Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database

Abstract

Background

Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry.

Methods

From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG.

Results

The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively).

Conclusion

The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.

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Effect of academic status on outcomes of surgery for rectal cancer

Abstract

Background

The purpose of our study was to investigate surgical outcomes following advanced colorectal procedures at academic versus community institutions.

Methods

The SPARCS database was used to identify patients undergoing Abdominoperineal resection (APR) and Low Anterior Resection between 2009 and 2014. Linear mixed models and generalized linear mixed models were used to compare outcomes. Laparoscopic versus open procedures, surgery type, volume status, and stoma formation between academic and community facilities were compared.

Results

Higher percentages of laparoscopic surgeries (58.68 vs. 41.32%, p value < 0.0001), more APR surgeries (64.60 vs. 35.40%, p value < 0.0001), more high volume hospitals (69.46 vs. 30.54%, p value < 0.0001), and less stoma formation (48.00 vs. 52.00%, p value < 0.0001) were associated with academic centers. After adjusting for confounding factors, academic facilities were more likely to perform APR surgeries (OR 1.35, 95% CI 1.04–1.74, p value = 0.0235). Minorities and Medicaid patients were more likely to receive care at an academic facility. Stoma formation, open surgery, and APR were associated with longer LOS and higher rate of ED visit and 30-day readmission.

Conclusion

Laparoscopy and APR are more commonly performed at academic than community facilities. Age, sex, race, and socioeconomic status affect the facility at which and the type of surgery patients receive, thereby influencing surgical outcomes.

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Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks

Abstract

Background

Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study.

Methods

Between October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract.

Results

Complete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents.

Conclusion

This study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects.

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Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis

Abstract

Background

In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures.

Methods

A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms.

Results

After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD − 0.99 95% CI − 1.4 to − 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1–2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18–1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9–1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16–1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD − 0.52; 95% CI − 0.52 to − 0.04, p = 0.035).

Conclusions

RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.

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Systematic review of robotic low anterior resection for rectal cancer

Abstract

Background

Potential advantages of robotic surgery, such as 3-dimensional high-definition vision, wrist-like movements of instruments, stable camera holding, motion filter for tremor-free surgery, and improved ergonomics, may provide better clinical, oncological, and functional outcomes in rectal cancer surgery, as suggested in many comparative studies. However, there has not been a systematic review specific to LAR/TME for rectal cancer that includes both robotic versus laparoscopic and robotic versus open comparative studies.

Methods

The PubMed and Scopus databases were systematically searched in a two-step process, first for all robotic publications, and then within those results, for studies that compared perioperative, oncologic, or functional outcomes of robotic versus laparoscopic or open LAR/TME. Randomized controlled trials, systematic reviews, and independent database population studies were included in the analysis.

Results

Thirteen publications reporting on 24,526 patients met the inclusion criteria. Two studies compared robotic and open surgery, ten compared robotic and laparoscopic surgery, and one study compared all three. Robotic surgery resulted in increased operating times, reduced blood loss, fewer transfusions, shorter hospital stay, and comparable oncologic outcomes versus open surgery, and reduced conversion and impotency rates versus laparoscopic surgery.

Conclusions

Robotic surgery is comparable to open and laparoscopic surgery concerning oncologic outcomes and seems to provide some clinical and functional benefits, although evidence is limited.

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Laparoscopy as a useful selection tool for patients with prior surgery and peritoneal metastases suitable for multimodality treatment strategies

Abstract

Background

Complete macroscopic cytoreduction in patients with peritoneal carcinomatosis (PC) is the basic requirement for long-term survival. Diagnostic laparoscopy (DL) can be difficult and of limited clinical value secondary to postoperative or tumor-induced adhesions. The aim of this study was to evaluate the role of DL in patients with prior surgery and PC.

Methods

The database of the surgical department of the University Medical Center of Regensburg was reviewed (9/2010–10/2014) selecting for DL in patients with PC. The operative report had a standardized format allowing for the determination of the extent of the intra-abdominal visible area and the extent of tumor on the surface of the small intestine. For the classification we used our own developed score.

Results

DL was performed in 102 patients. The complete abdominal cavity was evaluable in 48%. At least two quadrants and the largest part of the small intestine could be assessed in 70%. 37% of the patients had massive tumor manifestation on the small intestine or its mesentery. PCI (Peritoneal Cancer Index) could not be calculated in 71% of the patients due to incomplete visualization of the abdominal cavity and/or multiple tumor manifestations on the small intestine. 54% of patients were classified as non-resectable and 85% who seemed suitable for cytoreductive surgery underwent a CCR-0 resection and HIPEC.

Conclusions

In spite of prior surgery and PC, DL is frequently possible and a useful tool to define the extent of tumor spread. Lots of patients can be prevented from needless open laparotomy. The extent of tumor involvement of the small intestine seems to be more relevant than calculation of the PCI to determine the potential for complete resection. Therefore, in the presence of adhesions, inspection of the complete abdominal cavity does not offer added clinical benefit and further adhesiolysis can be avoided.

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Improving patient safety during procedural sedation via respiratory volume monitoring: A randomized controlled trial

Assess the utility of a respiratory volume monitor (RVM) to reduce the incidence of low minute ventilation events in procedural sedation.

