Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials

BACKGROUND: To compare single- with two- layer intestinal anastomosis after intestinal resection: a meta-analysis of randomized controlled trials. METHODS: Randomized controlled trials comparing single- with two-layer intestinal anastomosis were identified using a systematic search of Medline, Embase and the Cochrane Library Databases covering articles published from 1966 to 2004. Outcome of primary interest was postoperative leak. A risk ratio for trial outcomes and weighted pooled estimates for data were calculated. A fixed-effect model weighted using Mantel-Haenszel methods and a random-effect model using DerSimonian-Laird methods were employed. RESULTS: Six trials were analyzed, comprising 670 participants (single-layer group, n = 299; two-layer group, n = 371). Data on leaks were available from all included studies. Combined risk ratio using DerSimonian-Laird methods was 0.91 (95% CI = 0.49 to 1.69), and indicated no significant difference. Inter-study heterogeneity was significant (χ(2 )= 10.5, d.f. = 5, p = 0.06). CONCLUSION: No evidence was found that two-layer intestinal anastomosis leads to fewer post-operative leaks than single layer. Considering duration of the anastomosis procedure and medical expenses, single-layer intestinal anastomosis appears to represent the optimal choice for most surgical situations

Impact of concomitant thyroid pathology on preoperative workup for primary hyperparathyroidism

BACKGROUND: The former standard surgical treatment in patients with primary hyperparathyroidism (pHPT) has been bilateral cervical exploration. New localization techniques and the possibility of intraoperative measurement of intact parathormone (iPTH) permit a focused, minimally invasive parathyroidectomy (MIP). The introduction of MIP without complete neck exploration leads to the potential risk of missing thyroid pathology. The aim of the present study is to evaluate the value of MIP in respect to coexisting thyroid findings and their impact on preoperative workup for primary hyperparathyroidism. METHODS: This is a prospective study including 30 consecutive patients with pHPT (median age 65 years; 17 females, 13 males). In all patients preoperative localization was performed by ultrasonography and 99m Tc-MIBI scintigraphy- Intraoperative iPTH monitoring was routinely done. RESULTS: Ten patients (33%) had a concurrent thyroid finding requiring additional thyroid surgery, and two patients (7%) with negative localization results underwent bilateral neck exploration. Therefore, MIP was attempted in 18 (60%) patients. The conversion rate to a four gland exploration was 6% (1/18). The sensitivities of 99m Tc-MIBI scanning and ultrasonography were 83.3% and 76.6%, respectively. The respective accuracy rates were 83.3% and 76.6%. Of note, the combination of the two modalities did not improve the sensitivity and accuracy in our patient population. During a median follow-up of 40 months, none of the patients developed persistent or recurrent hypocalcaemia, resulting in a 100% cure rate. CONCLUSION: Coexisting thyroid pathology is relatively frequent in patients with pHPT in our region. Among patients having pHPT without any thyroid pathology, the adenoma localization is correct with either ultrasonography or 99m Tc-MIBI scintigraphy in the majority of cases. MIP with iPTH monitoring are highly successful in this group of patients and this operative technique should be the method of choice

Rapid HIV testing program implementation: lessons from the emergency department

Background: The US Centers for Disease Control and Prevention (CDC) guidelines and the World Health Organization (WHO) both recommend HIV testing in health-care settings. However, neither organization provides prescriptive details regarding how these recommendations should be adapted into clinical practice in an emergency department. Methods: We have implemented an HIV-testing program in the ED of a major academic medical center within the scope of the Universal Screening for HIV Infection in the Emergency Room (USHER) Trial—a randomized clinical trial evaluating the feasibility and cost-effectiveness of HIV screening in this setting. Results and conclusion: Drawing on our collective experiences in establishing programs domestically and internationally, we offer a practical framework of lessons learned so that others poised to embark on such HIV testing programs may benefit from our experiences

Habitat manipulation to mitigate the impacts of invasive arthropod pests

Exotic invaders are some of the most serious insect pests of agricultural crops around the globe. Increasingly, the structure of landscape and habitat is recognized as having a major influence on both insect pests and their natural enemies. Habitat manipulation that aims at conserving natural enemies can potentially contribute to safer and more effective control of invasive pests. In this paper, we review habitat management experiments, published during the last 10 years, which have aimed to improve biological control of invasive pests. We then discuss during what conditions habitat management to conserve natural enemies is likely to be effective and how the likelihood of success of such methods can be improved. We finally suggest an ecologically driven research agenda for habitat management programmes.We acknowledge the following funding sources: the Tertiary Education Commission, New Zealand, through the Bio-Protection Research Centre, Lincoln University, New Zealand (Mattias Jonsson and Steve Wratten), the New Zealand Foundation for Research, Science and Technology (FRST); project LINX0303 (Steve Wratten, Ross Cullen, Jean Tompkins), Lincoln University, New Zealand, for a Post-graduate Scholarship to Jean Tompkins, USDA CSREES Risk Avoidance and Mitigation Program (2004-51101-02210), USDA NC SARE Project (LCN 04-249), USDA CSREES Arthropod and Nematode Biology (2004-35302-14811), North Central Regional IPM, NSF-LTER at Kellogg Biological Station (NSF DEB 0423627), and the Michigan Agricultural Experiment Station (Doug Landis)

Toxicity of nanofibers on zebrafish embryogenesis – Impact of materials properties on inflammatory responses

Textile microfibers are the most common form of microplastic pollution and among the most dangerous to wildlife across multiple biomes. Besides toxicological challenges arising from their shapes, the morphology of fibrous materials make them excellent adsorbents and transportation media for harmful chemical pollutants and support both uptake and bioaccumulation across living organisms. The fragmentation of microfibers used in the textile industry is shown to lead to the formation of a broad range of sub-micron and nanofibers, with greater surface to volume ratio and much finer diameters, whose toxicity and environmental impact are not yet understood. Here, the impact of nanofibers on zebrafish embryos is studied to reveal risks associated with nanofiber pollution during early developmental stages. Exposure of embryos to nanofibers at a similar concentration to what has been observed in polluted water streams was found to dramatically increase apoptosis, neutrophils, and cytokine production that the chorion was unable to protect against. Furthermore, disturbed vascular basement membrane assembly in exposed embryos was detected leading to an expanded dorsal aorta diameter. These results obtained with model nanofibers demonstrate the risks of fragmented microplastics and the impact of surface properties on uptake and response by living organisms