The neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery.

AIM: The objective of the study was to evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) and the occurrence of perioperative complications in patients undergoing colorectal surgery. METHOD: A retrospective cohort study was conducted of patients who underwent resection for suspected or confirmed colorectal cancer from 2004 to 2012. Patient cohorts with a high vs low NLR were defined by receiver operating characteristic curve analysis. Univariate and multivariate logistic regression was used to determine whether patients with elevated NLR were more likely to suffer perioperative complications. RESULTS: In all, 583 patients were included. A preoperative NLR greater than or equal to 2.3 was significantly associated with a major perioperative complication (OR 2.52, 95% CI 1.26-5.01). On multivariate analysis, a high NLR (OR 2.25, 95% CI 1.12-4.52) and Charlson Comorbidity Index ≥ 3 (OR 4.55, 95% CI 2.17-9.56) were significantly related to major morbidity. No relationships were found between an elevated preoperative NLR and complication type, although there was a trend towards the occurrence of anastomotic leakage. CONCLUSION: Preoperative NLR ≥ 2.3 may be a risk factor for major surgical complications following colorectal resection. Further study is needed to validate this threshold and evaluate the clinical implications of these findings.

A scoping review of perineural steroids for the treatment of chronic postoperative inguinal pain.

PURPOSE: To review the literature on the efficacy and safety of perineural steroid injections around the ilioinguinal, iliohypogastric, and genitofemoral nerves for chronic postoperative inguinal pain (CPIP). METHODS: A scoping review was performed to find all relevant case reports, case series, prospective or retrospective cohort studies, case-control studies, and randomized controlled trials (RCTs) where a steroid was used for perineural procedures around ilioinguinal, iliohypogastric, and/or genitofemoral nerves for CPIP. Databases searched included Ovid MEDLINE, EMBASE, CINHAL, Cochrane CENTRAL, and Google Scholar. RESULTS: A total of five publications were found-three studies were prospective case series, one a retrospective cohort study, and one a RCT. The most common steroids used were methylprednisolone and triamcinolone. The average methylprednisolone-equivalent dose used per procedure was 46 mg (SD 21.9). Procedural guidance included anatomic landmarks (three studies), nerve stimulation and ultrasound (one study), and computed tomography guidance (one study). Four studies reported analgesic benefit in 55-75 % of included patients, with one study documenting an effect up to 50 months later after steroid perineural injections. The RCT demonstrated no benefit of adding steroid to a local anesthetic in the perioperative setting but it did not enroll patients with existing neuropathic pain. No adverse outcomes of perineural steroids were documented within reviewed studies. CONCLUSIONS: The paucity of data, heterogeneity and lack of appropriate control groups in the available literature precludes firm conclusions on the efficacy and safety of perineural steroids for CPIP. Future adequately powered, high-quality, placebo-controlled studies are needed.

Perspectives on the divorce process: parental perceptions of the legal system and its impact on family relations.

Through semistructured interviews, divorcing parents provide a consumer perspective of the legal process of divorce discussed in law and mental health literature. The parents offer a heightened awareness of families' basic needs within the legal system that may otherwise be overlooked by professionals. This article focuses on narrative accounts provided by 41 divorcing parents to describe both their positive and negative experiences with the legal system and court-related professionals. Although many parents entered the divorce process with hopes for a fair and reasonable experience and outcome, only 12 percent of the parents ended the process with positive expectations. Parents conveyed feelings of a lack of power and control over divorce outcomes. The responses from parents provide valuable insight into how reforms of the legal system can be structured best to increase the quality of the process and ameliorate potentially destructive effects of divorce on the family.

Weight and eating concerns in outpatient men and women being treated for substance abuse.

This study examined the specific features of weight and eating concerns, and explored gender differences, in a racially diverse group of outpatients (45 men and 39 women) currently being treated for substance abuse but abstinent from substance use. Overweight was prevalent and similarly distributed across gender: 60% of the men and 69% of the women were overweight. Most of the overweight participants did not identify themselves as such. No significant gender differences were observed in terms of the behavioural features of eating disorders: 8% of the men and 11% of the women reported binge eating on at least one day per week; inappropriate weight compensatory behaviours were reported by 8% of the men vs 16% of the women, but the women had significantly higher attitudinal scores than the men. Our findings suggest that, in patients recovering from substance abuse, overweight and features of eating disorders are common in both men and women, and occur in poor and minority groups.