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Time resolution requirements for civilian radioxenon emission data for the CTBT verification regime

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): Pieter De Meutter, Johan Camps, Andy Delcloo, Benoît Deconninck, Piet Termonia
The capability of the noble gas component of the International Monitoring System as a verification tool for the Comprehensive Nuclear-Test-Ban Treaty is deteriorated by a background of radioxenon emitted by civilian sources. One of the possible approaches to deal with this issue, is to simulate the daily radioxenon concentrations from these civilian sources at noble gas stations by using atmospheric transport models. In order to accurately quantify the contribution from these civilian sources, knowledge on the releases is required. However, such data are often not available and furthermore it is not clear what temporal resolution such data should have. In this paper, we assess which temporal resolution is required to best model the ¹³³Xe contribution from civilian sources at noble gas stations in an operational context. We consider different sampling times of the noble gas stations and discriminate between nearby and distant sources. We find that for atmospheric transport and dispersion problems on a scale of 1000 km or more, emission data with subdaily temporal resolution is generally not necessary. However, when the source-receptor distance decreases, time-resolved emission data become more important. The required temporal resolution of emission data thus depends on the transport scale of the problem. In the context of the Comprehensive Nuclear-Test-Ban Treaty, where forty noble gas stations will monitor the whole globe, daily emission data are generally sufficient, but for certain meteorological conditions, better temporally resolved emission data are required.



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Laparoscopic extended cholecystectomy for T3 gallbladder cancer

Abstract

Background

Gallbladder cancer (GBC) has been contraindicated for laparoscopic surgery since this procedure was introduced [1, 2]. Recently, however, there have been several reports of laparoscopic extended cholecystectomy for GBC, but most cases involved early GBC confined to the GB [3, 4]. This video describes our technique of laparoscopic extended cholecystectomy for T3 GBC.

Methods

A 77-year-old female presented with a gallbladder mass, which was incidentally detected during evaluation of back pain. Abdominal computed tomography and endoscopic ultrasonography revealed a 3.5 × 2.5 cm hypoechoic mass in the gallbladder fundus with liver invasion. We performed laparoscopic en bloc resection of the gallbladder and the gallbladder bed, as well as lymphadenectomy.

Results

Two 5-mm and three 12-mm trocars were used. After carefully dissecting Calot's triangle, the cystic duct was dissected and ligated. The cystic duct margin was negative on the frozen section biopsy. Cholecystectomy with en bloc wedge resection of the liver was performed first. Ultrasonic shears were used to transect the superficial hepatic parenchyma and a Cavitron Ultrasonic Surgical Aspirator was used to transect the deeper parenchyma. We then performed lymphadenectomy of involved lymph nodes (LNs) around the hepatoduodenal ligament, common hepatic artery, and posterior superior pancreas. After Kocherization of the duodenum, LNs were dissected from the posterior superior portion of the pancreas. LN dissection continued along the right side of the common bile duct and the portal vein. After dissection from the inferior vena cava and the aorta, the dissected LNs were pushed toward the left side under the portal vein. LN dissection continued along the left side of the hepatoduodenal ligament, while exposing the common hepatic artery and proper hepatic artery. Skeletonizing en bloc LN dissection was the final procedure. The operation time was 215 min and the estimated intraoperative blood loss was 200 mL. The postoperative pathology confirmed a small cell neuroendocrine carcinoma with clear resection margins. The pathologic staging was pT3N1. LN metastasis was found in one of 12 retrieved LNs. The patient was discharged on postoperative day 4 without postoperative complications. The patient received combined chemoradiation therapy for 6 months after surgery. There was no evidence of recurrence over the follow-up period of 14 months.

Conclusion

Laparoscopic extended cholecystectomy is technically feasible in patients with T3 GBC, and the extent of resection is the same as that of open surgery.

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Early laparoscopic adhesiolysis for small bowel obstruction: retrospective study of main advantages

Abstract

Background

The problem of managing adhesional small bowel obstruction (ASBO) is still unsolved. A conservative medical attitude is privileged even if it is associated to a high rate of recurrences, while surgery is applied to cases showing no improvement after 48–72 h. Adhesiolysis via laparotomy has been the standard surgical management, but it causes other adhesions in a vicious circle. The aim of the study is to evaluate the advantages of early laparoscopic adhesiolysis as an alternative approach.

Methods

From January 2010 to April 2017, 107 patients were admitted with a diagnosis of ASBO. Patients underwent medical treatment, early surgery, emergency surgery or delayed surgery after failure of medical treatment. A retrospective review and explorative statistical analysis were performed using graphical diagnostic plots, Mann–Whitney (MW) test, Kolmogorov–Smirnov (KS) test, exact binomial test, and χ ² test.

Results

Medical treatment led to resolution in the 77.3% of cases, but patients exhibit much more recurrences than those in the surgical group (χ ²p < .001). They also show a longer fasting time (MW p = .027; KS p = .102), a doubled number of radiological exams (MW p < .001; KS p < .001), and more major complications than those in the early surgery group. Early surgery group is associated to shorter fasting time (MW p < .001; KS p < .001), much shorter hospital stay (MW p < .001; KS p = .002) and a smaller number of radiological exams (MW p = .005; KS p = .002) compared with delayed surgery group. The laparoscopic group shows significantly earlier regain of intestinal transit (MW p < .001; KS p = .002), shorter fasting time (MW p = .002; KS p = .008), reduced number of radiological exams (MW p = .003; KS p = .014), reduced hospital stay (MW p < .001; KS p = .005), and no more complications than the open surgery group.

Conclusions

Early laparoscopic surgery can be proposed as an effective alternative treatment for ASBO.

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Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia

Abstract

Background

Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM.

Methods

A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database. The measure of effectiveness was quality-adjusted life years (QALYs) which were estimated from direct elicitation of utility using a visual analog scale. The primary outcome was the incremental cost-effectiveness ratio (ICER). Uncertainty was assessed by bootstrapping the sample and computing the cost-effectiveness acceptability curve (CEAC).

