 50 Hz between two vergences: 0 D (far vision) and −2.5 D (near vision). Different bifocal designs, including toric and combinations of spherical aberration, were simulated and assessed objectively. We found that typical corneal aberrations of a 60-year-old subject changes the shape of objective through-focus curves of a perfect bifocal lens. This methodology can be used to investigate subjective visual performance for different multifocal contact or intraocular lens designs.OCIS codes: (330.7335) Visual optics, refractive surgery; (110.3000) Image quality assessment; (220.1010) Aberrations (global); (220.1080) Active or adaptive optics; (330.7327) Visual optics, ophthalmic instrumentation     

Administration of antimicrobials via the respiratory tract for the treatment of patients with nosocomial pneumonia: a meta-analysis

BACKGROUND: Aerosolized antibiotics are a widely recognized treatment for patients with cystic fibrosis (CF). We sought to clarify their role in the treatment of non-CF patients with nosocomial pneumonia by performing a meta-analysis of randomized controlled trials (RCTs) that compared administration of antimicrobials via the respiratory tract (with or without concurrent usage of systemic antibiotics) with control treatment. METHODS: An extensive search of PubMed, Scopus, Cochrane Central Register of Controlled Trials, Current Contents and bibliographies from retrieved publications was made. RESULTS: Five RCTs were included in the meta-analysis. Administration of antimicrobials via respiratory tract (either inhaled or endotracheally instilled) as opposed to control was associated with better treatment success in intention-to-treat [fixed effect model: odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.29-4.44; random effects model: OR = 2.75, 95% CI 1.06-7.17] and in clinically evaluable patients (fixed effect model: OR = 3.14, 95% CI 1.48-6.70; random effects model: OR = 3.07, 95% CI 1.15-8.19). There were no statistically significant differences between therapeutic regimens regarding all-cause mortality (fixed effect model: OR = 0.84, 95% CI 0.43-1.64; random effects model: OR = 0.71, 95% CI 0.27-1.88), microbiological success (fixed effect model: OR = 2.06, 95% CI 0.91-4.68; random effects model: OR = 2.23, 95% CI 0.64-7.71) and toxicity (fixed effect model: OR = 0.34, 95% CI 0.04-2.53; random effects model: OR = 0.36, 95% CI 0.04-3.16). CONCLUSIONS: The limited available evidence seems not to preclude a benefit from the administration of antimicrobial agents via the respiratory tract for treating nosocomial pneumonia.     

Development and applications of a real-time quantitative RT-PCR method (QRT-PCR) for BRCA1 mRNA

OBJECTIVES: To develop a real-time quantitative RT-PCR method for BRCA1 mRNA and then use it for the study of BRCA1 gene expression in human MCF-7 breast cancer cells after their exposure to antineoplastic agents and gamma irradiation. DESIGN AND METHODS: The developed QRT-PCR method is based on the real-time monitoring of a fluorescein-labeled TaqMan probe, specific for BRCA1 mRNA, during PCR in the LightCycler. A BRCA1 PCR amplicon was purified, quantitated and used as a standard of known concentration for the development and analytical evaluation of the assay. The method was applied to study the alteration of BRCA1 gene expression after exposure to taxol, doxorubicin, 5-fluorouracil, etoposide or gamma irradiation in human MCF-7 breast cancer cells. RESULTS: The developed method is quantitative, highly specific for mRNA and highly sensitive (detection limit of 4 BRCA1 copies per mug of total RNA). We observed a reduction of BRCA1 expression for all antineoplastic agents used, while the gamma irradiated MCF-7 cells had an increase of expression with a peak at the 10 Gy dose. CONCLUSIONS: The developed BRCA1 QRT-PCR method is quantitative, highly sensitive and specific. The proposed method is rapid, automated, and cost effective and can be used to study BRCA1 expression in a variety of clinical samples.