Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer.

BACKGROUND: Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. METHODS: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. RESULTS: Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. CONCLUSION: Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.

A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer.

BACKGROUND: Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. METHODS: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as "cancer survivors" and those without a history of cancer as "no cancer history." We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. RESULTS: There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. CONCLUSION: Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.

Quantitative Synthesis of Timed 25-Foot Walk Performance in Multiple Sclerosis.

OBJECTIVE: To provide a meta-analysis of articles that have included the timed 25-foot walk (T25FW) in persons with multiple sclerosis (MS), quantify differences in T25FW scores between those with MS and controls without MS, and quantify differences between categories of disability status and clinical disease courses within MS. DATA SOURCES: The literature search was conducted using 4 databases (Google Scholar, PubMed, Cumulative Index to Nursing and Allied Health, EBSCO Host). We searched reference lists of published articles to identify additional articles. STUDY SELECTION: A systematic literature search identified articles reporting average T25FW performance in seconds between those with MS and controls without MS, between those with MS who had mild and moderate and/or severe disability status, and between relapsing-remitting and progressive clinical courses of MS. DATA EXTRACTION: Information was extracted and categorized based on reported data: comparisons of controls without MS and MS, comparisons of mild and moderate and/or severe MS based on study-defined Expanded Disability Status Scale groups, and comparisons of relapsing-remitting and progressive MS clinical courses. DATA SYNTHESIS: We performed a random effects meta-analysis to quantify differences between groups as estimated by effect sizes (ESs). We expressed the differences in Cohen d as well as the original units of the T25FW (ie, seconds). CONCLUSIONS: There was a large difference in T25FW performance in MS compared with controls without MS (ES=-0.93, mean difference=2.4s, P<.01). Persons with moderate and/or severe disability walked substantially slower compared with mild disability (ES=-1.02, mean difference=5.4s, P<.01), and persons with progressive courses of MS walked substantially slower than relapsing-remitting MS (ES=-1.4, mean difference=13.4s, P<.01).

Adsorption characteristics of activated carbon fibers (ACFs) for toluene: application in respiratory protection.

Granular activated carbon (GAC) is currently the standard adsorbent in respirators against several gases and vapors because of its efficiency, low cost, and available technology. However, a drawback of GAC due to its granular form is its need for containment, adding weight and bulkiness to respirators. This makes respirators uncomfortable to wear, resulting in poor compliance in their use. Activated carbon fibers (ACF) are considered viable alternative adsorbent materials for developing thinner, light-weight, and efficient respirators because of their larger surface area, lighter weight, and fabric form. This study aims to determine the critical bed depth and adsorption capacity of different types of commercially available ACFs for toluene to understand how thin a respirator can be and the service life of the adsorbents, respectively. ACF in cloth (ACFC) and felt (ACFF) forms with three different surface areas per form were tested. Each ACF type was challenged with six concentrations of toluene (50, 100, 200, 300, 400, 500 ppm) at constant air temperature (23°C), relative humidity (50%), and airflow (16 LPM) at different adsorbent weights and bed depths. Breakthrough data were obtained for each adsorbent using gas chromatography with flame ionization detector. The ACFs' surface areas were measured by an automatic physisorption analyzer. The results showed that ACFC has a lower critical bed depth and higher adsorption capacity compared to ACFF with similar surface area for each toluene concentration. Among the ACF types, ACFC2000 (cloth with the highest measured surface area of 1614 ± 5 m(2)/g) has one of the lowest critical bed depths (ranging from 0.11-0.22 cm) and has the highest adsorption capacity (ranging from 595-878 mg/g). Based on these studied adsorption characteristics, it is concluded that ACF has great potential for application in respiratory protection against toluene, particularly the ACFC2000, which is the best candidate for developing thinner and efficient respirators.

Influence of low-temperature environmental exposure on the mechanical properties and structural stability of dental zirconia.

