Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy

Purpose

Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy.

Methods

Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients’ history, and operative data using multivariate analysis.

Results

SSIs after laparoscopic cholecystectomy were seen in 0.8 % (n?=?291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95 % confidence interval [CI] 2.2–7.5), age over 55 years (OR 2.4 [1.8–3.2]), conversion to open procedure (OR 2.6 [1.9–3.6]), postoperative hematoma (OR 1.9 [1.2–3.1]), duration of operation >60 min (OR 2.5 [1.7–3.6], cystic stump insufficiency (OR 12.5 [4.2–37.2]), gallbladder perforation (OR 6.2 [2.4–16.1]), gallbladder empyema (OR 1.7 [1.1–2.7]), and surgical revision (OR 15.7 [10.4–23.7]. SSIs were associated with a significantly prolonged hospital stay (p?<?0.001), higher postoperative mortality (p?<?0.001), and increased rate of surgical revision (p?<?0.001).

Conclusions

Additional surgical procedure was identified as a strong risk factor for SSI after laparoscopic cholecystectomy. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy.     

What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries

Purpose

Child and adolescent mental health (CAMH) problems are common and serious all over the world and are linked to pre-mature deaths and serious dysfunction in adult life. Effective interventions have been developed in high income countries (HIC), but evidence from low income settings is scarce and scattered. The aim of this paper is to identify the most promising interventions in the area of global CAMH.

Method

A systematic review of all randomised controlled trials in CAMH in low and middle income countries (LAMIC) was carried out and supplemented by 1a level evidence from HIC as well as suitable information from child programme evaluations and adult studies in LAMIC.

Results

In behavioural disorders parent training is a highly promising intervention, which can successfully improve children’s compliance and bring down rates of conduct problems significantly. In young children cognitive, emotional and behavioural development can be enhanced through nutritional supplements and by stimulation through play, praise and reading. Trauma treatments can bring positive results even in severely traumatised children, who remain in unstable living conditions. In developmental disorders, there are successful prevention strategies as well as programmes that bring children out of isolation and improve their independence. Some classroom-based interventions for adolescents have reduced symptoms of common mental disorders as well as risk taking behaviours.

Conclusions

While many results are still tentative the evidence suggests that it is possible to develop affordable and feasible interventions that significantly improve the lives of affected children, their families and their communities around the world.     

Overexpression of human wild-type FUS causes progressive motor neuron degeneration in an age- and dose-dependent fashion

Amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) are relentlessly progressive neurodegenerative disorders with overlapping clinical, genetic and pathological features. Cytoplasmic inclusions of fused in sarcoma (FUS) are the hallmark of several forms of FTLD and ALS patients with mutations in the FUS gene. FUS is a multifunctional, predominantly nuclear, DNA and RNA binding protein. Here, we report that transgenic mice overexpressing wild-type human FUS develop an aggressive phenotype with an early onset tremor followed by progressive hind limb paralysis and death by 12 weeks in homozygous animals. Large motor neurons were lost from the spinal cord accompanied by neurophysiological evidence of denervation and focal muscle atrophy. Surviving motor neurons in the spinal cord had greatly increased cytoplasmic expression of FUS, with globular and skein-like FUS-positive and ubiquitin-negative inclusions associated with astroglial and microglial reactivity. Cytoplasmic FUS inclusions were also detected in the brain of transgenic mice without apparent neuronal loss and little astroglial or microglial activation. Hemizygous FUS overexpressing mice showed no evidence of a motor phenotype or pathology. These findings recapitulate several pathological features seen in human ALS and FTLD patients, and suggest that overexpression of wild-type FUS in vulnerable neurons may be one of the root causes of disease. Furthermore, these mice will provide a new model to study disease mechanism, and test therapies.     

Correction to: Translation and cross-cultural adaptation of eight pediatric PROMIS® item banks into Spanish and German

Quality of Life Research - In the original publication of the article, two of the author names “L. A. Schröder, F. Metzner” and email address of the authors “J. Devine, J....     

The flaccid lung syndrome and alpha 1-protease inhibitor deficiency

We examined breathing mechanics and alpha 1PI deficiency in 1,850 unrelated male subjects with various lung complaints. The loss in lung elasticity appeared to be significantly more pronounced in ZZ individuals as compared to MM, MS and also MZ individuals. The MZ group did not differ significantly in this respect from MM individuals. This implies that the excess risk of developing a flaccid lung (C greater than 1 kPa-1) due to the partial alpha 1-antitrypsin deficiency is negligible. PI MZ and PI ZZ frequencies are significantly higher in the population with flaccid lung compared to control subjects. Furthermore, it was found that the increase in residual volume in smokers is independent of the PI type.     

Mental Health Problems Among Preschoolers in Germany: Results of the BELLA Preschool Study

In a cross-sectional study, the prevalence rates of overall and specific mental health problems (MHP), as well as consequential impairments, were examined in a representative community sample of German preschoolers. MHP in 391 children were assessed by applying the Strength and Difficulties Questionnaire, as well as its impact supplement. Furthermore, the child behaviour checklist 1½–5 (CBCL 1½–5) and the IOWA-Conners behaviour rating scale were applied. Prevalence rates of MHP with 95 % confidence intervals (95 % CI) were determined. Odds ratios were calculated to analyse the relationships between MHP, age, gender, socioeconomic status, and geographical region using logistic regression. Overall, 7.4 % of the children showed symptoms of MHP. 12.9 % of the children were considered to be impaired by psychosocial problems. Depressive and anxiety symptoms were present in 4.2 % of the children; 11.8 % showed hyperactivity symptoms. The observed prevalence rates call for early mental health prevention in preschoolers.     

DNA damage induced by cis- and carboplatin as indicator for in vitro sensitivity of ovarian carcinoma cells

Background  

The DNA damage by platinum cytostatics is thought to be the main cause of their cytotoxicity. Therefore the measurement of the DNA damage induced by cis- and carboplatin should reflect the sensitivity of cancer cells toward the platinum chemotherapeutics.     

Parents and GPs at cross-purposes over hyperactivity: a qualitative study of possible barriers to treatment.

BACKGROUND: Although childhood hyperactivity is a common, serious, and treatable disorder, most affected children in Britain do not receive effective treatment. AIM: To investigate the views that parents and GPs hold about hyperactivity, and to explore how far these views, and clashes between these views, influence access to services. METHOD: Qualitative study making use of semi-structured interviews with 10 general practitioners (GPs) and 29 parents of hyperactive children drawn from parents' groups, community services, and specialist clinics. RESULTS: The views of parents and GPs differed markedly. Parents generally saw severe hyperactivity as a long-lasting, biologically-based problem that needed treatment in its own right and that benefited from diagnosis. Most of the GPs were unsure whether hyperactivity was a medical disorder warranting a label and specific treatment, and often saw it as a passing phase related to family stresses. Parents worried that professionals would blame them for their child's problem, whereas many GPs saw the parent's tendency to medicalise as a way to avoid thinking about their own shortcomings in parenting. CONCLUSION: Access to treatment was influenced by the views of parents and GPs, by the clashes between these views, and by each group's perceptions of the other group's beliefs. Clashes between the views of parents and GPs were particularly likely to lead to misunderstandings, dissatisfaction, and lack of access to effective help.