Incisional hernia repair following pancreatic surgery-open vs laparoscopic approach.

INTRODUCTION: For pancreatic procedures, transverse and midline or combined approaches are used. Having an increased morbidity after pancreatic surgery, these patients have an increased risk of developing an incisional hernia. In the following, we will analyze how the results of incisional hernia surgery after pancreatic surgery are presented in the Herniamed Registry. METHODS: Hospitals and surgeons from Germany, Austria and Switzerland can voluntarily enter all routinely performed hernia operations prospectively into the Herniamed Registry. All patients sign a special informed consent declaration that they agree to the documentation of their treatment in the Herniamed Registry. Perioperative complications (intraoperative complications, postoperative complications, complication-related reoperations and general complications) are recorded up to 30 days after surgery. After 1, 5, and 10 years, patients and primary care physicians are contacted and asked about any pain at rest, pain on exertion, chronic pain requiring treatment or recurrence. This retrospective analysis of prospectively collected data compares the outcomes of minimally invasive vs open techniques in incisional hernia repair after pancreatic surgery. RESULTS: Relative to the total number of all incisional hernia patients in the Herniamed Registry, the proportion after pancreatic surgery with 1-year follow-up was 0.64% (n = 461) patients. 95% of previous pancreatic surgeries were open. Minimally invasive incisional hernia repair was performed in 17.1% and open repair in 82.9% of cases. 23.2% of the defects were larger than 10 cm and 32.8% were located laterally or were a combination of lateral and medial defects. Among the few differences between the collectives, a significantly higher rate of defect closure (58.1% vs 25.3%; p < 0.001) and drainage (72.8% vs 13.9%; p < 0.001) was found in the open repairs, and larger meshes were seen in the minimally invasive procedures (340.6 cm2 vs 259.6 cm2; p < 0.001). No difference deemed a risk factor for chronic postoperative pain was seen in the rate of preoperative pain between the open and minimally invasive procedures (Appendix Table 4) No significant differences were found in either the perioperative complications or at 1-year follow-up. CONCLUSIONS: Incisional hernias after complex pancreatic surgery can be repaired safely and with a low recurrence rate in both open and minimally invasive techniques.

Physical Activity Promotion in North Carolina: a Reassessment of Public Park and Recreation Directors.

Regular physical activity is widely considered by public health and parks and recreation professionals as a key determinant of individual and community health and well-being. Prior research has shown that building sustainable health partnerships with community organizations can help parks and recreation departments meet many US health challenges. This descriptive study examined the perceptions of North Carolina public parks and recreation directors regarding physical activity and health partnership practices in their communities. The study was also a 15-year follow-up to a study and examined whether park and recreation director perceptions of health partnerships had changed given the many social, economic, and health events that have occurred since the original survey. Directors from two hundred seventy-five North Carolina city and county parks and recreation departments were surveyed in the Spring of 2022 to determine 1) directors' effort allocation in promoting physical activity toward vulnerable populations, 2) challenges associated with promoting community physical activity, and 3) differences in effort allocation, future priorities, and partnership among varying director and departmental demographics. Results were compared to findings from a 2007 study of NC perceptions of health partnerships, upon which the present study was based. One hundred twenty-three completed questionnaires were returned, resulting in a response rate of 45%. Directors in 2022 allocated similarly higher levels of effort toward older adults, families, and people with low income as did directors in 2007, while youth and adults with disabilities and people with chronic health conditions received lower allocations of effort from directors in 2022. Barriers such as lack of staff knowledge on how to promote physical activity, lack of citizen and political support, and lack of knowledge of under-represented groups' physical activity preferences were less pronounced in 2022 compared to 2007. Several distinct differences were revealed between female and male directors' rankings of effort and future priorities, as well as their perceptions of physical activity opportunities for women and people with disabilities. Partnerships with county health departments are being reported more in counties with the highest health disparities compared to more healthy counties, indicating that partnerships are being targeted and implemented in areas where resources are most needed. This study represents a meaningful extension of research conducted prior to the 2008 Great Recession and COVID-19 pandemic and provides recommendations for public parks and recreation departments to consider promoting physical activity and building community resilience in the face of future economic and health challenges.