PURPOSE: The effect of dental fabrication procedures of zirconia monolithic restorations and changes in properties during low-temperature exposure in the oral environment is not completely understood. The purpose of this study was to investigate the effect of procedures for fabrication of dental restorations by low-temperature simulation and relative changes of flexural strength, nanoindentation hardness, Young's modulus, surface roughness, and structural stability of yttria-stabilized zirconia. MATERIALS AND METHODS: A total of 64 zirconia specimens were prepared to simulate dental practice. The specimens were divided into the control group and the accelerated aging group. The simulated group followed the same procedure as the control group except for the aging treatment. Atomic force microscopy was used to measure surface roughness. The degree of tetragonal-to-monoclinic transformation was determined using X-ray diffraction. Nanoindentation hardness and modulus measurements were carried out on the surface of the zirconia specimens using a nanoindenter XP/G200 system. The yttria levels for nonaged and aged specimens were measured using energy dispersive spectroscopy. Flexural strength was determined using the piston-on-three-ball test. The t-test was used to determine statistical significance. RESULTS: Means and standard deviations were calculated using all observations for each condition and evaluated using a group t-test (p < 0.05). The LTD treatment resulted in increased surface roughness (from 12.23 nm to 21.56 nm for Ra and 15.06 nm to 27.45 nm for RMS) and monoclinic phase fractions (from 2% to 21%), with a concomitant decrease in hardness (from 16.56 GPa to 15.14 GPa) and modulus (from 275.68 GPa to 256.56 GPa). Yttria content (from 4.43% to 4.46%) and flexural strength (from 586 MPa to 578 MPa) were not significantly altered, supporting longer term in vivo function without biomechanical fracture. CONCLUSION: The LTD treatment induced the tetragonal-to-monoclinic transformation with surface roughening in zirconia prepared using dental procedures.

Exploring Factors Associated With Successful Nonpharmacological Interventions for People With Dementia.

BACKGROUND AND PURPOSE: We investigated existing nonpharmacological programs for people with dementia (PWD) to explore critical factors related to the effectiveness of these types of programs. METHODS: We conducted a qualitative systematic literature review to identify nonpharmacological intervention programs developed for PWD and reviewed 36 randomized controlled trials. Among several outcomes reported in each study, we focused on the most common outcomes including quality of life (QoL), neuropsychiatric symptoms, depression, agitation, and cognition for further review. RESULTS: Several factors were identified that might affect the outcomes of nonpharmacological interventions for PWD including study design, characteristics of the intervention, maintaining research participants, heterogeneity issues, and implementation fidelity. About half of studies in this review reported positive program effects on their targeted outcomes such as Well-being and Health for PWD on improving quality of life, neuropsychiatric symptoms and agitation; cognitive stimulation therapy on QoL, neuropsychiatric symptoms and cognition; and a stepwise multicomponent intervention on neuropsychiatric symptoms, depression and agitation. CONCLUSIONS: We found some programs even with a rigorous study design did not produce expected outcomes while other programs with poor designs reported positive outcomes, which necessitates further investigation on the validity of the assessments. Factors such as individual tailored and customized interventions, promoting social interactions, ease of administration and compatibility of interventions, and developing program theory need to be considered when developing nonpharmacological intervention programs.

Persistent rhinitis and epithelial remodeling induced by cyclic ozone exposure in the nasal airways of infant monkeys.

Children chronically exposed to high levels of ozone (O(3)), the principal oxidant pollutant in photochemical smog, are more vulnerable to respiratory illness and infections. The specific factors underlying this differential susceptibility are unknown but may be related to air pollutant-induced nasal alterations during postnatal development that impair the normal physiological functions (e.g., filtration and mucociliary clearance) serving to protect the more distal airways from inhaled xenobiotics. In adult animal models, chronic ozone exposure is associated with adaptations leading to a decrease in airway injury. The purpose of our study was to determine whether cyclic ozone exposure induces persistent morphological and biochemical effects on the developing nasal airways of infant monkeys early in life. Infant (180-day-old) rhesus macaques were exposed to 5 consecutive days of O(3) [0.5 parts per million (ppm), 8 h/day; "1-cycle"] or filtered air (FA) or 11 biweekly cycles of O(3) (FA days 1-9; 0.5 ppm, 8 h/day on days 10-14; "11-cycle"). The left nasal passage was processed for light microscopy and morphometric analysis. Mucosal samples from the right nasal passage were processed for GSH, GSSG, ascorbate (AH(2)), and uric acid (UA) concentration. Eleven-cycle O(3) induced persistent rhinitis, squamous metaplasia, and epithelial hyperplasia in the anterior nasal airways of infant monkeys, resulting in a 39% increase in the numeric density of epithelial cells. Eleven-cycle O(3) also induced a 65% increase in GSH concentrations at this site. The persistence of epithelial hyperplasia was positively correlated with changes in GSH. These results indicate that early life ozone exposure causes persistent nasal epithelial alterations in infant monkeys and provide a potential mechanism for the increased susceptibility to respiratory illness exhibited by children in polluted environments.

