The effect of prior back surgery on surgical outcome in patients operated on for lumbar spinal stenosis a matched-pair study

Summary It has been widely observed that the outcome after repeat lumbar surgery is rarely comparable to that of primary surgery. In particular, the results of repeat surgery for lumbar spinal stenosis (LSS) have not been favourable. We used a matched-pair format in an attempt to decrease the confounding factors so as to determine as exactly as possible the effect of prior back surgery on the LSS patients surgical outcome. The matching criteria were sex, age, myelographic findings, major symptom, and duration of symptoms. From one group of 251 patients without prior back surgery (SO patients) and another of fifty-three patients with one preceding back operation (RS patients), forty-one similar matched patients pairs (one SO and one RS-patient) were formed.There were 8 female and 33 male pairs. The mean age of the SO patients was 51.6 and of the RS patient 51.4 years, and the mean follow-up time was 4.6 and 4.4 years. The assessment of outcome was based on a subjective disability questionnaire. The SO patients fared significantly better than the RS patients (32.1 versus 41.3, P = 0.026). A short time interval between operations in the RS patients had a worsening effect on outcome, but this trend was not significant.We concluded that one preceding back operation had a worsening effect on the outcome of patients operated on for LSS. As a whole, the results of RS patients were unfavourable. The proper time for achieving good surgical results in LSS patients is the initial operation.     

Autosomal dominant juvenile vitreoretinal degeneration and retinal detachment

To study the inheritance and clinical picture of a new form of vitreoretinal dystrophy I examined 18 family members of a family with six generations. Seven patients, three male and four female, in three consecutive generations were observed to be affected indicating autosomal dominant inheritance. The disease was characterized by juvenile degeneration of the vitreous with detachment of the vitreous body and some floating vitreous opacities, cystoid degeneration of the peripheral retina with whitish glistening stippled areas of superficial retinal degeneration, spotty hyperpigmentation, patches of retinal atrophy with pigmentations, occasional atrophic retinal holes, and in four family members at the age of 4 to 12 years, unilateral or bilateral retinal detachment with breaks in the peripheral retina. Most patients had hyperopia with or without astigmatism. In eyes without detached retina, the disease did not show any marked progression, the lens was clear, the posterior fundus and the retinal and choroidal vessels were normal, and the visual acuity, visual fields, dark adaptation, colour vision, electroretinograms, and visually evoked response findings were normal.     

Phage types and genotypes of Shiga toxin-Producing Escherichia coli O157 in Finland

This study examined Shiga toxin-producing Escherichia coli (STEC) O157, using phage typing, pulsed-field gel electrophoresis, and typing of Shiga toxin variant genes by PCR with restriction fragment length polymorphism in an epidemiological survey of STEC O157 isolated from humans in Finland between 1990 and 1999.     

Sensation and sexual arousal in circumcised and uncircumcised men

IntroductionResearch, theory, and popular belief all suggest that penile sensation is greater in the uncircumcised as compared with the circumcised man. However, research involving direct measurement of penile sensation has been undertaken only in sexually functional and dysfunctional groups, and as a correlate of sexual behavior. There are no reports of penile sensation in sexually aroused subjects, and it is not known how arousal affects sensation. In principle, this should be more closely related to actual sexual function.AimThis study therefore compared genital and nongenital sensation as a function of sexual arousal in circumcised and uncircumcised men.MethodsTwenty uncircumcised men and an equal number of age-matched circumcised participants underwent genital and nongenital sensory testing at baseline and in response to erotic and control stimulus films. Touch and pain thresholds were assessed on the penile shaft, the glans penis, and the volar surface of the forearm. Sexual arousal was assessed via thermal imaging of the penis.ResultsIn response to the erotic stimulus, both groups evidenced a significant increase in penile temperature, which correlated highly with subjective reports of sexual arousal. Uncircumcised men had significantly lower penile temperature than circumcised men, and evidenced a larger increase in penile temperature with sexual arousal. No differences in genital sensitivity were found between the uncircumcised and circumcised groups. Uncircumcised men were less sensitive to touch on the forearm than circumcised men. A decrease in overall touch sensitivity was observed in both groups with exposure to the erotic film as compared with either baseline or control stimulus film conditions. No significant effect was found for pain sensitivity.ConclusionThese results do not support the hypothesized penile sensory differences associated with circumcision. However, group differences in penile temperature and sexual response were found. Payne K, Thaler L, Kukkonen T, Carrier S, and Binik Y. Sensation and sexual arousal in circumcised and uncircumcised men.     

Factors associated with higher oxytocin requirements in labor

Objective: To identify clinical characteristics associated with high maximum oxytocin doses in women who achieve complete cervical dilation.

