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Although racial disparities in receipt of immediate breast reconstruction (IBR) have been previously reported, prior studies may not have fully assessed the impact of recent advocacy efforts as healthcare disparities gain increased national attention. The aim of this study is to assess more recent racial differences and annual trends in receiving IBR. Using the National Surgery Quality Improvement Program database, black or white women over 18 years who underwent mastectomy from 2012 to 2021 were included. IBR was defined by undergoing mastectomy with breast reconstruction during the same anesthetic event. Propensity score analysis was utilized to balance variables between black and white patients. A multivariate logistic regression was performed to determine the effect of race on the odds of receiving IBR. The annual percentage of white patients receiving IBR remained stable at around 50% throughout the study period. The annual percentage of black patients receiving IBR increased from 34% in 2012 to 49% in 2021. Compared with white patients, black patients had lower odds of receiving IBR during the entire study period (odds ratio 0.57, 95% confidence interval 0.49–0.67). When assessing annual trends, black patients were less likely to receive IBR each year from 2012 to 2017. By 2021, both races had similar odds of IBR. Although racial disparities in IBR have been longstanding, this study demonstrates that the racial gap appears to be closing. This may be because of increased awareness of racial disparities and their impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Immediate contraceptive initiation, including start of a method before abortion completion, is a convenient option for women seeking abortion care.Objectives: To evaluate the effect of systemic hormonal contraception initiation on medical abortion effectiveness and the safety of hormonal contraceptive methods following abortion.Data Sources: PubMed, Popline, Cochrane Library, and Clinicaltrials.gov.Study Eligibility Criteria: Studies that assessed medical abortion effectiveness after systemic hormonal contraception initiation and the safety of hormonal contraception initiation after abortion.Participants: Pregnant persons undergoing or who had recently undergone an abortion.Interventions: Initiation of systemic hormonal contraception post abortion or on the day of the first pill of the medical abortion.Study Appraisal and Synthesis Methods: We assessed study quality using the US Preventive Services Task Force evidence grading system. We created narrative summaries and calculated pooled relative risks when appropriate.Results: We identified 16 studies for inclusion, 7 randomized controlled trials, and 9 cohorts. Nine studies assessed medical abortion effectiveness with hormonal contraception initiation and generally found no decreased risk of abortion success or increased risk of additional treatment. One fair-quality study reported a small increase in ongoing pregnancy rate with immediate depot medroxyprogesterone (DMPA) compared with delayed DMPA initiation (3.6% vs 0.9%, risk difference 2.7%, 90% confidence interval 0.4-5.6). We identified no bleeding-related safety concerns following hormonal contraception initiation after medical or surgical abortion. Pooled results were too imprecise to draw firm conclusions.Limitations: Included studies were poor or fair quality and primarily in high-income or upper-middle-income settings.Conclusions: Abortion effectiveness did not differ between immediate vs delayed initiation of most systemic hormonal contraceptive methods after a first trimester medical abortion. However, immediate DMPA initiation did show increased ongoing pregnancy. Bleeding effects with hormonal contraception initiation postabortion appeared minimal.Implications: Initiating a hormonal contraceptive method after an abortion and as early as the same day as the first pill of the medical abortion is an option if contraception is desired. The slight increase in ongoing pregnancy with immediate DMPA initiation highlights the importance of information provision during contraceptive counseling. [ABSTRACT FROM AUTHOR]

The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety. [ABSTRACT FROM AUTHOR]