Results

Patients treated within an 11-year period (2004–2016) were recruited for participation (20 POEM, 21 LHM). During the index admission, the mean costs for POEM ($8630 ± $2653) and the mean costs for LHM ($7604 ± $2091) were not significantly different (P = 0.179). Additionally, mean QALYs for POEM (0.413 ± 0.248) were higher than that associated with LHM (0.357 ± 0.338), but this difference was also not statistically significant (P = 0.55). The ICER suggested that it would cost an additional $18,536 for each QALY gained using POEM. There was substantial uncertainty in the ICER; there was a 48.25% probability that POEM was cost-effective at the mean ICER. At a willingness-to-pay threshold of $100,000, there was a 68.31% probability that POEM was cost-effective relative to LHM.

Conclusions

In the treatment of achalasia, POEM appears to be cost-effective relative to LHM depending on one's willingness-to-pay for an additional QALY.

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Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy

Abstract

Background

Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN.

Methods

From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student's t test or Mann–Whitney test. A CUSUM analysis was performed to investigate the learning curve.

Results

All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months.

Conclusion

Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.

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The NOVEL trial: natural orifice versus laparoscopic cholecystectomy—a prospective, randomized evaluation

Abstract

Introduction

The evolution of Natural Orifice Translumenal Endoscopic Surgery^® (NOTES^®) represents a case study in surgical procedural evolution. Beginning in 2004 with preclinical feasibility studies, and followed by the creation of the NOSCAR^® collaboration between The Society of American Gastrointestinal and Endoscopic Surgeons and the American Society for Gastrointestinal Endoscopy, procedural development followed a stepwise incremental pathway. The work of this consortium has included white paper analyses, obtaining outside independent funding for basic science and procedural development, and, ultimately, the initiation of a prospective randomized clinical trial comparing NOTES^® cholecystectomy as an alternative procedure to laparoscopic cholecystectomy.

Methods

Ninety patients were randomized into a randomized clinical trial with the primary objective of demonstrating non-inferiority of the transvaginal and transgastric arms to the laparoscopic arm. In the original trial design, there were both transgastric and transvaginal groups to be compared to the laparoscopic control group. However, after enrollment and randomization of 6 laparoscopic controls and 4 transgastric cases into the transgastric group, this arm was ultimately deemed not practical due to lagging enrollment, and the arm was closed. Three transgastric via the transgastric approach were performed in total with 9 laparoscopic control cases enrolled through the TG arm. Overall a total of 41 transvaginal and their 39 laparoscopic cholecystectomy controls were randomized into the study with 37 transvaginal and 33 laparoscopic cholecystectomies being ultimately performed. Overall total operating time was statistically longer in the NOTES^® group: 96.9 (64.97) minutes versus 52.1 (19.91) minutes.

Results

There were no major adverse events such as common bile duct injury or return to the operating room for hemorrhage. Intraoperative blood loss, length of stay, and total medication given in the PACU were not statistically different. There were no conversions in the NOTES^® group to a laparoscopic or open procedure, nor were there any injuries, bile leaks, hemorrhagic complications, wound infections, or wound dehiscence in either group. There were no readmissions. Visual Analogue Scale (VAS) pain scores were 3.4 (CI 2.82) in the laparoscopic group and 2.9 (CI 1.96) in the transvaginal group (p = 0.41). The clinical assessment on cosmesis scores was not statistically different when recorded by clinical observers for most characteristics measured when the transvaginal group was compared to the laparoscopic group. Taken as a whole, the results slightly favor the transvaginal group. SF-12 scores were not statistically different at all postoperative time points except for the SF-12 mental component which was superior in the transvaginal group at all time points (p < 0.05).

Conclusion

The safety profile for transvaginal cholecystectomy demonstrates that this approach is safe and produces at least non-inferior clinical results with superior cosmesis, with a transient reduction in discomfort. The transvaginal approach to cholecystectomy should no longer be considered experimental. As a model for intersociety collaboration, the study demonstrated the ultimate feasibility and success of partnership as a model for basic research, procedural development, fundraising, and clinical trial execution for novel interventional concepts, regardless of physician board certification.

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Benefits of laparoscopic liver resection in patients with hepatocellular carcinoma and portal hypertension: a case-matched study

Abstract

Background

The advantages of laparoscopy over open liver resection in patients with cirrhosis have been widely demonstrated. On the other hand, information on the role of minimally invasive liver surgery in the presence of clinically significant portal hypertension (CSPH) is scarce. The aim of this study was to evaluate the role of laparoscopic liver resection in selected cirrhotic patients with CSPH.

Methods

A retrospective case–control study of cirrhotic patients with hepatocellular carcinoma who were treated with laparoscopic liver resection was conducted from December 2005 to April 2016. A total of 45 patients were included. Patients were divided into two groups according to the presence or absence of clinically significant portal hypertension. Fifteen cirrhotic patients with CSPH were matched with 30 patients without CSPH.

Results

Overall, there were no differences in intraoperative results. No conversion to open surgery occurred in the CSPH group, and 3 patients were converted in the Non-CSPH group (0 vs. 10% p = 0.57). Only 2 (7%) patients in the Non-CSPH group and 1 (7%) in the CSPH group had relevant complications (modified Clavien–Dindo classification III). Two patients in the Non-CSPH group and one in the CSPH group developed transient ascites (7 vs. 7%). Postoperative hospital stay was similar in both groups, with a median of 4 days in the CSPH group and 3 days in the Non-CSPH group (p = 0.37). The median follow-up of the entire cohort was 38 months (range 7–100). Overall survival rates at 1 and 3 years were 100 and 87%, respectively. There was no significant difference between the groups in terms of survival (p = 0.8).

Conclusion

This initial study showed that laparoscopic resection in patients with CSPH can be performed safely in well-selected patients and expand the current surgical indications in patients with CSPH. Prospective trials with a larger sample size are necessary to confirm these results.

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Can we refine body mass estimations based on femoral head breadth?

