Ofra Barnett

Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy—a retrospective matched control study

OBJECTIVE Compare robotic-assisted laparoscopic myomectomy (RALM) to a matched control standard laparoscopic myomectomy (LM). DESIGN A retrospective matched control study. SETTING Private practice setting. PATIENT(S) Premenopausal and postmenopausal women who underwent either robotic-assisted or standard laparoscopic myomectomy. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Retrospective chart review was performed. Cases of laparoscopic robotic-assisted myomectomies were compared with a matched control group of standard LM. Comparisons were based on Fishers exact, Mann-Whitney, and exact chi-square tests. RESULT(S) Between January 2006 and August 2007, 15 consecutive RALMs were performed at our institution, compared with 35 matched control standard LMs. The two groups were matched by age, body mass index, parity, previous abdominopelvic surgery, size, number, and location of myomas. Mean surgical time for the RALM was 234 minutes (range 140-445) compared with 203 minutes (range 95-330) for standard LMs. Blood loss, hospitalization time, and postoperative complications were not significantly different. CONCLUSION(S) The RALM required a significant prolonged surgical time over LM. It appears that in the hands of a skilled laparoscopic surgeon, the RALM does not offer any major advantage. This technology, however, offers exciting potential applications while learning endoscopic surgery. Further studies are warranted to asses the utility of RALM for general gynecologic surgeons.

The Relationship Between Serum 25(OH)D and Parathyroid Hormone Levels

OBJECTIVE Low 25(OH)D levels are associated with increased parathyroid hormone levels leading to progressive bone loss. The serum levels of 25(OH)D sufficient to keep the parathyroid hormone level at a range that will prevent bone loss are still unclear. The current study was aimed at evaluating the relationship between 25(OH)D levels and concomitant parathyroid hormone levels. METHODS The computerized laboratory database of Clalit Health Services, a not-for-profit health maintenance organization covering more than half of the Israeli population, was searched for all 25(OH)D and parathyroid hormone tests performed in 2009. Concomitant tests of parathyroid hormone and 25(OH)D were identified in 19,172 people. RESULTS Serum parathyroid hormone levels were inversely correlated with 25(OH)D levels (r = -0.176, P < .001); 25(OH)D levels less than 50 nmol/L were associated with a steep increase in parathyroid hormone levels and hyperparathyroidism, which decreased with increasing 25(OH)D levels and reached a plateau at 25(OH)D levels of 75 to 85 nmol/L. The quadratic fit with plateau model showed that parathyroid hormone stabilizes at 25(OH)D level of 78.9 nmol/L. However, after excluding 5449 people with hypercalcemia or renal failure, the parathyroid hormone plateau was attained at a significantly lower 25(OH)D cut point of 46.2 nmol/L. CONCLUSION Our data suggest that a 25(OH)D threshold of 50 nmol/L is sufficient for parathyroid hormone suppression and prevention of secondary hyperparathyroidism in persons with normal renal function. 25(OH)D levels greater than 75 nmol/L do not seem to be associated with additional change in parathyroid hormone levels.

The Risk of All-Cause Mortality Is Inversely Related to Serum 25(OH)D Levels

CONTEXT AND OBJECTIVES Vitamin D plays a key role in maintaining bone health, but evidence for its nonskeletal effects is inconsistent. This study aims to examine the association between serum 25-hydroxyvitamin D [25(OH)D] levels and all-cause mortality in a large general population cohort. DESIGN, PARTICIPANTS, AND SETTING Using the computerized database of the largest health care provider in Israel, we identified a cohort of subjects 20 years old or older with serum 25(OH)D levels measured between January 2008 and December 2009. Vital status was ascertained through August 2011. RESULTS Median follow-up was 28.5 months (interquartile range 23.8-33.5 months); 7,247 of 182,152 participants (4.0%) died. Subjects who died had significantly lower serum 25(OH)D levels (mean 44.8 ± 24.2 nmol/liter) than those alive at the end of follow-up (51.0 ± 23.2 nmol/liter), P < 0.001. After adjustment for age, gender, ethnicity, and seasonality, the hazard ratio (HR) for all-cause mortality was 2.02 [95% confidence interval (CI) 1.89-2.15] for the lowest serum 25(OH)D quartile (<33.8 nmol/liter) compared with the highest. After further adjustment for comorbidity, use of vitamin D supplements and statins, smoking, socioeconomic status, and body mass index, the HR was 1.81 (95% CI 1.69-1.95). This remained, even after adjustment for serum low-density lipoprotein, high-density lipoprotein, calcium level (corrected for serum albumin levels), and glomerular filtration rate, 1.85 (95% CI 1.70-2.01). The fully adjusted HR associated with being in the second 25(OH)D quartile (33.8-49.4 nmol/liter) was 1.25 (95% CI 1.16-1.34). CONCLUSIONS All-cause mortality is independently and inversely associated with serum 25(OH)D levels at levels less than 50 nmol/liter.

