Family practice residents' attitudes toward organ donation

Shortage of organs for transplantation has been attributed in part to negative attitudes of medical personnel. As the demand for organ donations increases, it is likely that family physicians may encounter with increasing frequency situations in which they are in some way involved with the families of potential donors. This study was designed to assess residents' attitudes toward organ donation Overall attitudes were positive, with a mean attitude score of 1.275 (SD 1.415) where 0 = very favorable and 9 = very unfavorable. At the same time, however, concerns regarding premature declaration of death, feelings of the potential donor's family, and cost or benefit of organ donation were identified as well. Nearly one half the residents thought they had little knowledge about organ donation or transplant. Residents' feelings about donating their own organs were most predictive of their opinion of organ donation in general. Only 25 percent of residents had signed an organ donor card and had it witnessed. How much residents knew about organ donation and how they thought their own families felt were the best predictors of whether they had signed the donor form.     

Protein carbonyls are acutely elevated following single set anaerobic exercise in resistance trained men

The purpose of this investigation was to determine if a single set of strenuous squat exercise would result in an acute oxidative stress, as demonstrated previously by a single sprint. Thirteen resistance trained men performed one set of 15 repetitions of barbell squats using 70% of one repetition maximum and a 30 s maximal cycle sprint on two different occasions. The total work performed was calculated for each exercise bout. Heart rate, perceived exertion, blood lactate, protein carbonyls, 8-hydroxydeoxyguanosine, and malondialdehyde were measured before and within 1 min following exercise. No differences were noted between the squat and sprint tests for total work, heart rate or perceived exertion. An exercise test by time interaction was evident for blood lactate with values greater following sprinting compared to squatting (P = 0.0005). Postexercise protein carbonyls were not different between exercise tests but were elevated above rest (P = 0.04) by 111% and 74% following sprinting and squatting, respectively, while 8-hydroxydeoxyguanosine and malondialdehyde were relatively unaffected by either exercise test. These data indicate that a single bout of strenuous squatting and sprinting performed by resistance trained men results in elevated protein carbonyls, while having little impact on 8-hydroxydeoxyguanosine or malondialdehyde during the immediate postexercise period.     

Assessment of intrafamilial clinical variability of poikiloderma with neutropenia by a 10-year follow-up of three affected siblings

Clericuzio-type poikiloderma with neutropenia is a well-defined nosological entity, but despite a remarkable number of clinical reports, no long term follow-up data has been presented to date regarding patients with this rare condition.Here we describe the results of clinical follow-up of three siblings, one male (Patient 1) and two females (Patients 2 and 3), subsequent to their first clinical and then molecular diagnosis of Clericuzio-type poikiloderma with neutropenia syndrome due to mutation of USB1gene. Patient 1 always expressed the most severe phenotype, while patients 2 and 3 showed an intermediate and mild phenotype, respectively, as observed since their first clinical evaluation. None of the patients developed skin cancer and/or myelodysplastic disorders considering the peripheral haematological findings. Lens opacity, never reported before, was found in two of the three patients.The long term follow-up observations confirm the stability over time of the pronounced intra-familial heterogeneity of clinical manifestations observed prior to and upon molecular diagnosis. We conclude that prolonged follow-up is an adjunct tool to monitor intra-familial variability of PN clinical spectrum which may favour surveillance of more serious complications of the disease among siblings, when a patient-specific clinical expressivity is present.     

Relationship of physician behavior to patient compliance

The authors investigated patients' perception of two aspects of physician behavior during patient-physician interaction, namely, explanation given to the patient and concern for the patient. The relationship between these factors and patient compliance with the therapeutic regimen was then determined. Results showed a statistically significant relationship between these two aspects of physician behavior and patient compliance: the more patients perceived the physician as giving explanations and showing concern, the better was patient compliance.     

Is Robotic Revisional Bariatric Surgery Justified? An MBSAQIP Analysis

Background

The laparoscopic approach is utilized in greater than 90% of bariatric surgeries. With the growing prevalence of robotic-assisted surgery in bariatrics, there has been limited consensus on the superiority of either laparoscopic or robotic approaches, especially in revisional procedures (conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB)).