Publication date: Available online 7 December 2017
Source:Journal of Human Evolution
Author(s): Markku Niskanen, Juho-Antti Junno, Heli Maijanen, Brigitte Holt, Vladimir Sladék, Margit Berner
Femoral head breadth is widely used in body mass estimation in biological anthropology. Earlier research has demonstrated that reduced major axis (RMA) equations perform better than least squares (LS) equations. Although a simple RMA equation to estimate body size from femoral head breadth is sufficient in most cases, our experiments with male skeletons from European data (including late Pleistocene and Holocene skeletal samples) and the Forensic Anthropology Data Bank data (including the W. M. Bass Donated Skeletal Collection sample) show that including femoral length or anatomically estimated stature in an equation with femoral head breadth improves body mass estimation precision. More specifically, although directional bias related to body mass is not reduced within specific samples, the total estimation error range, directional bias related to stature, and temporal fluctuation in estimation error are markedly reduced. The overall body mass estimation precision of individuals representing different temporal periods and ancestry groups (e.g., African and European ancestry) is thus improved.



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Texas fire department welcomes first female firefighter-paramedic in 141 years

By Drew Smith Herald Democrat DENISON, Texas — Denison Fire Rescue crews welcomed Hanna Lindemuth to their team last week as not only one of the department's newest employees but as the first female firefighter and paramedic in the department's 141-year history. "We're happy she's here and we're proud of her at the same time," Assistant Fire Chief Mark Escamilla said ...

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Single-site robotic-assisted laparoscopic cholecystectomy in children and adolescents: a report of 20 cases

Abstract

Background

Single-site laparoscopy is increasingly popular for straightforward operations like appendectomy. Due to limited triangulation and maneuverability, single-site cholecystectomy is riskier and more difficult. Robotics offer to make it easier and safer.

Methods

Twenty children and adolescents underwent robotic-assisted single-site cholecystectomy at a large academic children's hospital. Patients were not randomized; patients were offered the option of robotic-assisted single-site (SSR) or standard four-incision laparoscopic (LAP) cholecystectomy. Demographics and perioperative details were compared with those of a comparable cohort who underwent LAP during the same period.

Results

The two groups were similar in physical characteristics and indications for operation. The robotic operations took longer but both groups received similar PRN doses of parenteral opiates. Patients in the SSR group were all discharged on the first postoperative day. There were no major complications in either group but a slightly higher incidence of minor wound complications in the SSR group.

Conclusion

Robotic-assisted single-site cholecystectomy appears to be a safe alternative to standard laparoscopy with a similar postoperative pain profile, short postoperative lengths of stay, and, for some, a superior cosmetic result. Nevertheless, it comes with longer set-up and operative times, a higher incidence of minor wound complications, an unknown but possibly higher risk of incisional hernia, and higher costs.

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Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes

Abstract

Introduction

Enteral access through the jejunum is indicated when patients cannot tolerate oral intake or gastric feeding. While multiple approaches for feeding jejunal access exist, few studies have compared the efficacy of these techniques. The purpose of this study was to investigate the long-term durability, re-intervention rates, and nutritional outcomes following percutaneous endoscopic gastrostomy tubes with jejunal extension tubes (PEG-JET) versus laparoscopic jejunostomy tubes (j-tubes).

Methods

Retrospective chart review was performed on all patients who underwent PEG-JET or laparoscopic jejunostomy tube placement from January 2005 through December 2015 at our institution. Thirty-day and long-term outcomes were compared between the two groups.

Results

A total of 105 patients underwent PEG-JET and 307 patients underwent laparoscopic j-tube placement during the defined study period. In terms of 30-day outcomes, patients who underwent PEG-JET placement were significantly more likely to experience a tube dislodgement event (p = 0.005) and undergo a re-intervention (p < 0.001). Patients who had a laparoscopic j-tube placed were significantly more likely to meet their enteral feeding goals (p = 0.002) and less likely to require nutritional supplementation with total parenteral nutrition (TPN) (p < 0.001). With regard to long-term outcomes, patients who underwent PEG-JET placement were significantly more likely to experience tube occlusion (p < 0.001) and require an endoscopic or surgical tube re-intervention (p < 0.001). Patients who underwent laparoscopic j-tube placement were significantly more likely to experience a tube site leak (p = 0.015) but were less likely to require nutritional supplementation with TPN (p = 0.001).

Conclusion

Laparoscopic jejunostomy tubes provide more durable long-term enteral access compared to PEG-JET. Consideration should be given to laparoscopic jejunostomy tube placement in eligible patients who cannot tolerate oral intake or gastric enteral feeding.

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Hypopharyngeal multichannel intraluminal impedance leads to the promising outcome of antireflux surgery in Japanese population with laryngopharyngeal reflux symptoms

Abstract

Background

Clinical characteristics of laryngopharyngeal reflux (LPR) in Japanese population remain unclear, and its treatment outcome is suboptimal. The objectives of this study were to evaluate Japanese patients with LPR symptoms using hypopharyngeal multichannel intraluminal impedance (HMII) and to assess the outcome of antireflux surgery (ARS).

Methods

Subjects included patients who had LPR symptoms for > 12 weeks or laryngoscopic findings suggestive of LPR and underwent laryngoscopy and esophageal testing including HMII. Abnormal proximal exposure (APE) was defined as LPR ≥ 1/day and/or full column reflux (FCR) (reflux 2 cm distal to the upper esophageal sphincter) ≥ 5/day on HMII. Patients with APE were offered ARS and the outcome of ARS was objectively assessed using Reflux Symptom Index (RSI).