The longitudinal variability of serum 25(OH)D levels

BACKGROUND The extent to which a single serum 25(OH)D measurement represents long-term vitamin D status remains unclear. This study aims to assess the variability of serum 25(OH)D between tests taken at different time intervals. METHODS Using the computerized database of the largest healthcare provider in Israel, we identified subjects in whom a serum 25(OH)D test was performed on at least two different occasions between January 2008 and September 2011 (n = 188,771). For these subjects we selected the first and the last dated tests, then we identified those who were not treated with supplements during the last 6 months before the first and before the last test (n = 94,418). Of these we analyzed subjects in whom the first and the last tests were performed in the same month of the year (n = 8881). RESULTS The mean serum 25(OH)D level at the first test was 51.7 ± 24.0 nmol/L and was 56.7 ± 24.7 at the last test (P<0.001); the overall correlation was 0.63 (P < 0.001). For vitamin D status in two categories (<50 versus ≥ 50 nmol/L), the percentage of agreement between the first and last tests was 74.4%, and was 50.8% for vitamin D status in four categories (<30, 30-49.9, 50-74.9, and ≥ 75 nmol/L). The correlation decreased with increasing time between the tests ranging from 0.83 for tests done at the same year to 0.55 after 3 years. The more the first levels were higher or lower, the more likely subjects remain in their first category (≥ 50 versus <50 nmol/L). CONCLUSIONS Long-term month specific serum 25(OH)D levels are relatively stable.

The Histogram and Boxplot for the Display of Lifetime Data

Abstract The importance of histograms and boxplots as exploratory data analysis (EDA) tools has been well established. Yet, adopting them for lifetime data is not straightforward. The first problem, particularly in histograms, is how to deal with censored observations. The second problem is that the underlying distribution of lifetime data is often highly positively skewed. Therefore, in the classical boxplot, large observations can be wrongly diagnosed as outliers. This article extends the definition of the histogram to accommodate for right-censored observations. We apply the “redistribution to the right” method so that the weight of each uncensored observation is actually the jump of the Kaplan—Meier estimation at this point. We also propose modified boxplots to resolve both problems of right censoring and skewness. In our procedure, the fences differ from those of the classical boxplot. Simulation results are presented for an evaluation of our procedure and an example is presented for illustration.

BRCA1/2 mutation carriers: living with susceptibility.

Objectives: To examine whether being a BRCA1/2 mutation carrier affects a wide array of aspects of life, and if so, how. Methods: Participants were grouped according to their carrier status (carrier and noncarrier status), health status (affected or unaffected by cancer), and their enrollment at the counseling service (probands and other family members). One hundred and sixty-five women completed a self-administered questionnaire following their genetic consultation session. Results: Probands/nonprobands and carriers/noncarriers did not differ with regard to demographic characteristics, health behaviors including medical checkups, the distress they experience or their resources (sense of coherence, social integration, religiosity). Individuals affected by cancer did differ on some of these aspects from participants without cancer. Conclusions: From the results of this study, being a carrier could not be considered a psychosocial risk factor, nor does it seem to have an effect on carriers’ resources and lifestyle.