Postnatal episodic ozone results in persistent attenuation of pulmonary and peripheral blood responses to LPS challenge.

Early life is a dynamic period of growth for the lung and immune system. We hypothesized that ambient ozone exposure during postnatal development can affect the innate immune response to other environmental challenges in a persistent fashion. To test this hypothesis, we exposed infant rhesus macaque monkeys to a regimen of 11 ozone cycles between 30 days and 6 mo of age; each cycle consisted of ozone for 5 days (0.5 parts per million at 8 h/day) followed by 9 days of filtered air. Animals were subsequently housed in filtered air conditions and challenged with a single dose of inhaled LPS at 1 yr of age. After completion of the ozone exposure regimen at 6 mo of age, total peripheral blood leukocyte and polymorphonuclear leukocyte (PMN) numbers were reduced, whereas eosinophil counts increased. In lavage, total cell numbers at 6 mo were not affected by ozone, however, there was a significant reduction in lymphocytes and increased eosinophils. Following an additional 6 mo of filtered air housing, only monocytes were increased in blood and lavage in previously exposed animals. In response to LPS challenge, animals with a prior history of ozone showed an attenuated peripheral blood and lavage PMN response compared with controls. In vitro stimulation of peripheral blood mononuclear cells with LPS resulted in reduced secretion of IL-6 and IL-8 protein in association with prior ozone exposure. Collectively, our findings suggest that ozone exposure during infancy can result in a persistent effect on both pulmonary and systemic innate immune responses later in life.

Fifteen-year trend in the use of male reproductive surgery: analysis of the healthcare cost and utilization project data.

OBJECTIVE: • To determine trends in male reproductive surgeries. MATERIALS AND METHODS: • A database analysis was performed using the Healthcare Cost and Utilization Project databases from 1988, 1992 and 1998-2002. SAS statistical software was used to estimate the total numbers of reproductive surgeries and their variances for each year. RESULTS: • The number of male reproductive surgeries has declined during the period of study, both in the inpatient and outpatient arenas. The number of procedures with a diagnosis of infertility has also declined. CONCLUSION: • The number of male reproductive surgeries has declined from 1988 to 2002.

Factors affecting the location and shape of face seal leak sites on half-mask respirators.

While there have been a number of studies on the effect of leak site and shape on the magnitude of measured leakage through respirator face seals, there have been very few studies to identify the location and size of these leaks. In a previous study we used a method of identifying the location and shape of respirator leaks on a half-mask respirator by the deposition of a fluorescent tracer during a fit test, and testing for their association with facial dimensions. The purpose of this study was to apply that methodology to conduct multiple fit tests to determine if gender, respirator brand, repeated fit tests, and test exercises affected the location and shape of face seal leak sites. Categorical analysis found that none of these factors had a significant effect on the location and shape of leaks. General linear model analysis found some significant effects of the study factors on leaks, but facial dimensions had a greater effect, and there were significant differences between facial dimensions of subjects with a leak and those without. Significant differences in leak site distributions between this and the previous study may have been due to differences in facial dimensions and racial/ethnic composition. Twice as many diffuse leaks as point leaks were observed in both studies, indicating that slit-like leaks would be most appropriate on mannequins used in laboratory respirator leakage studies, and in respirator flow and penetration models. That the study factors had no significant effects in the categorical analysis, significant effects for facial dimensions were found in the linear analysis, and leak site distribution differences between this and our previous study may have been affected by differences in facial dimensions, indicate that, in addition to size, the shape of an individual's face may be an important determinant of leak sites on a half-mask respirator. This would have implications for the design of respirator facepieces and in the selection of respirators for individual wearers.

Barrier membranes used for ridge augmentation: is there an optimal pore size?

