Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database

Robotic colorectal surgery has been shown to have lower rates of unplanned conversion to open surgery when compared to laparoscopic surgery. Risk factors associated with conversion from robotic to open colectomy and comparisons of the risk factors between robotic and laparoscopic approaches have not been previously reported. Patients who underwent elective laparoscopic and robotic colorectal surgeries between July 1, 2012 and April 28, 2015, were identified in the Michigan Surgical Quality Collaborative registry. Candidate covariates were identified, and hierarchical logistic regression models were used to identify risk factors for conversion. There were 4796 cases that met study inclusion criteria. Conversion was required in 18.2 % of laparoscopic and 7.7 % of robotic cases (p?<?0.0001). Risk factors for conversion in the laparoscopic group included the following: moderate/severe adhesions, obesity, colorectal cancer, hypertension, rectal operations, urgent priority, and tobacco use. Risk factors for conversion in the robotic group included the following: severe adhesions, bleeding disorder, presence of cancer, cirrhosis, and use of statins. Higher surgeon volume was protective in both groups. Conversion rates are lower for robotic than for laparoscopic colorectal surgery with fewer predictors of conversion. Recognition of factors predicting conversion may allow surgeons to choose an operative approach that optimizes the benefits of the available technologies.     

Interpretation of teasing during early adolescence

Research has suggested that teasing, especially about physical appearance, is a common experience with negative consequences for adolescents. This study aimed to examine the cognitive processes of adolescents exposed to teasing. Students from two middle schools were assigned randomly to view videotaped vignettes of appearance-related teasing, competency teasing, or a control situation and completed questionnaires to assess their cognitive reactions and memories of the teasing. Results indicated that adolescent girls recalled appearance-related teasing more readily than competency teasing, adolescent girls with high body dissatisfaction recalled fewer positive appearance words, and participants exposed to competency teasing were more likely to recall competency words. The findings indicated that cognitive processes may be important in the study of adolescents' interpretation of teasing and for clinical treatment of adolescents who are teased.     

alpha-methylacyl coenzyme A racemase is immunoreactive in extramammary Paget disease

alpha-Methylacyl-coenzyme A racemase (AMACR) has become a common tool in the diagnosis of morphologically difficult prostatic carcinoma and often is used in combination with the basal cell markers p63 and 34betaE12. Outside this context, applications have been limited. Although initially considered a specific marker of prostatic carcinoma, immunoreactivity for AMACR has been found in a variety of other neoplasms. We report findings in 21 cases of extramammary Paget disease (EMPD), a neoplasm not previously reported to show AMACR immunoreactivity. We found immunoreactivity for AMACR in 15 (71%) of 21 EMPD cases overall, in 5 (56%) of 9 cases in women, and in 10 (83%) of 12 cases in men. AMACR immunoreactivity is a common finding in EMPD in men and women.     

Ex vivo enrichment of malignant carcinoma cells in primary culture

AIMS: Establishing and maintaining human tumours in primary culture can be challenging. In this application, a short-term primary culture process is desired to ensure cells maintained in culture are representative of the in vivo tumour for the purpose of chemoresponse testing. To ensure the appropriate cells are being grown, the cultures must be evaluated for malignancy. The clinical gold standard determination of malignancy is cytological evaluation by a cytopathologist. METHODS: Fifty human tumour specimens (breast, colon, lung, ovary) were established and maintained in primary culture. Cytospins were prepared upon initiation of culture and again at completion of the culture process. Cytospins were stained (Diff-Quik, Papanicolaou) and evaluated by a cytopathologist for the percentage of malignant cells at both times. RESULTS: An increase in the percentage of malignant cells was noted in 86% (43/50) of the cultures evaluated; 8% (4/50) of the cultures maintained the same percentage of malignant cells throughout the culture period, and 6% (3/50) displayed a decrease in malignant cells. On average, the percentage of malignant cells increased by 37% and was not associated with the length of culture (range 5-28 days). CONCLUSIONS: The described primary culture process enriches for malignant cells, which is desirable for further evaluation such as chemoresponse testing.     

