Risk factors for surgical site infection after cholecystectomy

AbstractBackgroundThere are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.MethodsA retrospective cohort of commercially insured persons aged 18–64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI.ResultsSurgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P &amp;lt; .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27–1.96), open approach with (HR, 4.29; 95% CI, 2.45–7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96–8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74–8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87–13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection.ConclusionsAcute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.</jats:sec

Ursinus College Alumni Journal, March 1960

President\u27s page • 1960 - A democratic president • Faith in the individual • Teachers are made • Alumni elections - watch for your ballot in April • On recruiting • Recent changes in the Education Department • Attention: Alumna at work • Lamond promoted • The liberal arts • An interview with Flora Rahn Lentz, Class of 1889 • Esso grant • Summer Assembly • Dr. Lentz is dead • Dr. Rice publishes new Swedish text • Dr. Stein resigns • Medical college award • Washington regional • Lehigh Valley regional • New York City regional • Philadelphia regional • South Jersey regional • Schuylkill Valley regional • Ursinus Women\u27s Club • Facts concerning the directory • Alumnae hockeyites honored • New football coach • Fall sports\u27 record • Wrestling results • Please help us • Basketball review • New look in track facilities • Track • Vanishing crafts and their craftsmen • January 1960: Mid year report of the Loyalty Fund campaign • 1960 Loyalty Fund campaign • Alvin Weiss: Man of the year • News about ourselves • Weddings • Births • Necrology • Alumni Day Saturday, June 4, 1960https://digitalcommons.ursinus.edu/alumnijournal/1068/thumbnail.jp

Evidence of altered epidermal nerve fiber morphology in adults with self-injurious behavior and neurodevelopmental disorders

The purpose of this preliminary study was to examine the morphology and neuropeptide density of epidermal nerve fibers quantified through skin biopsy samples from three adults with neurodevelopmental disorders and chronic self-injurious behavior (SIB) secondary to mental retardation compared with non-SIB normal IQ controls. A cross-sectional design was used with 3 mm punch skin biopsies collected from each participant from non-self-injurious body sites and compared with site-matched existing normal control skin samples. The study was conducted at an outpatient clinic. The primary dependent measure for the morphology analyses was the coefficient of variation (CV) to quantify the mean gap length between epidermal nerve fibers for each subject. Visual microscopic examination and quantitative analysis of the microscopy images suggested there were morphological abnormalities (increased CV) in the epidermal nerve fibers among the chronic SIB cases. Substance P (SP) fiber density was increased with 2 to 3 times as many fibers in SIB subjects as control subjects. Additional empirical work is needed to clarify the relation between sensory innervation of the skin and self-injury to improve assessment and treatment outcomes

Comparing aerosol number and mass exhalation rates from children and adults during breathing, speaking and singing

Aerosol particles of respirable size are exhaled when individuals breathe, speak and sing and can transmit respiratory pathogens between infected and susceptible individuals. The COVID-19 pandemic has brought into focus the need to improve the quantification of the particle number and mass exhalation rates as one route to provide estimates of viral shedding and the potential risk of transmission of viruses. Most previous studies have reported the number and mass concentrations of aerosol particles in an exhaled plume. We provide a robust assessment of the absolute particle number and mass exhalation rates from measurements of minute ventilation using a non-invasive Vyntus Hans Rudolf mask kit with straps housing a rotating vane spirometer along with measurements of the exhaled particle number concentrations and size distributions. Specifically, we report comparisons of the number and mass exhalation rates for children (12–14 years old) and adults (19–72 years old) when breathing, speaking and singing, which indicate that child and adult cohorts generate similar amounts of aerosol when performing the same activity. Mass exhalation rates are typically 0.002–0.02 ng s(−1) from breathing, 0.07–0.2 ng s(−1) from speaking (at 70–80 dBA) and 0.1–0.7 ng s(−1) from singing (at 70–80 dBA). The aerosol exhalation rate increases with increasing sound volume for both children and adults when both speaking and singing

Decrease in plasma miR-27a and miR-221 after concussion in Australian football players

Introduction: Sports-related concussion (SRC) is a common form of brain injury that lacks reliable methods to guide clinical decisions. MicroRNAs (miRNAs) can influence biological processes involved in SRC, and measurement of miRNAs in biological fluids may provide objective diagnostic and return to play/recovery biomarkers. Therefore, this prospective study investigated the temporal profile of circulating miRNA levels in concussed male and female athletes. Methods: Pre-season baseline blood samples were collected from amateur Australian rules football players (82 males, 45 females). Of these, 20 males and 8 females sustained an SRC during the subsequent season and underwent blood sampling at 2-, 6- and 13-days post-injury. A miRNA discovery Open Array was conducted on plasma to assess the expression of 754 known/validated miRNAs. miRNA target identified were further investigated with quantitative real-time PCR (qRT-PCR) in a validation study. Data pertaining to SRC symptoms, demographics, sporting history, education history and concussion history were also collected. Results: Discovery analysis identified 18 candidate miRNA. The consequent validation study found that plasma miR-221-3p levels were decreased at 6d and 13d, and that miR-27a-3p levels were decreased at 6d, when compared to baseline. Moreover, miR-27a and miR-221-3p levels were inversely correlated with SRC symptom severity. Conclusion: Circulating levels of miR-27a-3p and miR-221-3p were decreased in the sub-acute stages after SRC, and were inversely correlated with SRC symptom severity. Although further studies are required, these analyses have identified miRNA biomarker candidates of SRC severity and recovery that may one day assist in its clinical management

