Associations between the menstrual cycle, lifestyle factors and clinical assessment of the ocular surface: a prospective observational study.

BACKGROUND: Little is known about the ocular surface changes over the menstrual cycle in young women and the interactions with lifestyle factors. Therefore, the purpose of this study was to explore the associations between modifiable lifestyle factors and menstrual cycle phases on the ocular signs and symptoms of dry eye in young healthy women. METHODS: This was a prospective 1-month observational study. Thirty young healthy women with regular, 24 to 32-day menstrual cycles were recruited. Participants attended three visits at day 7, 14, and 21 (± 1) of their menstrual cycle. At baseline, general health questionnaire was conducted. At each visit, symptomology was quantified using Ocular Surface Disease Index (OSDI) and overall ocular comfort (OOC, visual analogue scale). Ocular signs were assessed using Efron scales, tear break-up time (TBUT) and phenol red thread (PRT). Pearson's correlation was used to determine associations between variables at each visit. RESULTS: A total of 26 participants (mean age = 22.3 ± 3.7 years) with an average menstrual cycle of 28.3 ± 1.3 days completed the 3 visits. The interaction between signs/symptoms and lifestyle factors changed over the cycle. At the follicular phase (day 7), lifestyle factors such diet and levels of stress were correlated with PRT and OSDI, (r = - 0.4, p = 0.022; r = 0.4, p = 0.045 respectively). At the ovulation phase (day 14), the general health score was correlated with OOC scores (r = 0.4, p = 0.047). At day 14, exercise frequency correlated with PRT (r = - 0.4, p = 0.028) and caffeine intake was positively correlate with both; TBUT (r = 0.5, p = 0.020) and PRT (r = 0.5, p = 0.014). At the luteal phase (day 21), we found no correlations between lifestyle factors and dry eye signs or symptoms. CONCLUSIONS: The associations between lifestyle factors and objective and subjective ocular surface assessment appeared to be more pronounced during the ovulation phase of the menstrual cycle compared to the follicular and luteal phases. Misalignment of these factors with the ocular health during the luteal phase could be attributed to central sensitization and changes in levels of luteinising hormone. Natural hormonal changes during menstrual cycle should be considered for diagnosis and treatment of dry eye in young healthy women.

Evaluation of the Use of Remodelable Pericardial Bolsters during Cystectomy and Diversion to Prevent Enterocutaneous Fistulas.

INTRODUCTION: Enterocutaneous fistula is one of the most serious and potentially devastating complications after radical cystectomy, a complex operation with a significant morbidity rate. In this analysis we examined the potential benefit of biomaterial buttressing of staple lines in reducing the incidence of enterocutaneous fistula in patients undergoing cystectomy. METHODS: We retrospectively reviewed 398 patients undergoing cystectomy for bladder cancer during an approximately 11-year period at the University of Colorado Hospital, and compared the frequency of enterocutaneous fistula before and after the implementation of biomaterial buttressing for bowel anastomosis. RESULTS: In total, 301 surgical cases preceded biomaterial buttressing and 97 received buttressing with bovine pericardial strips. Seven cases (2.3%) of enterocutaneous fistula occurred without adjunctive reinforcement whereas zero cases were identified in the period using buttressing with bovine pericardial strips. Thus buttressing was associated with a nonsignificant reduction in the odds of enterocutaneous fistula (OR 0.20; 95% CI 0.01, 3.56; p=0.20). Although risk factor adjustment was prohibited by the low frequency of events, none of the cases of enterocutaneous fistula had received prior radiation therapy. Incidentally, the odds of postoperative functional bowel obstruction were significantly decreased after the implementation of buttressing (OR 0.28; 95% CI 0.08, 0.93; p=0.03). CONCLUSIONS: The absolute reduction in the incidence of enterocutaneous fistula and significantly decreased odds of functional bowel obstruction in this cohort warrant future investigation to confirm the benefit of bovine pericardial strip buttresses for bowel anastomoses in cystectomy.

The Past, Present, and Future in Management of Small Renal Masses.

Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.