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Parent-Adolescent Concordance Concerning Male fertility Perspectives and Sperm Financial Tries throughout Adolescent Men Along with Most cancers.
Background Aneurysmal subarachnoid hemorrhage (aSAH) patients have an inflammatory response in the cerebrospinal fluid (CSF). We determined CSF cell counts, erythrocyte/leukocyte ratio, and glucose- and protein concentrations in patients ≤20 days after aSAH without bacterial meningitis. Such knowledge may help to interpret CSF parameters in patients with an external drain if nosocomial bacterial meningitis or ventriculitis is suspected. Methods Patients with aSAH admitted between 2010 and 2017 with at least one CSF sample ≤ 20 days after ictus were included from a prospectively collected database. CSF samples were excluded if the patient used antibiotics or if the CSF culture was positive. We calculated estimated marginal means with 95% confidence intervals (CIs) with linear mixed models for CSF cell counts, glucose- and protein concentrations. Results We included 209 patients with 306 CSF samples. Highest estimated median leukocyte count was 305 (95%CI225-412) x10^6/L, and the lowest estimated median erythrocyte/leukocyte ratio was 109 (95%CI73-163). Estimated mean glucose concentrations remained within the normal range. The estimated median protein concentration decreased from 3.3 g/L (95%CI2.5-4.2) on day 0 to 1.0 g/L (95%CI0.8-1.2) on day 14. Conclusion The limits we found for the inflammatory reaction in aSAH patients may help physicians to interpret CSF parameters in aSAH patients with an external CSF drain. Future studies are needed to compare CSF parameters in aSAH patients with and without bacterial meningitis or ventriculitis.Background Elderly women with clinically node-positive (cN+) breast cancer (BC) often have comorbidities that limit life expectancy and complicate treatment. We sought to determine whether the number of lymph nodes (LNs) retrieved among older women with node-positive BC was associated with overall survival (OS). Methods Using the National Cancer Database (2010-2015), women 70-90 y with cN + BC and ≥1 LNs removed were categorized by treatment sequence upfront surgery or neoadjuvant chemotherapy (NAC). Multivariable Cox proportional hazards models with restricted cubic splines characterized the functional association of LN retrieval with OS; threshold values of LN retrieval were estimated. Cox proportional hazards models were used to estimate the association of LN retrieval groups with OS. Results In the upfront surgery cohort, a nonlinear association was identified between LNs retrieved and OS. In the NAC cohort, no association was identified. For the upfront surgery cohort, the optimal threshold value of LN retrieval was 21 LNs (90% confidence interval 18-23). Based on this estimate, LN retrieval groups were created 23 LNs. After adjustment, retrieval of less then 12 LNs in the upfront surgery group was associated with a worse OS. No differences were observed in the NAC group. Conclusions For elderly women receiving upfront surgery, there is no survival benefit to removing more than 12 LNs, and for those receiving NAC, there is no association between number of LNs removed and survival. In older women who present with cN + BC, aggressive surgery to remove more than 12 LNs may not be necessary.Background Sleep is necessary for recovery from physiological insults such as surgery. Although previous research has focused on sleep in the intensive care unit and medical setting, little is known about sleep quality among inpatients recovering from elective surgery. Therefore, we examined sleep quality and barriers to sleep among postsurgical inpatients. Methods We conducted an explanatory sequential mixed-method study among adult general-care surgical inpatients who underwent elective surgery. We used a quantitative survey to examine sleep quality and interruptions followed by a qualitative phone interview with a subsample of participants to examine barriers and aids to sleep in the hospital. Results were analyzed using descriptive statistics of survey data and descriptive coding of interview transcripts. Results Of 113, 102 (90%) eligible patients completed the survey. Less than half (n = 48, 47%) of patients reported sleeping well the previous night and 93% reported less sleep in the hospital compared with at home. Patients reported a median of 5 (4-7) interruptions each night. Patients with >3 sleep interruptions were more likely to report poor sleep than those with ≤3 interruptions (P less then 0.001). Phone interview responses cited barriers to sleep including staff interruptions and roommate noise when sharing a room but not pain. Patients suggested that improved timing and knowledge of interruptions or noise-reduction aids would facilitate sleep. Conclusions Most patients do not sleep well while recovering from elective surgery in the hospital, and most sleep disruptions are modifiable. TanshinoneI Minimizing interruptions at night by clustering care, informing patients of scheduled interruptions, and increasing access to noise-reduction aids may improve sleep quality. Optimal efforts to improve sleep quantity and quality will ultimately require a multilevel, multicomponent strategy.Background Contrast-induced acute kidney injury may occur in patients undergoing imaging studies. This study reviews all deceased kidney donors at a single center during a 15-y period to determine if donor contrast exposure results in contrast-induced acute kidney injury in the donor or is associated with worse outcomes in the transplant recipient. Methods Donor and recipient renal functions were recorded, including donor serum creatinine and recipient delayed graft function, creatinine clearance at 1 y, and early and late graft survival. Donor contrast exposure was recorded as the number of preprocurement contrasted studies. Results Donor and recipient records were available for 1394 transplants (88%). There were 51% of donors who received any contrasted study (38%, one study; 12%, two studies, and 1%, three studies). Donor contrast exposure was not associated with significant differences in preprocurement serum creatinine levels. Post-transplant, donor contrast