Measuring the Impact of a Formalized Surgical Patient Signout System.

OBJECTIVE: Routine patient signout within medical teams is an integral component of patient care. Standardized signout systems have shown lowered risks of harm and adverse outcomes to patients, however, many of these systems are difficult to utilize with surgical patients. The purpose of this study was to determine if a standardized surgical signout model would improve resident satisfaction of the signout process and improve resident preparedness for cross-covered services. DESIGN: A 16-question survey was administered to the surgical residents at a single general surgery residency program. A standardized signout using the mnemonic "CUTS" (Core problem, Updates, Things-to-do, Setbacks) was then implemented in the program. Residents retook the survey at 1, 3, and 6-month intervals to compare resident satisfaction on signout before and after the standardized signout implementation. The descriptive statistics of the survey were analyzed for trends over time, trends by resident training year, and for inferential statistics utilizing subscales. RESULTS: The descriptive statistics showed that there was an overall trend towards greater resident satisfaction with signout over time with satisfaction increasing from 41.1% to 80% in the general resident cohort. While there were no statistically significant differences, subscale analysis demonstrated greatest trends for improved satisfaction with the CUTS signout model for the PGY1 and PGY5 classes. There was additionally an increased resident preparedness for overnight events and calls, with a 27% increase in perceived preparedness "75% of the time" and a 5.5% increase in perceived preparedness "Always". There was no difference in time spent on signout after the implementation of the model. CONCLUSIONS: The surgical standardized signout model, CUTS, demonstrated that residents within a single program were more satisfied with signouts, had improved patient understanding and knowledge, and felt increased preparedness for overnight events on cross-covered patients. Further research is needed to determine the impact of the CUTS signout system on patient outcomes.

Plasma and synovial fluid pharmacokinetics of cefquinome following the administration of multiple doses in horses.

The plasma and synovial fluid pharmacokinetics and safety of cefquinome, a 2-amino-5-thiazolyl cephalosporin, were determined after multiple intravenous administrations in sixteen healthy horses. Cefquinome was administered to each horse through a slow i.v. injection over 20 min at 1, 2, 4, and 6 mg/kg (n = 4 horses per dose) every 12 h for 7 days (a total of 13 injections). Serial blood and synovial fluid samples were collected during the 12 h after the administration of the first and last doses and were analyzed by a high-performance liquid chromatography assay. The data were evaluated using noncompartmental pharmacokinetic analyses. The estimated plasma pharmacokinetic parameters were compared with the hypothetical minimum inhibitory concentration (MIC) values (0.125-2 µg/mL). The plasma and synovial fluid concentrations and area under the concentration-time curves (AUC) of cefquinome showed a dose-dependent increase. After a first dose of cefquinome, the ranges for the mean plasma half-life values (2.30-2.41 h), the mean residence time (1.77-2.25 h), the systemic clearance (158-241 mL/h/kg), and the volume of distribution at steady-state (355-431 mL/kg) were consistent across dose levels and similar to those observed after multiple doses. Cefquinome did not accumulate after multiple doses. Cefquinome penetrated the synovial fluid with AUCsynovial fluid /AUCplasma ratios ranging from 0.57 to 1.37 after first and thirteenth doses, respectively. Cefquinome is well tolerated, with no adverse effects. The percentage of time for which the plasma concentrations were above the MIC was >45% for bacteria, with MIC values of ≤0.25, ≤0.5, and ≤1 µg/mL after the administration of 1, 2, and 4 or 6 mg/kg doses of CFQ at 12-h intervals, respectively. Further studies are needed to determine the optimal dosage regimes in critically ill patients.

Effects of long-term exposure to 900 megahertz electromagnetic field on heart morphology and biochemistry of male adolescent rats.

