Background Minimally invasive Ivor Lewis esophagectomy (MIE) is gaining popularity for the treatment of esophageal cancer. However, as it is a technically demanding operation, a learning curve should ...be defined to guide training and allow implementation at institutions not currently using this technique. Study Design Our study included a retrospective series of the first 80 consecutive patients undergoing MIE by a single surgeon with advanced training in minimally invasive esophageal surgery in independent practice at a high-volume tertiary center. Patients were stratified into 2 groups of 40 patients, with chronological order defining early and late experiences. Primary end points included conversion to open procedure, surgical time, blood loss, chest drainage duration, time to oral intake, hospital stay, postoperative morbidity, and mortality. The cumulative sum methodology was used and analyzed by visually inspecting the plots. Results Conversion to open procedure occurred in 2 (5%) patients in the early group and none in the late group (p = 0.49). Comparing early vs late experience, mean surgical time was 364 vs 316 minutes (p < 0.01), estimated blood loss was 205 vs 176 mL (p = 0.14), median hospital stay was 7 vs 6 days (p < 0.01), and morbidity was observed in 16 (40%) and 14 (35%) patients (p = 0.82), respectively. There were no anastomotic leaks or 30-day mortality. Cumulative sum plots showed decreasing surgical time after patient 54 (plateau after patient 31), decreasing chest tube duration after patients 38 and 33, sooner oral intake after patient 35, and decreased hospital stay after patient 33. Conclusions Improved operative and perioperative parameters for MIE were observed in the last 40 patients when compared with the first 40 patients. A reasonable learning curve for MIE would require the operation and perioperative care of 35 to 40 patients.
Despite poor sleep quality being recognised in Duchenne Muscular Dystrophy, reports from milder forms of Muscular Dystrophy (MD), and accompanied associations with quality of life (QoL), pain and ...fatigue, remain limited however. Adult males (n = 15 Beckers MD (BMD), n = 12 Limb-Girdle MD (LGMD), n = 12 Fascioscapulohumeral (FSHD), n = 14 non-MD (CTRL)) completed assessments of body composition (Bio-electrical impedance), sleep (7-day 24-hour tri-axial accelerometer, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index, QoL (SF36-v2), pain (Visual analogue scale), fatigue (Modified Fatigue Index Scale) and functional assessments (Brookes and Vignos). FSHD and BMD reported worse sleep than CTRL on the PSQI. FSHD scored worse than CTRL on the Insomnia Severity Index (P<0.05). 25-63% and 50-81% of adults with MD reported poor sleep quality using the Insomnia Severity Index and PSQI, respectively. Accelerometery identified no difference in sleep quality between groups. Associations were identified between sleep measures (PSQI global and insomnia severity) with mental or physical QoL in LGMD, BMD and FSHD. Multiple regression identified associations between sleep impairment and fatigue severity (all MDs), body composition (BMD & LGMD), upper and lower limb function (LGMD, FSHD) and age (FSHD). 25-81% of men with MD, depending on classification, experience sleep impairment, using self-report sleep measures. Whilst BMD and FSHD showed worse sleep outcomes than CTRL, no group difference was observed between LGMD and CTRL, however all groups showed associations with sleep impairment and higher levels of fatigue. These findings, and associations with measures of health and wellbeing, highlight an area for further research which could impact QoL in adults with MD.
To assess the impact of endometriosis, alone or in combination with other infertility diagnoses, on IVF outcomes.
Population-based retrospective cohort study of cycles from the Society for Assisted ...Reproductive Technology Clinic Outcome Reporting System database.
Not applicable.
A total of 347,185 autologous fresh and frozen assisted reproductive technology cycles from the period 2008-2010.
None.
Oocyte yield, implantation rate, live birth rate.
Although cycles of patients with endometriosis constituted 11% of the study sample, the majority (64%) reported a concomitant diagnosis, with male factor (42%), tubal factor (29%), and diminished ovarian reserve (22%) being the most common. Endometriosis, when isolated or with concomitant diagnoses, was associated with lower oocyte yield compared with those with unexplained infertility, tubal factor, and all other infertility diagnoses combined. Women with isolated endometriosis had similar or higher live birth rates compared with those in other diagnostic groups. However, women with endometriosis with concomitant diagnoses had lower implantation rates and live birth rates compared with unexplained infertility, tubal factor, and all other diagnostic groups.
Endometriosis is associated with lower oocyte yield, lower implantation rates, and lower pregnancy rates after IVF. However, the association of endometriosis and IVF outcomes is confounded by other infertility diagnoses. Endometriosis, when associated with other alterations in the reproductive tract, has the lowest chance of live birth. In contrast, for the minority of women who have endometriosis in isolation, the live birth rate is similar or slightly higher compared with other infertility diagnoses.
The aim was to determine the reliability and validity of IPAQ measured sedentary behaviour (SB) and moderate-vigorous physical activity (MVPA) in older persons whilst examining any sex differences in ...reliability and validity results.
89 participants (73.7 ± 6.3 years, 54% female) completed the IPAQ. Participants were fitted with a thigh mounted triaxial accelerometer (GeneActiv Original) for seven consecutive days and subsequently completed a second IPAQ.
IPAQ showed weak reliability qualities for Total SB (h·week-1) and 10 minute MVPA (accumulated in bouts ≥ 10 continuous minutes, h·week-1). IPAQ had poor concurrent validity qualities for Total SB, 10 minute MVPA, but not Sporadic MVPA (accumulated in bouts < 10 continuous minutes, h·week-1). IPAQ only categorised participant physical behaviour classification correctly 2% of the time. Sex differences were only present for the correlation slope of IPAQ 10 minute MVPA reliability measures.
