This study is a prospective three-arm randomized controlled trial at a single academic-affiliated institution designed to assess the effect of common bowel care regimens on return of bowel function following total laparoscopic hysterectomy. Subjects were randomized using an equal allocation ratio to one of three groups: no bowel care medication, docusate sodium, or polyethylene glycol 3350 (PEG) for the first five days postoperatively. Women aged 18-85 years old undergoing total laparoscopic hysterectomy for benign indications were included. Exclusion criteria included a known underlying gynecologic malignancy, pre-existing gastrointestinal disorders such as Crohn’s disease, ulcerative colitis, irritable bowel syndrome, history of bowel resection, insulin-dependent diabetes or gastroparesis, known gastric dysmotility, chronic use of pain medications, anticipated bowel surgery, or non-English speaking. The primary outcome of the study was to assess the time to first bowel movement after randomization to a postoperative bowel care regimen. Secondary outcomes assessed were time to first flatus postoperatively, narcotic use measured in total oral morphine equivalents in the first five days postoperatively, as well as the constipation score and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire score.
There were no significant differences in time to first bowel movement postoperatively amongst those receiving no bowel care regimen, docusate sodium, or PEG (2.64 ± 1.19, 2.80 ± 1.08, 3.06 ± 1.18 days; p=0.436). Similarly, there were no significant differences in time to first flatus: 1.06 days (interquartile range 0.89-1.70) in the control group, 1.05 days (interquartile range 0.78-1.37) in the docusate sodium group, and 1.11 days (interquartile range 0.82-1.40) in the PEG group (p=0.975). Total narcotic use in the first five days postoperatively, constipation score, and the PAC-SYM score did not vary significantly amongst the groups. Body mass index (BMI) was a significant predictor of time to first bowel movement with an increased BMI associated with a shorter time to first bowel movement [HR 1.05 (1.01, 1.10); p=0.013].
In those undergoing laparoscopic hysterectomy for benign indications without any preexisting gastrointestinal disorders, the prescription of a bowel care medication does not significantly affect return of bowel function.
Contributors:Ikemsinachi C Nzenwa, Mina Mesri, Raimundas Lunevicius
Subtotal cholecystectomy (STC) is the partial removal of the gallbladder and is performed when the anatomy of the Calot’s triangle cannot be fully identified. It is thought to be associated with higher post-operative morbidity rates when compared with the conventional cholecystectomy technique. This systematic review of research papers published between 1985 and 2019 aims to ascertain the perioperative morbidity, mortality and clinical burden associated with STC. The protocol of the study has been registered with PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42020172808) (https://www.crd.york.ac.uk/prospero/).
Purpose: To determine the sensitivity and specificity of urinary aquaporin-1(uAQP-1) to diagnose renal cell carcinoma(RCC) and to establish baseline concentrations of this marker in our population.
Methods: A total of 72 participants were planned for enrollment with equal number of cases and healthy controls in a prospective two-gated design. Cases were enrolled from those who had an imaged renal mass, suspicious of RCC who were planned for surgery, while controls were selected from prospective voluntary kidney donors. uAQP-1 concentrations were estimated with a sandwich ELISA and normalized by measuring spot urine creatinine. A receiver operator curve was drawn to analyze the diagnostic accuracy of uAQP-1 for RCC.
Results: At the end of the study duration, 60 participants were enrolled. The median uAQP-1 concentrations among the imaged renal masses was 8.78ng/mg creatinine (IQR -7.11). Among healthy controls median uAQP-1 concentration was 9.52 ng/mg creatinine (IQR-6.89). The sensitivity and specificity of the test was 47.2% and 66.7%% respectively, and area under the curve was 0.52. Results indicated that this test did not discriminate between healthy individuals and patients with RCC.
Conclusion: uAQP-1 is not a suitable biomarker for renal cell carcinoma in the study population.
After more than 50 years experience of clincially treating and researching on schizophrenia, this is my hyopthesis about a plausible mechanism of the occurence of the various symptoms that are evident with the disorder.
En España el sistema de las formas pronominales de apelación está representado por la oposición entre las formas tú/usted (singular) y vosotros/ustedes (plural), en Colombia y Ecuador se da una oposición más compleja con las formas tú, vos contrapuestas a usted, su merced en singular el apelativo ustedes en plural (en este ultimo caso el sistema de formas pronominales de tratamiento es más sencillo en comparación al de España, con su oposición vosotros/ustedes). En Méjico y Cuba, el sistema de tratamientos pronominales está integrado por los pronombres personales tú/usted, ustedes. En Argentina, el juego de formas es
el siguiente: vos, tú/usted (singular), ustedes (plural).
Objective to investigate the role of social and laboral stress in the functionality and adaptability of adults screened as ADH(+) by the Adult ADHD Self report Scale in different professional settings.
Design. We conducted an online survey with convenience sampling about economic and academic performances (dysfunctionality) and self-perception of health problems and work-related subjective suffering (maladaptation), following a screening for ADHD using Adult Self Report Scale (ASRS). The subjects were naïve about the aim of this assessment. Among analyses, we realized a random stratified subsampling to mitigate the bias by convenience sampling.
Main Findings. There were 2173 participants, of which 28.06% were ADH(+). Even regarding only subjects with extreme ASRS scores (2.5), ADH(+) and (-) groups did not shown difference in functionality. We grouped subjects by professional career. The highest ADH(+) prevalence was found in publicity, where almost no difference in subjective suffering between the groups was observed.
Conclusions. High ADH(+) prevalence can be due convenience recruitment. Our results indicate that ADH(+) people can show equivalent functionality and adaptability than ADH(-) ones when they live in their preferred labor/social settings, arguing that dysfunctionality and mental suffering in adult ADHD could be secondary to social stress.
In the file 'Difference of St.Petersburg' there are answers to the question: What distinguishes St.Petersburg from other cities in the world? They are answers are of 174 respondents, school students in St. Petersburg (Russia) in Russian language.
The survey was conducted from December 2017 to May 2018 online using Google forms. The survey had several questions and its data is presented separately.
The answers are systematized in 4 variables' table: tradition; innovation; socialization; uniqueness and individual self-expression.
All answers were coded within binary oppositions, which are given according to analytical psychology and semiotics.
This table is made to catch the trends and ideas in the framework of the choice of representation of the city by students. Classification requires further verification by discussion and focus groups.
Primary sorting was carried out by the inductive method of understanding the message's meaning:
Does the message talk about resources and data (nature, architecture, climate) or about achievements and opportunities (merit, victory, the role of the city) within the opposition: conservatism versus innovation?
Does the message refer to people (hospitality, character, pastime practices) or uniqueness, “genius loci” (atmosphere, culture, art) within the opposition: collectivism versus individualism?
Includes the 45 images used in the tests for the validatation of a new methodology for determining effective colors for high-visibility safety.
The validation dataset consisted of 3 sets of 15 images. Each set depicted a different construction project. Photographs in Set A depict different stages of a short offshore removal operation. A barge is fitted with a lifting tower and sails at an offshore platform where six fenders are lifted and transported to the shore. Set B includes pictures from a fabrication hall where heavy steel structures are fabricated. Set C consist of photographs from the transport and installation of foundation structures for offshore wind turbines. Ground-truth bounding boxes have been included to show the location of workers