Perioperative risk of pancreatic head resection-nomogram-based prediction of severe postoperative complications as a decisional aid for clinical practice.

PURPOSE: To develop nomograms for pre- and early-postoperative risk assessment of patients undergoing pancreatic head resection. METHODS: Clinical data from 956 patients were collected in a prospectively maintained database. A test (n = 772) and a validation cohort (n = 184) were randomly generated. Uni- and multi-variate analysis and nomogram construction were performed to predict severe postoperative complications (Clavien-Dindo Grades III-V) in the test cohort. External validation was performed with the validation cohort. RESULTS: We identified ASA score, indication for surgery, body mass index (BMI), preoperative white blood cell (WBC) count, and preoperative alkaline phosphatase as preoperative factors associated with an increased perioperative risk for complications. Additionally to ASA score, BMI, indication for surgery, and the preoperative alkaline phosphatase, the following postoperative parameters were identified as risk factors in the early postoperative setting: the need for intraoperative blood transfusion, operation time, maximum WBC on postoperative day (POD) 1-3, and maximum serum amylase on POD 1-3. Two nomograms were developed on the basis of these risk factors and showed accurate risk estimation for severe postoperative complications (ROC-AUC-values for Grades III-V-preoperative nomogram: 0.673 (95%, CI: 0.626-0.721); postoperative nomogram: 0.734 (95%, CI: 0.691-0.778); each p ≤ 0.001). Validation yielded ROC-AUC-values for Grades III-V-preoperative nomogram of 0.676 (95%, CI: 0.586-0.766) and postoperative nomogram of 0.677 (95%, CI: 0.591-0.762); each p = 0.001. CONCLUSION: Easy-to-use nomograms for risk estimation in the pre- and early-postoperative setting were developed. Accurate risk estimation can support the decisional process, especially for IPMN-patients with an increased perioperative risk.

Association of Number of Indoor Tanning Salons With Neighborhoods With Higher Concentrations of Male-Male Partnered Households.

Importance: Both indoor tanning and skin cancer are more common among sexual-minority men, defined as gay and bisexual men, than among heterosexual men. Convenient access to indoor tanning salons may influence use patterns. Objective: To investigate whether indoor tanning salons are disproportionately located in areas with higher concentrations of gay men. Design, Setting, and Participants: This cross-sectional study used geographic information systems to integrate census data and business location data obtained from ArcGIS and Google Maps for the 10 US cities with the largest lesbian, gay, bisexual, and transgender populations in 2010, ie, Los Angeles, California; Chicago, Illinois; San Francisco, California; Seattle, Washington; San Diego, California; Dallas, Texas; Phoenix, Arizona; Washington, DC; Portland, Oregon; and Denver, Colorado. The association of indoor tanning salon locations with proportions of gay men, using the concentration of male-male partnered households as a proxy measure for the latter, was examined. Data analysis was performed in October 2018. Exposures: Census tracts with at least 1%, 5%, or 10% male-male partnered households, adjusting for median household income, percentage young women, and percentage non-Hispanic white residents. Main Outcomes and Measures: Presence of 1 or more indoor tanning salons within census tracts. Results: Across the 10 cities and 4091 census tracts in this study, there were 482 823 unmarried partnered households, of which 35 164 (7.3%) were male-male. The median (interquartile range) percentage of male-male partnered households per census tract was 0% (0%-10.6%). Odds of indoor tanning salon presence in areas with at least 10% male-male households were more than twice those of areas with less than 10% male-male households (odds ratio, 2.17; 95% CI, 1.59-2.97). When sensitivity analyses using a 1-mile euclidian buffer around each tanning salon were conducted, this association remained significant (odds ratio, 2.48; 95% CI, 2.14-2.88). After adjusting for median household income, percentage young women, and percentage non-Hispanic white residents, the odds of an indoor tanning salon being within 1 mile of a census tract with at least 10% male-male households remained twice that of census tracts with less than 10% male-male households (odds ratio, 2.00; 95% CI, 1.71-2.35). Conclusions and Relevance: In this study, indoor tanning salons were more likely to be located near neighborhoods with higher concentrations of male-male partnered households, possibly contributing to the disproportionate use of indoor tanning by sexual-minority men.