Our data suggests that the IPAQ is not suitable for assessing older adults habitual physical behaviour.
The menstrual cycle is an important biological process that can have implications for women's participation in activities of daily life. The purpose of this qualitative study was to understand ...women's experiences, interactions, and perceptions of sport and exercise participation throughout the menstrual cycle. Five focus groups with 25 physically active women were conducted to investigate women's perceptions of their menstrual cycle, their thoughts, feelings, and actions in sport and exercise environments throughout the menstrual cycle. The dramaturgical writings of Goffman were used to understand women's self-presentation and experiences of interactional dynamics in sport and exercise environments. The findings highlight that the period was the most impactful aspect of the menstrual cycle on physically active women's experiences of sport and exercise participation. The results explore strategies that the women adopted to manage their appearance, concerns that informed women's decision-making processes, and the women's purposeful impression management when undertaking sport and exercise during their period, particularly in interactions with male sport coaches. The findings emphasize the importance of unpacking the often-implicit norms and expectations associated with the period in order to normalize dialogues with practitioners (e.g., coaches) and support women's continued participation in sport and exercise throughout the menstrual cycle.
Lay summary: Following five focus groups with 25 physically active women, we found that concerns over what others might think if they found out that women were on their period led our participants to choose clothes selectively and suppress their discomfort in many interactions when participating in sport and exercise situations.
Implications for practice
Fear of leakage of menstrual blood and concerns over subsequent reactions of others (e.g., coaches, other gym members) makes the period particularly impactful on how women feel and act in sport and exercise situations.
Knowledge of what it means to women to be on their period (e.g., selective choice of clothing, suppressing of any signs of discomfort) is important for practitioners in the field to create open and relaxed conversational atmospheres that allow opportunity for women to open up about their feelings and experiences if they choose to do so.
The prevalence of urinary incontinence in Duchenne and Becker muscular dystrophy (D/BMD) is reported to be between 15-29%, this however includes ages across the lifespan, and with no description of ...impact on daily life. The present study, aimed to determine the prevalence of urinary incontinence in men with D/BMD, and to identify which aspects of daily life were impacted by urinary incontinence. Twenty-seven adult males, 11 with BMD and 16 with DMD, aged 20-57 years, volunteered to participate in this study. Six questionnaires were completed to provide an overview of participant mobility, urinary incontinence and distress caused by urinary incontinence. These included: The Barthel index of disability, International Consultation on Incontinence Questionnaire-Urinary Incontinence Form, Incontinence Impact Questionnaire Short Form, The Urogenital Distress Inventory, and the Brooke and Vignos scale. The prevalence of urinary incontinence within the present men with D/BMD was 37%, assessed as urine leakage of once a week or more. Those with urinary incontinence all reported only a "small amount" of urine leakage, with urinary incontinence frequency of once a week in 5/10 participants, two or three times a week in 2/10 participants, and once a day in 3/10 participants. Of those with urinary incontinence 8/10 experienced some impact on their daily life from urine leakage including travel (4/10), social aspects (5/10), and emotional aspects (8/10). All participants with urinary incontinence were bothered by some aspect, including urine leakage (9/10), and frequent urination (4/10). In conclusion, 37% of the present men with D/BMD experience urinary incontinence on a weekly or daily basis and negatively impacted aspects of life related to travel, social and emotional wellbeing. Urine leakage, and frequent urination should be considered a meaningful problem by care providers, and discussed openly with those with D/BMD.
Commentary: Practice makes perfect in cervical esophagogastric anastomosis Panda, Nikhil; Morse, Christopher R.
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
December 2020, 2020-12-00, 20201201, Letnik:
160, Številka:
6
Journal Article
To compare the relative changes in muscle-tendon complex (MTC) properties following high load resistance training (RT) in young males and females, and determine any link with circulating TGFβ-1 and ...IGF-I levels.
Twenty-eight participants were assigned to a training group and subdivided by sex (T males TM aged 20±1 year, n = 8, T females TF aged 19±3 year, n = 8), whilst age-matched 6 males and 6 females were assigned to control groups (ConM/F). The training groups completed 8 weeks of resistance training (RT). MTC properties (Vastus Lateralis, VL) physiological cross-sectional area (pCSA), quadriceps torque, patella tendon stiffness K, Young's modulus, volume, cross-sectional area, and length, circulating levels of TGFβ-1 and IGF-I were assessed at baseline and post RT.
Post RT, there was a significant increase in the mechanical and morphological properties of the MTC in both training groups, compared to ConM/F (p<0.001). However, there were no significant sex-specific changes in most MTC variables. There were however significant sex differences in changes in K, with females exhibiting greater changes than males at lower MVC (Maximal Voluntary Contraction) force levels (10% p = 0.030 & 20% MVC p = 0.032) and the opposite effect seen at higher force levels (90% p = 0.040 & 100% MVC p = 0.044). There were significant increases (p<0.05) in IGF-I in both TF and TM following training, with no change in TGFβ-1. There were no gender differences (p>0.05) in IGF-I or TGFβ-1. Interestingly, pooled population data showed that TGFβ-1 correlated with K at baseline, with no correlations identified between IGF-I and MTC properties.
Greater resting TGFβ-1 levels are associated with superior tendon mechanical properties. RT can impact opposite ends of the patella tendon force-elongation relationship in each sex. Thus, different loading patterns may be needed to maximize resistance training adaptations in each sex.
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