exposure was associated with risk of neither delayed graft function (4% for all) nor early kidney graft loss. Creatinine clearance at 1 y was equivalent. Five-year Cox regression demonstrated higher graft survival for contrast-exposed grafts (P = 0.03). Conclusions There is no negative effect of donor contrast administration on early and late kidney graft function. These findings included donor kidneys exposed to as many as three contrasted studies.Background Historically low, the proportion of female urology residents now exceeds 25% in recent years. Self-assessment is a widely used tool to track progress in medical education. However, the validity of its results and gender differences may influence interpretation. Simulation of surgical skills is increasingly common in modern residency training and standardizes certain objective tasks and skills. The objective of this study was to identify gender differences in self-assessment of surgeons and trainees when using simulation of surgical skills. Methods Medical students, residents, and attending and retired surgeons completed simple interrupted suturing. Assessment was self-rated using previously tested visual analog motion scales. Tasks were video recorded and rated by blinded expert surgeons using identical motion scales. Computer vision motion tracking software was used to objectively analyze the kinematics of surgical tasks. Results Proportion of female (n = 17) and male (n = 20) participants did notcompared with expert ratings, whereas male surgeon and trainee self-ratings and expert ratings were similar. Further work is needed to determine if these differences are accentuated across increasingly difficult tasks.Background A successful flush is the ability to flush through the appendicostomy or cecostomy channel, empty the flush through the colon, and achieve fecal cleanliness. We evaluated our experience with patients who were having flush difficulties based on a designed algorithm. Methods Eight patients with flush difficulties were initially evaluated. Based on the need for additional surgery versus changes in bowel management therapy (BMT), we developed an algorithm to guide future management. The algorithm divided flush issues into before, during, and after flushing. Children aged less then 20 y who presented with flush issues from September 2018 to August 2019 were evaluated to determine our algorithm's efficacy. Specific outcomes analyzed included changes in BMT versus need for additional surgery. Results After algorithm creation, 29 patients were evaluated for flush issues. The median age was 8.4 y (interquartile range 6, 14); 66% (n = 19) were men. Underlying diagnoses included anorectal malformations (n = 17), functional constipation (n = 7), Hirschsprung's disease (n = 2), spina bifida (n = 2), and prune belly (n = 1). A total of 35 flush issues/complaints were noted 29% before the flush, 9% during the flush, and 63% after the flush. Eighty percent of issues before the flush required surgical intervention, wherease 92% of issues during or after the flush were managed with changes in BMT. Conclusions Most flush issues respond to changes in BMT. This algorithm can help delineate which types of flush issues would benefit from surgical intervention and what problems might be present if patients are not responding to changes in their flush regimen.Background Academic journals have adopted strict authorship guidelines to eliminate the addition of authors who have not met criteria, also known as "courtesy authors." We sought to analyze current perceptions, practices, and academic rank-related variations in courtesy authorship use among modern surgical journals. Methods Authors who published original research articles in 2014-2015 in eight surgical journals were surveyed and categorized as junior (JF) or senior faculty (SF) by years in practice. Responses regarding courtesy authorship perceptions and practices were analyzed. Subanalyses were performed based on journal impact factor. Results A total of 455 authors responded (34% JF versus 66% SF). SF were older (52 versus 39 y) and more predominantly male (80% versus 61%) versus JF. JF more frequently added a courtesy author to the index publication versus SF (23% versus 13%, P = 0.02), but had similar historical rates of adding courtesy authors (58% versus 51%, P = not significant) or being added as a courtesy author (29% versus 37%, P = not significant). JF felt courtesy authorship was more common in their practice and felt more pressure by superiors to add courtesy authors. Perceptions regarding the practice of courtesy authorship differed significantly, with 70% of JF feeling courtesy authorship use has not declined versus 45% of SF (P less then 0.05). Both JF and SF cited courtesy authorship positives, including avoiding author conflicts (17% versus 33%, respectively) and increasing morale (25% versus 45%, respectively). Conclusions Courtesy authorship use continues to be common among both JF and SF. However, perceptions about the benefits, harms, and pressures vary significantly by academic rank and with journal impact factor.The representation of numbers in human adults is linked to space. In Western cultures, small and large numbers are associated respectively with the left and right sides of space. An influential framework attributes the emergence of these spatial-numerical associations (SNAs) to cultural factors such as the direction of reading and writing, because SNAs were found to be reduced or inverted in right-to-left readers/writers (e.g., Arabic, Farsi, or Hebrew speakers). However, recent cross-cultural and animal studies cast doubt on the determining role of reading and writing directions on SNAs. In this study, we assessed this role in mental arithmetic, which requires explicit number manipulations and has revealed robust leftward or rightward biases in Western participants. We used a temporal order judgement task in French and Arabic speakers, two languages that have opposite reading/writing directions. Participants had to solve subtraction and addition problems presented auditorily while at the same time determining which of a left or right visual target appeared first on a screen.
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