Resident physicians physical activity during on-call shifts: smartphone-based assessment.

BACKGROUND: Physical activity of resident physicians (RPs) during on-call shifts is difficult to objectively evaluate. The integration of smartphones in our daily routines may allow quantitative assessment, employing pedometric assessment. AIMS: To evaluate the number of steps that RPs walk during on-call shifts as a marker of physical activity by using smartphone-based pedometers. METHODS: Step counts were collected from 100 RPs' smartphones who volunteered to participate in the study between January 2018 and May 2019. The conversion rate was 1400 steps = 1 km (application's default). A shift was defined as regular morning work followed by an in-house on-call stay, totalling 26 hours. Statistical analyses included univariate and multivariate linear mixed models, and Fisher exact test. A P-value < 0.05 was considered statistically significant. RESULTS: The average walking distance was 12 118 steps (8.6 km/RP/shift). Paediatric intensive care unit and neurosurgery residents recorded the longest walking distances 16 347 and 15 630 steps (11.67 and 11.16 km/shift), respectively. Radiology residents walked the shortest distances 4718 steps (3.37 km/shift). Physically active RPs walked significantly longer distances during their shifts than non-physically active RPs: 12 527 steps versus 11 384 steps (8.95 versus 8.13 km/shift, P < 0.05), respectively. Distances covered during weekday shifts were longer than weekend shifts: 12 092 steps versus 11 570 steps (8.63 versus 8.26 km/shift, P < 0.05), respectively. CONCLUSIONS: Smartphone-based pedometers can aid in analysing physical activity and workload during on-call shifts; such information can be valuable for human resource department, occupational health authorities and medical students with impaired physical mobility when choosing a speciality.

Disparity in fetal growth between twin and singleton gestation: the role of adipokines.

OBJECTIVE: Twin pregnancies are characterized by unique pattern of attenuated fetal weight gain during late gestation compared with singleton gestation. The mechanism(s) responsible for regulating twin growth has not yet elucidated. Leptin and adiponectin are two adipocytokines implicated in metabolism and energy balance of fetuses, newborns and adults. Moreover, these hormones have been suggested to play a role in fetal growth. The objective of the study was to determine cord blood adiponectin and leptin in twins and singletons, with and without growth impairment. STUDY DESIGN: This was a case-control study. It included two groups of newborns, matched for gestational age and birth weight percentile: singleton (n=60 newborns) and twins (n=44 newborns). Adiponectin and leptin were determined in cord blood, and compared between the groups according to clinical and demographic characteristics. Non-parametric and parametric statistical methods were employed. RESULTS: Median adiponectin and leptin concentrations were lower in twins vs singletons (P<0.001 for both comparisons). Among small for gestational age newborns (SGA), median concentration of adiponectin (P=0.04), but not leptin (P=0.1), was lower in twins compared to singletons. In pooled analysis (singleton plus twins), cord blood adiponectin and leptin were strongly correlated with gestational age (P<0.001 and P=0.005, respectively) and birth weight (P<0.001 and P<0.001, respectively). Regression analysis revealed that plurality (P=0.02) was significantly and independently associated with cord blood adiponectin concentrations, after adjustment for confounding variables. Similar regression in which leptin was the independent variable revealed that only birth weight (P=0.01) was significantly and independently associated with cord blood leptin concentrations. CONCLUSIONS: Twin pregnancies are associated with lower cord blood concentrations of adiponectin and leptin compared with singleton gestations. However, only cord blood adiponectin, but not leptin, was lower in SGA neonates. Collectively, these data suggest that adiponectin may be implicated in the mechanism accounting for the growth disparity between twins and singletons.

Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women.

