Gynecological Laparoscopic Surgeries under Spinal Anesthesia: Benefits and Challenges.

OBJECTIVE: This prospective study investigated the feasibility of performing laparoscopic pelvic surgery under spinal anesthesia and analyzed the intraoperative side effects, like pain, nausea, and vomitus, of 915 patients. METHODS: The implementation and performance of laparoscopic surgery under local anesthesia on 915 patients (out of a total of 3212 who underwent laparoscopic pelvic surgery under spinal anesthesia) were analyzed in relation to BMI (body mass index), obesity, pain during surgery, amount of intraperitoneal mmHg CO2 gas pressure, and surgical complications. RESULTS: BMI > 30, intra-abdominal adhesions, increased duration of the operation, bleeding, and increased intraperitoneal CO2 pressure were statistically significant as the main causes of pain during laparoscopic surgery under spinal anesthesia. Underweight patients, on the other hand, had less pain when intra-abdominal pressure increased compared to those of normal weight. The appearance of pain, nausea, and vomitus occurred in 10.3% of patients, and these events were easy to manage and treat. They did not affect the surgeon's work or the course of the operation. CONCLUSIONS: In light of these observations, we are proposing spinal anesthesia for laparoscopic surgery as the first choice in patients who have no contraindications. To the best of our knowledge, this clinical study constitutes the largest clinical observation and dataset concerning spinal anesthesia in laparoscopic pelvic surgery. TRIAL REGISTRATION: ISRCTN38987, 10 December 2019.

Prevalence and Significance of Patient Prosthesis Mismatch Following Edwards SAPIEN XT and SAPIEN 3 Transcatheter Aortic Valve Replacement.

Background Severe patient prosthesis mismatch (sPPM) after surgical aortic valve replacement is associated with worse outcomes. Limited data exists on the impact of sPPM on outcomes after transcatheter aortic valve replacement (TAVR), especially regarding the newer generation valves. The aim of this study was to evaluate the incidence, determinants, and outcomes of sPPM in patients undergoing TAVR with Edwards SAPIEN XT (ES XT) and Edwards SAPIEN 3 (ES3) valves (Edwards Lifesciences, Irvine, CA, USA). Methods We retrospectively reviewed 366 patients who underwent TAVR with ES XT (n = 114) or ES3 (n = 252) valves between July 2012 and June 2018. sPPM was defined as indexed effective orifice area (iEOA) <0.65 cm2/m2. Kaplan-Meier survival estimates were used to determine outcomes. Results Multivariate linear regression analysis was utilized to determine potential independent effects of PPM on outcomes. sPPM was present in 40 (11%) of the patients [8 (7%) ES XT and 32 (13%) ES3] and was associated with female sex, smaller left ventricular outflow tract (LVOT) diameter and aortic valve annular area, absence of prior coronary artery bypass graft (CABG) surgery, shorter height, higher body mass index, and smaller pre-TAVR valve area (all p < 0.05). Among those with ES3 valves, the incidence of sPPM was inversely proportional to the valve size (50%, 25%, 5% and 3% for 20-, 23-, 26- and 29-mm valve sizes, respectively; p < 0.001). At a mean follow-up period of 3.5 ± 1.5 years, there was no difference in all-cause mortality (22.5% vs. 25.6%, p = 0.89) or a composite endpoint of heart failure, arrhythmias, stroke, and myocardial infarction (30% vs. 34%, p = 0.24) in those with or without sPPM. Conclusion ES3 was associated with a higher incidence of sPPM, particularly with smaller valve sizes. However, the presence of sPPM as defined by iEOA was not an independent predictor of adverse outcomes in patients undergoing TAVR within an intermediate follow-up period.

Personality Type D, Level of Perceived Stress, Insomnia, and Depression Among High School Teachers in Poland.

Teaching is inherently connected with specific burdens that may imply stressful situations. The goal of this study was to explore the prevalence of type D (distressed) personality in teachers. This is known to cause depressive episodes and sleep disorders, which not only have direct physical health effects, but can also impact the wellbeing of individuals and hence adversely affect their job performance. The participants consisted of 412 high school teachers from the Silesian Province, located in the south of Poland. Using the following research tools: Type D Scale (DS14), Perceived Stress Scale, Athens Insomnia Scale, and Beck Depression Inventory, it was found that type D personality was observed in a large percentage of teachers (30.1%). It was reported that teachers with distressed personality suffered from insomnia and depression significantly more often. Findings from the current study indicate the need to implement preventive activities focused on reducing psychosocial risk factors in the work environment in order to reduce the frequency of depressive disorders among teachers.

Concentration of cadmium and lead in vegetables and fruits.

Chemical contamination of foods pose a significant risk to consumers. A source of this risk is due to the consumption of products contaminated with heavy metals such as cadmium (Cd) and lead (Pb). The aim of the study was to research the levels of Cd and Pb contamination of selected species of vegetables and fruits in the form of fresh, frozen, dried and processed products. The goal was to verify which of these food groups was more contaminated with heavy metals. The study covered 370 samples of fruits and vegetables including apples, pears, grapes, raspberries, strawberries, cranberries, as well as beetroots, celeries, carrots and tomatoes. The content of Cd and Pb was determined by atomic absorption spectrometry. Quantitative results were analyzed using statistical models: analysis of variance, outlier analysis, post-hoc multiple comparison Tukey test. The tests showed that the levels of Cd and Pb concentration in samples of fresh, processed, frozen and dried fruits and vegetables varied substantially. The highest concentrations were recorded in dried products. Several fruit and vegetable samples exceeded the maximum permissible concentrations of Cd and Pb. The contamination of these products could be a significant source of consumer exposure to heavy metals when these products are a part of the diet.

