Opportunities for change and levelling up: a trust wide retrospective analysis of 8 years of laparoscopic and abdominal myomectomy.

Background: Laparoscopic myomectomy is increasingly considered the gold standard uterine preserving procedure and has well documented benefits over the open approach. Barriers that women have in accessing the most appropriate treatment need to be addressed to ensure optimal patient care and outcomes. Objectives: To analyse rates of open and laparoscopic myomectomy at a large NHS trust and identify how many cases could potentially have been performed laparoscopically, and any variation between sites. Materials and Methods: A retrospective review of preoperative imaging reports and a surgical database containing information for all myomectomies performed between 1st January 2015 and 31st December 2022. Main outcome measures: Number of procedures suitable for alternative surgical approach; length of hospital stay; estimated blood loss; cost differences. Results: 846 myomectomies were performed; 656 by laparotomy and 190 by laparoscopy. 194/591 (32.8%) open myomectomies could have been performed laparoscopically and 26/172 (15.1%) laparoscopic myomectomies may have been better performed via an open approach. Length of hospital stay, and estimated blood loss were significantly higher in the open group. Had cases been performed as indicated by pre-operative imaging, the cost differences ranged from -£115,752 to £251,832. Conclusions: There is disparity in access to the gold standard care of laparoscopic myomectomy. Due to multifactorial reasons, even at sites where the rate of laparoscopic myomectomy is high, there is still underutilisation of this approach. It is clear that there is scope for change and "levelling up" of this imbalance. What is new?: Robust pathways and guidelines must be developed, and more laparoscopic surgeons should be trained to optimise care for women with fibroids.

Stem cell therapy for stress urinary incontinence: a systematic review in human subjects.

PURPOSE: To systematically evaluate the current evidence on the safety and efficacy of stem cell therapy (SCT) in stress urinary incontinence (SUI) to allow objective comparison with existing surgical techniques. METHODS: Systematic literature search of Medline from years 1946-2012 using terms: "stem", "cell", "stress", "urinary", and "incontinence". Included studies presented empirical data on the treatment of SUI using SCT. OUTCOMES: adverse events, incontinence, quality of life, urodynamic, transurethral ultrasound and urethral EMG findings. RESULTS: Eight studies met inclusion criteria (seven observational and one randomized). Quality score: median 10.75 of 20 (range 2-12.5). Adverse events: one patient had bladder perforation and two procedures could not be completed due to pain. Temporary urinary retention and cystitis were also reported. Incontinence score: Four studies describe significant improvement. Quality of life: significant improvement in four studies. Urodynamic outcomes: four studies show significant improvement in contractility of urethral sphincter; three studies demonstrate no change in bladder capacity and significant reduction in residual volume; significant improvement in urinary flow three studies, although two found no difference; increase in leak point pressure and detrusor pressure in three studies. Urethral ultrasound: three studies found significant increases in rhabdosphincter thickness and contractility. Urethral EMG: two studies found significant increases in the EMG at rest and at contraction. CONCLUSION: Data suggest that SC treatment for SUI is safe and effective in the short term. However, the quality and maturity of the data are limited. Robust data from better quality studies comparing this to current surgical techniques are needed.

Antimicrobial Resistance, Virulence Properties and Genetic Diversity of Salmonella Typhimurium Recovered from Domestic and Imported Seafood.

The quantity of seafood imported and produced by domestic aquaculture farming has increased. Recently, it has been reported that multidrug-resistant (MDR) Salmonella Typhimurium may be associated with seafood. However, information is limited to the antimicrobial resistance, virulence properties, and genetic diversity of S. Typhimurium recovered from imported and domestic seafood. This study investigated the antimicrobial resistance, virulence properties, and genetic diversity of S. Typhimurium isolated from domestic and imported catfish, shrimp, and tilapia. A total of 127 isolates were tested for the presence of multidrug-resistance (MDR), virulence genes (invA, pagC, spvC, spvR), and genetic diversity using the Sensititre micro-broth dilution method, PCR, and pulsed-field gel electrophoresis (PFGE), respectively. All isolates were uniformly susceptible to six (amoxicillin/clavulanic acid, ceftiofur, ceftriaxone, imipenem, nitrofurantoin, and trimethoprim/sulfamethoxazole) of the 17 tested antimicrobials and genetically diverse. Fifty-three percent of the Salmonella isolates were resistant to at least one antimicrobial and 49% were multidrug resistant. Ninety-five percent of the isolates possessed the invA gene, 67% pagC, and 43% for both spvC, and spvR. The results suggest that S. Typhimurium recovered from seafood is frequently MDR, virulent, and have the ability to cause salmonellosis.

