Randomized Blinded Study Comparing a Bipolar Sealer and Standard Electrocautery in Reducing Transfusion Requirements in Anterior Supine Intermuscular Total Hip Arthroplasty

Managing blood loss in total hip arthroplasty (THA) minimizes complications and decreases cost. Tissue-sparing anterior supine intermuscular THA (ASI-THA) may offer a quicker recovery but increases blood loss and transfusion requirements. This double-blinded prospective study compared a bipolar sealer (Aquamantys 6.0 bipolar sealer) to standard monopolar electrocautery in reducing blood loss in ASI-THA. Differences in calculated actual blood loss (ABL), hemoglobin, and transfusion requirements were examined. One hundred hips were randomized to each group. Transfusion rates were similar, 6% and 4%, respectively (p > 0.05). ABL and change in hemoglobin were identical (1.35 and 3.3 g). No significant differences in transfusion, blood loss, or hemoglobin were seen with a bipolar sealer device. Routine use of this bipolar sealer device has been discontinued in ASI-THA.     

The incremental benefit of two quadrant lavage for peritoneal cytology at staging laparoscopy for oesophagogastric adenocarcinoma

Background

Patients with positive peritoneal cytology from oesophagogastric cancer have a poor prognosis. The purpose of this study was to compare lavage cytology from the pelvis alone with the pelvis and subphrenic areas at staging laparoscopy in patients with potentially resectable oesophagogastric adenocarcinoma.

Methods

Between November 2006 and November 2010, all patients with operable oesophagogastric adenocarcinoma on spiral CT considered fit for surgical resection underwent staging laparoscopy. Subphrenic and pelvic peritoneal lavage for cytology was performed followed by laparoscopic biopsy of any visible peritoneal disease. Patients were divided into groups: macroscopic peritoneal metastases (P+), no macroscopic peritoneal disease with negative cytology (P?C?), no macroscopic peritoneal disease with positive pelvic cytology (P?PC+), no macroscopic peritoneal disease with positive subphrenic cytology (P?SC+), or both (P?PSC+).

Results

A total of 316 staging laparoscopy procedures were performed; 245 patients (78 %) were P?C?, 28 (9 %) were P+, and 43 (14 %) were P?C+, of whom 29 (9 %) were P?PSC+, 10 (3 %) were P?SC+, and 4 (1 %) were P?PC+. Pelvic cytology alone had 76.7 % sensitivity for peritoneal disease, and subphrenic cytology alone had 90.7 % sensitivity.

Conclusions

Peritoneal lavage for cytology at staging laparoscopy has an incremental benefit for staging oesophagogastric adenocarcinoma in the absence of macroscopic metastatic disease. Subphrenic washings have the highest yield of positive results. Performing isolated pelvic washings for cytology will understage 23.3 % of patients with microscopic peritoneal disease. The routine use of subphrenic in combination with pelvic lavage for cytology at staging laparoscopy in patients with oesophagogastric adenocarcinoma has an incremental benefit in detecting cytology-positive disease over either pelvic or subphrenic cytology alone.     

Acculturation and Food Insecurity Among Puerto Ricans Living in Boston

Objective

To examine the associations among acculturation, food environment, and food insecurity among Puerto Ricans in Boston.

Physical activity and sedentary time among preschoolers in centre-based childcare: a systematic review

Background

Many preschoolers spend a substantial portion of their day enrolled in centre-based childcare; the amounts of physical activity and sedentary time accumulated in this environment are critical to preschoolers’ ability to meet movement guidelines. The purpose of this systematic review was to provide a comprehensive overview of the objectively assessed physical activity and sedentary time of preschoolers in centre-based childcare (registration no. CRD42016033502).

Methods

Eight online databases were searched using terms related to physical activity, sedentary time, preschoolers and centre-based childcare. Published, peer-reviewed primary studies written in English that objectively assessed (via accelerometry) the physical activity and sedentary time of preschoolers (2-5 years) in centre-based childcare were included.

Results

Fifty-five studies (published 2004-2017) from 11 countries, representing 13,956 participants were included. Studies reported light physical activity (n=38) ranging from 2.94 to 29.96 mins/hr, moderate-to-vigorous physical activity (n=46) which ranged from 1.29 to 22.66 mins/hr, and total physical activity (n=42) ranging from 4.23 to 47.17 mins/hr. Sedentary time (n=47) ranged from 12.38 to 55.77 mins/hr.

Conclusion

Physical activity and sedentary time were highly varied and inconsistent between studies; therefore, it is difficult to determine preschoolers’ true amount of physical activity and sedentary time during childcare hours. Despite this variability, preschoolers were noted to participate in high rates of sedentary time in this setting. The lack of homogeneity is an important finding in and of itself as it highlights the lack of consistency in measuring, processing, and reporting paediatric physical activity data.

     

Sociodemographic and Lifestyle Factors,and Health Conditions of Dominican Adults Living in Puerto Rico

Dominicans are the largest migrant community in Puerto Rico, yet understudied. We compared risk factors and health conditions of Dominicans versus Puerto Ricans (PRs). Cross-sectional survey of Dominicans (n?=?55) and PRs (n?=?310) aged 30–75 years, assessed with validated questionnaires and standardized anthropometric measurements. Significantly, more Dominicans than PRs had attained <8th grade education (37.7 vs. 8.0%), reported household income ≤$10,000 (76.1 vs. 56.9%), lacked health insurance (19.6 vs. 5.5%), and reported food insecurity (24.5 vs. 12.1%). They spent fewer hours/day watching television (2.9 vs. 3.8), and were less likely to smoke (7.6 vs. 19.6%). Medically-diagnosed depression was lower among Dominicans than PRs (9.6 vs. 23.0%); questionnaire-based high depressive symptomatology was similar (47.9 vs. 52.8%). Dominicans living in Puerto Rico had more socioeconomic risk factors but healthier lifestyle behaviors and lower prevalence of medically-diagnosed depression than PRs. Tailored approaches are needed to ameliorate disparities in each ethnic group.