Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database.

PURPOSE: Anterior abdominal wall hernias are among the most commonly encountered surgical disease. We sought to identify risk factors that are associated with 30-day postoperative mortality following emergent abdominal wall hernia repair using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. METHODS: A retrospective analysis of data from the ACS NSQIP from 2005 to 2010 was performed. Patients were selected using Current Procedural Terminology (CPT) and International Classification of Disease 9 Clinical Modification (ICD9) codes for the repair of inguinal, femoral, umbilical, epigastric, ventral, or incisional hernias that were incarcerated, obstructed, strangulated, or gangrenous. Only emergent cases occurring within two days of admission and admitted as inpatients were included. Univariate and multivariable analysis was performed. A risk score was also created. RESULTS: There were 4298 cases of emergent anterior abdominal wall hernia surgery. The most common was inguinal (25.3 %), followed by incisional (23.8 %), umbilical (23.5 %), ventral (12.1 %), femoral (8.8 %), and epigastric (6.5 %) hernias. Multivariable analysis demonstrated six statistically significant predictors of short-term mortality, including history of congestive heart failure (CHF) [odds ratio (OR) 8.24, 95 % confidence interval (CI) 4.05-16.75), age (OR 5.52, 95 % CI 3.48-8.77), history of peripheral vascular disease (PVD) (OR 4.98, 95 % CI 2.08-11.92), presence of ascites (OR 3.16, 95 % CI 1.64-6.08), preoperative blood urea nitrogen (OR 1.35, 95 % CI 1.22-1.49), and preoperative white blood cell count (OR 1.22, 95 % CI 1.02-1.45). The C-statistic for the risk model was 0.858. CONCLUSION: We present a large study on short-term mortality following emergent anterior abdominal wall hernia repairs based on the ACS NSQIP with a derived risk model that demonstrates excellent discriminative ability.

The Key Proteins of Dopaminergic Neurotransmission of Human Peripheral Blood Lymphocytes: Changed mRNA Level in Alcohol Dependence Syndrome.

The expression of dopamine receptor (DRD), Nurr1 transcription factor (NR4A2), and α-sinucleine (SNCA) genes in peripheral blood lymphocytes is evaluated. The results indicate that alcohol dependence is associated with high expression of SNCA and DRD4 (signifi cantly higher than in the control group) and is not associated with changes in the work of NR4A2 and DRD3 genes. The levels of DRD3 and DRD4 mRNA form a positive linear correlation (p≤0.05). The expression of SNCA and DRD4 genes can serve as an important peripheral marker of alcohol dependence development, which is essential for antipsychotic therapy.

Algicidal effectiveness of Clearigate, Cutrine-Plus, and copper sulfate and margins of safety associated with their use.

Laboratory studies of algicide toxicity to algal species provide information to improve the efficacy and efficiency of copper-containing algicides in actual field situations. The objectives of this study were (1) to measure the influence of copper form, initial concentration, and duration of exposure on the response of Raphidocelis subcapitata, a planktonic freshwater green alga; (2) to determine the contact time required for these copper-containing algicides (Clearigate, Cutrine-Plus, and copper sulfate) and the target species to obtain control; (3) to measure the critical burden of the three algicides required to obtain control of R. subcapitata; (4) to measure the residence time of the copper applied as the algicides in the water column of three waters having different water characteristics ( i.e., alkalinity, hardness, pH, and conductivity); and (5) to contrast exposures of copper (as algicides) required to control algae and the lower thresholds causing adverse effects on sensitive nontarget animal species. Algal control (EC(100)) was accomplished at 55.8, 117.5, and 187.5 microg Cu/L for CuSO(4), Cutrine-Plus and Clearigate with a contact time of 3 days in all cases. The critical burdens of copper (concentration sorbed by the algae) were 4.2, 7.3, and 7.9 microg Cu/mg algae (dry weight) for CuSO(4), Cutrine-Plus, and Clearigate, respectively. Because algicide toxicity generally decreases as cell density increases, the density of cells in algal blooms may hamper algicide effectiveness even at maximum label application rates. Determinations of critical burdens for algicides and target algal species provide necessary information to forecast the performance of algicide applications in field situations. The margin of safety ( i.e., the difference between the concentration where control of algae was obtained and the lower threshold concentration causing adverse effects on nontarget species) was greatest for Cutrine-Plus. However, the margins of safety are minimal (< 0, 12.5, and 82.5 microg Cu/L for Ceriodaphnia dubia exposed to CuSO(4), Clearigate, and Cutrine-Plus, respectively) when they are applied according to their labels.

Characterisation of acute myocardial ischaemia in a canine model based on principal component analysis of unipolar endocardial electrograms.

