A systematic review and meta-analysis of laparotomy compared with laparoscopic management of interstitial pregnancy.

BACKGROUND: Interstitial pregnancy is a rare but life-threatening condition accounting for 1-4% of all types of tubal ectopic pregnancies. It can be managed by open and minimally invasive surgical techniques. Our goal was to compare laparoscopic and open surgery for managing interstitial pregnancy. SEARCH STRATEGY: We searched PubMed, Scopus, Web of Science, and Cochrane up to May 2020. SELECTION CRITERIA: 1) Women with interstitial pregnancy, 2) Intervention: laparoscopic surgery, 3) Comparator: open surgery, 4) Outcomes: Hospital stay, operation time, pain scale, blood loss. Secondary outcomes: any other reported 5) Study designs: interventional and observational. DATA COLLECTION AND ANALYSIS: Data was extracted from the relevant articles and was pooled as mean difference (MD) or relative risk (RR) with a 95% confidence interval (CI). MAIN RESULTS: We included six studies, three of which provided eligible data. The duration of hospital stay was lower in the laparoscopic surgery group (MD = -1.42, 95% CI [-1.72, -0.76], P < 0.0001). There was no significant difference in operative time (MD = 5.90, 95% CI [-11.30, 23.09], P = 0.50, blood loss (MD = -9.43, 95% CI [-214.18, 195.32], P = 0.93), complications (RR = 1.54, 95% CI [0.20, 11.85], P = 0.68), or blood transfusions (RR = 0.77, 95% CI [0.50, 1.25], P = 0.30). CONCLUSION: Laparoscopic surgery is associated with shorter hospital stay, with no difference in terms of blood loss, post-, and intraoperative complications, and need for blood transfusion compared with laparotomy.

Raman Spectroscopy identifies differences in ochronotic and non-ochronotic cartilage; a potential novel technique for monitoring ochronosis.

OBJECTIVE: Alkaptonuria (AKU) is a rare, inherited disorder of tyrosine metabolism, where patients are unable to breakdown homogentisic acid (HGA), which increases systemically over time. It presents with a clinical triad of features; HGA in urine, ochronosis of collagenous tissues, and the subsequent ochronotic arthritis of these tissues. In recent years the advance in the understanding of the disease and the potential treatment of the disorder looks promising with the data on the efficacy of nitisinone. However, there are limited methods for the detection and monitoring of ochronosis in vivo, or for treatment monitoring. The study aim was to test the hypothesis that Raman spectra would identify a distinct chemical fingerprint for the non-ochronotic, compared to ochronotic cartilage. DESIGN: Ochronotic and non-ochronotic cartilage from human hips and ears were analysed using Raman spectroscopy. RESULTS: Non-ochronotic cartilage spectra were similar and reproducible and typical of normal articular cartilage. Conversely, the ochronotic cartilage samples were highly fluorescent and displayed limited or no discernible Raman peaks in the spectra, in stark contrast to their non-ochronotic pairs. Interestingly, a novel peak was observed associated with the polymer of HGA in the ochronotic cartilage that was confirmed by analysis of pigment derived from synthetic HGA. CONCLUSION: This technique reveals novel data on the chemical differences in ochronotic compared with non-ochronotic cartilage, these differences are detectable by a technique that is already generating in vivo data and demonstrates the first possible procedure to monitor the progression of ochronosis in tissues of patients with AKU.

Black powder drugs: an innovative response to drug control policy.

As the intensity of the War on Drugs escalates, the social control of drug interdiction crosses international borders and employs more technologically advanced detection and apprehension tactics. In response to this intensification, drug traders develop advanced counter-surveillance strategies that diminish their chances of being detected and apprehended. This results in an interesting relationship between those who choose to indulge in drug-related behavior and agents who actively try to detect, identify, and apprehend drug traders. Drug traders appear to have recently gained the upper hand with the production of "Black Powder," which represents the most innovative and effective anti-surveillance technique to date. Black powder is a simple industrial cloaking method that renders many surveillance strategies and chemical tests futile. Black powder is but one evolution in this exchange driven by tangible rewards, which results in intensified anti-drug strategies and an escalation of social control.

Forming an integrated documentation system.

A new documentation system changed not only the pieces of paper people write on, but also the way they deliver patient care. The patient record integrated all disciplines' care plans, assessments, flow sheets and Kardex into one document.

Preliminary investigation of a Bayesian network for mammographic diagnosis of breast cancer.

Bayesian networks use the techniques of probability theory to reason under conditions of uncertainty. We investigated the use of Bayesian networks for radiological decision support. A Bayesian network for the interpretation of mammograms (MammoNet) was developed based on five patient-history features, two physical findings, and 15 mammographic features extracted by experienced radiologists. Conditional-probability data, such as sensitivity and specificity, were derived from peer-reviewed journal articles and from expert opinion. In testing with a set of 77 cases from a mammography atlas and a clinical teaching file, MammoNet performed well in distinguishing between benign and malignant lesions, and yielded a value of 0.881 (+/- 0.045) for the area under the receiver operating characteristic curve. We conclude that Bayesian networks provide a potentially useful tool for mammographic decision support.