The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study.

BACKGROUND: The type of sellar barrier observed between a pituitary tumor and cerebrospinal fluid (CSF) on preoperative magnetic resonance imaging (MRI) may predict intraoperative CSF leak during endonasal pituitary surgery. This is the first multicentric prospective cohort trial to study the sellar barrier concept and CSF leak rate during endoscopic pituitary surgery. METHODS: This multi-center, international study enrolled patients operated for pituitary adenomas via fully endoscopic endonasal surgery over a period of 4 months. The independent variable was the subtype of sellar barrier observed on preoperative MRI (strong, mixed or weak); the dependent variable was the presence of an intraoperative CSF leak. The primary goal was to determine the association between a particular type of sellar barrier and the risk of intraoperative CSF leak. Appropriate statistical methods were then applied for data analysis. RESULTS: Over the study period, 310 patients underwent endoscopic endonasal surgery for pituitary tumor. Preoperative imaging revealed a weak sellar barrier in 73 (23.55%), a mixed sellar barrier in 75 (24.19%), and a strong sellar barrier in 162 (52.26%) patients. The overall rate of intraoperative CSF leak among all patients was 69 (22.26%). A strong sellar-type barrier was associated with significantly reduced rate of intraoperative CSF leak (RR = 0.08; 95% CI 0.03-0.19; p < 0.0001), while a weak sellar barrier associated with higher rates of CSF leak (RR = 8.54; 95% CI 5.4-13.5; p < 0.0001). CONCLUSIONS: The preoperative MRI of pituitary patients can suggest intraoperative CSF leak rates, utilizing the concept of the sellar barrier. Patients with a weak sellar barrier carry a higher risk for an intraoperative CSF leak, whereas a strong sellar barrier on MRI seems to mitigate intraoperative CSF leak. We propose that preoperatively assessment of the sellar barrier can prepare surgeons for intraoperative CSF leak repair.

Fur Color and Nutritional Status Predict Hair Cortisol Concentrations of Dogs in Nicaragua.

This study examined the relationships between hair cortisol concentrations (HCC) and sex, age, nutritional status (as determined by body condition scores, or BCS), and body mass (geometric mean calculated from morphometric measurements), as well as the potential influence of hair pigmentation (light, dark, or agouti/mixed) on HCC in dogs of the Bosawas Biosphere Reserve, Nicaragua. The dogs examined in this study live in a marginal environment where disease, malnutrition, and mortality rates are high. For fur color, HCC was significantly higher in light fur than in than dark and mixed fur (p < 0.001). In addition, BCS scores were found to have a negative effect on HCC (p < 0.001). Measures of sex and body size exhibited inconclusive effects on HCC, and when compared to adult dogs, juvenile dogs did not exhibit significantly different HCC. Repeated measures of dogs over time reveal a moderate intra-class correlation, suggesting that there are unmeasured sources of individual-level heterogeneity. These findings imply a need to account for fur color in studies of HCC in dogs, and the study suggests an overlooked relationship between cortisol and body condition scores in undernourished dogs in diverse settings.

Giardia Infection and Trypanosoma Cruzi Exposure in Dogs in the Bosawás Biosphere Reserve, Nicaragua.

Indigenous Mayangna and Miskitu inhabit Nicaragua's remote Bosawás Biosphere Reserve, located in the North Caribbean Coast Autonomous Region. They are sedentary horticulturists who supplement their diet with wild game, hunting with the assistance of dogs. To test whether hunting dogs increased the risk of human exposure to protozoal zoonotic neglected tropical diseases (NTDs), we sampled dogs from three communities varying in population size and level of contact with other communities. We screened dog feces (n = 58) for Giardia and Cryptosporidium DNA and sera (n = 78) for Trypanosoma cruzi antibodies and DNA. Giardia DNA was detected in 22% (13/58) of samples; sequencing revealed the presence of both zoonotic genotypes (assemblages A and B) and dog-specific genotypes (assemblages C and D). Giardia shedding was associated with community and age. Older dogs and those in the two, more accessible communities had greater odds of shedding parasites. Seroprevalence of T. cruzi antibodies, indicating prior exposure, was 9% (7/78). These results contribute to the limited literature on NTDs in indigenous populations, and suggest hunting dogs can both serve as sentinels of environmental NTDs and pose zoonotic risk for their owners and communities.

ICAR: endoscopic skull-base surgery.

BACKGROUND: Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS: Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS: The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION: A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.

Endometrial safety of low-dose vaginal estrogens in menopausal women: a systematic evidence review.

