Incidence and risk factors of postoperative urinary tract infection after uterosacral ligament suspension

Introduction and hypothesis

We assessed the incidence of and risk factors for developing urinary tract infection (UTI) after uterosacral ligament suspension (USLS).

Methods

Retrospective analysis of patients undergoing USLS in 2008–2009 was performed. Postoperative UTI was defined as a positive urine culture within 1 month following surgery. Factors analyzed were patient age, body mass index, parity, history of UTI before surgery, passing voiding trial, discharge with Foley catheter or intermittent self-catheterization, antibiotics at discharge, history of diabetes or renal disease, and surgeon.

Results

Surgical records from 169 patients were reviewed. Twenty-three patients (14%) developed UTI. There were no differences in preoperative factors between patients who developed UTI and those who did not. Subgroup analysis revealed those patients who went home with a Foley catheter and did not receive antibiotics had the highest proportion of UTI.

Conclusion

Patients requiring Foley catheter at discharge following vaginal prolapse repair are at highest risk for UTI and require prophylactic antibiotics.     

Challenging the 10-year rule: The accuracy of patient life expectancy predictions by physicians in relation to prostate cancer management

Introduction:

We assess physicians’ ability to accurately predict life expectancies. In prostate cancer this prediction is especially important as it affects screening decisions. No previous studies have examined accuracy in the context of real cases and concrete end points.

Methods:

Seven clinical scenarios were summarized from charts of deceased patients. We recruited 100 medical professionals to review these scenarios and estimate each patient’s life expectancy. Responses were analyzed with respect to the patients’ actual survival end points, then stratified based on the demographic information provided.

Results:

Respondent factors, such as sex, level of training, location of work or specialty, made no significant difference on prediction accuracy. Furthermore, respondents were typically pessimistic in their estimations with a negative linear trend between estimated life expectancy and actual survival. Overall, respondents were within 1 year of actual life expectancy only 15.9% of the time; on average, respondents were 67.4% inaccurate in relation to actual survival. If framed in terms of correctly identifying which patients would live more than or less than 10 years (dichotomous accuracy), physicians were correct 68.3% of the time.

Conclusions:

Physicians do poorly at predicting life expectancy and tend to underestimate how long patients have left to live. This overall inaccuracy raises the question of whether physicians should refine screening and treatment criteria, find a better proxy or dispose of the criteria altogether.     

The pathophysiology of acne vulgaris in children and adolescents, part 2: Tailoring treatment

Various pathophysiologic factors are involved in the development of acne lesions, microcomedones, comedones, and inflammatory lesions. These factors include follicular hyperkeratosis, increased colonization of follicles by Propionibacterium acnes, increased sebum production, and inflammatory mediators. Optimal treatment of acne involves the use of agents that address these various underlying pathogenetic factors.     

In vitro effect of glucocorticoids on nasal polyps

Glucocorticoids are considered the main treatment option for nasal polyps, but their effect is only recently being understood.AimTo evaluate whether fluticasone propionate (FP) inhibits the inflammatory process induced by TNF-alpha in vitro, and to assess if NF-kappaB is associated to this inhibition.Study DesignExperimental in vitro study.Materials and MethodsNasal polyp fibroblasts were cultured during 24 hours. Three different concentrations of FP (1, 10 and 100 nM, added to TNF-alpha) were compared to negative (without additive) and positive (TNF-alpha) controls. Gene expression (RTQ-PCR) and protein concentration (ELISA) of VCAM-1, ICAM-1, eotaxin and RANTES were measured, as well as the nuclear translocation of NF-kappaB.ResultsTNF-alpha significantly increased protein concentration and RNA expression of all the studied molecules, as well as the nuclear translocation of NF-kappaB, when compared to the negative control. FP decreased these parameters in a dose-dependent manner, statistically different from positive control up to 100nM.ConclusionsFP extensively inhibited inflammatory recruiters, at both protein and RNA levels, confirming the ability of glucocorticoids to modulate the inflammatory process in nasal polyps. This inhibition was associated to decreased NF-kappaB nuclear translocation, demonstrating that this is an important mechanism of glucocorticoids action for nasal polyps.     