Methods

A retrospective analysis was performed of the MBSAQIP PUF database of patients who underwent conversion from SG to RYGB procedures in either laparoscopic or robotic-assisted approaches. The groups underwent 2:1 propensity matching and primary outcomes included post-conversion days until discharge (POD), conversion operation length, total and major morbidity, 30-day readmission, 30-day reoperation, 30-day reintervention, and 30-day mortality after conversion.

Results

After 2:1 propensity score matching, 3411 patients (2274 laparoscopic vs 1137 robotic) were included in the study. Intraoperatively, no significant difference was found in total morbidity (6.5% lap vs 5.9% robotic) or major morbidity (1.9% lap vs 1.7% robotic); however, the operative times were significantly longer robotically (126 min vs 164 min). Post-operatively, no significant differences were found in discharge day (1.8 lap vs 1.8 robotic), 30-day readmission (7.6% lap vs 8.6% robotic), reoperation rate (2.9% lap vs 3.7% robotic), additional intervention rate (2.5% lap vs 3.3% robotic), or 30-day mortality (0.1% vs 0.1%).

Conclusion

There is no significant difference in perioperative or intraoperative outcomes between laparoscopic and robotic-assisted SG to RYGB conversion procedures other than a longer operative time in the robotic approach, suggesting increased efficiency with the laparoscopic approach.

Graphical abstract

     

Ultrathin self-assembled fibrin sheets

Fibrin polymerizes into the fibrous network that is the major structural component of blood clots and thrombi. We demonstrate that fibrin from three different species can also spontaneously polymerize into extensive, molecularly thin, 2D sheets. Sheet assembly occurs in physiologic buffers on both hydrophobic and hydrophilic surfaces, but is routinely observed only when polymerized using very low concentrations of fibrinogen and thrombin. Sheets may have been missed in previous studies because they may be very short-lived at higher concentrations of fibrinogen and thrombin, and their thinness makes them very difficult to detect. We were able to distinguish fluorescently labeled fibrin sheets by polymerizing fibrin onto micro-patterned structured surfaces that suspended polymers 10 μm above and parallel to the cover-glass surface. We used a combined fluorescence/atomic force microscope system to determine that sheets were ≈5 nm thick, flat, elastic and mechanically continuous. Video microscopy of assembling sheets showed that they could polymerize across 25-μm channels at hundreds of μm²/sec (≈10¹³ subunits/s·M), an apparent rate constant many times greater than those of other protein polymers. Structural transitions from sheets to fibers were observed by fluorescence, transmission, and scanning electron microscopy. Sheets appeared to fold and roll up into larger fibers, and also to develop oval holes to form fiber networks that were “pre-attached” to the substrate and other fibers. We propose a model of fiber formation from sheets and compare it with current models of end-wise polymerization from protofibrils. Sheets could be an unanticipated factor in clot formation and adhesion in vivo, and are a unique material in their own right.     

Sclerosing Papillary Carcinoma Arising in a Lingual Thyroid: Report of a Case

Ectopic lingual thyroid tissue is an uncommon congenital anomaly. Tumors with identical pathological characteristics to those arising in thyroid tissue may be present in ectopic locations, but there are very few cases of malignant ectopic thyroid tumors reported in the literature. We present a review of this phenomenon and report a case of papillary carcinoma of the base of the tongue, located in ectopic lingual thyroid tissue, in a 30-year-old woman. The patients presenting symptoms were dysphagia and oral bleeding, and we performed radical resection of the neoformation at the base of the tongue with part of the muscles of the floor of the mouth and the body of the hyoid bone, as well as total thyroidectomy. Histological examination revealed a sclerosing papillary carcinoma. The patient was treated with ¹³¹I and substitutive thyroid hormonal therapy. An ultrasonogram done 5 years later showed bilateral laterocervical lymph node recurrence, which was effectively treated with bilateral laterocervical lymphectomy.