The pathological effects of exposure to an electromagnetic field (EMF) during adolescence may be greater than those in adulthood. We investigated the effects of exposure to 900 MHz EMF during adolescence on male adult rats. Twenty-four 21-day-old male rats were divided into three equal groups: control (Cont-Gr), sham (Shm-Gr) and EMF-exposed (EMF-Gr). EMF-Gr rats were placed in an EMF exposure cage (Plexiglas cage) for 1 h/day between postnatal days 21 and 59 and exposed to 900 MHz EMF. Shm-Gr rats were placed inside the Plexiglas cage under the same conditions and for the same duration, but were not exposed to EMF. All animals were sacrificed on postnatal day 60 and the hearts were extracted for microscopic and biochemical analyses. Biochemical analysis showed increased levels of malondialdehyde and superoxide dismutase, and reduced glutathione and catalase levels in EMF-Gr compared to Cont-Gr animals. Hematoxylin and eosin stained sections from EMF-Gr animals exhibited structural changes and capillary congestion in the myocardium. The percentage of apoptotic myocardial cells in EMF-Gr was higher than in either Shm-Gr or Cont-Gr animals. Transmission electron microscopy of myocardial cells of EMF-Gr animals showed altered structure of Z bands, decreased myofilaments and pronounced vacuolization. We found that exposure of male rats to 900 MHz EMF for 1 h/day during adolescence caused oxidative stress, which caused structural alteration of male adolescent rat heart tissue.

Effects of low sleep quality on sexual function, in women with fibromyalgia.

Sexual dysfunction is a common experience in women with fibromyalgia. However, the physiopathology of this association is unclear. We aimed to evaluate whether sleep disturbance has an influence on sexual function in women with fibromyalgia. Fifty-four sexually active premenopausal women with fibromyalgia were enrolled in the study. The following questionnaires were used: the Female Sexual Function Index (FSFI), the Pittsburgh Sleep Quality Index (PSQI), the Fibromyalgia Impact Questionnaire (FIQ) and the Beck Depression Inventory (BDI). Appropriate statistical analyses were used by using SPSS 18. The mean FSFI score was 25.344 ± 6.52 and showed no correlation with age, body mass index, BDI or duration of fibromyalgia. However, a positive correlation between sexual dysfunction and low sleep quality was found (r=0.43; P=0.001). In addition, the median FSFI score was 29.2 (27.2-32.4) in patients with higher sleep quality (PSQI⩽5), whereas it was 21.4 (18.9-25.3) in patients with lower sleep quality (PSQI>5) (P<0.001). There was a positive correlation between sexual dysfunction and symptoms of fibromyalgia as indicated by a higher FIQ score (r=0.37; P=0.006). Sexual dysfunction in female patients with fibromyalgia may be due to low sleep quality. Treatment of the sleep disorder may improve female sexual function.

Quantitation of ortho-cresyl phosphate adducts to butyrylcholinesterase in human serum by immunomagnetic-UHPLC-MS/MS.

Tri-ortho-cresyl phosphate (ToCP) is an anti-wear, flame retardant additive used in industrial lubricants, hydraulic fluids and gasoline. The neurotoxic effects of ToCP arise from the liver-activated metabolite 2-(o-cresyl)-4H-1,3,2-benzodioxaphosphoran-2-one (cresyl saligenin phosphate or CBDP), which inhibits esterase enzymes including butyrylcholinesterase (BChE). Following BChE adduction, CBDP undergoes hydrolysis to form the aged adduct ortho-cresyl phosphoserine (oCP-BChE), thus providing a biomarker of CBDP exposure. Previous studies have identified ToCP in aircraft cabin and cockpit air, but assessing human exposure has been hampered by the lack of a laboratory assay to confirm exposure. This work presents the development of an immunomagnetic-UHPLC-MS/MS method for the quantitation of unadducted BChE and the long-term CBDP biomarker, oCP-BChE, in human serum. The method has a reportable range from 2.0 ng/ml to 150 ng/ml, which is consistent with the sensitivity of methods used to detect organophosphorus nerve agent protein adducts. The assay demonstrated high intraday and interday accuracy (≥85%) and precision (RSD ≤ 15%) across the calibration range. The method was developed for future analyses of potential human exposure to CBDP. Analysis of human serum inhibited in vitro with CBDP demonstrated that the oCP-BChE adduct was stable for at least 72 h at 4, 22 and 37 °C. Compared to a previously reported assay, this method requires 75% less sample volume, reduces analysis time by a factor of 20 and demonstrates a threefold improvement in sensitivity. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms.

In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts. In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one. Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.

Is coxa valga a predictor for the severity of knee osteoarthritis? A cross-sectional study.

