Can Fried Frailty Score predict postoperative morbidity and mortality in gynecologic cancer surgery? Results of a prospective study

BackgroundAim of this study is to evaluate the predictive ability of Fried Frailty Score for surgical outcomes in patients undergoing gynecologic cancer surgery.MethodsThis is a prospective cohort study at an academic gynecological cancer center from Oct 2015 through Jan 2017. We applied systematically numerous screening tools, geriatric questionnaires and single measurements which may provide predictions for surgical outcomes. We classified frailty according to the Fried definition and surgical complications were graded according Clavien-Dindo criteria. Using logistic regression analysis, we identified predictive clinical variables for postoperative complications (POC).ResultsOverall 226 patients were enrolled (median age 59 years, range 18–87 years). The prevalence of frailty based on the presence of three or more frailty criteria was 14.2%, the presence of one or two frailty criteria was classified as prefrail with 59.4% and without any presence as robust with 26.5%. Within 30 days of surgery, nine (3.8%) patients have died and 40 (18.3%) experienced a grade ≥ IIIb complication. In the regression analysis obesity (OR: 5.37, 95% CI 1.99–14.49, p = 0.001) as well as ECOG >1 (OR: 4.32, 95% CI 1.28–1.55, p = 0.018) and Albumin<3.6 g/dl (OR: 3.88, 95% CI 1.37–10.98, p = 0.011) emerged as significant predictors of postoperative complications (POC). Fried Frailty Score (OR: 2.41, 95% CI 0.91–6.41, p = 0.077) showed no significant additional predictive value.ConclusionFried Frailty Score could help the surgeon to estimate the risk for POC among patients undergoing gynecologic cancer surgery. But preoperatively determined ECOG, BMI and Albumin can predict severe POC in patients undergoing gynecologic surgery more precisely and should be assessed routinely.     

Pathogenesis of hemorrhage induced by bilitoxin, a hemorrhagic toxin isolated from the venom of the common cantil (Agkistrodon bilineatus bilineatus)

The pathogenesis of hemorrhage induced by the i.m. injection of the hemorrhagic toxin, bilitoxin, was studied using light and electron microscopy. White mice were injected with sublethal doses of the toxin, and tissue samples were obtained at 5 and 30 min, and 1, 3 and 24 hr after the injection. There was a good correlation between amount of toxin injected and amount of hemorrhage observed. Microscopically, hemorrhage was visible in all parts of the connective tissue surrounding muscle cells just 5 min after injection and fibrin was present both intravascularly and extravascularly. At later time periods the hemorrhage was more extensive and there was more fibrin. Many vessels were plugged with platelets. At 30 min after the injection, muscle cells appeared to be damaged having either delta lesions or disrupted myofibrils. Electron microscopy revealed damaged capillaries with ruptured endothelial cells, disrupted basal lamina and intact intercellular junctions. Thus, this hemorrhagic toxin acts rapidly to disrupt the capillary endothelium without damaging the intercellular junctions, and it also appears to damage skeletal muscle cells.     

Sexuelle Gesundheitsinformationen in sozialen Medien: Ein systematisches Scoping Review

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Informationen zur sexuellen und reproduktiven Gesundheit werden zunehmend auch über soziale Medien verbreitet und erreichen...     

Assessment of neutralization of Micrurus venoms with a blend of anti-Micrurus tener and anti-ScNtx antibodies

BackgroundMicrurus venoms contain two main groups of toxic protein components: short-chain α-neurotoxins (SNtx) and phospholipases type A₂ (PLA₂). In North America, generally, the Micrurus venoms have low abundance of SNtx compared to that of PLA₂s; however, both are highly toxic to mammals, and consequently both can play a major role in the envenomation processes. Concerning the commercial horse-derived antivenoms against Micrurus from the North America region, they contain a relatively large amount of antibodies against PLA₂s, and a low content of antibodies against short chain α-neurotoxins. This is mainly due to the lower relative abundance of SNtxs, and also to its poor immunogenicity due to their size and nature. Hence, Micrurus antivenoms made in North America usually present low neutralizing capacity towards Micrurus venoms whose lethality depend largely on short chain α-neurotoxins, such as South American Micrurus species.MethodsHorses were hyperimmunized with either the venom of M. tener (PLA₂-predominant) or a recombinant short-chain consensus α-neurotoxin (ScNtx). Then, the combination of the two monospecific horse antibodies (anti-M. tener and anti-ScNtx) was used to test their efficacy against eleven Micrurus venoms.ResultsThe blend of anti-M. tener and anti-ScNtx antibodies had a better capacity to neutralize the lethality of diverse species from North, Central and South American Micrurus venoms. The antibodies combination neutralized both the ScNtx and ten out of eleven Micrurus venom tested, and particularly, it neutralized the venoms of M. distans and M. laticollaris that were neither neutralized by monospecific anti-M. tener nor anti-ScNtx.ConclusionsThese results provide a proof-of-principle for using recombinant immunogens to enrich poor or even non-neutralizing antisera against elapid venoms containing short chain α-neurotoxins to develop antivenoms with higher effectiveness and broader neutralizing capacity.     

Classrooms in Peace Within Violent Contexts: Field Evaluation of <Emphasis Type="Italic">Aulas en Paz</Emphasis> in Colombia

Classrooms in Peace (Aulas en Paz) is an elementary school-based multicomponent program for prevention of aggression and promotion of peaceful relationships. Inspired by international programs and socio-emotional research, it includes (1) a classroom universal curriculum, (2) parent workshops and home visits to parents of the 10% most aggressive children, and (3) extracurricular peer groups of two aggressive and four prosocial children. Activities seek to promote socio-emotional competencies such as empathy, anger management, creative generation of alternatives, and assertiveness. A 2-year quasi-experimental evaluation was conducted with 1154 students from 55 classrooms of seven public schools located in neighborhoods with the presence of youth gangs, drug cartels, and high levels of community violence in two Colombian cities. Despite several implementation (e.g., about half of the activities were not implemented) and evaluation (e.g., randomization problems, large number of missing data, and changes between treatment and control groups) challenges, positive results were found in prosocial behavior and in reduction of aggressive behavior, according to teacher reports, and in assertiveness and reduction of verbal victimization, according to student reports. Furthermore, implementation cost (25 US dollars per student per year) was very low compared to other programs in developed countries. This study shows that the Classrooms in Peace program has an important potential to generate positive results and highlights the challenges of implementing and evaluating prevention programs in highly violent environments.