Methods: A retrospective nested case-control study was performed within a cohort of all term women at a single center between 2004 and 2008 who reached the second stage of labor. Cases were defined as women who had a maximum oxytocin dose during labor >20?mu/min, while women in the control group had a maximum oxytocin dose during labor of ≤20?mu/min. Exclusion criteria included no oxytocin administration during labor, multiple gestations, major fetal anomalies, nonvertex presentation, and prior cesarean delivery. Multiple maternal, fetal, and labor factors were evaluated with univariable analysis and multivariable logistic regression.

Results: Maximum oxytocin doses >20?mu/min were administered to 108 women (3.6%), while 2864 women received doses ≤20?mu/min. Factors associated with higher maximum oxytocin dose after adjusting for relevant confounders included maternal diabetes, birthweight >4000?g, intrapartum fever, administration of magnesium, and induction of labor.

Conclusions: Few women who achieve complete cervical dilation require high doses of oxytocin. We identified maternal, fetal and labor factors that characterize this group of parturients.     

Functional genomics bridges the gap between quantitative genetics and molecular biology

Deep characterization of molecular function of genetic variants in the human genome is becoming increasingly important for understanding genetic associations to disease and for learning to read the regulatory code of the genome. In this paper, I discuss how recent advances in both quantitative genetics and molecular biology have contributed to understanding functional effects of genetic variants, lessons learned from eQTL studies, and future challenges in this field.Most of human genetics research falls under two main questions: What are the genetic origins of variation in human disease and other traits? How does the blueprint of the human genome function to give rise to a living individual? These questions have different historical roots—in quantitative or medical genetics and molecular biology, respectively—as well as different molecular and statistical methods, and thus for decades they have been largely distinct areas of research. However, a question of increasing importance for understanding the human genome lies at their intersection: What are the functional effects of genetic variants across the human genome?The study of the evolutionary origins of human genetic variation and its contribution to human disease and traits has its origins in quantitative, statistical, and population genetics. Advances in high-throughput genotyping and sequencing technologies during the past 10 years have led to tremendous progress in this field, with the HapMap and 1000 Genomes projects (The International HapMap Consortium et al. 2007; The 1000 Genomes Project Consortium 2012) creating the foundation for hundreds of genome-wide association studies (GWAS) and now also rare variant analyses in the context of both common and rare diseases (Bamshad et al. 2011; Lee et al. 2014). However, these maps of genetic associations to disease do not give us direct information of the function of these variants: how they perturb the biology of the genome, the cell, and eventually the organism to affect disease risk—or from a population genetics perspective, to affect different selective pressures. Without such understanding, the information from genetic association studies will yield little benefit to human health.On the other side, understanding the mechanistic function of the human genome—as well as genomes of other species—has always been one of the fundamental questions of molecular biology. During the past five years, the approach has become genome-wide via the development of diverse high-throughput sequencing assays, applied to multiple cell types. Projects such as ENCODE (The ENCODE Project Consortium 2012), the Epigenomics Roadmap (Roadmap Epigenomics Consortium 2015), and FANTOM (The FANTOM Consortium and the RIKEN PMI and CLST (DGT) 2014) have produced large catalogs of functional elements in the genome—or more accurately, some genomes, since naturally, there is no archetype of the human genome. These studies do not typically capture variation in genome function among individuals, and the contribution of genetic differences in variation between samples is often ignored in study design. Thus, while these resources are used to annotate the putative regulatory function of genetic variants, this is done via indirect inference rather than direct measurement of genetic contribution to human phenotype diversity at the cellular level.The need to bridge conventional quantitative genetics and functional or molecular genetics has now become widely acknowledged (Fig. 1). The concept is not new—medical genetics has a long history of characterizing cellular effects of disease-causing mutations. However, the development of genome-wide methods now allows systematic high-throughput analysis, which is eventually more cost-efficient and informative of generalizable patterns than laborious locus-specific characterization. High-throughput analysis, with scalable and robust molecular assays, careful statistical analysis, and deep biological interpretation, are essential to achieve the future goal of being able to accurately read the genetic code, i.e., predict functional and phenotypic effects of genetic variants.Open in a separate windowFigure 1.Intersections of fields analyzing genetic variation, molecular biology, and medicine. GWAS and EWAS stand for genome-wide and epigenome-wide association studies, respectively, and eQTL is an abbreviation of expression quantitative trait loci.     

Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour

Objectives: This study aimed to examine “intention to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior.

Materials and methods: A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected.

Results: The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β?=?0.21, p?p?p?p?<0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care.

Conclusion: The Theory of Planned Behavior provides understanding of “intention to” and “performance of” oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation.

• Implications for Rehabilitation

• Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia).

• Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation.

• A large-scale national survey was conducted to understand “intentions to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model.

• These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.