PURPOSE: In the present study, we aimed to evaluate the affect of the variations in hip anatomy and pelvic geometry on the severity of knee OA. METHODS: Idiopathic knee OA patients fulfilling the clinical criteria of American College of Rheumatology for OA were enrolled in the study. Several measurements regarding the hip and pelvis were performed on pelvic radiographs. Each knee was graded according to the Kellgren and Lawrence (KL) radiographic system (0-4) along with a categorization in accordance with the medial tibiofemoral joint space widths (JSW). RESULTS: The study group consisted of 111 subjects. The inner and outer pelvic diameters were getting wider as the JSW grade increased. Likewise, among the hip measurements, femoral head, neck and shaft diameters and hip axis lengths were linked with KL grade. There were significant differences in neck-shaft angle (NSA) between groups of JSW with a highest NSA in JSW grade 3. The optimal cut-off value for NSA in predicting the severity of knee OA was 134.4°. Furthermore, NSA beyond 134.4° was found to increase the risk of severe knee OA eightfold. CONCLUSIONS: Variations in pelvic geometry and hip anatomy are associated with the severity of knee OA. People with NSA of above 134.4° have eightfold increased risk of developing severe knee OA. Pelvic radiographies could be evaluated at younger ages-particularly in people with high genetic predispositions-to identify the individuals at high risk and in turn, to tailor the preventive measures to these subjects.

Pathological effects of prenatal exposure to a 900 MHz electromagnetic field on the 21-day-old male rat kidney.

We investigated the effects on kidney tissue of 900 megahertz (MHz) EMF applied during the prenatal period. Pregnant rats were exposed to 900 MHz EMF, 1 h/day, on days 13-21 of pregnancy; no procedure was performed on control group pregnant rats or on mothers or newborns after birth. On postnatal day 21, kidney tissues of male rat pups from both groups were examined by light and electron microscopy. Malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione levels also were investigated. Light microscopy revealed some degenerative changes in the tubule epithelium, small cystic formations in the primitive tubules and large cysts in the cortico-medullary or medullary regions in the experimental group. Electron microscopy revealed a loss of peritubular capillaries and atypical parietal layer epithelial cells in the experimental group. Biochemical analysis showed significantly increased MDA levels in the experimental group and decreased SOD and CAT levels. EMF applied during the prenatal period can caused pathological changes in kidney tissue in 21-day-old male rats owing to oxidative stress and decreased antioxidant enzyme levels.

Short-term plasticity of gray matter associated with leptin deficiency and replacement.

CONTEXT: Leptin affects neurogenesis, neuronal growth, and viability. We previously reported that leptin supplementation increased gray matter (GM) concentration in the anterior cingulate gyrus (ACG), cerebellum, and inferior parietal lobule, areas that are also involved in food intake. OBJECTIVE: The aim of this study was to report the changes in brain structure at different states of leptin supplementation. DESIGN: We conducted a nonrandomized trial. SETTING AND PATIENTS: We studied three adults with congenital leptin deficiency due to a mutation in the leptin gene. INTERVENTION: Patients received treatment with recombinant methionyl human leptin, with annual 11- to 36-d periods of treatment withholding followed by treatment restoration over 3 yr. MAIN OUTCOME MEASURES: GM concentration (by voxel-based morphometry analysis of magnetic resonance scans) was correlated with body mass index (BMI) and leptin supplementation. RESULTS: Annually withholding leptin supplementation for several weeks increased BMI and reversed the original effects of leptin in the cerebellum and ACG. The changes in the ACG were consistent with an indirect effect of leptin mediated through increased BMI. In the cerebellum, where leptin receptors are most dense, GM changes appeared to be direct effects of leptin. Leptin restoration did not lead to recovery of GM in the short term but did lead to an unexpected GM increase in the posterior half of the left thalamus, particularly the pulvinar nucleus. CONCLUSION: These findings provide the first in vivo evidence of remarkably plastic, reversible, and regionally specific effects of leptin on human brain morphology. They suggest that leptin may have therapeutic value in modulating plasticity-dependent brain functions.

Extrarenal pseudoaneurysm of the arterial anastomosis in a renal transplant: endovascular coil embolization with balloon remodeling technique.