Objectives: To provide updated and more detailed pooled intrauterine device expulsion rates and expulsion risk estimates among women with postpartum intrauterine device placement by timing of insertion, delivery type, and intrauterine device type to inform current intrauterine device insertion practices in the United States.Data Sources: We searched PubMed, Cochrane Library, and ClinicalTrials.gov through June 2019.Study Eligibility Criteria: We included all studies, of any study design, that examined postpartum placement of Copper T380A (copper) or levonorgestrel-containing intrauterine devices that reported counts of expulsion.Study Appraisal and Synthesis Methods: We evaluated intrauterine device expulsion among women receiving postpartum intrauterine devices in the "immediate" (within 10 minutes), "early inpatient" (>10 minutes to <72 hours), "early outpatient" (72 hours to <4 weeks), and interval (≥4 weeks) time periods after delivery. We assessed study quality using the US Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of partial and complete intrauterine device expulsion separately and estimated adjusted relative risks by the timing of postpartum placement, delivery type, and intrauterine device type using log-binomial multivariable regression.Results: We identified 48 level I to II-3 studies of poor to good quality that reported a total of 7661 intrauterine device placements. Complete intrauterine device expulsion rates varied by timing of placement as follows: 10.2% (range, 0.0-26.7) for immediate; 13.2% (3.5-46.7) for early inpatient; 0% for early outpatient; and 1.8% (0.0-4.8) for interval placements. Complete intrauterine device expulsion rates also varied by delivery type: 14.8% (range, 4.8-43.1) for vaginal and 3.8% (0.0-21.1) for cesarean deliveries. Among immediate postpartum vaginal placements, the expulsion rate for levonorgetrel intrauterine devices was 27.4% (range, 18.8-45.2) and 12.4% (4.8-43.1) for copper intrauterine devices. Compared with interval placement, immediate and early postpartum placements (inpatient and outpatient combined) were associated with greater risk of complete expulsion (adjusted risk ratio, 8.33; 95% confidence interval, 4.32-16.08, and adjusted risk ratio, 5.27; 95% confidence interval, 2.56-10.85, respectively). Among immediate postpartum placements, risk of expulsion was greater for placement after vaginal compared with cesarean deliveries (adjusted risk ratio, 4.57; 95% confidence interval, 3.49-5.99). Among immediate placements at the time of vaginal delivery, levonorgestrel intrauterine devices were associated with a greater risk of expulsion compared with copper intrauterine devices (adjusted risk ratio, 1.90; 95% confidence interval, 1.36-2.65).Conclusion: Although intrauterine device expulsion rates vary by timing of placement, type, and mode of delivery, intrauterine device insertion can take place at any time. Understanding the risk of intrauterine device expulsion at each time period will enable women to make an informed choice about when to initiate use of an intrauterine device in the postpartum period based on their own goals and preferences. [ABSTRACT FROM AUTHOR]

Preliminary evidence indicates beneficial acute effects of resistance exercise on domain-specific cognitive function. Studies on dose response relationships and underlying mechanisms so far failed to deduce the impact of intensity and overall workload. To analyze the impact of different intensities and workloads on effects of full body resistance training on cognitive attention, executive function performance, and affective response. Twenty-six volunteers (9 (35%) female, age 25.9 ± 4.0 years) participated in three workload-matched (60%, 75% and 90% one repetition maximum intensity (1RM) resistance exercise interventions (RE)) and one workload reduced but intensity matched (75% 1RM, 50% overall workload) RE. Order was randomized, REs were on separate days with ≥48 h washout in between. Stroop Test performance (Attention: word and color condition; Interference control: word color interference), self-perceived levels of arousal and ability to concentrate were assessed before and after each RE. Workload-matched REs induced significant changes in attention and interference control. The workload reduced 75% 1RM RE induced changes in interference control, but no changes in attention performance. 75% 1RM exercise with full and 50% workload induced significant changes in arousal. Only 75% 1RM exercise with full workload significantly increased participants ability to concentrate. The repeated measures ANCOVA (Covariates: sex and fluid intelligence) indicated greater changes of interference control after 60% 1RM compared to 90% 1RM RE and greater changes of attention performance after 90% 1RM compared to 75% 1RM and 50% workload RE. Higher cognitive functions such as interference control seem to particularly benefit from moderate intensity RE whereas lower cognitive functions may be stimulated by higher intensity and higher workload RE. Self-perceived subjective factors did not mediate these dose response relationships. Future studies could analyze changes in cortisol levels, oxygenation, blood flow or electrophysiological signals to deduce triggers for increased stimulus-driven brain response and more controlled brain function. • The first study deducing the impact of intensity and workload. • Higher cognitive functions seem to benefit from moderate intensity resistance exercise. • Lower cognitive functions may be stimulated by higher intensity and higher workload resistance exercise. • Affective response to resistance exercise was associated with beneficial effects on cognitive function. • Affective response was not associated with workload or intensity dependent dose response relationships. [ABSTRACT FROM AUTHOR]