PURPOSE: To identify the optimal pore size of barrier membranes for successful alveolar ridge reconstruction procedures, to determine if cortical perforations have any effect on bone regeneration, and to reiterate that bone graft containment is an important parameter for successful regeneration. MATERIALS AND METHODS: This was a prospective, randomized, controlled study performed on hound dogs. Corticocancellous tibial bone grafting was performed to the lateral border of the mandible and protected with barrier membranes (meshes). The experiment analyzed three different pore sized meshes, compared with controls without the mesh. Two meshes (macroporous and microporous) were made of titanium, and one was a resorbable mesh. Meshes were preformed into the shape of a cube with one face open. Each side of the cube measured approximately 10 mm. Cubes were open-faced on one side, to facilitate packing of the graft material. The dogs received bilateral ramus grafts. Cortical perforations were created on the left ramus of all the dogs and compared with the right side, which did not have perforations. The dogs were randomly divided into 3 groups and sacrificed at intervals of 1, 2, and 4 months. Before sacrifice, all dogs received 2 doses of tetracycline as a marker for new bone formation. Histomorphometry was performed by using Bioquant image-analysis software. Areas of new bone and soft tissue were measured. The rate of mineral apposition was also calculated. All values obtained via histomorphometry were statistically analyzed with a t test. RESULTS: Thirty-one experimental sites were evaluated. The amount of new bone growth into the macroporous mesh was significantly higher than in the other groups. The mean area of new bone formation in large and small meshes was 66.26 +/- 13.78 mm(2) and 52.82 +/- 24.75 mm(2), respectively. In the resorbable mesh group, the mean area of new bone formed was 46.76 +/- 21.22 mm(2). The amount of new bone formed in the control group was 29.80 +/- 9.35 mm(2). There was no significant difference in amount of bone formation between left and right sides (P = .3172). Resorbable meshes had significant soft tissue ingrowth (23.47 mm(2)) compared with macroporous mesh (16.96 mm(2)) and microporous mesh (22.29 mm(2)). Controls had the least amount of soft tissue ingrowth (9.41 mm(2)). Mineral apposition rate was found to be higher in the resorbable group (2.41 microm/day), and the rate was lowest (1.09 microm/day) in the large pore mesh group. CONCLUSION: Macroporous membranes facilitated greater bone regeneration compared with microporous and resorbable membranes. Macroporous mesh also prevented significant soft tissue ingrowth compared with other meshes. Containment of a bone graft is the most critical parameter in successful bone regeneration. Cortical perforations did not have any effect on the quantity of regenerated bone. Further research should be directed toward identifying a critical pore size and manufacturing a reliable mesh that would prevent excessive soft tissue ingrowth in ridge augmentation procedures.

Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease.

BACKGROUND: Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously. OBJECTIVES: Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2). METHODS: Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). RESULTS: There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m(2)) and by 2D-Echo Doppler (2.06 l/min/m(2)) and bias and precision was 0.05 (2.4%) and +/-0.48 l/min/m(2) (+/-23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05). CONCLUSIONS: MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease.

Walking endurance in multiple sclerosis: Meta-analysis of six-minute walk test performance.

BACKGROUND: The 6-minute walk (6 MW) is the most commonly applied measure of endurance walking capacity in persons with multiple sclerosis (MS); however, we are not aware of a quantitative synthesis of 6 MW performance in MS. RESEARCH QUESTION: We undertook a meta-analysis quantifying the overall magnitude of difference in 6 MW performance between MS and healthy controls (HCs), and then within MS as a function of disability status. We further examined possible moderator variables of 6 MW performance. METHODS: The systematic search was conducted for articles that included the 6 MW in persons with MS and involved comparison groups (i.e., HCs or MS disability subgroups (i.e., mild vs moderate-to-severe disability status)). The mean and standard deviation of the distance traveled during the 6 MW as well as sample sizes were entered into Comprehensive Meta-Analysis software and we estimated the overall effect size (Cohen's d) using a random effects model and examined categorical variables as possible moderators (e.g., instruction protocol, provision of encouragement, method of distance measurement, and course description). RESULTS: Thirty-four studies met inclusion criteria with a total sample size of 3204 persons (MS: 2683; HC: 521) yielding 42 total comparisons. Persons with MS walked a shorter distance than HCs (mean difference = -177.2 ±â€¯19.1 m) with a large effect size (d = - 1.87). Persons with mild disability walked further than those with moderate-to-severe disability (mean difference = 185.19 ±â€¯9.2 m) with a large effect (d = 1.83). The categorical variables of provision of encouragement and course layout moderated the effect of MS and course layout moderated the effect of disability status on 6 MW performance. SIGNIFICANCE: This meta-analysis of 6 MW performance defines mean difference in 6 MW performance in MS compared with HCs and provides an estimate of the disease-related effect of MS on endurance walking capacity for application within clinical research and practice.

Regional Disparities in Ovarian Cancer in the United States.