The outbreaks and prevalence of antimicrobial resistant Salmonella in poultry in the United States: An overview.

Salmonella is a Gram-negative, rod-shaped, facultative anaerobic, and non-spore-forming bacterium that belongs to the family of Enterobacteriaceae and is the causative agent for typhoid/paratyphoid fever and salmonellosis. Salmonella causes the highest amount of foodborne illness among bacteria at 15.5 cases per 100,000 and causes an estimated 410,000 antibiotic-resistant infections each year in the U.S. The use of antibiotics has been a staple in poultry production for the prevention of diseases and growth promotion for the last 70 years. Due to the over-and misusage of antibiotics, there has been an emerging public health crisis. Salmonella is developing resistance and may render antibiotics inoperative in a foodborne outbreak. Poultry, when not handled properly, is a major carrier and transmitter of Salmonella, causing human illness and fatality. This review summarizes the major Salmonella outbreaks over the past three decades, the prevalence of Antimicrobial Resistant (AMR) Salmonella related to poultry, and the control measures being implemented to reduce and prevent AMR Salmonella in poultry.

Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit.

BACKGROUND: For patients presenting with symptomatic internal carotid artery stenosis, carotid endarterectomy (CEA) surgery is recommended to be performed generally within a 48-hr to 14-day window. This study aimed to assess timeliness of delivery, and outcomes, of CEA surgery in a tertiary vascular centre. METHOD: Patients with symptomatic internal carotid artery stenosis who underwent CEA between 1 June 2014 and 31 June 2017 were identified and data were obtained from hospital records. The timeline of their journey from presentation to surgery was then mapped together with their outcomes. RESULTS: One hundred and seventy-two cases were included in the study. Overall, the median time from development of presenting symptoms to surgery was 9 days and 119 (69%) cases were operated on within 14 days. The median time from development of presenting symptoms to ultrasound imaging was 2 days and the median time from symptoms to vascular referral was also 2 days. There were no deaths, strokes or transient ischaemic attacks within 30 days of CEA. At 1 year, survival was 100% but 15 (8.7%) had experienced at least one transient ischaemic attack or stroke. In the 53 cases operated upon beyond 14 days the dominant cause of delay in 32 (60%) was accessing surgery after review by the vascular service. CONCLUSION: The aim of delivering CEA within 14 days of developing relevant symptoms was achieved in most cases with good outcomes. Nevertheless, points of delay in the patient journey that could be targeted for future quality improvement were identified.

Google searches and medical publication trends since the 2014 US Food and Drug Administration position on power morcellation: Do these translate into patient awareness?