The management of symptomatic giant hepatic hemangiomas (> 10 cm) varies in the literature. Multiple interventional approaches have been described including surveillance, embolization, enucleation, and resection based on tumor size, location, relationship to vascular and biliary structures, and the quality and quantity of the functional liver remnant. Resection is often performed as a last resort due to the risk of major hemorrhage. Preoperative arterial embolization is an option; however, many patients will experience severe pain, fever, transaminitis, acidosis, recanalization, and collateral inflow that limit its utility. Furthermore, patients require post-procedure inpatient observation, and there is no consensus on the appropriate time interval between procedures. We present and demonstrate a technique in the video that utilizes a hybrid operating room with on-table angiogram capabilities to perform hemangioma inflow embolization and immediate hepatic resection under the same anesthesia in a single procedure. Combining on-table embolization with immediate resection avoids many of the pitfalls of preoperative embolization, while enhancing the safety of the resection by decreasing the size of the tumor, enabling compressibility, and facilitating exposure of the vascular inflow and outflow. It is an efficient use of hospital resources and eliminates an intervening hospital admission. We have found it to be a preferred approach to enhance the safety and feasibility of resection for massive hepatic hemangiomas with minimal intraoperative blood loss and reduced risk. [ABSTRACT FROM AUTHOR]

The current study aimed to examine the effect of giving temporally framed health information regarding either the immediate or long-term health consequences of consuming high-calorie snacks, for people with high Negative Urgency (a dimension of impulsivity), and for those primed with impulsivity. We expected that for participants with high Negative Urgency, and those primed with impulsivity, information which detailed the immediate health benefits of avoiding snack consumption would be more effective than information which detailed long-term health benefits. Participants (N=110) completed a measure of Negative Urgency, reported their snacking frequency over the previous seven days, and completed either an impulsivity or neutral prime task. Following this, they read information detailing either the immediate or long-term health benefits of avoiding high-calorie snacks. High-calorie snack consumption was reported 7days later. The results showed a significant three-way interaction between Negative Urgency, prime task, and temporal frame. Participants who were primed with impulsivity and those high in Negative Urgency showed a greater reduction in snacking frequency after being given information about the immediate vs. long-term health benefits of snacking. The results suggest that the immediacy of health consequences should be considered when designing health information to reduce impulsive snacking behaviour. [ABSTRACT FROM AUTHOR]

In the case of prelabor rupture of membranes at term, the risk for neonatal and maternal infectious morbidity increases progressively with time from prelabor rupture of membranes. Although most studies identified a benefit associated with early induction within the first 24 hours following term prelabor rupture of membranes, there is currently no precise data regarding how early should induction be scheduled. This study aimed to identify the optimal timing of labor induction among women with term prelabor rupture of membranes by comparing the maternal and neonatal outcomes associated with labor induction with those of expectant management at any given 1-hour interval following prelabor rupture of membranes. This was a secondary analysis of data from the TERMPROM trial, an international, multicenter, randomized clinical trial on immediate delivery vs expectant management of women with prelaor rupture of membranes at term (≥37+0/7 weeks' gestation). We considered all participants as a single cohort of women with term prelabor rupture of membranes, irrespective of the original randomized study group allocation. For each given 1-hour time interval within the first 36 hours following prelabor rupture of membranes, we compared the outcomes of subjects for whom labor induction was initiated during this interval with those of subjects managed expectantly at the same time interval. The primary neonatal outcome was a composite of neonatal infection and admission to the neonatal intensive care unit. The primary maternal outcomes included maternal infection (clinical chorioamnionitis or postpartum fever) and cesarean delivery. Of the 4742 subjects who met the study criteria, 2622 underwent labor induction, and 2120 experienced a spontaneous onset of labor. The rates of the neonatal composite outcome, neonatal admission to intensive care unit, and maternal infection increased progressively with time after prelabor rupture of membranes. The risk for these outcomes was lower among women who underwent induction when compared with those managed expectantly within the first 15 to 20 hours after prelabor rupture of membranes without affecting the risk for cesarean delivery. In addition, women who underwent labor induction within the first 30 to 36 hours had a shorter prelabor rupture of membranes to delivery time and a shorter total maternal hospital stay when compared with those managed expectantly at the same time interval. Among women managed expectantly, less than two-thirds (64%; 1365/2120) experienced a spontaneous onset of labor within the first 24 hours following prelabor rupture of membranes. These findings suggest that immediate labor induction seems to be the optimal management strategy to minimize neonatal and maternal morbidity in the setting of prelabor rupture of membranes at term gestations. In cases for which immediate induction is not feasible, labor induction remains the preferred option over expectant management if performed within the first 15 to 20 hours after prelabor rupture of membranes. [ABSTRACT FROM AUTHOR]