Results

From July 2015 to September 2016, 52 patients with LPR symptoms (28 men, 24 women, median BMI 22.3) underwent HMII, and 38 patients (73%) had APE. Of them, 29 (76%) patients were not obese (BMI < 25) and 19 (50%) patients had a negative DeMeester score. Approximately one-third of LPR and FCR events were non-acid in the distal esophagus. A positive symptom-association probability was seen only in 18 patients (35%). Mild esophagitis and hiatal hernia were found in 5 (10%) and 23 (48%) patients, respectively. All 12 patients (100%) who had undergone ARS were able to discontinue PPI and had a significant improvement in the RSI scores postoperatively (22.9 ± 10.0 vs. 6.8 ± 6.8, p < .001).

Conclusions

APE was frequently observed in Japanese patients with LPR symptoms. Obesity and esophagitis were uncommon in this population. Since a large number of patients with APE had negative DeMeester score and proximal reflux events were often non-acid, a conventional pH monitoring is insufficient. HMII is crucial to evaluate patients with LPR symptoms as the documentation of APE is a key for successful outcome of ARS.

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How bariatric surgery affects liver volume and fat density in NAFLD patients

Abstract

Introduction

Nonalcoholic fatty liver disease (NAFLD) is an epidemic in the obese population. Bariatric surgery is known to reverse multiple metabolic complications of obesity such as diabetes, dyslipidemia, and NAFLD, but the timing of liver changes has not been well described.

Materials and Methods

This was an IRB-approved, two-institutional prospective study. Bariatric patients received MRIs at baseline and after a pre-operative liquid diet. Liver biopsies were performed during surgery and if NAFLD positive, the patients received MRIs at 1, 3, and 6 months. Liver volumes and proton-density fat fraction (PDFF) were calculated from offline MRI images. Primary outcomes were changes in weight, body mass index (BMI), percent excess weight loss (EWL%), liver volume, and PDFF. Resolution of steatosis, as defined as PDFF < 6.4% based on previously published cutoffs, was assessed. Secondarily, outcomes were compared between patients who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB).

Results

From October 2010 to June 2015, 124 patients were recruited. 49 patients (39.5%) completed all five scans. EWL% at 6 months was 55.6 ± 19.0%. BMI decreased from 45.3 ± 5.9 to 34.4 ± 5.1 kg/m² and mean liver volume decreased from 2464.6 ± 619.4 to 1874.3 ± 387.8 cm³ with a volume change of 21.4 ± 11.4%. PDFF decreased from 16.6 ± 7.8 to 4.4 ± 3.4%. At 6 months, 83.7% patients had resolution of steatosis. Liver volume plateaued at 1 month, but PDFF and BMI continued to decrease. There were no statistically significant differences in liver volume or PDFF reduction from baseline to 6 months between the LSG versus LRYGB subgroups.

Conclusion

Patients with NAFLD undergoing bariatric surgery can expect significant decreases in liver volume and hepatic steatosis at 6 months, with 83.7% of patients achieving resolution of steatosis. Liver volume reduction plateaus 1-month post-bariatric surgery, but PDFF continues to decrease. LSG and LRYGB did not differ in efficacy for inducing regression of hepatosteatosis.

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Laparoscopic removal of retroperitoneal tumor with maneuver of hanging inferior vena cava

Abstract

Background

Laparoscopic resection of retroperitoneal mass is challenging because of its location close to major vessels and a limited range of laparoscopic instruments [1–3]. We report a case of a huge retroperitoneal paraganglioma that was successfully excised laparoscopically using maneuver of hanging IVC

Method

A 67-year-old female had abdominal mass detected during routine check-up. She had no symptoms associated mass. Hematologic, biochemical investigations, and hormone tests reveal normal results. Preoperative CT shows retroperitoneal tumor, measuring 6.1 cm in diameter, which was closely adhered to right adrenal gland and seemed to originate from adrenal gland. Three 12-mm trocars and two 5-mm trocars were used. Laparoscopic views showed that severe adhesion in peritoneal cavity due to previous subtotal gastrectomy for gastric polyp about 30 years ago. After adhesiolysis, the mass was visualized behind inferior vena cava. The mass was carefully dissected and separated from duodenum and inferior vena cava as well as right adrenal gland. Inferior vena cava was retracted with hanging maneuver of IVC with vascular tape. The fibrotic tissues covering the mass were dissected with ligasure™. The feeding vessels supplying mass were identified and clipped, then subsequently sealed and divided. After complete resection of mass, the specimen was inserted into plastic retrieval bag and extracted via extended umbilical port. And then Jackson Pratt drain was placed around inferior vena cava.

Result

There was no intraoperative transfusion and complications during laparoscopic retroperitoneal excision for paraganglioma. The operation time was 190 min, and estimated blood loss was 100 ml. The patient was discharged on postoperative 5th day without complications. Final pathologic result was paraganglioma of 7.5 cm sized with PASS score 4 (pheochromocytoma of the adrenal gland scaled score).

Conclusion

Laparoscopic surgery for huge retroperitoneal paraganglioma behind IVC was successfully performed with the maneuver of hanging IVC. This procedure could be useful with appropriate laparoscopic technique and proper patient selection.

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The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose

Abstract

Background

Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1–2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team.

Methods

The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status.

Results

The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE.

Conclusions

The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.

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Gastric neuroendocrine tumor arising from heterotopic pancreas

Abstract

There are few English reports on secondary tumors from heterotopic pancreas. Here, we describe a case of gastric neuroendocrine tumor (NET) arising from heterotopic pancreas. A 72-year-old woman underwent esophagogastroduodenoscopy as part of a general health check-up. An endoscopic examination revealed a submucosal tumor on the greater curvature of the gastric body. Laparoscopic and endoscopic cooperative surgery was performed. Histological diagnosis concluded that it was a Grade 1 NET arising from heterotopic pancreas. We report this extremely rare case of a NET presenting as a submucosal tumor, considered to have originated from heterotopic pancreatic tissue.