Management and outcomes of intraductal papillary mucinous neoplasms.

Background: This study evaluated the outcome and survival of patients with radiologically suspected intraductal papillary mucinous neoplasms (IPMNs). Methods: IPMN management was reviewed according to Fukuoka risk factors and IPMN localization, differentiating main-duct (MD), mixed-type (MT) and branch-duct (BD) IPMNs. Perioperative results were compared with those of patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) over the same interval (2010-2014). Overall (OS) and disease-specific (DSS) survival rates were calculated and subgroups compared. Results: Of 142 patients with IPMNs, 26 had MD-IPMN, eight had MT-IPMN and 108 had BD-IPMN. Some 74 per cent of patients with MD- and MT-IPMN were managed by primary resection, whereas this was used in only 27·8 per cent of those with BD-IPMN. The risk of secondary resection and malignant transformation for BD-IPMNs smaller than 20 mm was 8 and 2 per cent respectively during follow-up. Pancreatic head resection of IPMNs was associated with an increased risk of postoperative pancreatic fistula grade B/C compared with resection of PDAC (12 of 33 (36 per cent) versus 41 of 221 (18·6 per cent) respectively; P = 0·010), and greater morbidity and mortality (Clavien-Dindo grade III: 15 of 33 (45 per cent) versus 56 of 221 (25·3 per cent) respectively; grade IV: 1 (3 per cent) versus 7 (3·2 per cent); grade V: 2 (6 per cent) versus 2 (0·9 per cent); P = 0·008). Five-year OS and DSS rates in patients with MD-IPMN were worse than those for MT- and BD-IPMN (OS: 44, 86 and 97·4 per cent respectively, P < 0·001; DSS: 60, 100 and 98·6 per cent; P < 0·001). Patients with invasive IPMN had worse OS and DSS rates than those with non-invasive dysplasia (OS: IPMN-carcinoma (10 patients) 33 per cent, high-grade dysplasia 100 per cent, intermediate-grade dysplasia 63 per cent, low grade-dysplasia 100 per cent, P < 0·001; DSS: IPMN-carcinoma 43 per cent, all grades of dysplasia 100 per cent, P < 0·001). Patients with high-risk stigmata had poorer survival than those without risk factors (OS: high-risk stigmata (35 patients) 55 per cent, worrisome features (31) 95 per cent, no risk factors (76) 100 per cent, P < 0·001; DSS: 71, 100 and 100 per cent respectively, P < 0·001). Conclusion: The risk of malignant transformation was very low for BD-IPMNs, but the development of high-risk stigmata was associated with disease-specific mortality. Patients with IPMN had greater morbidity after resection than those having resection of PDAC.

A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial.

BACKGROUND: Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents. METHODS/DESIGN: Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments. DISCUSSION: This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations. TRIAL REGISTRATION: Clinical Trials NCT03683173 , September 25, 2018.

Cross-sectional associations of active transport, employment status and objectively measured physical activity: analyses from the National Health and Nutrition Examination Survey.