OBJECTIVES: Our primary objective was to assess patient awareness by observing Google Trends comparing search terms used in relation to morcellation rather than morcellation alone. Our secondary objective was to review trends and locations of publications on leiomyosarcoma and morcellation following the US Food and Drug Administration (FDA) position statement. STUDY DESIGN: To assess Internet trends, we obtained the relative search volume (RSV) for each month from 1 January 2004 to 1 March 2019 from Google Trends using the terms 'fibroid', 'morcellation', and 'fibroid cancer'. RSV ranges from 0 to 100 with 100 being peak popularity for the term, and all other monthly search activity relative to the peak. To assess academic trends, we performed a systematic review of published literature discussing fibroid morcellation within the same time period. We used a two-way independent t-test to compare median RSV, and chi-squared test to compare academic output. P < 0.05 was considered statistically significant. RESULTS: Search volume for 'morcellation' peaked during the FDA statement (RSV 0.5 to 2.9, t = 17.5, p < 0.05) but was not sustained. There is an increase in 'fibroid' activity post-FDA statement (RSV 68.8 to 76.3, t = 3.9, p < 0.05). 'Fibroid cancer' remained static throughout (t = 1.5, p = 0.1 and t=-0.5, p = 0.6). Afro-Caribbean countries had the highest RSV for 'fibroid', whereas 'morcellation' RSV was highest in predominantly Western countries. There was a significant increase in the rate of papers published on the subject following the FDA statement (6.8 vs 55.6 papers per year, 95% CI -53.96 to -43.64, p < 0.0001). No academic papers on morcellation were published from countries with the highest RSV for 'fibroid'. CONCLUSION: Our study suggests that interest in uterine fibroids has increased since the FDA statement, but the public are perhaps unaware or not concerned of the consequent potential risk of leiomyosarcoma following morcellation. Countries where fibroid interest is highest are not necessarily those that can offer power morcellation. Further studies are required to address how the Internet influences patient choice and informed consent, and how medical professionals can use it to further educate patients on the risks and benefits of laparoscopic myomectomy and power morcellation.

Risperidone for autism spectrum disorder.

BACKGROUND: Autistic spectrum disorder encompasses a wide variety of behavioural and communicative problems. Both the core features and non-core features of autism have been targeted in a variety of therapies. Atypical antipsychotic medications, including risperidone, have been used for symptom and behaviour improvement and have shown beneficial outcomes, particularly in certain aspects of the disorder. However, given the nature of the condition presenting in young patients, the risks of these potentially long term therapies must be weighed against the benefits. OBJECTIVES: To determine the efficacy and safety of risperidone for people with autism spectrum disorder. SEARCH STRATEGY: Electronic databases: CENTRAL (Cochrane Central Register of Controlled Trials) 2006 (Issue 3); MEDLINE (1966 to April 2006); EMBASE (1980 to April 2006);PsycINFO (1887 to April 2006); CINAHL (1982 to April 2006); LILACS (1982 to April 2006 ); Clinicaltrials.gov (USA) (accessed April 2006); ZETOC (1993 to April 2006); National Research Register (NRR) (UK) 2006 (Issue 1) were searched. In addition further data were retrieved through contact with pharmaceutical companies and authors of published trials. SELECTION CRITERIA: All randomised controlled trials of risperidone versus placebo for patients with a diagnosis of autism spectrum disorder. All trials had to have at least one standardised outcome measure used for both intervention and control group. DATA COLLECTION AND ANALYSIS: Data were independently evaluated and analysed by the reviewers. Data were evaluated at the end of each randomised controlled trial. Unpublished data were also considered and analysed. MAIN RESULTS: Only three randomised controlled trials were identified. Meta-analysis was possible for three outcomes. Some evidence of the benefits of risperidone in irritability, repetition and social withdrawal were apparent. These must however be considered against the adverse effects, the most prominent being weight gain. AUTHORS' CONCLUSIONS: Risperidone can be beneficial in some features of autism. However there are limited data available from studies with small sample sizes. In addition, there lacks a single standardised outcome measure allowing adequate comparison of studies, and long-term followup is also lacking. Further research is necessary to determine the efficacy pf risperidone in clinical practice.

Immunoglobulin class (IgG, IgM) determination by dithiothreitol in sensitized kidney transplant candidates.