Anastomotic pseudoaneurysms of transplanted kidneys are a very rare complication and encountered in less than 1% of such operations. They may be devastating and cause functional impairment and even loss of the graft. In this report, we present the first case of treatment of extrarenal pseudoaneurysm of arterial anastomosis in a renal transplant patient with endovascular coil embolization with the balloon remodeling technique. This method is mostly used in the treatment of wide-neck intracranial aneurysms.

Effects of the usage of dried brewing yeast in the diets on the performance, egg traits and blood parameters in quails.

This experiment was carried out to determine the effects of the usage of dried brewing yeast in quail diets on laying performance, egg traits and blood parameters. A total of 240 Japanese quails (Coturnix coturnix japonica) aged 10 weeks were randomly allocated into one control group and three treatment groups. Each group was divided into five replicates as subgroups, comprising 12 quails each. Dried brewing yeast (Saccharomyces cerevisiae) was used at the levels of 1.5%, 3.0% and 4.5% in the diets of the first, second and third treatment groups, respectively. Soyabean meal was replaced with dried brewing yeast. The diets were formulated to be isocaloric and isonitrogenous. The experimental period lasted 18 weeks. Dietary treatments did not significantly affect body weight, daily feed intake, daily protein intake, egg production, egg weight, feed efficiency, mortality, egg shell thickness, egg albumen index, egg yolk index, egg Haugh unit, the percentages of egg shell, albumen and yolk, excreta moisture and small intestinal pH. Inclusion of 3% and 4.5% dried brewing yeast in diets reduced egg yolk cholesterol concentration as mg per yolk and mg per g yolk (P < 0.01). Blood serum cholesterol of groups fed diets with dried brewing yeast was significantly lower (P < 0.01) than that of the control group. Feeding diets containing 3.0% and 4.5% dried brewing yeast resulted in significant increases (P < 0.01) in blood serum levels of total protein, alanine aminotransferase at the end of the experiment. Blood serum levels of uric acid, triglyceride, aspartate aminotransferase and alkaline phosphatase were not affected by dietary dried brewing yeast. It is concluded that dried brewing yeast can be used up to 4.5% in the diets of laying quails without adverse effects on the measured parameters.

Early and midluteal phase blood estradiol levels after ovum pickup and pregnancy rates after ICSI cycles.

OBJECTIVE: To examine whether blood estradiol level tendencies during the late follicular and early luteal phases and the 11 days after embryo transfer have any association with the outcome of intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. STUDY DESIGN: This prospective study involved 38 assisted reproductive technology cycles in 35 infertile patients treated with assisted reproductive technologies in which blood samples taken on the 4th, 7th, 9th and 11th days following ET were tested for progesterone, estradiol and hCG levels using an enzyme-linked immunoassay. The estradiol blood levels were compared with the maximal follicular phase blood estradiol. The data were analyzed using Microsoft Excel (Redmond, Washington) and SPSS 10.0 (Chicago, Illinois). The chi2, Mann-Whitney U, Wilcoxon and Pearson tests were usedfor statistical analysis. RESULTS: Average maximum estradiol blood level, number of oocytes produced,fertilization rates and cleavage rates did not show any significant difference between pregnant and nonpregnant cycles. The lower the ratios of estradiol levels measured on posttransfer days 4, 7 and 9 to the maximumfollicular phase level, the lower the probability of pregnancy (P < .01, P < .01 and P < .01, respectively). CONCLUSION: The steeper the decline in blood estradiol levels (affecting the periimplantation period) following ovum pickup relative to the maximum follicular phase estradiol levels, the lower the chance of pregnancy in ICSI-ET cycles.

Fluoroscopically guided endoluminal balloon dilatation of esophageal stricture due to epidermolysis bullosa dystrophica.

Epidermolysis bullosa dystrophica is a hereditary blistering disorder in which the mucosal surface of the esophagus is frequently involved in addition to skin. Blister formation after minor trauma leads to erosions, ulcerations, scarring, and stricture formation in the esophagus and causes dysphagia. There is no definitive medical management for esophageal lesions. Colonic interposition has considerable mortality and morbidity, while surgical or endoscopic bougienage is not recommended because it causes further trauma to the esophagus, which accelerates stricture formation, and has a high risk of perforation. Herein we report a case of esophageal stricture successfully treated with repeated balloon dilatations.