BACKGROUND: To investigate associations between active transport, employment status and objectively measured moderate-to-vigorous physical activity (MVPA) in a representative sample of US adults. METHODS: Cross-sectional analyses of data from the National Health and Nutrition Examination Survey. A total of 5180 adults (50.2 years old, 49.0% men) were classified by levels of active transportation and employment status. Outcome measure was weekly time spent in MVPA as recorded by the Actigraph accelerometer. Associations between active transport, employment status and objectively measured MVPA were examined using multivariable linear regression models adjusted for age, body mass index, race and ethnicity, education level, marital status, smoking status, working hour duration (among the employed only) and self-reported leisure time physical activity. RESULTS: Patterns of active transport were similar between the employed (n=2897) and unemployed (n=2283), such that 76.0% employed and 77.5% unemployed engaged in no active transport. For employed adults, those engaging in high levels of active transport (≥90 min/week) had higher amount of MVPA than those who did not engage in active transport. This translated to 40.8 (95% CI 15.7 to 65.9) additional minutes MVPA per week in men and 57.9 (95% CI 32.1 to 83.7) additional minutes MVPA per week in women. Among the unemployed adults, higher levels of active transport were associated with more MVPA among men (44.8 min/week MVPA, 95% CI 9.2 to 80.5) only. CONCLUSIONS: Findings from the present study support interventions to promote active transport to increase population level physical activity. Additional strategies are likely required to promote physical activity among unemployed women.

Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity.

BACKGROUND: This study examined whether specific worksite supports for physical activity (PA) were associated with total and domain-specific PA. METHODS: A cross-sectional, telephone-based study was conducted in four Missouri, USA, metropolitan areas in 2012 and 2013. Outcome variables included total PA and sub-domains (leisure, work, travel) measured using the International Physical Activity Questionnaire. Logistic regression determined odds of meeting PA recommendations, given access to and use of 18 unique PA worksite supports. A subsample of 119 participants also wore hip accelerometry for seven consecutive days and maintained a wear-time diary. Access to worksite supports were associated with odds of meeting objective moderate and vigorous (MV) PA above 150 min per week. RESULTS: Among 2013 survey participants, meeting PA recommendations while performing work-related tasks was significantly associated with several supports (e.g., walking maps, stair prompts), as was meeting recommendations during travel (e.g., flextime for PA, incentives for public transportation, walking/bicycling to work). Access to 11 worksite supports increased odds of meeting PA recommendations through leisure-time PA; five supports were associated with total PA. There were significant differences between access to and use of supports. Using objective MVPA, access to worksite challenges and bike storage were significantly associated with five and three times greater odds of meeting 150 min of MVPA per week, respectively. CONCLUSIONS: Worksite wellness plans are increasing across the US and employers are eager for evidence-based supports for increasing PA. This study provides insights into the utility of multiple worksite supports for PA to increase odds that employees meet PA recommendations.

GPS-Based Exposure to Greenness and Walkability and Accelerometry-Based Physical Activity.

Background: Physical inactivity is a risk factor for cancer that may be influenced by environmental factors. Indeed, dense and well-connected built environments and environments with natural vegetation may create opportunities for higher routine physical activity. However, studies have focused primarily on residential environments to define exposure and self-reported methods to estimate physical activity. This study explores the momentary association between minute-level global positioning systems (GPS)-based greenness exposure and time-matched objectively measured physical activity.Methods: Adult women were recruited from sites across the United States. Participants wore a GPS device and accelerometer on the hip for 7 days to assess location and physical activity at minute-level epochs. GPS records were linked to 250 m resolution satellite-based vegetation data and Census Block Group-level U.S. Environmental Protection Agency (EPA) Smart Location Database walkability data. Minute-level generalized additive mixed models were conducted to test for associations between GPS measures and accelerometer count data, accounting for repeated measures within participant and allowing for deviations from linearity using splines.Results: Among 360 adult women (mean age of 55.3 ± 10.2 years), we observed positive nonlinear relationships between physical activity and both greenness and walkability. In exploratory analyses, the relationships between environmental factors and physical activity were strongest among those who were white, had higher incomes, and who were middle-aged.Conclusions: Our results indicate that higher levels of physical activity occurred in areas with higher greenness and higher walkability.Impact: Findings suggest that planning and design policies should focus on these environments to optimize opportunities for physical activity. Cancer Epidemiol Biomarkers Prev; 26(4); 525-32. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."