Population trends related to injury from explosive munitions in Lao PDR (1964–2008): a retrospective analysis

Background

The presence of landmines and explosive remnants of war (ERW) including unexploded ordnance (UXO) poses a serious public health risk for populations living in conflict-affected and contaminated areas. Current analysis, however, provides only a partial view of the burden. In this study, we examined the multivariable relationship between year of injury, activity at the time of the incident, case fatalities and casualty rates in order to provide decision-makers with a more fine-grained understanding of landmines and ERW injuries in the Lao PDR.

Methods

Using data from a retrospective, national household survey, frequency tables, logistic and Poisson regressions were performed using STATA 13 to predict the case fatality and population-standardized incidence rates for ERW casualties.

Results

The findings indicated that most casualties were male (86.75%), with the majority of incidents (74.7%) occurring during the conflict period (1964–1979). The odds of death for the conflict period was 1.5 times that of the post-conflict period (1980–2008). The highest odds of death during the conflict period was associated with big bombs (OR?=?1.38, 95% CI: 1.243–1.522, p <?0.01), and landmine injuries were more common during conflict compared to the post-conflict period (IRR?=?1.42, 95% CI: 1.368–1.477, p?<?0.01). Post conflict, cluster munitions had the highest incidence rate for death or injury (IRR?=?1.07, 95%CI: 1.006–1.143, p =?0.03). Scrap collection which is often the target of mine risk education and thought to be one of the main activities at time of injury had the second lowest incidence rate of the activities related to incident during post-conflict period.

Conclusions

As the first study of this nature in Lao PDR, this research provides information essential for planning services and prevention. This study suggests more effort needs to be directed towards addressing the geographical regions and population subgroups experiencing increased casualty numbers and odds of death. Further research is required to improve the documentation and understanding of the health and socio-economic consequences of landmine and ERW injuries.

     

Agricultural Experiences Are Positively Associated With High School Students' Fruit and Vegetable Perceptions and Consumption

Objective

To examine the relationship between high school students' agricultural experiences and their (1) attitudes about consuming local fruits and vegetables, (2) willingness to try new fruits and vegetables, and (3) fruit and vegetable consumption.

The impact of long‐term care on quality of life

Long‐term care services are provided to help people manage the consequences of impairment, but their impact goes beyond the meeting of basic needs. Accordingly, the main aim was to explore the marginal effectiveness of care when measured in terms of people's overall care‐related quality of life (CRQoL) and assess changes in marginal effect for increasing intensity. The associated aim was to refine and apply an observational method to estimate marginal effectiveness. A “production function” approach was used with survey data, including Adult Social Care Outcomes Toolkit‐measured CRQoL, whereby we statistically modelled the expected relationship between service utilisation rates and CRQoL. This method seeks to limit endogeneity issues by controlling on observables and using instrumental variable. Using a survey of publicly funded long‐term care service users in England, we found that community‐based long‐term care significantly improved people's CRQoL but with diminishing marginal effects and effects differentiated by baseline impairment levels. There are implications for how the care system should respond to changes in global public budgets. For example, where there is unmet need, a system aimed to maximise (unadjusted) CRQoL would put more emphasis on access (more recipients) than intensity of support compared to a system operating on a needs basis.     

Is Long-Acting Reversible Contraceptive Use Increasing? Assessing Trends Among U.S. College Women, 2008–2013

Objective To assess LARC use trends among college women (18–24 years) and identify groups that have increased LARC use. Methods Data were extracted from the National College Health Assessment-II (NCHA-II) fall 2008–2013 surveys. Logistic regression statistics were used to assess LARC use. Results Although LARC use increased from 2008 to 2013 (aOR?=?2.62; 95% CI 2.23–3.07), less than half of the sample (44%) reported using contraception at last vaginal sex. Only 2.5% of college women in this study reported using a LARC method; of LARC users, 90% reported using an intrauterine device. Nearly all sociodemographic factors were significantly associated with increases in LARC use including: age, sexual orientation, and insurance status. Conclusions LARC use significantly increased among college women. However, less effective methods such as condoms and short-acting reversible contraceptives are used more frequently. Promoting LARC use for women who desire to effectively prevent pregnancy can reduce unintended pregnancy and improve health outcomes for women while in college. Future work should examine the importance of individual and lifestyle factors that influence college women’s decision to choose a LARC method and seek to eliminate barriers to college women choosing a contraceptive method they believe works best for them.