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Hypothalamic paraventricular nucleus neuronal nitric oxide synthase activity is a major determinant of renal sympathetic discharge in conscious Wistar rats

Abstract

The paraventricular nucleus of the hypothalamus (PVN) plays a crucial role in cardiovascular and neuroendocrine regulation. Application of nitric oxide donors to the PVN stimulates GABAergic transmission, and may suppress sympathetic nerve activity (SNA) to lower arterial pressure. However, the role of endogenous nitric oxide within PVN in regulating renal SNA chronically remains to be established in conscious animals. To address this, we used our previously established lentiviral vectors to selectively knock down neuronal nitric oxide synthase (nNOS) in the PVN of conscious Wistar rats. Blood pressure (BP) and renal SNA were monitored simultaneously and continuously for 21 days (n = 14) using radio-telemetry. Renal SNA was normalised to maximal evoked discharge and expressed as a percent change from baseline. The PVN were microinjected bilaterally with a neurone-specific tetracycline-controllable lentiviral vector, expressing a short hairpin miRNA-30 (shRNA) interference system targeting nNOS (n = 7) or expressing a mis-sense as control (n = 7). Recordings continued for a further 18 days. The vectors also expressed GFP, and successful expression in the PVN, and nNOSknockdown, was confirmed histologically post-hoc. Knock-down of nNOS expression in the PVN resulted in a sustained increase in BP (95 ± 2 to 104 ± 3 mmHg, P < 0.05), with robust concurrent sustained activation of renal sympathetic nervous activity (>70%, P < 0.05). The study reveals a major role for nNOS-derived nitric oxide within the PVN in chronic set-set point regulation of cardiovascular autonomic activity in the conscious, normotensive rat.

This article is protected by copyright. All rights reserved

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Short vs. long pulses for testing knee extensor neuromuscular properties: does it matter?

Abstract

Purpose

The present study aimed at comparing knee extensor neuromuscular properties determined with transcutaneous electrical stimulation using two pulse durations before and after a standardized fatigue protocol.

Methods

In the first sub-study, 19 healthy participants (ten women and nine men; 28 ± 5 years) took part to two separate testing sessions involving the characterization of voluntary activation (twitch interpolation technique), muscle contractility (evoked forces by single and paired stimuli), and neuromuscular propagation (M-wave amplitude from vastus lateralis and vastus medialis muscles) obtained at supramaximal intensity with a pulse duration of either 0.2 or 1 ms. The procedures were identical in the second sub-study (N = 11), except that neuromuscular properties were also evaluated after a standardized fatiguing exercise. Electrical stimulation was delivered through large surface electrodes positioned over the quadriceps muscle and a visual analog scale was used to evaluate the discomfort to paired stimuli evoked at rest.

Results

There was no difference between pulse durations in the estimates of voluntary activation, neuromuscular propagation, and muscle contractility both in the non-fatigued and fatigued states. The discomfort associated with supramaximal paired electrical stimuli was also comparable between the two pulse durations.

Conclusions

It appears that 0.2- and 1-ms-long pulses provide a comparable evaluation of knee extensor neuromuscular properties.

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The acclimatised spinal cord

Abstract

Fatigue is a universal and daily phenomenon that involves a myriad of complex mechanisms ultimately characterised as an exercise-induced decrease in the maximal force produced by a muscle.

This article is protected by copyright. All rights reserved

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Early Effects of Rhodomyrtone on Membrane Integrity in Methicillin-Resistant Staphylococcus aureus

Microbial Drug Resistance , Vol. 0, No. 0.


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Apical Membrane Alterations in Non-intestinal Organs in Microvillus Inclusion Disease

Abstract

Objectives

Microvillus inclusion disease (MVID) is a severe form of neonatal diarrhea, caused mainly by mutations in MYO5B. Inactivating mutations in MYO5B causes depolarization of enterocytes in the small intestine, which gives rise to chronic, unremitting secretory diarrhea. While the pathology of the small intestine in MVID patients is well described, little is known about extraintestinal effects of MYO5B mutation.

Methods

We examined stomach, liver, pancreas, colon, and kidney in Navajo MVID patients, who share a single homozygous MYO5B-P660L (1979C>T p.Pro660Leu, exon 16). Sections were stained for markers of the apical membrane to assess polarized trafficking.

Results

Navajo MVID patients showed notable changes in H/K-ATPase-containing tubulovesicle structure in the stomach parietal cells. Colonic mucosa was morphologically normal, but did show losses in apical ezrin and Syntaxin 3. Hepatocytes in the MVID patients displayed aberrant canalicular expression of the essential transporters MRP2 and BSEP. The pancreas showed small fragmented islets and a decrease in apical ezrin in pancreatic ducts. Kidney showed normal primary cilia.

Conclusions

These findings indicate that the effects of the P660L mutation in MYO5B in Navajo MVID patients are not limited to the small intestine, but that certain tissues may be able to compensate functionally for alterations in apical trafficking.

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Cortical thickness, resting state heart rate, and heart rate variability in female adolescents

Abstract

Resting state heart rate variability (HRV) is a psychophysiological marker that has gained increasing research interest, in particular in developmental neuroscience. HRV has been shown to be associated with mental and physical health, beyond simple measures of heart rate (HR) and shows inter- and intraindividual variance across aging. Recently, three studies reported on a positive correlation between resting state HRV and cortical thickness in selected regions of interest (ROIs) in adult samples. Structural thickness, HRV, and HR change during the sensitive period of adolescence. Previously, no study has addressed the structural concomitants of resting HR and HRV in adolescents. Cortical thickness (3-T MRI), HR, and HRV were recorded in 20 healthy, female adolescents (mean age: 15.92 years; SD = 1.06; range: 14–17). In line with existing research in adults, cortical thickness in a number of ROIs was associated with resting state HRV but not HR. The comparison of regression analyses using the Bayes factor revealed evidence for a correlation between HRV and cortical thickness of the bilateral rostral anterior cingulate cortex. However, unlike in adults, greater cortical thickness was associated with reduced HRV in female adolescents. Analyses on HR showed no superior model fit. Results suggest that greater HRV might be beneficial for cortical development during adolescence (cortical thinning). On the other hand, cortical development might determine changes in autonomic nervous system function in adolescents. Future studies are needed to replicate these findings in larger samples including boys and to test these hypotheses in longitudinal designs.