Summary Introduction Women undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction may be offered a contralateral symmetrisation either at the time of reconstruction (simultaneous/immediate) or at a later stage (delayed). Simultaneous contralateral breast symmetrisation may be more beneficial to patients and healthcare institutions by avoiding staged surgery, although there is limited evidence on which to base practice. This deficit formed the rationale for our study. The primary outcome was the overall rate of revision surgery. Methods Over a 6-year period, this prospective cohort study recorded the demographics, cancer treatments and operative outcomes of all consecutive unilateral DIEP flap breast reconstructions with or without contralateral symmetrising surgery. Patients were categorised into three groups: (1) simultaneous symmetrisation, 2) delayed symmetrisation and (3) no symmetrisation for comparative analysis. Results During the study period, 371 women underwent unilateral DIEP flap breast reconstruction 194 (52.3%) were not symmetrised, 155 (41.8%) were simultaneously symmetrised and 22 (5.9%) underwent delayed symmetrisation. Simultaneous symmetrisation of the contralateral breast and unilateral DIEP flap breast reconstruction increased the mean total operative time by 28 min. There were no differences in the rates of peri-operative complications. There were significantly higher rates of all-cause revision surgery (OR 3.97 [1.58, 9.94], p = 0.003) in women undergoing delayed symmetrisation, because of higher rates of revision lipomodelling, scar revision and revision contralateral symmetrisation. Conclusion Simultaneous contralateral breast symmetrisation was associated with a lower risk of all-cause revision surgery. It is safe, beneficial and likely to be more cost-effective for women undergoing unilateral free DIEP flap breast reconstruction. [ABSTRACT FROM AUTHOR]

Summary Because of the inevitable postoperative shrinkage, an initial hypercorrection is emphasized in nipple reconstruction with a random skin flap. However, the breast shape will be damaged if an excessively large flap is raised on the surface of the breast mound. A technique for immediate two-stage nipple reconstruction with a local mastectomy flap during the secondary breast reconstruction was reported in this study. From February 2011 to March 2014, 33 patients underwent breast reconstruction and immediate two-stage nipple reconstructions. A bipedicle deep inferior epigastric artery perforator (DIEP) flap was raised and folded upward to form the breast. Simultaneously, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of the future nipple. After 3 weeks, the pedicle of the mastectomy flap was divided, and the paddle was modeled to form the new nipple. Both the new nipple and the DIEP flaps survived postoperatively. The average projection of the reconstructed nipple was 15.4 ± 2.7 mm immediately after the surgery, which gradually decreased to 8.2 ± 1.1 mm during the first year of follow-up. A total of 29 patients ranked the aesthetic appearance of the reconstructed nipple and breast as “very good” or “good.” On the basis of our breast-shaping techniques, the proposed immediate two-stage nipple reconstruction approach is able to maintain long-term residual projection and results in considerable patient satisfaction. Level of evidence IV. [ABSTRACT FROM AUTHOR]

Study design: Prospective cohort. Introduction: The Immediate Controlled Active Motion program, used to manage extensor tendon repairs in the hand, immobilizes the wrist in an orthosis with the affected finger(s) placed in a separate yoke orthosis allowing controlled flexion. Purpose: To compare our outcomes using similar programs in patients with simple extensor tendon lacerations to those previously reported. To compare our 4-week orthotic intervention to our 6-week orthotic intervention. Methods: 18 subjects received a 4-week orthotic intervention, 45 subjects received a 6-week orthotic intervention. Range of motion was measured 4, 6 and 8 weeks post-repair, grip strength at 6 and 8 weeks, and patient-rated outcomes at baseline, 6 and 12 weeks post-repair. Results: Significant improvements in all outcomes were seen over time (p < 0.0001), with no significant differences between programs. Conclusion: Outcomes were comparable with those previously published and similar between the 4-week and 6-week orthotic interventions. Level of evidence: III [ABSTRACT FROM AUTHOR]