The study presents a method for identifying endocardial electrical features relevant to local ischaemia detection at rest. The method consists of, first, normalisation of electrograms to a uniform representation; secondly, the use of principal component analysis to reduce the dimensionality of the electrogram vector space; and, thirdly, a search for a classification axis that matches the degree of ischaemia present in the tissue. Left ventricular myocardial states were assessed by echocardiography and NOGA mapping in eight dogs at baseline and then immediately after, 5h after and 3 days after occlusion of the left anterior descending coronary artery. Five principal components were required to approximate electrograms with an average error of less than 10% of the peak-to-peak amplitude. Correlations of 0.77, 0.80 and 0.84 were obtained between the principal component-based parameters and the echocardiography scores at the three ischaemic stages, respectively. Expression of these parameters in the time domain showed that the major changes occurred in the depolarisation segment of the endocardial electrogram as well as in the ST-segment. In conclusion, the proposed method provides a suitable alternative co-ordinate system for the classification of ischaemic regions and highlights signal segments that change as a result of pathology.

Models of intelligence in late life: comment on Hultsch et al. (1999).

The authors comment on D. F. Hultsch, C. Hertzog, B. J. Small, and R. A. Dixon's (1999) report of the latest results of the Victoria Longitudinal Study, which are presented as a test of the engagement hypothesis, and on their reanalysis of the data from the Veterans Study (Pushkar Gold et al., 1995), which proposes an alternative model of intellectual function. Differences between the methodologies, variables, and concepts of engaged lifestyle in the 2 studies lead to different tests of the engagement hypothesis and different conclusions. Failure to report specified paths and unjustified assumptions lessen the credibility of the Hultsch et al. model for the Veterans Study data. The authors conclude that their original model, which indicates a small but significant effect of engaged adult lifestyle on the maintenance of intellectual verbal abilities in later life, provides a better explanation of the Veterans Study data.

Intergenerational transfer of psychosocial risk in women with childhood histories of aggression, withdrawal, or aggression and withdrawal.

Intergenerational transfer of risk between mothers and children, based on mothers' childhood aggression and social withdrawal, was examined in an inner-city sample. Each of the 3 studies reported involved a subset of the 909 female participants in the Concordia Longitudinal Risk Project, initiated when the participants were of school age. Using medical records, Study 1 (n = 853) focused on prediction of teen motherhood, delivery complications during childbirth, multiparity, and close spacing of births. Study 2 (n = 428) examined pathways to school dropout and teen parenthood. Study 3 (n = 89) involved prediction of observed parent and child behavior from mothers' childhood characteristics. Mothers' childhood aggression was consistently predictive of negative outcomes in each area of intergenerational risk, especially when combined with social withdrawal and low levels of academic achievement. Education was protective: Mothers' years of schooling predicted positive outcomes.

Testing a dual-process family model in understanding the development of eating pathology: a structural equation modeling analysis.

OBJECTIVE: The present study tested a dual-process family model in understanding the relationships among dysfunctional family relationships, family preoccupation with weight and appearance, and body- and self-esteem problems in the development of eating and psychiatric symptoms. METHOD: Subjects, 918 adolescent girls from eight high schools, completed measures assessing familial factors, body- and self-esteem problems, and eating and general psychiatric symptoms. RESULTS: Structural equation analyses suggested that family environment contributed to the development of eating and psychiatric symptoms through two interrelated pathways. On one hand, family preoccupation with weight and appearance had direct effects on body dissatisfaction and eating symptoms. Body dissatisfaction had direct effects on self-esteem deficit and eating symptoms, and indirect effects mediated by self-esteem deficit on eating and psychiatric symptoms. On the other hand, general family dysfunction had direct effect on negative self-esteem, and indirect effects through negative self-esteem on eating and psychiatric symptoms. DISCUSSION: Findings are discussed in relation to the possible mechanisms by which dysfunctional family relationships and family preoccupation with weight may predispose girls to eating pathology.

Longitudinal study of early childhood injuries and acute illnesses in the offspring of adolescent mothers who were aggressive, withdrawn, or aggressive-withdrawn in childhood.

In a 15-year longitudinal study, the medical records of 94 children whose adolescent mothers had childhood histories of aggressive, withdrawn, aggressive-withdrawn, or normative (nondeviant) social behavior were examined. The children's annual rates of visits to the emergency room (ER) and to nonemergency medical facilities, post-ER hospitalizations, diagnoses of injuries, acute illness and infection, asthma, and emergency surgical consultations were examined between birth and 48 months of age. Group differences were found for the annual rate at which children were brought to the ER and for injury-related post-ER hospitalizations. Sons of women in the aggressive group and both sons and daughters of women in the aggressive-withdrawn group had elevated and distinctive profiles in respect to specific emergency diagnostic and treatment variables compared with children of women in the nondeviant group.