Health risks from consumption of medicinal plant dietary supplements.

The aim of this study was to determine the heavy metal contents of dietary supplements manufactured from medicinal plants and assess the potential daily burden on their consumers. The study consisted of 41 dietary supplements produced from terrestrial plants or microalgae. The analysis of cadmium, lead, and mercury content was performed using analytical methods. The content of Cd and Pb was determined by flame atomic absorption spectrometry (FAAS). The mercury content was determined using atomic absorption spectrometry with the generation of cold mercury vapor (CVAAS). The presence of at least one of the three analyzed heavy metals was found in 79.2% samples of supplements produced from terrestrial plants and in 88.2% supplement samples produced from microalgae. Hazard quotient was used to calculate noncarcinogenic risk for humans by ingestion of dietary supplements containing heavy metals. From among all supplements, 68.3% of samples were contaminated with Cd and Pb (this does not always apply to the same samples) and 29.3% of samples were contaminated with Hg. The health risk assessment of consumers of dietary supplements showed, in an extreme case, that taking this supplement for only one week poses a health risk associated with exposure to Pb. The health risk associated with the intake of dietary supplements primarily depends on the duration of consumption.

PCDDs, PCDFs and PCBs in locally produced foods as health risk factors in Silesia Province, Poland.

Dioxins (PCDDs), furans (PCDFs) and polychlorinated biphenyls (PCBs) emitted into the environment can accumulate in foods and become a significant source of dietary exposure for consumers of these compounds. This study aims to assess the dietary exposure of the residents in a rural area of the Silesia region in southern Poland to PCDDs, PCDFs and PCBs. The goal is to estimate cancer and non-cancer health risks due to the consumption of foods of animal origin. The area has relatively higher concentration of PCDDs, PCDFs and PCBs in the air in comparison to large industrialized cities of the Silesia province. Three popular foods of animal origin, namely free-range chicken meat, free-range chicken eggs, and cow milk produced in the farms were used. The control samples were the same foods from the local grocery stores. Two exposure scenarios were considered: Firstly that residents consumed free-range foods and secondly that the food items were purchased from stores in the study area. In the first scenario, exposure to concentrations of PCDDs, PCDFs, and dioxin-like PCBs (dl-PCBs) yielded evidence of elevated cancer and non-cancer risks. The hazard quotient (HQ) was 71.3 for non-cancer risk and 7.5 × 10-3 for cancer risk. The health risk from exposure to PCDDs, PCDFs and dl-PCBs in the second scenario was 6.9 × 10-4 and HQ = 0.8, respectively. Implementation of educational activities in the study area is needed to increase the resident's awareness of the risks associated with the emissions of chlorinated persistent organic pollutants to the environment, including aspects such as the main sources of the emission and how to avoid exposure to these compounds.

Median-of-subsets normalization of intensities for cDNA array data.

cDNA arrays allow quantitative measurement of expression levels for thousands of genes simultaneously. The measurements are affected by many sources of variation, and substantial improvements in the precision of estimated effects accompany adjustments for these effects. Two generic nuisance variations, one associated with the magnitude of expression and the other associated with array location, are common in data from filter arrays. Procedures, like normalization using lowess regression, are effective at reducing variation associated with magnitude, and they have been widely adopted. However, variation associated with location has received less attention. Here, a simple, but effective method based on localized median is expounded for dealing with these nuisance effects, and its properties are discussed. The proposed methodology handles location-dependent variation ("splotches") and magnitude-dependent variation (background and/or saturation) effectively. The procedure is related to lowess when implemented to adjust magnitude-dependent variation, and it performs similarly. The proposed methodology is illustrated with data from the National Center for Toxicological Research (NCTR), where treatment differences in levels of mRNA from rat hepatocytes were assessed using 33P-labeled samples hybridized to cDNA spotted arrays. Normalizing intensities by the median-of-subsets removes systematic variation associated with the location of a gene on the array and/or the level of its expression. This procedure is easy to implement using iteratively reweighted least-squares algorithms. Although less sophisticated than lowess, this procedure works nearly as well for normalizing intensities based upon their magnitude. Unlike lowess, it can adjust for location-dependent effects.

Quantitative risk assessment for developmental neurotoxic effects.

Developmental neurotoxicity concerns the adverse health effects of exogenous agents acting on neurodevelopment. Because human brain development is a delicate process involving many cellular events, the developing fetus is rather susceptible to compounds that can alter the structure and function of the brain. Today, there is clear evidence that early exposure to many neurotoxicants can severely damage the developing nervous system. Although in recent years, there has been much attention given to model development and risk assessment procedures for developmental toxicants, the area of developmental neurotoxicity has been largely ignored. Here, we consider the problem of risk estimation for developmental neurotoxicants from animal bioassay data. Since most responses from developmental neurotoxicity experiments are nonquantal in nature, an adverse health effect will be defined as a response that occurs with very small probability in unexposed animals. Using a two-stage hierarchical normal dose-response model, upper confidence limits on the excess risk due to a given level of added exposure are derived. Equivalently, the model is used to obtain lower confidence limits on dose for a small negligible level of risk. Our method is based on the asymptotic distribution of the likelihood ratio statistic (cf. Crump, 1995). An example is used to provide further illustration.