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Endoscopic ultrasound staging is adversely affected by placement of a self-expandable metal stent: fact or fiction? Accurate preoperative staging of pancreatic cancer Pca is crucial to direct management.

There is a perception that endoscopic ultrasound EUS staging should be performed before biliary decompression because of artifact caused by self-expandable metal stents SEMS. Fifty-five patients 35 men; mean age, 67 years with newly diagnosed Pca staged in the last 5 years and captured prospectively were divided into 2 groups matched by age, sex, and final staging.

The gold standard was surgical pathology, or cytologic confirmation of metastatic disease. Multivariate analysis was effected on age, sex, presence of SEMS, and presence of metastasis to assess prediction of staging inaccuracy.

Logistic regression analysis identified only metastasis as a predictor of inaccuracy in EUS staging. The major reason for misstaging in both groups was failure to detect metastatic disease. Diagnosis of potential stressors adversely affecting benthic Greenwich Bay is an urbanized embayment of Narragansett Bay potentially impacted by multiple stressors. The present study identified the important stressors affecting Greenwich Bay benthic fauna.

First, existing data and information were used to confirm that the waterbody was impaired. Second, the presence of source, stressor, and effect were established. Then linkages between source, stressor, and effect were developed. This allows identification of probable stressors adversely affecting the waterbody. Three pollutant categories were assessed: chemicals, nutrients, and suspended sediments. This weight of evidence approach indicated that Greenwich Bay was primarily impacted by eutrophication-related stressors.

The sediments of Greenwich Bay were carbon enriched and low dissolved oxygen concentrations were commonly seen, especially in the western portions of Greenwich Bay. The benthic community was depauperate, as would be expected under oxygen stress.

Although our analysis indicated that contaminant loads in Greenwich Bay were at concentrations where adverse effects might be expected, no toxicity was observed, as a result of high levels of organic carbon in these sediments reducing contaminant bioavailability. Our analysis also indicated that suspended sediment impacts were likely nonexistent for much of the Bay.

This analysis demonstrates that the diagnostic procedure was useful to organize and assess the potential stressors impacting the ecological well-being. Factors known or suspected to be adversely affecting native amphibian populations in the US were identified using information from species accounts written in a standardized format by multiple authors in a forthcoming book. The authors investigated whether adversity in a female, before she conceives, will influence the affective and social behavior of her progeny.

Virgin female rats were either undisturbed controls or exposed to varied, unpredictable, stressors for 7 days preconceptual stress [PCS] and then either mated immediately after the end of the stress…. Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris. Background and purpose - The initial outcomes following metal-on-metal hip arthroplasty MoMHA revision surgery performed for adverse reactions to metal debris ARMD were poor.

Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients hip resurfacing and large-diameter MoM total hip arthroplasty , with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision.

Results and interpretation - The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors type of revision procedure and bearing surface implanted , meaning surgeons could potentially reduce failure rates.

However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons' treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs. Although effective in the neonatal population, exogenous pulmonary surfactant has not demonstrated a benefit in pediatric and adult subjects with hypoxic lung injury despite a sound physiologic rationale.

We suspected a connection between F IO 2 and surfactant performance. Therefore, we sought to assess a possible mechanism by which the activity of pulmonary surfactant is adversely affected by direct oxygen exposure in in vitro experiments. The mechanical performance of pulmonary surfactant was evaluated using 2 methods.

Second, dynamic light scattering was utilized to measure the size of pulmonary surfactant particles in aqueous suspension. Furthermore, dynamic light-scattering experiments revealed a micelle diameter of This suggests that reductions in pulmonary compliance and associated adverse effects could begin to take effect in a very short period of time.

If these findings can be demonstrated in vivo, a. PubMed Central. Summary Smoking adversely affects hematopoietic stem cell transplantation outcome.

We asked whether smoking affected outcome of newly diagnosed acute myeloid leukemia AML patients treated with chemotherapy. Data were collected on AML patients treated with high-dose cytarabine and idarubicin-containing regimens at Roswell Park Cancer Institute who had smoking status data at diagnosis.

Among the males and females with a median follow-up of The proportion of patients between never and ever smokers was similar with respect to age, AML presentation, WBC count at diagnosis or karyotype based on univariate analysis of these categorical variables.

Never smokers had a significantly longer overall survival In multivariate analysis incorporating gender, age, AML presentation, WBC count, karyotype, and smoking status as covariates, age, karyotype and smoking status retained prognostic value for overall survival. In summary, cigarette smoking has a deleterious effect on overall survival in AML.