Immunoglobulin class plays an important role in the histocompatibility crossmatch test to predict hyperacute rejection in kidney transplantation. The existing data indicates that immunoglobulin (Ig) M antibodies, particularly when they are autoantibodies, are not deleterious to the renal allograft. We used the reducing agent dithiotreitol (DTT) to inactivate IgM but not IgG in the crossmatch assay to help sensitized patients have the chance for successful transplantation. In this descriptive study, 57 candidates for kidney transplantation with final positive crossmatches who had a history of panel-reactive antibody (PRA) greater than 30% were selected. Two of 57 patients had systemic lupus erythematous (SLE). The sera of patients were treated by DTT and then measured for cytotoxicity against donor lymphocytes and a panel of 12 cells using the complement-dependent cytotoxicity (CDC) method. Autocrossmatch was also performed to differentiate autoantibodies and alloantibodies by the CDC method. Of the 57 patients, six subjects (10.53%) had IgM and 51 patients (89.47%) IgG in their serum against donor lymphocytes. Also against panel cells, 39 of 57 patients (68.43%) had IgG, three patients (5.26%) had IgM, and 15 patients (26.31%) had both IgG and IgM antibodies. Autolymphocytotoxic antibodies were detected in 1.75% patients (1 of 57) who had SLE. According to our results, 5.26% of the patients who were IgM-positive and IgG-negative for both crossmatch and PRA assays may experience successful kidney transplantation.

Simulation study of accelerator based quasi-mono-energetic epithermal neutron beams for BNCT.

Filtered neutron techniques were applied to produce quasi-mono-energetic neutron beams in the energy range of 1.5-7.5 keV at the accelerator port using the generated neutron spectrum from a Li (p, n) Be reaction. A simulation study was performed to characterize the filter components and transmitted beam lines. The feature of the filtered beams is detailed in terms of optimal thickness of the primary and additive components. A computer code named "QMNB-AS" was developed to carry out the required calculations. The filtered neutron beams had high purity and intensity with low contamination from the accompanying thermal, fast neutrons and γ-rays.

Peripheral neuropathy in systemic lupus erythematosus in Southern Iran.

The prevalence of clinically apparent peripheral neuropathy in systemic lupus erythematosus (SLE) is reported to be between 2-27%. The purpose of this descriptive cross sectional study was to determine the prevalence of peripheral neuropathy (PN) using electrodiangostic criteria in SLE in southern Iran. Subgroup analysis was performed to determine whether PN correlated with disease activity, serum immune markers and duration of disease and clinical findings. The right median, ulnar, peroneal, tibial and sural sensory and motor nerve conduction studies were conducted in 64 SLE cases. PN in our study was defined as any abnormal values in sensory action potential, motor action potential, or conduction velocity affecting 2 or more nerves. Of 64 patients studied, PN was present in 12 patients (18.7%), of which 4 (6.6%) were symptomatic. There was no significant correlation between PN and serum immune markers, and there was a trend showing decreased motor and sensory action potential amplitude in our SLE group compared to the controls. This observation was also seen in active disease group where compared to inactive disease. The amplitude of the action potential and then NCV were more often affected than distal latency, and sensory nerves were more susceptible than motor nerves and regarding the results electrodiognostic study is more sensitive than clinical evidence in detecting PN in SLE.

Filtered epithermal quasi-monoenergetic neutron beams at research reactor facilities.

Filtered neutron techniques were applied to produce quasi-monoenergetic neutron beams in the energy range of 1.5-133keV at research reactors. A simulation study was performed to characterize the filter components and transmitted beam lines. The filtered beams were characterized in terms of the optimal thickness of the main and additive components. The filtered neutron beams had high purity and intensity, with low contamination from the accompanying thermal emission, fast neutrons and γ-rays. A computer code named "QMNB" was developed in the "MATLAB" programming language to perform the required calculations.

Monte carlo simulation of x-ray spectra in diagnostic radiology and mammography using MCNP4C.