Predicting life‐time and regular cannabis use during adolescence; the roles of temperament and peer substance use: the TRAILS study

Aims The aim of the present study was to determine the mediating role of affiliation with cannabis‐using peers in the pathways from various dimensions of temperament to life‐time cannabis use, and to determine if these associations also contributed to the development of regular cannabis use. Methods Objectives were studied using data from 1300 participants of the Tracking Adolescents' Individual Lives Survey (TRAILS), a large, general population study of Dutch adolescents. We used parent‐reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high‐intensity pleasure, shyness, fearfulness, frustration and effortful control at age 10–12 years. By means of self‐reports, life‐time and regular cannabis use were determined at age 15–18 years, and proportion of substance‐using peers was determined at ages 12–15 and 15–18 years. Models were adjusted for age, sex, intelligence and parental cannabis use. Results High‐intensity pleasure [odds ratio (OR) = 1.09, 95% confidence interval (CI) = 1.05–1.13] and effortful control (OR = 0.92, 95% CI = 0.89–0.96) affected the risk for life‐time cannabis use through their influence on affiliation with cannabis‐using peers. Shyness affected this risk independently from peer cannabis use. Only the pathway from effortful control was associated additionally with the development of regular cannabis use (OR = 0.93, 95% CI = 0.89–0.98). Conclusions Peer cannabis use and, to a lesser extent, certain temperamental characteristics affect an adolescent's risk of cannabis use, and should be considered in prevention programmes. We recommend future research to focus upon factors that potentially modify the association between temperament, affiliation with cannabis‐using peers and cannabis use.     

DNA sequence-dependent deformability deduced from protein–DNA crystal complexes

The deformability of double helical DNA is critical for its packaging in the cell, recognition by other molecules, and transient opening during biochemically important processes. Here, a complete set of sequence-dependent empirical energy functions suitable for describing such behavior is extracted from the fluctuations and correlations of structural parameters in DNA–protein crystal complexes. These elastic functions provide useful stereochemical measures of the local base step movements operative in sequence-specific recognition and protein-induced deformations. In particular, the pyrimidine-purine dimers stand out as the most variable steps in the DNA–protein complexes, apparently acting as flexible “hinges” fitting the duplex to the protein surface. In addition to the angular parameters widely used to describe DNA deformations (i.e., the bend and twist angles), the translational parameters describing the displacements of base pairs along and across the helical axis are analyzed. The observed correlations of base pair bending and shearing motions are important for nonplanar folding of DNA in nucleosomes and other nucleoprotein complexes. The knowledge-based energies also offer realistic three-dimensional models for the study of long DNA polymers at the global level, incorporating structural features beyond the scope of conventional elastic rod treatments and adding a new dimension to literal analyses of genomic sequences.     

Relapse prevention in panic disorder with pharmacotherapy: where are we now?

ABSTRACT

Introduction: A substantial number of patients with PD experience relapse after the discontinuation of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk.

Area covered: The present systematic review examines randomized, double-blind, placebo-controlled relapse prevention studies published over the last 20 years involving recommended medications. The authors aim to provide an overview of this topic and evaluate whether recent advances were achieved. Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy with constant doses had protective effects against relapse in patients who had previously exhibited satisfactory responses to the same medication at the same doses. The duration of maintenance treatment did not influence relapse risk. No data were available concerning the use of lower doses or the predictors of relapse.

Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive indications are lacking. Rethinking pharmacological research in PD may be productive. Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter long-term naturalistic studies, and implementing recent technological innovations (e.g., electronic medical records/‘big data’ platforms, wearable devices, and machine learning techniques) may help identify reliable predictive models.