Abstract: Complete control of emesis caused by cyclophosphamide (CPA) is of immense interest to both patients and physicians. Serotonin 5-HT3- and tachykinin NK1-receptor antagonists are widely used antiemetics in clinic, but they fail to completely control CPA-induced emesis. New antiemetic targets for the full control of CPA-induced vomiting are lacking. We therefore examined the effects of CPA on emetic targets downstream of 5-HT3- and NK1- receptors in an attempt to better understand the molecular bases of CPA-induced emesis. Acute CPA (200mg/kg, i.p.) administration in the least shrew caused a biphasic pattern of emesis over a 40h observation period, with maximal peak vomit frequency during the 1st hour of treatment (acute phase), followed by a delayed-phase which peaks at 27th hour. The NK1 receptor mRNA levels increased significantly at 8h post-CPA treatment in the brainstem, and at 28h in the whole intestine. Substance P mRNA levels tended to increase both in the brainstem and intestine at most time-points post-CPA injection, however due to large variability, they failed to attain significance. Likewise, protein expression profiles of both NK1- and 5-HT3 -receptors in the brainstem were unchanged at any time-point. However, phosphorylation levels of protein kinase A (PKA), but not of extracellular signal-regulated protein kinase 1/2 (ERK1/2), were increased at 2, 8, 22, 28, and 33h time-points after the treatment with CPA. Moreover, brainstem but not frontal cortex cAMP tissue levels tended to be elevated at most time-points, but significant increases occurred only at 1 and 2h post-CPA treatment. The phosphodiesterase inhibitor, rolipram, caused significant increases in shrew brainstem cAMP levels which were associated with its capacity to produce vomiting, while pretreatment with SQ22536, an inhibitor of adenylyl cyclase, prevented rolipram-induced emesis. The results demonstrate that accumulation of cAMP and subsequent activation of PKA in the brainstem may help to initiate and sustain emesis induced by CPA in the least shrew. Our findings suggest that suppression of the cAMP/PKA cascade may have antiemetic potential in the management of CPA-induced emesis. [Copyright &y& Elsevier]

Summary: Background: There remains controversy as to whether immediate autologous breast reconstruction with postoperative radiotherapy is associated with acceptable complications and aesthetic outcomes. This systematic review analyses the literature regarding outcomes of immediate autologous breast reconstruction with postoperative radiotherapy compared with no radiotherapy, as well as with delayed autologous breast reconstruction following post-mastectomy irradiation. Methods: Pubmed (1966 to October 2012), Ovid MEDLINE (1966 to October 2012), EMBASE (1980 to October 2012), and the Cochrane Database of Systematic Reviews (Issue 10, 2012) were searched. Overall complications (including fat necrosis), fat necrosis, revisional surgery, loss of volume, and aesthetic outcome, were analysed individually. Comparable data from observational studies were combined for meta-analysis where possible and quality assessment of the studies was performed. Results: The majority of studies of immediate autologous breast reconstruction and postoperative radiotherapy reported satisfactory outcomes (19 of 25 studies; n = 1247 patients). Meta-analysis of observational studies demonstrated no significant differences in total prevalence of complications (p = 0.59) or revisional surgery (p = 0.38) and a summary measure for fat necrosis favouring the group without radiotherapy (OR 2.82, 95% CI 1.35–5.92, p = 0.006). The majority of studies comparing immediate reconstruction and postoperative radiotherapy with delayed reconstruction following post-mastectomy radiotherapy (10 of 12 observational studies; n = 1633 patients) reported satisfactory outcomes following immediate reconstruction. Meta-analysis of observational studies demonstrated no significant difference in overall incidence of complications (p = 0.53) and fat necrosis (OR 0.63, 95% CI 0.29–1.38, p = 0.25), and a summary measure for revisional surgery (OR 0.15, 95% CI 0.05–0.48, p = 0.001) favouring the delayed surgery group. No randomised-controlled trials met the inclusion criteria, and all of the observational studies included were missing more than one important component for reporting of observational studies. Discussion: The majority of studies reported satisfactory outcomes and a similar incidence of complications for immediate autologous breast reconstruction and adjuvant radiotherapy when compared with no radiotherapy or delayed reconstruction following radiotherapy; the proportion that required revisional surgery was higher though for immediate than delayed breast reconstruction. The findings are limited by the paucity of high quality data in the published literature, and until better data is available the findings of this review suggest that immediate autologous breast reconstruction should at least be considered when adjuvant chest wall radiotherapy is anticipated. [Copyright &y& Elsevier]

Abstract: Immediate placement refers to the placement of an implant into a tooth socket at the time of extraction; early placement refers to the placement of an implant after substantial gingival healing, but before any clinically significant bone fill occurs within the socket. This study evaluated the success and survival rates of implants following immediate and early placement. 50 implants were placed in 36 patients. 26 immediate (group I) and 24 early placements (group II) were performed. Pain or tenderness with function, mobility, radiographic bone loss from initial surgery and exudate history were evaluated. Mean vertical bone loss in the immediate placement group was 0.55mm and 0.80mm in the early placement group. The survival rate for the immediate placement group was 96.16% with 51.6 months follow-up and in the early placement group was 100% with 61.9 months follow-up. The results of this study suggest that although the success and survival rates of early placed implants were a little higher and the follow up period was longer than immediately placed implants, the difference was not remarkable. In conclusion, both implant insertion techniques are safe and reliable procedures with considerably high survival rates. [Copyright &y& Elsevier]