Variaciones musculares del cuello: fascículo accesorio del músculo elevador de la escápula / Muscular variations of the neck: accessory fascicle of the levator scapulae muscle

El músculo elevador de la escápula ha sido descrito como un músculo plano conformado por fascículos que se originan en los procesos transversos de C1 a C4. Sin embargo, se han descrito variaciones anatómicas de este músculo, que incluyen a sus fascículos vertebrales, orígenes en la cabeza o terminando en músculos vecinos a su inserción usual. Durante la disección rutinaria de un cadáver formolizado de un individuo masculino, chileno, de 75 años de edad, observamos en su lado izquierdo, un fascículo accesorio del músculo elevador de la escápula, el cual tenía su origen en la vértebra C5 y terminaba en la fascia del músculo serrato anterior. En ambos lados el músculo elevador de la escápula provino de las vértebras C1-C4. El fascículo accesorio se originó desde el tubérculo posterior del proceso transverso de la quinta vértebra cervical, conformando un músculo que se dirigió medial e inferiormente, paralelo al músculo elevador de la escápula, para insertarse en la fascia del músculo serrato anterior, inferior a la inserción del músculo mencionado, en el ángulo superior de la escápula. Es importante comunicar las variaciones anatómicas para complementar el conocimiento de las mismas, las que pueden explicar ciertos trastornos físicos y dolorosos en la región cervico-escapular.

The levator scapulae muscle has been described as a flat muscle composed by fascicles originating from the transverse processes of C1 through C4. However, anatomical variations of this muscle are described, including its vertebral fascicles arising in the head or ending in neighboring muscles to the usual insertion. During routine dissection of a formolized cadaver of a 75 year-old Chilean male individual, we observed on the left side, an accessory fascicle of levator scapulae muscle, which had its origin in the C5 vertebra and ended at the serratus anterior muscle fascia. On both sides of the levator scapulae muscle came from C1­C4 vertebrae. The accessory muscular fascicle originated from the posterior tubercle of the transverse process of the fifth cervical vertebra, which runs medially and downward, parallel to the levator escapulae, and inserted to the serratus anterior muscle fascia, inferior to the insertion of the mentioned muscle, in the superior angle of the scapula. It is important to communicate anatomical variations to complement the knowledge of them, which may explain certain painful conditions in the cervico-scapular region.

Review of measures of worksite environmental and policy supports for physical activity and healthy eating.

INTRODUCTION: Obesity prevention strategies are needed that target multiple settings, including the worksite. The objective of this study was to assess the state of science concerning available measures of worksite environmental and policy supports for physical activity (PA) and healthy eating (HE). METHODS: We searched multiple databases for instruments used to assess worksite environments and policies. Two commonly cited instruments developed by state public health departments were also included. Studies that were published from 1991 through 2013 in peer-reviewed publications and gray literature that discussed the development or use of these instruments were analyzed. Instrument administration mode and measurement properties were documented. Items were classified by general health topic, 5 domains of general worksite strategy, and 19 subdomains of worksite strategy specific to PA or HE. Characteristics of worksite measures were described including measurement properties, length, and administration mode, as well as frequencies of items by domain and subdomain. RESULTS: Seventeen instruments met inclusion criteria (9 employee surveys, 5 manager surveys, 1 observational assessment, and 2 studies that used multiple administration modes). Fourteen instruments included reliability testing. More items were related to PA than HE. Most instruments (n = 10) lacked items in the internal social environment domain. The most common PA subdomains were exercise facilities and lockers/showers; the most common HE subdomain was healthy options/vending. CONCLUSION: This review highlights gaps in measurement of the worksite social environment. The findings provide a useful resource for researchers and practitioners and should inform future instrument development.

Workplace social and organizational environments and healthy-weight behaviors.

