Dejesusblanchard7796

Background Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC), and it should be performed within 72 h of symptoms onset if possible. In many undesired situations, LC was performed beyond the golden 72 h. However, the safety and feasibility of prolonged LC (i.e., performed more than 72 h after symptoms onset) are largely unknown, and therefore were investigated in this study. Methods We retrospectively enrolled the adult patients who were diagnosed as AC and were treated with LC at the same admission between January 2015 and October 2018 in an emergency department of a tertiary academic medical center in China. The primary outcome was the rate and severity of adverse events, while the secondary outcomes were length of hospital stay and costs. Results Among the 104 qualified patients, 70 (67.3%) underwent prolonged LC and 34 (32.7%) underwent early LC ( less then 72 h of symptom onset). There were no differences between the two groups in mortality rate (none for both), conversion rates (prolonged LC 5.4%, and early LC 8.8%, P = 0.68), intraoperative and postoperative complications (prolonged LC 5.7% and early LC 2.9%, P ≥ 0.99), operation time (prolonged LC 193.5 min and early LC 198.0 min, P = 0.81), and operation costs (prolonged LC 8,700 Yuan, and early LC 8,500 Yuan, P = 0.86). However, the prolonged LC was associated with longer postoperative hospitalization (7.0 days versus 6.0 days, P = 0.03), longer total hospital stay (11.0 days versus 8.0 days, P less then 0.01), and subsequently higher total costs (40,400 Yuan versus 31,100 Yuan, P less then 0.01). Conclusions Prolonged LC is safe and feasible for patients with AC for having similar rates and severity of adverse events as early LC, but it is also associated with longer hospital stay and subsequently higher total cost.Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.Purpose The objectives of this study are to evaluate cochlear implant (CI) listeners' ability to infer low frequency (LF) pitch information from temporal fine structure (TFS) cues and to gain insight into its effects on speech perception, especially in the presence of a fluctuating background noise. Pitch perception assessment using linguistic stimuli is believed to better reflect the role of pitch in communicatively realistic situations. MLN2480 manufacturer Methods The low-pass-filtered sentence intonation (SI-LPF) test based on linguistic stimuli marked by intonation changes is used to estimate a difference limen for discrimination of LF pitch changes in adult CI listeners (N = 17 ears). Speech perception in the presence of noise is assessed using the sentence test with adaptive randomized roving level (STARR), where everyday sentences are presented at low, medium, and high levels in a fluctuating background noise. SI-LPF correlations with STARR are compared to those with sentence recognition tests presented in quiet (SRQ) and in noise, using fixed signal-to-noise ratio (SNRs at +10 and +5 dB). Results SI-LPF findings show significant positive correlations with STARR performance (rs = 0.63, p = 0.007), whilst the associations with SRQ (rs = - 0.37, p = 0.149), SNR + 10 (rs = - 0.24, p = 0.345), and SNR + 5 (rs = - 0.14, p = 0.587) are not statistically significant. Conclusions Present findings reflecting considerably stronger correlations than previous studies using non-linguistic stimuli, in particular for speech perception with roving-level adaptive test method (STARR) highlight the effects of LF pitch perception and TFS sensitivity on challenging everyday situations, where CI users listen to speakers with varying levels in a fluctuating background.Background/objective An adult with vocal fold nodules can suffer from hoarseness, breathiness and vocal fatigue, which, in turn, significantly affects their vocal participation as well as activities. A well-designed voice therapy program improves the quality of life and vocal functionality. This is a narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules. Methods Several key terms were used for the database electronic search of articles. Strict inclusion criteria were used and a broad evaluation of the studies was performed. This included the level of evidence based on the National Health and Medical Research Council levels of evidence, assessment, and critical appraisal. Results Nine out of 30 reviewed articles met the criteria of inclusion and reported positive effects of voice therapy intervention on adult patients with vocal fold nodules. The vast majority of the reviewed studies reported multidimensional voice measures outcome data, most of them containing visual-perceptual, auditory-perceptual, acoustic and self-assessment results.