The general purpose Monte Carlo N-particle radiation transport computer code (MCNP4C) was used for the simulation of x-ray spectra in diagnostic radiology and mammography. The electrons were transported until they slow down and stop in the target. Both bremsstrahlung and characteristic x-ray production were considered in this work. We focus on the simulation of various target/filter combinations to investigate the effect of tube voltage, target material and filter thickness on x-ray spectra in the diagnostic radiology and mammography energy ranges. The simulated x-ray spectra were compared with experimental measurements and spectra calculated by IPEM report number 78. In addition, the anode heel effect and off-axis x-ray spectra were assessed for different anode angles and target materials and the results were compared with EGS4-based Monte Carlo simulations and measured data. Quantitative evaluation of the differences between our Monte Carlo simulated and comparison spectra was performed using student's t-test statistical analysis. Generally, there is a good agreement between the simulated x-ray and comparison spectra, although there are systematic differences between the simulated and reference spectra especially in the K-characteristic x-rays intensity. Nevertheless, no statistically significant differences have been observed between IPEM spectra and the simulated spectra. It has been shown that the difference between MCNP simulated spectra and IPEM spectra in the low energy range is the result of the overestimation of characteristic photons following the normalization procedure. The transmission curves produced by MCNP4C have good agreement with the IPEM report especially for tube voltages of 50 kV and 80 kV. The systematic discrepancy for higher tube voltages is the result of systematic differences between the corresponding spectra.

Application of 8-amino-N-(2-hydroxybenzylidene)naphthyl amine as a neutral ionophore in the construction of a lanthanum ion-selective sensor.

In this work, a novel La(III) membrane sensor based on 8-amino-N-(2-hydroxybenzylidene)naphthylamine (AIP) is presented. This electrode reveals good selectivity for La(3+) over a wide variety of lanthanides metal ions. Theoretical calculations and conductance study of AIP to lanthanum and some other metal ions were carried out and confirmed selectivity toward La(III) ions. The electrode comprises 7% AIP, 30% PVC, 61% NPOE and 2% KTpClPB. The sensor displays a linear dynamic range between 1.0 x 10(-7) and 1.0 x 10(-1) M, with a nice Nernstian slope of 20.3+/-0.3 mV per decade and a detection limit of 8.0 x 10(-8) M. The potentiometric response is independent of pH in the range of 4.0-9.0. The proposed sensor posses the advantage of short response time, and especially, very good selectivity towards a large number of cations, such as Sm(III), Ce(III, Pr(III), Yb(III) and Hg(II), low detection limit and wide linear dynamic range in comparison with former ones. The electrode can be used for at least seven weeks without any considerable divergence in the potentials. It was used as an indicator electrode in the potentiometric titration of La(III) ions with EDTA. The sensor was applied to the determination of La(III) ions concentration in binary mixtures. It was also applied for the determination of fluoride ions in mouth wash preparations.

IgG autoantibody activity in normal mouse serum is controlled by IgM.

In the serum of normal BALB/c mice, IgG antibody reactivity to mouse actin and tubulin, DNA, and TNP groups was very low compared to that of the IgM. This activity was considerably increased when IgG was separated, by affinity chromatography on protein A-Sepharose, whereas no difference in the IgM activity was observed. Addition of IgM to IgG isolated from the same serum resulted in the inhibition of IgG binding to these Ag. Isolation of IgG antibodies on actin, TNP, and tubulin immunoadsorbents has indicated that at least part of the IgG antibodies is polyreactive. In order to understand this inhibition better, experiments with F(ab')2 fragments of IgG were performed. IgM inhibited the binding of F(ab')2 to the antigens in a dose-dependent manner and reacted with immobilized F(ab')2. IgM isolated on F(ab')2 immunoadsorbent, as compared to the initial IgM preparation, were less active toward the Ag but more inhibitory for IgG binding to the Ag. In some pathologic situations, IgM failed to inhibit some IgG antibody activities. The anti-DNA IgG activity from (NZB x NZW)F1 mice was not affected by autologous IgM. Similarly the anti-tubulin IgG from mice infected with Trypanosoma cruzi were less inhibited by IgM from autologous serum than antitubulin IgG from normal mice. These results are compatible with the existence in normal mice of an idiotypic-like network, regulating via an IgM population in the serum, the binding of IgG autoantibodies to self Ag. Modifications of this idiotype-anti-idiotype system might lead to the expression and/or expansion of autoreactive IgG-producing clones.