BACKGROUND: The workplace is an important setting for health promotion including nutrition and physical activity behaviors to prevent obesity. This paper explores the relationship between workplace social environment and cultural factors and diet and physical activity (PA) behaviors and obesity among employees. METHODS: Between 2012 and 2013, telephone interviews were conducted with participants residing in four Missouri metropolitan areas. Questions included demographic characteristics, workplace socio/organizational factors related to activity and diet, and individual diet and PA behaviors, and obesity. Multivariate logistic regression was used to examine associations between the workplace socio/organizational environment and nutrition, PA, and obesity. RESULTS: There were differences in reported health behaviors and socio/organizational environment by gender, race, age, income, and worksite size. For example, agreement with the statement the 'company values my health' was highest among Whites, older employees, and higher income workers. As worksite size increased, the frequency of reporting seeing co-workers doing several types of healthy behaviors (eat fruits and vegetables, doing PA, and doing PA on breaks at work) increased. In adjusted analyses, employees agreeing the company values my health were more likely to engage in higher PA levels (aOR=1.54, 95% CI: 1.09-2.16) and less likely to be obese (aOR=0.73, 95% CI: 0.54-0.98). Seeing co-workers eating fruits and vegetables was associated with increased reporting of eating at least one vegetable per day (aOR=1.43, 95% CI: 1.06-1.91) and seeing co-workers being active was associated with higher PA levels (aOR 1.56, 95% CI: 1.19-2.05). CONCLUSIONS: This research suggests that social/organizational characteristics of the workplace environment, particularly feeling the company values the workers' health and to seeing co-workers engaging in healthy behaviors, may be related to nutrition and PA behaviors and obesity. These findings point to the potential for intervention targets including environment and policy changes.

[Operation time for suprapubic transumbilical cholecystectomy: Results of a prospective randomized trial]. / Operationszeit bei der suprapubisch-transumbilikalen Cholezystektomie : Ergebnisse einer prospektiv-randomisierten Studie.

BACKGROUND: Over the last decade new innovative minimally invasive techniques (e.g. transvaginal cholecystectomy and single incision laparoscopic cholecystectomy) have been developed to reduce operative trauma, postoperative pain and to achieve better cosmetic results. Nevertheless, most of these techniques are more difficult and time-consuming than conventional laparoscopic cholecystectomy (CLC). A new approach, the Minden technique for combined suprapubic transumbilical cholecystectomy (MI-CHE) has been proven to provide a very good cosmetic outcome with reduced operative trauma. The aim of this study was to survey whether MI-CHE prolongs operation times to a relevant degree compared to CLC. METHODS: A total of 40 patients undergoing laparoscopic cholecystectomy were randomized between both techniques. The duration of the operation and other perioperative data were recorded. Surgery was performed by four resident surgeons who had not yet performed any technique of laparoscopic cholecystectomy, neither MI-CHE nor CLC but were assisted by the same senior staff surgeon in all cases. The two patient groups showed no differences in age, gender and body mass index. The study was registered (DRKS00003271). Non-inferiority was tested using 95% confidence intervals (95% CI). RESULTS: The mean operation time was shorter by - 4.2 min (95% CI, + 6.4 min to - 14.8 min) in the MI-CHE as compared to the CLC group (65.5 min versus 69.7 min). There were no open conversions but in one patient intestinal injury occurred during the umbilical mini-laparotomy. There were no differences in patient satisfaction and perioperative pain between both procedures. CONCLUSION: The MI-CHE, which provides very good cosmetic results, is not more time-consuming than CLC. Additionally, it seems to be safe and not more difficult to learn than CLC.

Cardiovascular stability and unchanged muscle sympathetic activity during xenon anaesthesia: role of norepinephrine uptake inhibition.