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Physiological coherence in healthy volunteers during laboratory-induced stress and controlled breathing

Abstract

Physiological coherence has been related with a general sense of well-being and improvements in health and physical, social, and cognitive performance. The aim of this study was to evaluate the relationship between acute stress, controlled breathing, and physiological coherence, and the degree of body systems synchronization during a coherence-generation exercise. Thirty-four university employees were evaluated during a 20-min test consisting of four stages of 5-min duration each, during which basal measurements were obtained (Stage 1), acute stress was induced using validated mental stressors (Stroop test and mental arithmetic task, during Stage 2 and 3, respectively), and coherence states were generated using a controlled breathing technique (Stage 4). Physiological coherence and cardiorespiratory synchronization were assessed during each stage from heart rate variability, pulse transit time, and respiration. Coherence measurements derived from the three analyzed variables increased during controlled respiration. Moreover, signals synchronized during the controlled breathing stage, implying a cardiorespiratory synchronization was achieved by most participants. Hence, physiological coherence and cardiopulmonary synchronization, which could lead to improvements in health and better life quality, can be achieved using slow, controlled breathing exercises. Meanwhile, coherence measured during basal state and stressful situations did not show relevant differences using heart rate variability and pulse transit time. More studies are needed to evaluate the ability of coherence ratio to reflect acute stress.

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Correction to: Acute and chronic neuromuscular adaptations to local vibration training

Abstract

The author would like to correct the reference in the publication of the original article. The corrected reference is given below for your reading.

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Fibroblast growth factor 21 increases hepatic oxidative capacity but not physical activity or energy expenditure in hepatic PGC-1α deficient mice

Abstract

Fibroblast growth factor 21 (FGF21) treatment drives metabolic improvements, including increased metabolic flux and reduced hepatic steatosis, but mechanisms responsible for these effects remain to be fully elucidated. We tested if a targeted reduction in hepatic PGC-1α, which has been shown to occur with obesity, negatively impacted the metabolic effects of FGF21. We infused FGF21 (1 mg kg⁻¹ day⁻¹) or saline in chow-fed wild-type (WT) and liver-specific PGC-1α +/- (LPGC-1α) mice for 4 weeks. FGF21 administration lowered serum insulin and cholesterol (P ≤ 0.05), and tended to lower FFAs (P = 0.057). LPGC-1α mice exhibited reduced complete hepatic fatty acid oxidation (FAO) (1788 ± 165 (LPGC-1α) compared to 2572 ± 437 (WT) nmol g⁻¹ hr⁻¹; P < 0.001), which was normalized with FGF21 treatment (2788 ± 519 nmol g⁻¹ hr⁻¹; P < 0.001). FGF21 also increased hepatic incomplete FAO 12% in both groups and extra-mitochondrial FAO 89 and 56% in WT and LPGC-1α mice respectfully (P = 0.001), and lowered hepatic TAGs 30–40% (P < 0.001). Chronic treatment with FGF21 lowered body weight and fat mass (P < 0.05) while increasing food consumption (P < 0.05), total energy expenditure (TEE) (7.3 ± 0.60 vs. 6.6 ± 0.39 kcals/12 hours in WT mice; P = 0.009) and resting (REE) (5.4 ± 0.89 vs. 4.6 ± 0.21 kcals/12 hours in WT mice; P = 0.005). Interestingly, FGF21 only increased ambulatory activity in the WT mice (P = 0.03) without a concomitant increase in non-resting energy expenditure. In conclusion, while reduced hepatic PGC-1α expression was not necessary for FGF21 to increase FAO, it does appear to mediate FGF21 induced changes in TEE, REE, and ambulatory activity in lean mice.

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Case of idiopathic and complete appendiceal intussusception

Abstract

Appendiceal intussusception is a rare disease in which the appendix invaginates into the cecum. It is often caused by organic diseases. The present case involved an appendiceal intussusception without an organic disease, and laparoscopic resection of part of the cecum was performed. Appendiceal intussusception has various causes, including malignant diseases. Therefore, diagnosis and selection of operative method are complex and could potentially lead to an excessively invasive option. By performing SILS with a multiuse single-site port, we were able to provide an appropriate, non-invasive treatment that had a good esthetic outcome.

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A Prospective Multicenter Study of a Fully Covered Metal Stent in Patients with Distal Malignant Biliary Obstruction: WATCH-2 Study

Abstract

Background

Both fully covered (FC) and partially covered (PC) self-expandable metal stents (SEMSs) are now commercially available for distal malignant biliary obstruction (MBO). While FCSEMS can be easily removed at the time of re-interventions, it is theoretically prone to migration. However, few comparative data between FC and PC SEMSs have been reported.

Aims

The aim of this study was to compare clinical outcomes of FCSEMS with those of PCSEMS.

Methods

This was a multicenter, prospective study of FCSEMS for unresectable distal MBO with a historical control of PCSEMS, which was previously reported as the WATCH study. The primary outcome was recurrent biliary obstruction (RBO), and secondary outcomes were stent migration, stent removal, stent-related adverse events, and survival.