Abstract: Scant information is available regarding the effects of cisplatin on the expression profile of tachykinin NK1 receptors and downstream signaling during cisplatin-induced emesis. Cisplatin causes peak early- and delayed-phase emesis in the least shrew at 1–2 and 33h post-injection. To investigate the expression profile of NK1 receptor during both emetic phases, we cloned the cDNA corresponding to a ∼700 base pairs of mRNA flanked by two stretches of nucleotides conserved among different species and demonstrated that the shrew NK1 receptor nucleotide sequence shares ∼90% sequence identity with the human NK1 receptor. Of the 12 time-points tested, significant increases in expression levels of NK1 receptor mRNA in the shrew brainstem occurred at 2 and 28h post-cisplatin injection, whereas intestinal NK1 receptor mRNA was increased at 28h. Shrew brainstem and intestinal substance P mRNA levels also tended to increase during the two phases. Furthermore, expression levels of NK1 receptor protein were significantly increased in the brainstem at 2, 8, and 33h post-cisplatin. No change in brainstem 5-HT3 receptor protein expression was observed. The temporal enhancements in NK1 receptor protein expression were mirrored by significant increases in the phosphorylation status of the brainstem ERK1/2 at 2, 8, and 33h post-cisplatin. Phosphorylation of PKA significantly increased at 33rd and 40th hour. Our results indicate associations between cisplatin’s peak immediate- and delayed-phase vomiting frequency with increased: (1) expression levels of NK1 receptor mRNA and its protein level, and (2) downstream NK1 receptor-mediated phosphorylation of ERK1/2 and PKA signaling. [Copyright &y& Elsevier]

Abstract: This will provide an overview of allergy to facilitate an understanding of the epidemiology, immuno-pathology, and the early life origins of the allergic diseases, which are increasing in prevalence worldwide. This veritable allergy epidemic poses a significant public health burden in both the developed and the developing worlds and makes optimal allergy care in both primary and tertiary settings a priority. A clear body of literature supports the commonly observed evolution of early food allergies and atopic dermatitis to the later development of the airways allergic diseases, namely allergic rhinitis and asthma. The main hypotheses behind these concepts are described. A typical clinical case is discussed in order to highlight this allergic march in the clinical setting and current and future strategies for allergy prevention are explored. [Copyright &y& Elsevier]

Abstract: Objectives: To investigate the pathomechanisms involved in cases of immediate hypersensitivity reactions occurring after the administration of iodinated contrast media. Materials and methods: Patients having presented clinical signs of immediate hypersensitivity suggesting allergy after iodinated contrast medium were investigated. Histamine and tryptase concentrations were measured, and/or skin tests were performed. Patients with positive skin tests to the culprit contrast agent were classified as IgE-mediated allergic hypersensitivity (Group I) and patients with negative skin tests as non-allergic hypersensitivity (Group II). Results: 38 patients were included. Most reactions appeared after non-ionic (n =32). Reactions were more frequently severe following ionic than non-ionic (p =0.014). Skin testing was not performed in 11 patients. Skin tests with the culprit contrast agent were negative in 26% of the patients (Group II, n =7) whereas they were found positive with the contrast agent in 73% of the patients (Group I, n =19). Latex-induced reaction was diagnosed in one patient, and was consequently excluded from the cohort. In Group I, the frequency of cross-reactivity with the other commercialized iodinated contrast media was low (7%). Cardiovascular signs were present in Group I (52.6%, n =10), and absent in Group II (p =0.023). Histamine and tryptase concentrations were higher in patients who had cardiovascular signs (p <0.02). Conclusion: Immediate reactions with clinical signs suggesting allergy along with positive skin tests with the administered contrast agent confirm immediate allergic hypersensitivity (anaphylaxis) to this agent. Consequently, the culprit contrast agent should be definitely avoided as well as cross-reactive ICM in order to prevent further recurrences. [Copyright &y& Elsevier]

Abstract: This report demonstrates the clinical use of a modified, truly anatomic, root-analogue zirconia implant for immediate replacement of a two-rooted, left first mandibular molar. A 50-year-old female patient with chronic apical periodontitis of the left mandibulary first molar was referred and the tooth was extracted. The mesial root had to be removed surgically due to a root fracture. A truly anatomical, root identical, roughened zirconia implant modified by macro-retentions was manufactured and placed into the extraction socket by tapping 7 days later. After 4 months a composite crown was cemented in place. No complications occurred during the healing period. A good functional and aesthetic result was achieved with minimal bone resorption and soft tissue recession at 30 months follow-up. This report describes the successful clinical use of an immediate, single stage, truly anatomical root-analogue zirconia implant for replacement of a two-rooted tooth. Significant modifications such as macro-retentions yielded primary stability and excellent osseointegration. This novel approach is minimally invasive, respects the underlying anatomy, aids socket prevention, is time- and cost-saving with good patient acceptance as there is no need for bone drilling, sinus lift, bone augmentation or other traumatic procedures. [Copyright &y& Elsevier]