Comparisons of Aerosol Generation Across Different Musical Instruments and Loudness

Highlights•Aerosol number and mass concentrations measured during musical instrument playing.•A 1 dBA increase in sound pressure level yields ∼10% increase in number concentration.•Loudness of playing explains some but not all differences across instruments.•Musical instrument playing size distributions are consistent with those of breathing.•Simple songs sufficient to characterise aerosol emission during actual performance.AbstractRespiratory aerosols can serve as vectors for disease transmission, and aerosol emission is highly activity-dependent. COVID-19 severely impacted the performing arts due to concerns about disease spread by respiratory aerosols and droplets generated during singing and playing musical instruments. Aerosol generation from woodwind and brass performance is less understood compared to singing due to uncertainty about how the diverse range of musical instruments may impact respiratory aerosol concentrations and size distributions. Here, aerosol number and mass concentrations along with size distributions were measured for breathing, speaking, and playing four different woodwind and brass instruments by 23 professional instrumentalists. We find that a 1 dBA increase in sound pressure level corresponds to a ∼10% increase in aerosol number concentration. The aerosol size distribution is consistent with that of breathing. Differences in aerosol emission across musical instruments can be partly explained by the loudness of performance. Measuring aerosol generation from single notes or simple songs may be sufficient to characterise the aerosol emission range during actual performance, provided a range of loudnesses are accessed. These results provide insight into the factors contributing to aerosol emission during musical performance and facilitate risk assessments associated with infectious respiratory disease transmission in the performing arts

Childhood brain tumors: A review of strategies to translate CNS drug delivery to clinical trials

Brain tumors account for over 20% of childhood cancers and are the biggest cancer killer in children and young adults. Several initiatives over the past 40 years have tried to identify more effective drug treatments, but with very limited success. This is largely due to the bloodâ brain barrier, which restricts the entry of many drugs into the brain. In this review, we describe the main techniques that are being developed to enhance brain tumor drug delivery and explore the preclinical brain tumor models that are essential for translational development of these techniques. We also identify existing approved drugs that, if coupled with an efficient delivery method, could have potential as brain tumor treatments. Bringing this information together is part of a funded initiative to highlight drug delivery as a research strategy to overcome the current challenges for children diagnosed with brain tumors

Effects of leucine-enriched essential amino acid and whey protein bolus dosing upon skeletal muscle protein synthesis at rest and after exercise in older women

Background & aims: Impaired anabolic responses to nutrition and exercise contribute to loss of skeletal muscle mass with ageing (sarcopenia). Here, we tested responses of muscle protein synthesis (MPS), in the under represented group of older women, to leucine-enriched essential amino acids (EAA) in comparison to a large bolus of whey protein (WP). Methods: Twenty-four older women (65 ± 1 y) received (N ¼ 8/group) 1.5 g leucine-enriched EAA supplements (LEAA_1.5), 6 g LEAA (LEAA_6) in comparison to 40 g WP. A primed constant I.V infusion of 13C6-phenylalanine was used to determine MPS at baseline and in response to feeding (FED) and feeding-plus-exercise (FED-EX; 6 x 8 unilateral leg extensions; 75%1-RM). We quantified plasma insulin/AA concentrations, leg femoral blood flow (LBF)/muscle microvascular blood flow (MBF), and anabolic signalling via immunoblotting. Results: Plasma insulineamia and EAAemia were greater and more prolonged with WP than LEAA, although LEAA_6 peaked at similar levels to WP. Neither LEAA or WP modified LBF or MBF. FED increased MPS similarly in the LEAA_1.5, LEAA_6 and WP (P < 0.05) groups over 0e2 h, with MPS significantly higher than basal in the LEAA_6 and WP groups only over 0e4 h. However, FED-EX increased MPS similarly across all the groups from 0 to 4 h (P < 0.05). Only p-p70S6K1 increased with WP at 2 h in FED (P < 0.05), and at 2/4 h in FED-EX (P < 0.05). Conclusions: In conclusion, LEAA_1.5, despite only providing 0.6 g of leucine, robustly (perhaps maximally) stimulated MPS, with negligible trophic advantage of greater doses of LEAA or even to 40 g WP. Highlighting that composition of EAA, in particular the presence of leucine rather than amount is most crucial for anabolism