OBJECTIVE: The aim of the study was to systematically review studies that evaluated endometrial hyperplasia or cancer incidence with unopposed vaginal estrogens. METHODS: PubMed and EMBASE were searched from inception to August 2017 for relevant articles and abstracts. Bibliographies of review articles and abstracts of major women's health medical meetings were examined. Eligible studies (independently reviewed by 4 authors) had to report menopausal vaginal estrogen use and endometrial histology, or incidence of endometrial hyperplasia or cancer. RESULTS: Of 5,593 abstracts from the literature search and 47 articles from other sources, 36 articles and 2 abstracts were eligible, describing 20 randomized controlled studies, 8 interventional studies, and 10 observational studies. Collectively, the studies did not support an increased risk of endometrial hyperplasia or cancer with low-dose vaginal estrogens. Rates of endometrial cancer and hyperplasia were 0.03% and 0.4%, respectively, from 20 randomized controlled trials (2,983 women) of vaginal estrogens. Overall, reports of endometrial hyperplasia were observed with various doses and durations and appeared sporadic (except 1.25 mg conjugated equine estrogens), consistent with endometrial hyperplasia rates in the general population. A Denmark registry study was an exception and may be of limited applicability to the United States. The Women's Health Initiative Observational Study showed no association (1.3 cases/1,000 women-years with vaginal estrogens versus 1.0/1,000 women-years for nonuse). CONCLUSION: This systematic review supports the use of low-dose vaginal estrogens for treating vulvar and vaginal atrophy in menopausal women without a concomitant progestogen. This review does not support increased endometrial hyperplasia or cancer risk with low-dose, unopposed vaginal estrogens; however, longer-term, real-world data are needed.

A Comparison of Social Dominance Theory and System Justification: The Role of Social Status in 19 Nations.

This study tests specific competing hypotheses from social dominance theory/realistic conflict theory (RCT) versus system justification theory about the role of social status. In particular, it examines whether system justification belief and effects are stronger among people with low socioeconomic status, and in less socially developed and unequal nations than among better-off people and countries. A cross-national survey was carried out in 19 nations from the Americas, Western and Eastern Europe, Asia, and Oceania using representative online samples ( N = 14,936, 50.15% women, Mage = 41.61 years). At the individual level, system justification beliefs, right-wing authoritarianism, social dominance orientation, national identification, sociopolitical conservatism, sex, age, and social status were measured. At the national level, the human development index and the Gini index were used. Multilevel analyses performed indicated that results fit better with the social dominance/RCT approach, as system justification was higher in high-status and developed nations; further, associations between legitimizing ideologies and system justification were stronger among high-status people.

System justification enhances well-being: A longitudinal analysis of the palliative function of system justification in 18 countries.

According to the palliative function of ideology hypothesis proposed by System Justification Theory, endorsing system-justifying beliefs is positively related to general psychological well-being, because this fulfils existential, epistemic, and relational needs. We discuss and address three main issues: (1) the role of societal inequality, (2) comparisons by social status, and (3) cross-sectional versus longitudinal research. We used a longitudinal survey of representative online samples (N = 5,901) from 18 countries. The results supported the main argument proposed by the theory, in that system justification was positively and significantly related to life satisfaction and negatively related to anxiety and depression. The pattern of results suggested that the palliative function of system justification is more homogeneously distributed across individual and collective measures of social status than proposed by the theory, because the function was unaffected either by society-level inequality or by individual-level social status. These results allow us to infer that one of the reasons for the high stability of social arrangements is located in the psychological domain of palliative effects.

Multiple-host pathogens in domestic hunting dogs in Nicaragua's Bosawás Biosphere Reserve.

Nicaragua's Bosawás Biosphere Reserve is a vast forested area inhabited largely by indigenous Mayangna and Miskitu people. Most Bosawás residents rely on subsistence hunting and swidden agriculture, and hunting dogs are important for finding and securing wild game. We investigated the health of hunting dogs in three communities differing in location, size, and economy. Dogs in all communities were nutritionally compromised and experienced a heavy burden of disease. Seroprevalence of canine distemper, canine parvovirus, Rickettsia rickettsii, and Leptospira spp. exceeded 50% of dogs. At least one dog was actively shedding leptospires in urine, and many dogs were anemic and/or dehydrated. These dogs interact with wildlife in the forest and humans and domestic livestock in the communities, and may therefore serve as sources of zoonotic and wildlife diseases. Bosawás represents one of the largest intact tracts of habitat for jaguars (Panthera onca) in Central America, and given that these communities are located within the forest, jaguars may be at risk from disease spillover from hunting dogs. Dog owners reported that four of 49 dogs had been attacked and killed by jaguars in the past year, and that retaliatory killing of jaguars was sometimes practiced. Disease spillover from dogs to wildlife could occur both in the course of dogs' hunting activities as well as during jaguar attacks. A better understanding of dog depredation by jaguars, pathogen exposure in jaguars, and a management strategy for the hunting dog population, are urgently needed to mitigate these dual threats to jaguars, improve the lives of hunting dogs, and safeguard the health of their owners.