Results

A total of 151 cases with unresectable distal MBO undergoing FCSEMS placement were enrolled and compared with a historical cohort of 141 cases undergoing PCSEMS placement. No significant differences were found in the rate of RBO (29 vs. 33%; P = 0.451), time to RBO (318 vs. 373 days; P = 0.382), and survival (229 vs. 196 days; P = 0.177) between FCSEMS and PCSEMS. The rate of stent migration also did not differ significantly between the two groups (14 vs. 8%; P = 0.113). The removal of FCSEMSs was successful in all 24 attempted cases (100%).

Conclusions

FCSEMSs appeared comparable to PCSEMSs in terms of RBO without a significant increase in stent migration rate in patients with unresectable distal MBO.

Clinical Trial Registration Number

UMIN000007131.

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Technique Utilizing a Modified Oral Ring-Adair-Elwyn Tube to Provide Continuous Oxygen and Sevoflurane Delivery During Nasotracheal Intubation in an Infant With a Difficult Airway: A Case Report.

Technique Utilizing a Modified Oral Ring-Adair-Elwyn Tube to Provide Continuous Oxygen and Sevoflurane Delivery During Nasotracheal Intubation in an Infant With a Difficult Airway: A Case Report.

A A Case Rep. 2017 Nov 27;:

Authors: Man JY, Fiadjoe JE, Hsu G

Abstract
Managing the airway of an infant with Pierre Robin sequence (PRS) is particularly challenging for anesthesiologists. Patients with PRS have the triad of micrognathia, glossoptosis, and airway obstruction that potentially and frequently leads to difficulty with both ventilation and intubation. Thus continuous oxygenation and spontaneous ventilation during intubation are essential. We describe a new method to deliver continuous oxygen and volatile anesthetic during nasotracheal intubation in an infant with PRS.

PMID: 29210721 [PubMed - as supplied by publisher]

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Do free-ranging rattlesnakes use thermal cues to evaluate prey?

Abstract

Rattlesnakes use infrared radiation to detect prey animals such as small mammals and lizards. Because ectotherm locomotor performance depends on temperature, rattlesnakes could use prey temperature to evaluate the potential of lizards to evade attacks. Here, we tested whether hunting rattlesnakes use infrared information to (1) detect and (2) evaluate prey before attack. We expected thermal contrast between prey and background to be the best predictor of predatory behaviour under the prey detection hypothesis, and absolute prey temperature under the prey evaluation hypothesis. We presented lizard carcasses of varying temperatures to free-ranging sidewinder rattlesnakes (Crotalus cerastes) and scored behavioural responses as a function of thermal contrast, absolute lizard temperature, and light level. Thermal contrast and light level were the most salient predictors of snake behaviour. Snakes were more likely to respond to lizards and/or respond at greater distances at night and when thermal contrast was high, supporting the known prey detection function of infrared sensing. Absolute lizard temperature was not an important predictor of snake behaviour; thus, we found no evidence for temperature-based prey evaluation. Infrared sensing is still poorly understood in ecologically relevant contexts; future research will test whether rattlesnakes learn to evaluate prey based on temperature with experience.

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Acute oxygen-sensing by the carotid body: a rattlebag of molecular mechanisms

Abstract

The molecular underpinnings of the oxygen-sensitivity of the carotid body Type I cells are becoming better defined as research begins to identify potential interactions between previously separate theories. Nevertheless, the field of oxygen-chemoreception still presents the general observer with a bewildering array of potential signalling pathways by which a fall in oxygen levels might initiate Type I cell activation. The purpose of this brief review is to address five of the current oxygen-sensing hypotheses.

1. The lactate/Olfr78 hypothesis of oxygen chemotransduction.
2. The role mitochondrial ATP and metabolism may have in chemotransduction.
3. The AMP-activated protein kinase (AMPK) hypothesis and its current role in oxygen-sensing by the carotid body.
4. Reactive oxygen species as key transducers in the oxygen-sensing cascade.
5. The mechanisms by which H₂S, reactive oxygen species and Heme Oxygenase may integrate to provide a rapid oxygen-sensing transduction system.

Over the previous fifteen years several lines of research into acute hypoxic chemotransduction mechanisms have focused on the integration of mitochondrial and membrane signalling. This review places an emphasis on the subplasmalemmal-mitochondrial microenvironment in Type I cells and how theories of acute oxygen-sensing are increasingly dependent on functional interaction within this microenvironment (see Abstract Figure).

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Fathers Count: The Impact of Paternal Risk Factors on Birth Outcomes

Abstract

Objective To determine the contribution of paternal factors to the risk of adverse birth outcomes. Methods This is a retrospective cross-sectional analysis using birth certificate data from 2004 to 2015 retrieved from the Finger Lakes Regional Perinatal Data System. Primiparous women with singleton pregnancies were analyzed in the study. Two multivariate logistic regression models were conducted to assess potential paternal risk factors including age, race/ethnicity, and education on four birth outcomes, including preterm birth (PTB), low birthweight (LBW), high birthweight (HBW), and small for gestational age (SGA). Results A total of 36,731 singleton births were included in the analysis. Less paternal education was significantly related to an elevated risk of PTB, LBW, and SGA, even after adjustment for maternal demographic, medical, and lifestyle factors (P < 0.05). Paternal race/ethnicity was also significantly associated with all four birth outcomes (P < 0.05) while controlling for maternal factors. Older paternal age was associated with increased odds (OR 1.012, 95% CI 1.003–1.022) of LBW. Maternal race/ethnicity partially mediated the association of paternal race/ethnicity with HBW and SGA. Maternal education partially mediated the relationship between paternal education and SGA. Conclusion Paternal factors were important predictors of adverse birth outcomes. Our results support the inclusion of fathers in future studies and clinical programs aimed at reducing adverse birth outcomes.

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