Effects of brief exposure to water, breast-milk substitutes, or other liquids on the success and duration of breastfeeding: a systematic review

AIM: To systematically evaluate the effect of supplemental fluids or feedings during the first days of life on the overall breastfeeding duration and rate of exclusive breastfeeding among healthy infants. METHODS: Medical subject headings and free-language terms were used to search the following electronic databases for studies relevant to breastfeeding: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library, and La Leche League. Only randomized, controlled trials (RCT) were considered for study inclusion. RESULTS: Of 56 potentially relevant clinical trials identified, only one RCT (170 infants) met the inclusion criteria for this systematic review. In this study, formula feeding was significantly more frequent at 4 wk in the experimental group in which breastfeeding had been supplemented with 5% glucose ad libitum during the first 3 d of life (n = 83) than in the exclusively breastfed control group (n = 87) (p < 0.05). At 16 wk (5 mo postpartum), the percentage of mothers who continued breastfeeding, either exclusively or partially, was significantly lower in the experimental group than in the control group (p < 0.01).Conclusion: There remains considerable uncertainty about the effect of brief exposure to water, breast-milk substitutes, or other liquids on the success and duration of breastfeeding.     

Surface Evaluation of Orthodontic Wires Using Texture and Fractal Dimension Analysis

Mechanical properties of orthodontic wires can have a very significant impact both on the resistance of the entire appliance to the oral cavity conditions and directly on the effectiveness of the therapy. Striving to achieve repeatability of mechanical characteristics of orthodontic wires of a given type should be an obligatory condition in their production. To achieve it, these components should be thoroughly analyzed using various mechanical tests. Twenty-four steel and nickel-titanium orthodontic wires from four different manufacturers were examined. Each wire was subjected to fractal dimension analysis and texture analysis. The two sides of each wire were compared against each other, as well as in terms of variation in the surface area for each wire type made by different manufacturers. Most wires showed significant variation in fractal dimension and texture, both when comparing two sides of the same wire and between individual wires of a given type made by a single manufacturer. When conducting research and clinically using orthodontic wires made of Ni-Ti alloys and stainless steel, it should be assumed that the surface of orthodontic wires shows a significant degree of variation, and wires of the same type from the same manufacturer may differ significantly in this respect.     

Outcome of operation in patients with adrenocortical cancer invading the inferior vena cava—a European Society of Endocrine Surgeons (ESES) survey

Background

Most patients with adrenocortical cancer (ACC) continue to present with advanced disease. Invasion into the inferior vena cava (IVC) defines stage III disease and the management of such patients raises additional difficulties.

Method

A multicentre survey was organized by emailing a standardized proforma to members of the European Society of Endocrine Surgery (ESES). Anonymised retrospective clinical data were collected.

Results

Replies were received from 18 centres in nine countries. ACC with IVC invasion was encountered in 38 patients (18F:20M, age 15?C84?years, median 54?years). There were 16 nonfunctioning tumours and 22 functioning tumours predominantly right-sided (26R:12L) and measuring 18?C255?mm (median 115?mm). Fourteen patients had metastatic disease at presentation. Tumour thrombus extended in the prehepatic IVC (n?=?21), subdiaphragmatic IVC (n?=?6) or into the SVC/right atrium (n?=?3). Open adrenalectomy was associated with resection of surrounding viscera in 24 patients (nephrectomy n?=?16, liver resection n?=?14, splenectomy n?=?3, Whipple procedure n?=?2). IVC was controlled locally (n?=?27), at suprahepatic levels (n?=?6) or necessitated cardiac bypass (n?=?5). Complete resection (R0, n?=?20) was achieved in the majority of patients, with a minority having microscopic persistent disease (R1, n?=?7) or macroscopic residual disease (R2, n?=?4). Perioperative 30-day mortality was 13% (n?=?5). Postoperative Mitotane was used in 23 patients and chemotherapy in eight patients. Twenty-five patients died 2?C61?months after their operation (median 5?months). Currently, 13 patients are alive at 2?C58?months (median 16?months) with known metastatic disease (n?=?7) or with no signs of distant disease (n?=?6).

Conclusion

This dataset is limited by the lack of a denominator as it remains unknown how many other patients with ACC presenting with IVC invasion did not undergo surgery. The relatively low perioperative mortality and the long disease-free survival achieved by some patients should encourage surgeons with adequate experience to offer surgical treatment to patients presenting with advanced adrenocortical cancers.     

Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism

Background and aims

Cognitive functions have been reported to be impaired in patient with primary hyperparathyroidism (pHPT). The aim of this psychological study was to evaluate cognitive disturbances in pHPT in relation to serum calcium levels before and after surgery.

Patients and methods

A prospective, case–control study with 1-year follow-up of 35 pHPT patients versus 35 matched controls was undertaken. All patients were tested before surgery and at 12–18?months following surgery with a battery of selected cognitive function psychological tools: Benton Visual Retention Test (BVRT), Wisconsin Card Sorting Test (WCST), Memory Verbal Learning Test (DCS), The Rey's Auditory Verbal Learning Test (RAVLT), Trail Making Test A & B, Verbal Fluency Test, and Beck Depression Inventory. In addition to psychological testing, serum calcium, parathyroid hormone and phosphate levels were evaluated.

Results

The following cognitive functions of pHPT patients versus controls were deteriorated before surgery: impaired concentration, decreased nonverbal learning process, difficulties in using direct memory, verbal fluency and visual constructive abilities. However, no correlation was found between serum calcium levels and the results of neuropsychological tests. In longitudinal comparison of pHPT patients before and 1?year after surgery, there was a significant improvement in visual memory, visual–constructive abilities and direct memory.

Conclusions

pHPT patients have significantly decreased concentration level, nonverbal learning process, access to verbal resources and constructional and visual memory ability. Thus, neuropsychological testing may be useful in the decision making for early surgery in patients with mild asymptomatic disease in order to avoid further deterioration of cognitive functions.     

Use of a novel technique, solid phase microextraction, to measure tranexamic acid in patients undergoing cardiac surgery

Purpose

Solid phase microextraction (SPME) is a technique widely used and accepted in the field of food technology and in environmental and biological analyses. Despite its numerous advantages over older analytical methods, it has not been studied extensively in the medical sciences. Tranexamic acid (TXA) is currently the sole antifibrinolytic agent used during cardiac surgery involving the use of cardiopulmonary bypass (CPB). The current standard method of measuring TXA in plasma is based on plasma protein precipitation (PPP), but this analytical approach is time-consuming and not practical for routine use. The aim of the current study was to compare plasma TXA levels measured with the PPP method vs those acquired with the novel, highly efficient SPME technique. We also investigated the use of automated SPME with the aim of improving the technique so it could be used efficiently for measuring plasma TXA levels.

Methods

With Research Ethics Board approval, we undertook a prospective, investigator-blinded study in ten patients undergoing cardiac surgery with CPB. An initial TXA bolus of 30?mg·kg^?1 was infused over 15?min followed by a 16?mg·kg^?1·hr^?1 infusion until chest closure with a 2?mg·kg^?1 load in the pump prime. Each blood sample was divided into two portions and assigned a random number to blind the analyzing laboratory. The blood TXA concentration was measured using both PPP and SPME. Agreement between the two tests was analyzed using the Bland-Altman plot.

Results

Comparisons of plasma TXA concentrations measured with the two methods (PPP and SPME) showed good agreement. Absolute recovery of TXA for PPP was 64.9-78.2%; its precision, as a percentage of the relative standard deviation (RSD) was < 10% [with the exception of the lower limit of quantification (LLOQ), where the RSD was 18%]; and its accuracy, as the bias against the nominal concentration, was < 7% (for LLOQ it was 15%). Thus, extraction with SPME compared favourably with the PPP technique.

Conclusions

Solid phase microextraction is a relatively simple, rapid extraction technique that can facilitate future pharmacokinetic studies analyzing TXA drug concentrations and drug dosing in various clinical settings.     

Pancreatitis-related abdominal aortic pseudoaneurysms treated with stent-grafts

Endovascular treatment of pseudoaneurysms that develop as a complication of pancreatitis is increasingly more common. A case of a pseudoaneurysm of the abdominal aorta initially treated by implantation of a straight aortic stent-graft is presented. In the 4 months after the procedure, chronic inflammation of the retroperitoneal space caused a further perforation on the posterior wall of the aorta in the area of the bifurcation, distal to the graft. Implantation of a bifurcated stent-graft was subsequently performed. The aneurysm was excluded, with the implant and peripheral arteries remaining patent.