The aim of this study was to investigate the association between geographic regions and ovarian cancer disparities in the United States. Data from the Surveillance, Epidemiology, and End Results (SEER) Program was used to identify women diagnosed with ovarian cancer. 18 registries were divided into two groups: South region and US14 region. Chi-Square tests were used to compare proportions, the logistic regression model to evaluate the association between 5-year survival and other variables, and the Cox proportional hazards model to estimate hazard ratios. The South region had a lower incidence rate than the US14 region (12.0 vs. 13.4 per 100,000), and a lower 5-year observed survival rate (37.5% vs. 39.8%). White women living in the US14 region had the best overall survival, compared to white women living in the South region, and black women living in both regions. Women in the South region were less likely to have insurance (6.6% vs. 2.7%, p<0.0001) and surgery (73.4% vs. 76.2%, p<0.0001). Women living in the South were 1.4 times more likely to die after five years of diagnosis than women living in the US14 region. The data confirmed regional disparities in ovarian cancer in the United States, showing women living in the South region were disadvantaged in ovarian cancer survival regardless of race, black or white. Future research focusing on the identification of contributing factors to regional disparity in ovarian cancer is necessary to develop practical approaches to improve health outcomes related to this lethal disease.

Medical decision-making capacity in cognitively impaired Parkinson's disease patients without dementia.

Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision-making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD-CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD-CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD-CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment.

Obesity and pelvic floor disorders: a systematic review.

OBJECTIVE: To review the current literature and summarize the effect of obesity on outcomes of surgical treatment of pelvic floor disorders as well as the effect of weight loss on pelvic floor disorder symptoms. DATA SOURCES: Relevant sources were identified by a MEDLINE search from 1966 to 2007 using the key words obesity, pelvic floor disorders, urinary incontinence (UI), fecal incontinence, and pelvic organ prolapse (POP). References of relevant studies were hand searched. METHODS OF STUDY SELECTION: Relevant human observational studies, randomized trials, and review articles were included. A total of 246 articles were identified; 20 were used in reporting and analyzing the data. Meta-analyses were performed for topics meeting the appropriate criteria. TABULATION, INTEGRATION, AND RESULTS: There is good evidence that surgery for stress UI in obese women is as safe as in their nonobese counterparts, but cure rates may be lower in the obese patient. Meta-analysis revealed cure rates of 81% and 85% for the obese and nonobese groups, respectively (P<.001; odds ratio [OR] 0.576, 95% confidence interval [CI] 0.426-0.779). Combined bladder perforation rates were 1.2% in the obese and 6.6% in the nonobese (P=.015; OR 0.277, 95% CI 0.098-0.782). There is little evidence on which to base clinical decisions regarding the treatment of fecal incontinence and POP in obese women, because few comparative studies were identified addressing the outcomes of prolapse surgery in obese patients compared with healthy-weight patients. Weight loss studies indicate that both bariatric and nonsurgical weight loss lead to significant improvements in pelvic floor disorder symptoms. CONCLUSION: Surgery for UI in obese women is safe, but more trials are needed to evaluate its long-term effectiveness as well as treatments for both fecal incontinence and POP. Weight loss, both surgical and nonsurgical, should be considered in the treatment of pelvic floor disorders in the obese woman.

Reconstruction of the maxilla and mandible with particulate bone graft and titanium mesh for implant placement.

PURPOSE: The purpose of the study was to evaluate the magnitude of ridge augmentation with titanium mesh, overall graft success, anatomic location of ridge defects and their relationship to mesh exposure. MATERIALS AND METHODS: This retrospective study evaluated 44 patients who received mandibular or maxillary reconstruction with autogenous particulate bone graft and titanium mesh for the purpose of implant placement. Autogenous bone graft was harvested from the iliac crest, tibia, and mandibular symphysis. A total of 45 sites were included in the study. Average augmentation bone heights were measured and compared. Statistical analysis was done with ANOVA and Student's t test. Histomorphometric analysis was performed on the soft tissue specimen found between the mesh and the bone graft. RESULTS: Twenty-nine sites underwent mandibular reconstruction and 16 underwent maxillary reconstruction. The mean augmentation in partial maxillary defects was 11.33 +/- 1.56 mm, and in complete maxillary augmentation, the height achieved was 14.3 +/- 1.39 mm. In the mandible, mean increase in height for partial defects was 14 +/- 1.42 mm and for complete augmentation it was 13.71 +/- 1.14 mm. The mean augmentation for all sites was 13.7 mm (12.8 mm in the maxilla and 13.9 mm in the mandible). A total of 82 implants were placed in the maxilla and 92 implants were placed in the mandible. In the maxillary group, 7 sites had exposure of the titanium mesh and 16 sites were exposed in the mandible. The success of the bone grafting procedure was 97.72%. CONCLUSIONS: Porous titanium mesh is a reliable containment system used for reconstruction of the maxilla and the mandible. This material tolerates exposure very well and gives predictable results.