Acknowledgement to the Reviewers

Stephen J.J. Clarke, St. Leonards, Australia Robert L. Coleman, Houston, USA Pier Franco Conte, Modena, Italy Jay Cooper, Brooklyn, USA Daniela Cornelio, Porto Alegre, Brazil Renzo Corvo, Genoa, Italy Long H. Dang, Gainesville, USA Aimery de Gramont, Paris, France Marc Denis, Nantes, France Francesco Di Costanzo, Florence, Italy Phillip J. DiSaia, Orange, USA Tomislav Dragovich, Gilbert, USA Elisabeth L. Dupont, Lakeland, USA Grace K. Dy, Buffalo, USA Florian Eckel, Munich, Germany Patricia Eifel, Houston, USA Bassel F. El-Rayes, Atlanta, USA Matti Eskelinen, Kuopio, Finland Marwan G. Fakih, Ann Arbor, USA Nicola Fazio, Milan, Italy Kate Fife, Cambridge, UK Eric Francois, Nice, France Martin Fruh, St. Gallen, Switzerland Masashi Fujii, Tokyo, Japan Sirish M. Gadgeel, Detroit, USA Vassilis Georgoulias, Heraklion, Greece Domenico Germano, Benevento, Italy Julia Glade Bender, New York, USA Martin Glas, Bonn, Germany Boon-Cher Goh, Singapore, Singapore Erdem Goker, Bornova, Turkey Maria Gonzalez Cao, Barcelona, Spain Christian Gratzke, Munich, Germany Juan-Jose Grau, Barcelona, Spain Tim F. Greten, Bethesda, USA Francesco Grossi, Genova, Italy Victor Gruenwald, Hannover, Germany Pascal Hammel, Clichy, France Toshiyuki Harada, Sapporo, Japan Motohiro Hirao, Osaka, Japan Wolfgang Hohenforst-Schmidt, Coburg, Germany Michael Holick, Boston, USA Masaru Horio, Osaka, Japan Dieter Horsch, Bad Berka, Germany Ghassan K. Abou-Alfa, New York, USA Ana Lucia Abujamra, Porto Alegre, Brazil Banke Agarwal, Saint Louis, USA Jaffer A. Ajani, Houston, USA Masashi Akiyama, Nagoya, Japan Frederic Amant, Leuven, Belgium Peter M. Anderson, Houston, USA Rose Anorlu, Lagos, Nigeria Makoto Arai, Chiba City, Japan Yasuaki Arai, Tokyo, Japan S.A. Arnold, Nashville, USA Ofer Arnon, Beer-Sheva, Israel David August, New Brunswick, USA Hideo Baba, Kumamoto, Japan Alexander Bachmann, Basel, Switzerland Joseph M. Backer, Brookfield, USA Aristotle Bamias, Vrilissia, Athens, Greece Thomas I. Barron, Dublin, Ireland Jean-Pierre Bellocq, Strasbourg, France Jaafar Bennouna, Nantes, France Al B. Benson, Chicago, USA Thierry Berghmans, Brussels, Belgium Jordan D. Berlin, Nashville, USA Stefan Bielack, Stuttgart, Germany Julie Bienertova-Vasku, Brno, Czech Republic Stefan Biesterfeld, Dusseldorf, Germany Narikazu Boku, Sunto-gun, Japan Olivier Braissant, Basel, Switzerland Nguyen Binh Bui, Bordeaux, France Ronald M. Bukowski, Pepper Pike, USA Abdullah Buyukcelik, Kayseri, Turkey Alfredo Carrato, Madrid, Spain Marc Carrier, Ottawa, Canada James Cassidy, Nutley, USA Darko Cerne, Ljubljana, Slovenia Stephen Lam Chan, Hong Kong, China Judy-Anne W. Chapman, Kitchener, Canada Kazuaki Chayama, Hiroshima, Japan Ming-Huang Chen, Taipei, Taiwan Ann-Lii Cheng, Taipei, Taiwan Ya-Wen Cheng, Taichung, Taiwan Marco Chinol, Milan, Italy Julia C. Chisholm, Sutton, UK