DNA methylation predicts age and provides insight into exceptional longevity of bats.

Exceptionally long-lived species, including many bats, rarely show overt signs of aging, making it difficult to determine why species differ in lifespan. Here, we use DNA methylation (DNAm) profiles from 712 known-age bats, representing 26 species, to identify epigenetic changes associated with age and longevity. We demonstrate that DNAm accurately predicts chronological age. Across species, longevity is negatively associated with the rate of DNAm change at age-associated sites. Furthermore, analysis of several bat genomes reveals that hypermethylated age- and longevity-associated sites are disproportionately located in promoter regions of key transcription factors (TF) and enriched for histone and chromatin features associated with transcriptional regulation. Predicted TF binding site motifs and enrichment analyses indicate that age-related methylation change is influenced by developmental processes, while longevity-related DNAm change is associated with innate immunity or tumorigenesis genes, suggesting that bat longevity results from augmented immune response and cancer suppression.

Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm.

The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss > or = 6 L, or intraoperative resuscitation with > or = 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% (p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 (p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 (p = .77).Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.

One size does not fit all: current disposable laparoscopic devices do not fit the needs of female laparoscopic surgeons.

INTRODUCTION: An increasing number of women are entering the field of general surgery. Because surgical devices have traditionally been targeted at men, we hypothesized that, due to smaller hand size, female general surgery residents would have significantly more difficulty utilizing the "one size fits all" handles of disposable laparoscopic (lap) devices when compared with male residents. METHODS: General surgery residents were anonymously surveyed at four university general surgery training programs. Participants were asked to describe their use of four disposable lap instruments: the lap stapler, lap Harmonic scalpel (Ethicon, Inc., Somerville, New Jersey), lap LigaSure (Valleylab, Boulder, Colorado), and lap retrieval bag. Data were tabulated and analyzed, comparing male with female residents for each instrument as well as according to glove size. RESULTS: A total of 120 residents were asked to participate with 65 anonymous responses (28 women and 37 men). Women's median glove size was significantly smaller than men's (6.5 vs. 7.5, p<0.0001), whereas the clinical year and number of lap cases were not significantly different. Women reported the following devices more awkward than their male counterparts: lap stapler, lap Harmonic scalpel, and the lap LigaSure. Women were more likely to use two hands and describe these devices as "always awkward." When results were analyzed by glove size independently of gender we found that, with increasing glove size, residents were more likely to describe these devices as easy to use and used these devices with only one hand. CONCLUSIONS: Current disposable lap devices are not designed for individuals with small hands. Women have significantly smaller hands than their male counterparts and have difficulty with the "one size fits all" lap device handles. With the increasing number of women entering general surgery programs, this problem will likely persist until devices are designed for surgeons with small hand sizes.