A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort.

BACKGROUND: Hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to patients with no cancer history. We compared the risk of sepsis between cancer survivors and no cancer history participants, and examined whether race was an effect modifier. METHODS: We performed a prospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer, excluding non-melanoma skin cancer. We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We performed Cox proportional hazard models to examine the risk of sepsis after cancer (adjusted for sociodemographics, health behaviors, and comorbidities), and stratified by race. RESULTS: Among 29,693 eligible participants, 2959 (9.97%) were cancer survivors, and 26,734 (90.03%) were no cancer history participants. Among 1393 sepsis events, the risk of sepsis was higher for cancer survivors (adjusted HR: 2.61, 95% CI: 2.29-2.98) when compared to no cancer history participants. Risk of sepsis after cancer survivorship was similar for Black and White participants (p value for race and cancer interaction = 0.63). CONCLUSION: In this prospective cohort of community-dwelling adults we observed that cancer survivors had more than a 2.5-fold increased risk of sepsis. Public health efforts should attempt to mitigate sepsis risk by awareness and appropriate treatment (e.g., antibiotic administration) to cancer survivors with suspected infection regardless of the number of years since cancer remission.

Meta-analysis: some clinical and statistical contributions in several medical disciplines.

Meta-analysis in its present form of statistically integrating information from several studies all with a common underlying theme has been around for over 25 years. The medical field has seen many attempts by many investigators to pull summary data together from various sources within a discipline with the goal of making some definitive statement about the state of the science in that discipline. Likewise authors of manuscripts in the background and rationale section of their paper always summarize what they believe to be the state of affairs up to the time of the presentation of their own results in that particular paper. The new data and results they present in their current publication is an attempt to update the progress in that field. Thus in a sense they have performed a partial meta- analysis of summarizing information from the past, presenting their added contribution and thus updating the knowledge base. They have not quite integrated past data in a rigorous statistical way with their new data, but have merely used the data history to justify their current research which pretty much stands on its own. Thus meta-analysis is an after the fact attempt to pull together the current knowledge base whether it be publications or raw data and present a statistical synthesis of all the information and reach a conclusion as to the best treatment or intervention strategy based on all these past contributions. Now it's time to look back at some of these meta-analyses and determine what contributions, if any, they have made to the knowledge base within certain medical disciplines. Many disciplines including psychiatry have been visited by meta- analysis. One now examines some of these studies in the areas of oncology, orthopedics, psychiatry, pediatrics and cardiology. The purpose is to determine, given the information presented, what contributions, statistical challenges and peripheral issues in these disciplines have been brought to light in these meta- analyses.

Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism.

CONTEXT: Hirsutism (i.e. facial and body terminal hair growth in a male-like pattern in women) is the principal clinical sign of hyperandrogenism, although its definition remains unclear. OBJECTIVE: The purposes of the present study were to define 1) the degree of facial and body terminal hair, as assessed by the modified Ferriman-Gallwey (mFG) score, in unselected women from the general population; 2) the effect of race (Black and White) on the same; and 3) the normative cutoff values. DESIGN AND SETTING: We conducted a prospective observational study at a tertiary academic medical center. PATIENTS/PARTICIPANTS: Participants included 633 unselected White (n = 283) and Black (n = 350) women presenting for a preemployment physical exam. INTERVENTIONS: Interventions included history and physical examination. MAIN OUTCOME MEASURES: Terminal body hair growth was assessed using the mFG scoring system; nine body areas were scored from 0-4 for terminal hair growth distribution. RESULTS: The mFG scores were not normally distributed; although cluster analysis failed to identify a natural cutoff value or clustering of the population, principal component and univariate analyses denoted two nearly distinct clusters that occurred above and below an mFG value of 2, with the bulk of the scores below. Overall, an mFG score of at least 3 was observed in 22.1% of all subjects (i.e. the upper quartile); of these subjects, 69.3% complained of being hirsute, compared with 15.8% of women with an mFG score below this value, and similar to the proportion of women with an mFG score of at least 8 who considered themselves to be hirsute (70.0%). Overall, there were no significant differences between Black and White women. CONCLUSIONS: Our data indicate that the prevalence and degree of facial and body terminal hair growth, as assessed by the mFG score, is similar in Black and White women and that an mFG of at least 3 signals the population of women whose hair growth falls out of the norm.