Sonographic measurements of the liver, spleen and kidney dimensions in the healthy term and preterm newborns.

This study was conducted in order to assess normal liver, spleen and kidney dimensions in premature and term newborns and determine the acceptable range. A total of 253 (99 preterm and 154 term) healthy newborns were evaluated within the first week of life by sonography. Gestational age ranged from 24 to 41 weeks, weight ranged from 638 to 4800 g. Measurements were compared with gestational age, weight and height of the infants. Normal ranges for kidney, liver and spleen measurements according to gestational age and weight were obtained. We found that weight showed the best correlation with any one of the mentioned organ dimensions.

Liposarcoma of the spermatic cord.

A 64-year-old male presented with a 4-year history of a mass in the left scrotum. Radical orchiectomy was performed. Pathological analysis demonstrated a well-differentiated liposarcoma. No evidence of recurrence or metastasis has been noted during the 3-month follow-up without any postoperative adjuvant therapy.

Peyronie's disease in men under age 40: characteristics and outcome.

Peyronie's disease is most commonly seen in the fifth decade of life. However, a wide range of age (20-83 y) is reported. During a 6-year period, men with Peyronie's disease presenting under the age of 40 were reviewed retrospectively and followed-up. The prevalence of Peyronie's patients presenting under age 40 was 8.2%. Their mean age was 32.47 +/- 5.37 (range: 23-39) y and 78.9% of them presented during the acute phase of the disease. Pain on erection was a part of presenting symptom complex in 52.6% and the majority (84%) had a degree of penile curvature < 60 degrees. Erectile dysfunction (ED) was present in 21% of patients, who responded well to intracavernous injection test. After a minimal 2-year follow-up, improvement in penile deformity was observed in 36.8%, and 42.1% had stable disease while 21% experienced deterioration of the penile curvature. The onset of Peyronie's disease is clinically more noisy and acute in patients presenting under age 40 and this forces the physicians to treat them more vigorously.

Multicentral clinical evaluation of the aetiology of erectile dysfunction: a survey report.

Patients with erectile dysfunction, who admitted to 4 different urological centres in Turkey were evaluated in terms of aetiological factors to establish the aetiology of erectile dysfunction in our population and compare it with the data derived from Western communities. After the history, physical examination, psychological evaluation and laboratory testing, a clinical diagnosis was established as primarily psychogenic, organic, or mixed aetiology. Mean patient age was 43.5 years (range 17 to 69), and 9 of the patients were unmarried. Of the patients 53 had vascular risk factors, and 10 reported a history of alcohol abuse. Eleven patients were using drugs that might interfere with the disorder. In this multicentral study of 115 impotent men, an organic cause was found in 43%, psychogenic in 47%, and mixed in 19%. Mean age of the overall patients was 43.48. When the ages of the patients with organic erectile dysfunction and those with psychogenic erectile dysfunction were compared, it was clearly seen that those with organic erectile dysfunction were much older (52.73 versus 33.02).

Evaluation of side effects of sildenafil in group of young healthy volunteers.

We evaluated the safety and side effects of sildenafil in a group of sexually active volunteers younger than 40 years under conditions without sexual stimulation. Single oral dose of 50 mg dildenafil (n = 20) or placebo (n = 20) was randomly administered to 40 sexually active volunteers with the mean age of 26.80 +/- 5.29 in sildenafil group and 25.70 +/- 4.95 in placebo group. All the subjects were informed about the study, but not about the medicine. The following tests were performed immediately before and 90 minutes after the administration of the medicine: resting heart rate, blood pressure, electrocardiogram, visual acuity, color vision. The subjects were also asked to describe any discomfort or difference. Mann Whitney U test was used for statistical analyses. The only statistically significant difference was between heart rates before and after the administration of the sildenafil (p = 0.02). Color vision, visual acuity tests yielded no differences. The decrease in blood pressure was not significant. The most common side effects were flushing (75% and 0%), headache (50% and 5%), dyspepsia (15% and 5%), unintentional incomplete sexual arousal (15% and 0%) and palpitation (15% and 10%) in groups of sildenafil and placebo, respectively. The only serious side effect requiring medical treatment was arthralgia on the knee in one subject. Although these side effects can be acceptable, the likelihood of these side effects needs to be made clear to potential users of this medication.