Hepatitis C virus adversely affects quality of life. Chronic liver disease secondary to hepatitis C virus HCV infection is a common clinical problem. HCV is likely to adversely affect the quality of life QoL of the patient. This effect is said to be disproportionate to the severity of the disease. The aim of our study was to evaluate QoL in HCV-positive patients focusing both on health status and subjective satisfaction. We adopted two generic tools: SF a health status questionnaire and SAT-P a satisfaction profile for psychological assessment of the patients.

The scores obtained from the study groups were also compared with the reference scores of the healthy Italian population. Both the groups were comparable with respect to age, histological and clinical severity of liver disease as assessed by MELD and Child Pugh scores. Patients with ETOH-HCV scored less in the vitality and role emotional status domains of the SF scores and the psychological function, social function and free time domains of the satisfaction profile.

These results show a significant impact of HCV infection on health status and subjective satisfaction. Karger AG, Basel. Describes investigation of ways in which combat decreases marital quality and stability. Results support three models: 1 factors propelling men into combat also make them poor marriage material; 2 combat causes problems that increase marital adversity ; and 3 combat intensifies premilitary stress and antisocial behavior which then negatively….

Urban sprawl and you: how sprawl adversely affects worker health. Urban sprawl, once thought of as just an environmental issue, is currently gaining momentum as an emerging public health issue worthy of research and political attention. Characteristics seen in sprawling communities include increasing traffic volumes; inadequate public transportation; pedestrian unfriendly streets; and the division of businesses, shops, and homes.

These characteristics can affect health in many ways. Greater air pollution contributes to higher asthma and other lung disorder rates. An increased dependence on the automobile encourages a more sedentary lifestyle and can potentially contribute to obesity.

The increased danger and stress of long commutes can lead to more accidents, anxiety, and social isolation. Occupational health nurses can become involved by promoting physical activity in the workplace, creating programs for injury prevention and stress management, becoming involved in political smart growth measures, and educating and encouraging colleagues to become active in addressing this issue.

Obesity adversely affects survival in pancreatic cancer patients. Higher body-mass index BMI has been implicated as a risk factor for developing pancreatic cancer, but its effect on survival has not been thoroughly investigated. The authors assessed the association of BMI with survival in a sample of pancreatic cancer patients and used epidemiologic and clinical information to understand the contribution of diabetes and hyperglycemia. A survival analysis using Cox proportional hazards by usual adult BMI was performed on unselected patients with pancreatic adenocarcinoma; analyses were adjusted for covariates that included clinical stage, age, and sex.

Secondary analyses incorporated self-reported diabetes and fasting blood glucose in the survival model. BMI as a continuous variable was inversely associated with survival from pancreatic adenocarcinoma hazard ratio [HR], 1. Higher BMI is associated with decreased survival in pancreatic cancer. Although the mechanism of this association remains undetermined, diabetes and hyperglycemia do not appear to account for the observed association.

There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty MoM THA may be less prone to the adverse reactions to metal debris ARMD seen with large-diameter heads.

We generally used these implants in younger, more active, higher-demand patients. Three hundred hips patients had MoM THA using a titanium modular acetabular component with a cobalt-chromium tapered insert and were available for review with minimum 2-year followup mean, 10 years; range, years.

Clinical records and radiographs were reviewed to determine the frequency and etiology of revision. Kaplan-Meier survivorship analysis was performed. Using multivariate analysis, no variable tested, including height, weight, body mass index, age, cup diameter, cup angle, use of screws, stem diameter, stem type, head diameter, preoperative clinical score, diagnosis, activity level, or sex, was significant as a risk factor for revision.

Twenty hips have been revised: two for infection, four for aseptic loosening, and 14 for ARMD. The late onset. Outcomes following revision surgery performed for adverse reactions to metal debris in non- metal-on-metal hip arthroplasty patients.

Objectives Few studies have assessed outcomes following non- metal-on-metal hip arthroplasty non-MoMHA revision surgery performed for adverse reactions to metal debris ARMD. Methods We performed a retrospective observational study using data from the National Joint Registry for England and Wales.

Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression. Results Intra-operative complications occurred in 6. The cumulative four-year patient survival rate was Re-revision surgery was performed in The cumulative four-year implant survival rate was Conclusions Non-MoMHAs revised for ARMD have a high short-term risk of re-revision, with important predictors of future re-revision including selective component revision, multiple revision indications, and ceramic-on-polyethylene revision bearings.

Our findings may help counsel patients about the risks of ARMD revision, and guide reconstructive decisions.

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