Minimizing trochar site herniation in laparoscopic cholecystectomy.

The technique for laparoscopic cholecystectomy (LC) was originally devised and described has remained unchanged because of its efficacy. LC involves a 10-mm trochar in periumbilical region, 10-mm trochar in the epigastrium, and two 5-mm trochars at the right anterior axillary line and right midclavicular line. The exposure and dissection provided by the instruments placed through these trochars is usually adequate and the necessity for additional ports is rare. Our technique modification eliminates the epigastric 10-mm port and replaces it with a 5-mm epigastric port and also eliminates one of the lateral 5-mm ports. Recent articles have reported a significant incidence of Richter's or incisional hernias at the trochar sites. Our modification of the standard technique has the advantage of eliminating a potential incisional hernia at the epigastric port site and further improvement of cosmetic result.

Structural equation model of intellectual change and continuity and predictors of intelligence in older men.

This study examined the effects of abilities as a young adult, an engaged lifestyle, personality, age, and health on continuity and change in intellectual abilities from early to late adulthood. A battery of measures, including a verbal and nonverbal intelligence test, was given to 326 Canadian army veterans. Archival data provided World War Two enlistment scores on the same intelligence test for this sample: Results indicated relative stability of intellectual scores across 40 years, with increases in vocabulary and decreases in arithmetic, verbal analogies, and nonverbal skills. Young adult intelligence was the most important determinant of older adult performance. Predictors for verbal intelligence were consistent with an engagement model of intellectual maintenance but also indicated the importance of introversion-extraversion and age. Nonverbal intelligence in late life was predicted by young adult nonverbal scores, age, health, and introversion-extraversion.

Abdominal wall recurrence after laparoscopic colectomy for colon cancer.

BACKGROUND: Although rare, abdominal wall recurrences after laparoscopic surgery for cancer have been increasing at an alarming rate as the range and sheer number of laparoscopic surgical procedures have increased. Overall, 13 case reports of abdominal wall cancer recurrence after laparoscopic surgery have been published. METHODS AND RESULTS: We present the fourth known case of abdominal wall recurrence after laparoscopic colectomy involving a patient with a TNM stage III (T3, N2, M0) colon cancer. Recurrent cancer was located in the abdominal wall incision and also in all four port sites 9 months after surgery. These four cases have all involved patients with advanced cancers of the right side of the colon who underwent a laparoscopic-assisted right hemicolectomy. These cases of abdominal wall cancer recurrence carry ominous implications for the future of laparoscopic surgical procedures involving colorectal malignancy. Recurrent cancer in minilaparotomy incisions may simply be due to local spread of cancerous cells. However, remote port site recurrence may be due to the liberation of cancer cells throughout the abdomen from advanced colorectal cancer no longer confined to the bowel wall facilitated by intraperitoneal carbon dioxide insufflation during laparoscopy. CONCLUSIONS: Abdominal wall cancer recurrence is enhanced by the laparoscopic approach to colectomy for colorectal cancer. Except for controlled, clinical studies, laparoscopic colectomy for malignancy should be abandoned.

A novel deletion in the low-density lipoprotein receptor gene in a patient with familial hypercholesterolemia from Petersburg.

Fifty St. Petersburg patients with type IIa hyperlipoproteinemia were screened for the presence of structural rearrangements in the low-density lipoprotein receptor (LDLR) gene. One novel deletion of the length about 5 kilobases (kb) was found. This deletion seems to remove completely exons 4, 5, and 6 from the LDLR gene, coding for the largest part of the receptor ligand-binding domain.

The role of psychosocial context, age, and intelligence in memory performance of older men.

The hypothesis that psychosocial contextual factors contribute to developmental changes in memory was examined using 326 male World War II veterans. Availability of young adult intelligence scores made it possible to separate the contributions of contextual variables and age to maintenance of general intelligence from their direct contributions to performance on 4 memory tasks. Being younger, healthier, more educated, more introverted, more intellectually active, and more satisfied with social support predicted less intellectual decline and, indirectly, better memory performance. Age, personality, locus of control, and extent of social support directly contributed to performance on 1 or more memory tasks. Age contributions were consistent with Craik's (1986) proposed continuum of task demands for self-initiated effort. Possible elaborations of Craik's hypothesis to accommodate contextual variables are suggested.

Early disruptive behavior, poor school achievement, delinquent behavior, and delinquent personality: longitudinal analyses.