BACKGROUND: Intraoperative hypotension is associated with increased risk of perioperative complications. The N-methyl-d-aspartate (NMDA) receptor (NMDA-R) antagonist xenon (Xe) induces general anaesthesia without impairment of cardiac output and vascular resistance. Mechanisms involved in cardiovascular stability have not been identified. METHODS: Muscle sympathetic activity (MSA) (microneurography), sympathetic baroreflex gain, norepinephrine (NE) plasma concentration (high-performance liquid chromatography), anaesthetic depth (Narcotrend(®) EEG monitoring), and vital parameters were analysed in vivo during Xe mono-anaesthesia in human volunteers (n=8). In vitro, NE transporter (NET) expressing HEK293 cells and SH-SY5Y neuroblastoma cells were pre-treated with ketamine, MK-801, NMDA/glycine, or vehicle. Subsequently, cells were incubated with or without Xe (65%). NE uptake was measured by using a fluorescent NET substrate (n=4) or [(3)H]NE (n=6). RESULTS: In vivo, Xe anaesthesia increased mean (standard deviation) arterial pressure from 93 (4) to 107 (6) mm Hg and NE plasma concentration from 156 (55) to 292 (106) pg ml(-1), P<0.01. MSA and baroreflex gain were unaltered. In vitro, ketamine decreased NET activity (P<0.01) in NET-expressing HEK293 cells, while Xe, MK-801, and NMDA/glycine did not. Xe reduced uptake in SH-SY5Y cells expressing NET and NMDA-Rs (P<0.01). MK-801 (P<0.01) and ketamine (P<0.01) also reduced NET activity, but NMDA/glycine blocked the effect of Xe on [(3)H]NE uptake. CONCLUSIONS: In vivo, Xe anaesthesia does not alter sympathetic activity and baroreflex gain, despite increased mean arterial pressure. In vitro, Xe decreases the uptake of NE in neuronal cells by the inhibition of NET. This inhibition might be related to NMDA-R antagonism and explain increased NE concentrations at the synaptic cleft and in plasma, contributing to cardiovascular stability during Xe anaesthesia.

The use of a virtual three-dimensional model to evaluate the intraosseous space available for percutaneous screw fixation of acetabular fractures.

We created virtual three-dimensional reconstruction models from computed tomography scans obtained from patients with acetabular fractures. Virtual cylindrical implants were placed intraosseously in the anterior column, the posterior column and across the dome of the acetabulum. The maximum diameter which was entirely contained within the bone was determined for each position of the screw. In the same model, the cross-sectional diameters of the columns were measured and compared to the maximum diameter of the corresponding virtual implant. We found that the mean maximum diameter of virtual implant accommodated by the anterior columns was 6.4 mm and that the smallest diameter of the columns was larger than the maximum diameter of the equivalent virtual implant. This study suggests that the size of the screw used for percutaneous fixation of acetabular fractures should not be based solely on the measurement of cross-sectional diameter and that virtual three-dimensional reconstructions might be useful in pre-operative planning.

Cancer vaccines: an update.

This review summarizes the most recent findings and the future directions in designing cancer vaccines. The newest tumor-associated antigens and the most promising approaches to cancer vaccine development are discussed. We categorized them as follows: peptide vaccines, recombinant viral vaccines, DNA vaccines, dendritic cell-based immunotherapy, and the use of heat shock proteins and adjuvants. We focus on their advantages and disadvantages in addition to clinical potential.

Postfracture instability of vertebrae with simulated defects can be predicted from computed tomography data.

STUDY DESIGN: Structural properties of vertebrae with simulated defects were measured from computed tomography data. Relations between structural properties and postfracture stability were tested using linear regressions. OBJECTIVES: To determine whether the postfracture stability of lumbar and thoracic vertebrae can be predicted from noninvasive, prefracture measurements of structural properties. SUMMARY OF BACKGROUND DATA: Sensitive and specific guidelines are needed that can predict fracture risk and spinal stability after pathologic fractures. Such guidelines may help determine whether treatment is needed to prevent neurologic complications. Simple measurements made from computed tomography data can predict the load-bearing capacity of intact vertebrae and vertebrae with simulated and actual metastatic defects. It is not known whether these same measurements can also predict postfracture stability. METHOD: Simulated metastatic defects were created in human three-vertebrae segments from the lumbar and thoracic spine. Axial rigidity was calculated from quantitative computed tomography data, and failure load and postfracture stability were measured. RESULTS: Postfracture stability was linearly correlated with both failure load (r2 = 0.3-0.6) and axial rigidity (r2 = 0.3-0.6). CONCLUSIONS: The postfracture stability of three-vertebrae segments with simulated defects was modestly related to noninvasively measured, prefracture structural properties.