Laparoscopic Ligation of Uterine Vasculature for Fertility-Sparing Management of Postabortal Hemorrhage

Study Objective

To present a surgical video in which bilateral uterine vasculature was ligated laparoscopically in order to preserve the uterus in a patient with postabortal hemorrhage.

High jugular bulb: different osseous landmarks and their clinical implications

Purpose

The purpose of this investigation was to compare the rate of high jugular bulb (HJB) in relation to internal acoustic meatus (IAM), round window (RW) and endolymphatic sac and to study their clinical implications.

Methods

Eighty-seven cadaveric non-pathologic human temporal bones were micro-dissected to expose the jugular fossa (JF) and RW. The minimum distance of JF from RW was measured. On the inner surface of petrous part of temporal bone, minimum vertical distance of JF from IAM and saccus endolymphaticus (E sac) was also measured. If the distance of summit of JF from RW or IAM was ≤2 mm or if there was no distance between JF and slit on which E sac opens, they were classified as HJB cases.

Results

The mean minimum distance of JF from the RW, IAM and E sac was found to be 2.85 ± 1.58, 3.83 ± 2.38 and 2.06 ± 2.38 mm and the rate of HJB was 32.2, 24.1 and 41.4 % respectively.

Conclusions

The rate of HJB varies even in a particular specimen using different landmarks i.e. the RW, IAM and E sac. The preoperative awareness in relation to these landmarks will be useful in cochlear implantation, surgical removal of vestibular schwanommas and clinical findings of Meniere’s disease.

     

Antigen‐specific TIL therapy for melanoma: A flexible platform for personalized cancer immunotherapy

Tumor infiltrating lymphocyte (TIL) therapy has shown objective clinical response rates of 50% in stage IV melanoma patients in a number of clinical trials. Nevertheless, the majority of patients progress either directly upon therapy or after an initial period of tumor control. Recent data have shown that most TIL products that are used for therapy contain only low frequencies of T cells reactive against known melanoma‐associated epitopes. Because of this, the development of a technology to create T‐cell products that are enriched for reactivity against defined melanoma‐associated antigens would seem valuable, both to evaluate the tumoricidal potential of T cells directed against different antigen classes and to potentially increase response rates. Here, we developed and validated a conditional MHC streptamer‐based platform for the creation of TIL products with defined antigen reactivities. We have used this platform to successfully enrich both high‐frequency (≥1%) and low‐frequency (<1%) tumor‐specific CD8⁺ T‐cell populations, and thereby created T‐cell products with enhanced tumor recognition potential. Collectively, these data demonstrate that selection of antigen‐specific T‐cell populations can be used to create defined T‐cell products for clinical use. This strategy thus forms a highly flexible platform for the development of antigen‐specific cell products for personalized cancer immunotherapy.     

Lower levels of oxidative DNA damage and apoptosis in lymphocytes from patients undergoing surgery with propofol anesthesia

Propofol, which is widely used as an intravenous anesthetic, has a phenolic structure similar to that of α‐tocopherol with antioxidant properties that could prevent genotoxicity and cytotoxicity in lymphocytes of anesthetized patients. The aims of this study were to evaluate oxidative DNA damage and apoptosis in lymphocytes and the expression of DNA repair genes in blood cells from patients undergoing elective surgery under anesthesia with propofol. Twenty healthy adults of both genders (18–50 years old) who were scheduled for otorhinological surgery were enrolled in this study. Blood samples were collected before anesthesia induction (T₁‐baseline), 120 min after anesthesia induction (T₂), and on the first postoperative day (T₃). Oxidative DNA damage in peripheral lymphocytes was assessed using the comet assay. Lymphocytes were phenotyped as T helper or cytotoxic T cells, and apoptosis was evaluated using flow cytometry. The expression of DNA repair genes (hOGG1 and XRCC1) was assessed by quantitative polymerase chain reaction. A reduction in the level of oxidized purines in DNA (P < 0.01) was observed 120 min after anesthesia induction, and reduced apoptosis of T helper cells was observed 120 min after anesthesia induction and on the first postoperative day. Down‐regulation of hOGG1 and XRCC1 gene expression was observed on the first postoperative day. In conclusion, patients undergoing non‐invasive surgery under propofol anesthesia presented lower levels of oxidized purines and apoptosis of T helper lymphocytes. Furthermore, anesthesia with propofol did not directly influence the expression of the DNA repair genes hOGG1 and XRCC1 in blood cells. © Environ. Mol. Mutagen. 2012. Published 2011 Wiley Periodicals, Inc.     

Community violence exposure and delinquent behaviors among youth: The moderating role of coping

This study examines the moderating roles of guardian and peer support and behavioral coping strategies on the relations between youths' community violence exposure and their delinquent behavior. A sample of 667 public school sixth‐graders in a large inner‐city school district, and their parents or guardians, were interviewed to assess youths' recent exposure to community violence, their delinquent behavior, and proposed moderating variables. Support from guardians buffered the relation between girls' victimization by community violence and delinquency. Support from peers buffered the effects of witnessing community violence on delinquent behavior of boys, but it amplified the effects of victimization for both girls and boys. Avoidant coping behavior buffered the effect of victimization on delinquency for boys but unexpectedly amplified the effect of witnessing violence on delinquency for girls. For both genders, confrontational coping strategies amplified the impact of victimization on delinquency and, for boys only, amplified the impact of witnessing violence as well. Controls were imposed for variables expected to influence the relation between exposure and delinquency, such as ethnicity, family violence, delinquent behavior of friends, and recruitment cohort. Suggestions for future research and implications for intervention are discussed. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 489–512, 2003.     