Abstract: This study evaluated non-submerged, root-analogue zirconia implants with two different surfaces for immediate single-rooted tooth replacement in 18 patients. After tooth extraction the root was laser scanned and one-piece root analogue zirconia dental implants with one of two different surfaces were manufactured. In group A (n =6) the implant surface was roughened by sandblasting only, in group B (n =12) additional macroretentions limited to the interdental space, to avoid fracture of the thin buccal cortex, were designed prior to laser scanning. Implants were placed in the socket 1–8 days after extraction by tapping and restored with a composite crown 3–5 months later. Implant survival, level of marginal bone and adverse soft tissue changes were recorded. No complications occurred during the healing period. In group A, all implants were lost within 2 months, with an unaltered extraction socket. In group B, overall survival rate was 92% for implants that were functional for 1–33 months. Excellent aesthetic and functional results were achieved with the composite crown with minimal bone resorption and soft tissue recession. Significant modifications, such as macroretentions seem to indicate that primary stability and excellent osseointegration of immediate root-analogue zirconia implants can be achieved, while preventing unaesthetic bone resorption. [Copyright &y& Elsevier]

• Early commencement of oxytocin augmentation significantly reduced the duration of labour by 72 min. • More successful vaginal deliveries were seen within 4 h of amniotomy in the early oxytocin augmentation group. • No difference in adverse neonatal outcomes was seen between the early and delayed oxytocin augmentation groups. to compare the effect of amniotomy with early vs delayed oxytocin infusion on successful vaginal delivery. randomised controlled trial of nulliparous women with spontaneous labour at term. Setting: labour suite of a university teaching hospital in Kuala Lumpur, Malaysia. 240 women were included (120 randomised into two arms). the randomisation sequence was generated using a computer randomisation program in two blocks: oxytocin infused early following amniotomy; and oxytocin infused 2 h after amniotomy. labour duration, mode of delivery, oxytocin dosage used, uterine hyperstimulation, postpartum haemorrhage, Apgar score and admission to the neonatal intensive care unit were recorded. No differences in vaginal delivery rate (62.9% vs 70.9%; p = 0.248) and second-stage labour were found between the early and delayed oxytocin infusion groups (21.2 ± 18.3 min vs 25.5 ± 19.9 min; p = 0.220). The mean interval from amniotomy to vaginal delivery was significantly shorter for the early group (5.8 ± 1.7 h vs 7.0 ± 1.9 h; p = 0.001), and more women in the early group delivered during/before the planned review at 4 h after amniotomy (53.6% vs 10.6%; p <0.001). Maximum oxytocin usage was lower in the early group (5.6 ± 4.4 mL/hour vs 6.8 ± 5.3 mL/hour; p = 0.104). early oxytocin augmentation following amniotomy could be employed in low-risk primigravida, given that it is associated with a shorter labour duration without jeopardising maternal or neonatal outcomes. low-risk primigravida benefit from early oxytocin infusion following amniotomy, and this can be offered as an additional practice in labour room care. [ABSTRACT FROM AUTHOR]

Abstract: To determine effects of APOE ε4 (ε4) on cognitive performance of healthy elderly, 116 nondemented elders (mean age 81 years) were cognitive tested. The established tests Faces, Family Pictures, Spatial Span Forward and Backward, and the object recognition and spatial navigation tests developed in our laboratory were used as cognitive tests. Salivary samples were collected to determine APOE genotype and salivary testosterone and cortisol levels. Non-ε4- and ε4-carrying men and women did not differ in age, Mini-Mental State Examination, Wide Range Achievement Test-Reading, Beck Anxiety Inventory, or reaction time scores. There was an effect of ε4 on the object recognition and spatial navigation tests, with non-ε4 carriers outperforming ε4 carriers, but not in the other cognitive tests. No relationship was found for sex and ε4 status or sex and performance during the hidden session of Memory Island. In men, salivary cortisol levels correlated with object recognition. These results show that object recognition and spatial navigation tests are useful to assess cognitive function in the elderly. [Copyright &y& Elsevier]