OBJECTIVE: The aim of this study was to describe maternal central hemodynamic parameters before and during delivery as well at the early puerperium in healthy women undergoing elective cesarean section (CS) at term. STUDY DESIGN: The noninvasive Cardiac System (NICaS, NI Medical, Petah-Tikva, Israel) is a regional impedance device that measures cardiac output (CO) and its derivatives with a good correlation with the gold standard Swan-Ganz catheter. We performed a prospective longitudinal study of healthy women with a singleton pregnancy at term. Maternal hemodynamic parameters were assessed by the NICaS at six time points: a few minutes before undergoing an elective CS, immediately after receiving spinal anesthesia, immediately after delivery of the fetus and placenta, after abdominal fascia closure, and within 24 to 36 and 48 to 72 h postpartum. RESULT: Sixty-one consenting women were recruited during the study period (January 2015 to June 2015). Baseline (pre-CS) mean arterial pressure (MAP) was 87.7±7.9 mm Hg, baseline CO was 7.5±1.7 l per min and baseline total peripheral resistance (TPR) was 994±301 dyne × s per cm5. After spinal anesthesia CO significantly increased by 13%, no significant changes were observed in MAP or TPR. Immediately after delivery, a nadir for all parameters was reached: MAP and TPR were significantly reduced by 8% and 26%, respectively (comparing to pre-CS), and CO further increased by 9% (24% comparing to pre-CS). After fascia closure, partial recoveries of all parameters were observed. Twenty-four to thirty-six hours postpartum MAP returned to pre-CS values, while CO and TPR reached -9% and +11% comparing to baseline, respectively. None of the parameters differed significantly between 24 to 36 and 48 to 72 h postpartum. CONCLUSION: Significant hemodynamic changes (reduction of TPR and increase of CO) take place at the time of delivery of fetus and placenta. Knowledge of normal hemodynamic values using a reliable noninvasive technique during various stages of pregnancy and the postpartum period is feasible, and might assist clinicians in assessing the level of patient deviation from expected cardiac performance, especially in high-risk women.

Changes in the Activity of Catalase (EC 1.11.1.6) in Relation to the Dormancy of Grapevine (Vitis vinifera L.) Buds.

Catalase activity in grapevine (Vitis vinifera L.) buds cv. ;Perlette.' increased to a maximum in October and thereafter decreased within 3 months to less than half its maximal rate. The decrease in catalase activity coincided with the decline in temperature during winter. The rate of sprouting of buds forced at 23 degrees C was negatively related to the activity of catalase. Artificial chilling of grapevine canes at 5 degrees C resulted in a 25% decrease of catalase activity in the buds after 3 days and 31% after 17 days. The activity of catalase increased to the control level only 96 hours after removing canes from 5 degrees C to room temperature. Efficient buddormancy breaking agents, such as thiourea and cyanamide decreased catalase activity to 64 and 50% of the controls respectively, while the activity of peroxidase remained the same under those conditions. A less efficient dormancy breaking agent dinitro-ortho-cresol, did not decrease catalase activity.

Anaplastic seminoma.

Fourteen patients with anaplastic seminoma were analyzed retrospectively. At the time of presentation anaplastic seminoma has similar prognosis stage for stage as the classic seminoma. However, the distinctive histologic findings and the high rates of local invasion and of elevations of serum beta-subunit human chorionic gonadotropin serve to distinguish anaplastic seminoma from the classic seminoma. These features, suggesting a possibly greater metastatic potential for anaplastic seminoma, warrant its continued identification as a distinct pathologic subtype.

CAT scanning in staging of prostatic cancer.

Forty-six patients with histologically proved adenocarcinoma of the prostate underwent pelvic lymphadenectomy after CAT scanning. The accuracy, specificity, and sensitivity of the CAT scan in detecting nodal metastasis were 70, 93 and 30 per cent, respectively; this compares favorably with pedal lymphangiography. Seventeen of the patients had radical prostatectomy. The accuracy, specificity, and sensitivity of the CAT scan in depicting local extent of the tumor were 47, 100, and 18 per cent, respectively; although low, no other clinical or biochemical method provides a better result.

Treatment of mild breast asymmetry.

Three young woman had mild breast asymmetry that was corrected by a wedge partial subcutaneous mastectomy through a circumareolar incision. Results and patients satisfaction were excellent, with almost no scarring.

Simple method for 60-degree Z-plasty.

The 60-degree two-flap Z-plasty is extremely useful and versatile. Its success depends upon accurate construction of the flaps. In the past, the intraoperative measurements required have been either quite involved or quite inaccurate. We present a simple but accurate method for planning the 60-degree two-flap Z-plasty.

Endogenous cytokinins in maturing manzanillo olive fruits.

Cytokinin activity was found in mature black olive fruits while in green fruits the activity was markedly lower. The substances with cytokinin activity showed chromatographic properties similar to those of nucleotides. Acid hydrolysis caused a shift of the active zone in the organic phase of 1-butanol-acetic acid-water (4:1:5) from R(F) 0.1 to R(F) 0.8. The possible relation of these endogenously appearing cytokinins to anthocyanin accumulation and aging of the fruit is discussed.