A randomized controlled trial examining the addition of folic acid to iron supplementation in the treatment of postpartum anemia

Objective

To evaluate the efficacy of adding folic acid to oral iron supplementation in postpartum women with anemia.

Methods

A randomized controlled trial was conducted in the Netherlands between April 8, 2008, and August 31, 2010. A total of 112 postpartum women with anemia (hemoglobin < 10.5 g/dL) were randomly allocated to receive 600 mg/day ferrous fumarate plus 1 mg/day folic acid (FFFA group) or 600/day ferrous fumarate alone (FF group) for 4 weeks. Primary outcome measures were hemoglobin and health status. Secondary outcome measures were fatigue, compliance, and adverse reactions.

Results

No between-group differences were observed in hemoglobin and health status after treatment, and no differences were found in fatigue scores. Approximately 75% of all women reported having at least one symptom resulting from ferrous fumarate use. Constipation caused by ferrous fumarate was significantly associated with non-compliance (P = 0.014).

Conclusion

The addition of folic acid to iron supplementation is not beneficial in women with postpartum anemia, as it has no effect on hematologic or health status parameters. Clinical Trial Registration: CCMO website NL21797.028.08 and Netherlands Trial Register NTR2232.     

Comparison of inflammatory cytokine profiles in plasma of patients undergoing otorhinological surgery with propofol or isoflurane anesthesia

Objective and design

The effects of anesthetics on cytokine release in patients without comorbidities who undergo minor surgery are not well defined. We compared inflammatory cytokine profiles in adult patients undergoing minimally invasive surgery who received isoflurane or propofol anesthesia.

Methods

Thirty-four patients without comorbidities undergoing minor surgery were randomly assigned to receive an inhaled anesthetic (isoflurane; n = 16) or an intravenous anesthetic (propofol; n = 18). Blood samples were drawn before premedication and anesthesia (T1), 120 min after anesthesia induction (T2), and on the first post-operative day (T3). Plasma concentrations of interleukins (IL-) 1β, 6, 8, 10 and 12 and tumor necrosis factor (TNF)-α were measured using flow cytometry.

Results

The pro-inflammatory cytokine IL-6 was increased in the isoflurane group at T2 and T3 compared to T1 (P < 0.01). In the propofol group, IL-6 and IL-8 were significantly increased at T3 compared to T1. However, there were no significant differences in cytokine concentrations between the isoflurane and propofol groups.

Conclusion

An inflammatory response occurred earlier in patients who received an inhaled agent compared with an intravenous anesthetic, but no differences in plasma cytokine profiles were evident between isoflurane and propofol anesthesia in patients without comorbidities undergoing minimally invasive surgeries.     

Socioeconomic Disparities and Metabolic Risk in Veterans with Serious Mental Illness

Socioeconomic disparities were assessed in predicting metabolic risk among veterans with serious mental illness. Veterans with schizophrenia, schizoaffective, or bipolar disorders were identified in VISN 4 facilities from 10/1/2010 to 9/30/2012. Differences between patients with and without metabolic syndrome were compared using t-tests, Chi square tests and multivariate logistic regressions. Among 10,132 veterans with mental illness, 48.8% had metabolic syndrome. Multivariate logistic regression analysis confirmed that patients with metabolic syndrome were significantly more likely to be older, male, African-American, married, and receiving disability pensions but less likely to be homeless. They were more likely to receive antipsychotics, antidepressants, or anticonvulsants. Bivariate cross-sectional analysis revealed that patients with metabolic syndrome had higher rates of coronary artery disease, cerebrovascular disease, and mortality, and that metabolic syndrome was more often associated with emergency visits and psychiatric or medical hospitalizations. Demographics, socioeconomic status and medications are independent predictors of metabolic syndrome and should be considered in broader screening of risk factors in order to provide preventive interventions for metabolic syndrome.     

Electrodermal Responsivity in Young Hypotensive and Hypertensive Men

Electrodermal responses were recorded during the presentation of 16 moderately intense (1000 Hz, 90dB) tones in three groups of young men: borderline hypertensives (138/79 mmHg), normotensives (112/65 mmHg), and hypotensives (104/63 mmHg). Electrodermal response habituation was measured as a decline in response over trials, number of trials to a response criterion of three successive nonresponses, and number of inversions of response amplitude (larger responses following smaller responses) in the stimulus sequence. Habituation was fastest in hypotensives. Nonspecific electrodermal responses at rest and during tone presentations were most frequent in borderline hypertensives, least frequent in the hypotensive group, with the normotensive group falling in between. There were no significant differences in electrodermal level. The rapid habituation rate in hypotensives is discussed in terms of cursory information processing associated with impulsive behaviour. The higher nonspecific electrodermal activity in borderline hypertensives is interpreted to indicate increased sympathetic nervous system activity.     

Screening for Substance Abuse in Women's Health: A Public Health Imperative

Alcohol and drug use is a significant public health problem with particular implications for the health and safety of women. Women who abuse these substances are more likely to have untreated depression and anxiety and are at higher risk for intimate partner violence, homelessness, incarceration, infectious disease, and unplanned pregnancy. Substance abuse during pregnancy places both mother and fetus at risk for adverse perinatal outcomes. Data regarding the prevalence of substance abuse in women are conflicting and difficult to interpret. On the clinical level, strong arguments exist against routine urine drug testing and in favor of the use of validated instruments to screen women for drug and alcohol use both in primary women's health care and during pregnancy. A number of sex‐specific screening tools are available for clinicians, some of which have also been validated for use during pregnancy. Given the risks associated with untreated substance abuse and dependence in women, the integration of drug and alcohol screening into daily clinical practice is imperative. This article reviews screening tools available to providers in both the prenatal and primary women's health care settings and addresses some of the challenges raised when women screen positive for drug and alcohol abuse.