Abstract: Background: To evaluate the differences between the immediate and tapered cessation protocols of hormone therapy in terms of recurrence of menopausal symptoms. Materials and methods: In this prospective, randomized clinical study 70 consecutive patients in whom hormone therapy was no longer preferred were recruited from the menopause clinic of a university hospital and rank randomized into two groups. In group 1 (n =35) hormone therapy was immediately discontinued and in group 2 (n =35) the medication was tapered. Every patient was questioned about vasomotor symptoms before the initiation of hormone therapy at the first visit, and then revisited at the end of 2 and 4 weeks. Results: We did not find any statistically significant difference between two protocols in terms of symptom severity and frequency at the end of 2 and 4 weeks of discontinuation. Although statistically insignificant, the symptoms tended to recur in fewer patients and in a less severe form in both groups when compared with their pretreatment status. Conclusions: Tapering or immediate discontinuing of hormone therapy did not affect the recurrence rate and severity of menopausal symptoms at the end of 4 weeks. [Copyright &y& Elsevier]

Abstract: We report a grade III allergic hypersensitivity reaction occurring in a 72-year-old patient immediately after anaesthesia induction. Anaphylaxis to cisatracurium was diagnosed on clinical symptoms, biological tests and positivity of the cutaneous tests to this neuromuscular blocking agent. Five days after this allergological assessment, rocuronium, a muscle relaxant for which skin tests appeared negative was used during surgery without adverse effects. The authors underline the value of a detailed allergological assessment to identify the pathophysiologic mechanism, the culprit drug and to propose a safer alternate drug that might be used. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to compare the effect of immediate versus delayed post space preparation on the apical seal using AH Plus sealer. Forty-six single rooted anterior extracted teeth were instrumented and divided into four groups. Twenty teeth in groups 1 and 2 and three teeth in groups 3 and 4. In groups 1 and 2, each canal was obturated using warm vertical compaction and AH Plus sealer. In group 1 the post space was made immediately at the time of obturation and in group 2 the post space was made after placing the teeth in saline at 37°C for 1 wk. Group 3 and 4 represented positive and negative control groups, respectively. The teeth were placed in India ink for 72 h. The teeth were sectioned and the amount of apical dye migration was measured. Significant differences were found between teeth whose post spaces are prepared at the time of obturation versus 1 wk later using warm vertical condensation and AH Plus sealer. [Copyright &y& Elsevier]

Abstract: Background: Upper eyelid paralysis leads to lagophthalmos with the risk of exposure keratitis, corneal ulceration and blindness. Methods: Consecutive patients undergoing gold weight implantation and/or lateral tarsorrhaphy were identified from our prospective database and reviewed. Results: Sixty-three patients were identified, 36 of whom underwent immediate reanimation procedure either during cancer excision (n = 35) or repair of facial laceration (n = 1). Twenty-seven patients had a delayed procedure either following tumour excision (n = 21) or unresolved Bell''s palsy (n = 3), or facial palsy due to complex craniofacial fracture (n = 3). Nine patients required revision to achieve optimal weight. Fifty-two patients had full eye closure. The remaining 11 patients had almost complete eye closure. Conclusions: Facial paralysis is devastating for the patient and immediate facial reanimation should be performed. We have demonstrated that gold weight implantation and lateral tarsorrhaphy are simple and effective in achieving eye closure. [Copyright &y& Elsevier]

Summary: Giant fibroadenoma is a rare, benign stromal tumor that typically occurs in adolescent women. This rapidly-growing tumor can result in a significant aesthetic and psychosocial morbidity due to gross asymmetry changes in the overlying skin envelope and concerns about malignancy. On initial work-up this lesion must be differentiated from other rare primary breast tumors, including phyllodes tumor, or metastatic disease. Appropriate treatment of giant fibroadenoma requires surgical excision; however, many surgeons are reluctant to perform a concomitant mastopexy or reconstruction at the time of tumor extirpation. This conservative approach results in a loose, ptotic, aesthetically displeasing breast postoperatively. While some degree of skin retraction is expected, patients may have to wait for up to a year to see final results, and further surgical correction may still be required. It is unknown whether these surgeons are not familiar with these techniques or hesitate to increase the amount of scarring on the breast mound of a young female. Using an immediate dermoglandular preserving mastopexy after giant fibroadenoma excision, we have decreased postoperative breast ptosis, removed much of the lax, poor-quality skin and achieved stable, long-term results in two patients. This technique improves the immediate aesthetic outcome, reduces the psychosocial comorbidity associated with waiting for skin retraction and decreases the likelihood of a second surgery. [ABSTRACT FROM AUTHOR]