Three alternative models concerning the causal links between early disruptive behavior, poor school achievement, and delinquent behavior or antisocial personality were tested with linear structural equation modeling. Subjects were boys and girls followed from first grade to age 14. Disruptive behavior was assessed in Grade 1; school achievement was assessed in Grades 1 and 4; delinquent behavior and antisocial personality were assessed at age 14. With regard to self-reported delinquent behavior at age 14, results indicate that the best model for boys was a direct causal link between Grade 1 disruptive behavior and delinquent behavior. Poor school achievement was not a necessary causal factor. For girls, none of the tested models were a good fit to the delinquent behavior data. As for delinquent personality, results indicate that, for both boys and girls, poor school achievement was a necessary component of the causal path between Grade 1 disruptive behavior and age 14 delinquent personality.

A longitudinal study of competence in elderly veterans: the role of alcohol and education.

Follow-up examinations were made of 326 World War II veterans who had served in the Canadian army and for whom enlistment data were available for 1942-45. The veterans were classified into three groups on the basis of their alcohol-related behavior and educational attainments following military service. Eighteen men who had identified themselves as alcoholics were compared to 159 nonalcoholic men who had obtained post-service education and 149 nonalcoholic men who had not obtained post-service education. At time of enlistment the 159 nonalcoholic men who subsequently obtained additional education after their army service had not differed on socioeconomic background but had had significantly more years of education and had scored significantly higher on five of the eight subtests of the Army M test of intelligence than had the other two groups. Examination of current performance revealed that alcoholic and nonalcoholic men with no post-service education continued to function significantly more poorly on the same M Test subtests, and in addition functioned more poorly on socioeconomic criteria, daily functioning, adjustment and personality measures than did the group of veterans with post-service education. Compared to the nonalcoholic veterans who had not gained post-service additional education, the alcoholic group functioned more poorly on measures of health, coping with stress and adjustment. The results are discussed, emphasizing the influence of alcohol and education on psychological functioning in later life.

Painting group portraits: studying life outcomes for aggressive and withdrawn children.

Aggression and social withdrawal have long been of interest to personality psychologists. The present article presents a longitudinal study of the development of children selected from a community sample who were high on aggression and withdrawal. The selection of outcome variables is discussed, and outcomes during adolescence are described. For both males and females, high aggressiveness was predictive of low intelligence, poor school achievement, and psychiatric problems. For females, high aggressiveness was also predictive of general health problems. High social withdrawal was predictive of poor school achievement. Females who were high on withdrawal also had an elevated rate of abortions. Individuals who were high on both aggression and withdrawal had relatively poor social competence, had general problems with behavior, had low intelligence, and were performing poorly in school.

The predictive power of first-grade peer and teacher ratings of behavior: sex differences in antisocial behavior and personality at adolescence.

Peer and teacher assessments of aggression, social withdrawal, and likability using the Pupil Evaluation Inventory were recorded for 104 French Canadian girls and boys in grade 1. Self-reported delinquency and personality measures were administered to these children when they were in junior high school 7 years later. Linear regression analyses revealed significant predictive differences between the grade 1 assessment of girls and boys: For antisocial behavior, teacher and peer assessments of boys were equally good predictors, and the combination of the two assessments did not improve prediction; for girls, peer and teacher assessments taken separately were weak predictors, but, taken together, they were better predictors for girls than for boys; for personality, peers were better predictors than teachers both for girls and for boys. When categorical analyses were used to predict extreme antisocial behavior, peer and teacher assessments were equally good predictors for girls and boys. The use of peer and teacher ratings together, however, decreased the number of false positives. The implications of these findings for research and clinical work are discussed.

Measurement and correlates of verbosity in elderly people.

Two studies were conducted to develop measures of verbosity in elderly people and to determine the social and psychological correlates of verbose speech. In the first study, 346 elderly people were classified into three categories of verbosity on the basis of their verbal behavior during an interview and questionnaire session. Personality variables, stress in daily living, and age differentiated extremely verbose individuals from others. In the second study, frequency and extent of off-target speech were rated quantitatively for the verbal behavior of 203 older men, with a second rater independently making the same ratings for 98 of the men. Classification into the three categories of verbosity was made for 179 of the men. Interrater reliability was established at .76 and .70 for the two measures of verbosity. There was significant agreement between the qualitative classification and the quantitative rating assessments of verbosity. In addition to the previously found associations between verbosity and personality and social variables, higher nonverbal intellectual performance scores obtained in the early adult years combined with poorer current nonverbal scores predicted verbosity in late life.

[The evaluation of difficult children.]. / L'évolution des enfants difficiles.

In this article, the authors discuss a study carried out during a Concordia Longitudinal Risk Project that deals with the adjustment of socially atypical children in their adolescent years. More precisely, they try to answer the following question : What child behaviors and which tangents of their development lead to major psychological problems as an adolescent and as an adult? After a complex analysis of various factors, their results indicate that children perceived as aggressive, keeping to themselves or often aggressive and keeping to themselves because of peer pressure, are liable to have problems in their adolescent years. The authors then elaborate on the difficulties experienced by each of these three groups.