Anergy during pregnancy.

OBJECTIVE: This study was undertaken to determine whether the prevalence of anergy is higher among pregnant women than among nonpregnant women. STUDY DESIGN: Sixty human immunodeficiency virus-seronegative women (n = 30 pregnant, n = 30 nonpregnant) from the Duke University Medical Center (Durham, North Carolina) clinic were enrolled. Skin tests were performed with purified protein derivative of tuberculin, Candida antigen, mumps antigen, and tetanus toxoid. A power calculation was done to determine adequate sample size, and data were analyzed with the Fisher exact test and the t test. RESULTS: Three women in each group did not have a response to any of the antigens tested, for an anergy prevalence of 10%. Pregnant women were less likely to have a reaction to skin testing with tetanus toxoid than were nonpregnant women (10% vs 40%; P <.02). CONCLUSION: Human immunodeficiency virus-seronegative pregnant women did not appear to have a higher prevalence of anergy than that seen among comparable nonpregnant women. Human immunodeficiency virus-seronegative pregnant women who are being evaluated with the purified protein derivative of tuberculin skin test are therefore unlikely to need anergy skin testing just because they are pregnant.

Teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in binge eating disorder.

OBJECTIVE: The primary goal of this study was to examine associations among teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in women with Binge Eating Disorder (BED). RESEARCH METHODS AND PROCEDURES: Subjects were 115 female adults who met DSM-IV criteria for BED. Measurements assessing teasing history (general appearance [GAT] and weight and size [WST] teasing), current eating disorder psychopathology (binge frequency, eating restraint, and concerns regarding eating, shape, and weight), body dissatisfaction, and psychological functioning (depression and self-esteem) were obtained. RESULTS: History of GAT, but not WST, was associated with current weight concerns and body dissatisfaction, whereas both GAT and WST were significantly associated with current psychological functioning. Patients with earlier onset of obesity reported more WST than patients with later onset of obesity, but the groups did not differ significantly in GAT, current eating disorder psychopathology, body dissatisfaction. or psychological functioning. Obese women reported more WST than non-obese women, but no differences in GAT or the other outcome variables were observed. Higher frequency of GAT was associated with greater binge frequency in obese women, and with greater eating restraint in non-obese women. DISCUSSION: Although physical appearance teasing history is not associated with variability in most eating disorder psychopathology, it is associated with related functioning, most notably body dissatisfaction, depression, and self-esteem. Our findings also suggest that the age of onset of obesity and current body mass index status in isolation are not associated with eating psychopathology or associated psychological functioning in adult patients with BED.

The myogenic component in distention-induced peristalsis in the guinea pig small intestine.

In an in vitro model for distention-induced peristalsis in the guinea pig small intestine, the electrical activity, intraluminal pressure, and outflow of contents were studied simultaneously to search for evidence of myogenic control activity. Intraluminal distention induced periods of nifedipine-sensitive slow wave activity with superimposed action potentials, alternating with periods of quiescence. Slow waves and associated high intraluminal pressure transients propagated aborally, causing outflow of content. In the proximal small intestine, a frequency gradient of distention-induced slow waves was observed, with a frequency of 19 cycles/min in the first 1 cm and 11 cycles/min 10 cm distally. Intracellular recording revealed that the guinea pig small intestinal musculature, in response to carbachol, generated slow waves with superimposed action potentials, both sensitive to nifedipine. These slow waves also exhibited a frequency gradient. In addition, distention and cholinergic stimulation induced high-frequency membrane potential oscillations (~55 cycles/min) that were not associated with distention-induced peristalsis. Continuous distention produced excitation of the musculature, in part neurally mediated, that resulted in periodic occurrence of bursts of distally propagating nifedipine-sensitive slow waves with superimposed action potentials associated with propagating intraluminal pressure waves that caused pulsatile outflow of content at the slow wave frequency.