Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

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Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont

BackgroundRural populations face many health disadvantages compared to urban areas. There is a critical need to better understand the current lung cancer screening landscape in these communities to identify targeted areas to improve the impact of this proven tool.MethodsData from the County Health Rankings of New Hampshire and Vermont was reviewed for population density, distribution of adult smokers, and level of education compared to the distribution of Lung Cancer Screening Facilities throughout these two states.ResultsScreening programs in southern counties of Vermont with lower levels of education have decreased access. In New Hampshire, there are no programs within 30 miles of the areas with the largest distribution of smokers, and decreased access in some areas with the lowest levels of education.ConclusionsImproving equitable access to high-quality screening services in rural regions and the creation of targeted interventions to address decreased access in areas of high tobacco use and low education is vital to decreasing the incidence of latestage presentations of lung cancer within these populations.     

Non-weightbearing imaging and standard knee radiographs are inferior to formal alignment radiographs for calculating coronal alignment of the knee

IntroductionRealignment knee osteotomy relies on accurate preoperative assessment of coronal alignment. Weightbearing (WB) ‘long-leg’ (LL) radiographs are the accepted gold-standard investigation, though in practice standard knee radiographs (short leg; SL) and non-weightbearing (NWB) cross-sectional imaging such as computed tomography (CT) scanograms have been used. We compare the accuracy of SL and NWB radiographs to formal LL alignment radiographs.MethodsA prospectively maintained osteotomy database was reviewed to identify the study population. All patients underwent standardised weightbearing long-leg alignment radiographs. The series was screened consecutively until 30 patients who also underwent WB SL radiographs (‘WB cohort’), and 30 with NWB SL (‘NWB cohort’) radiographs, were identified. Anatomic tibiofemoral angle was calculated by independent reviewers using a validated technique from both radiographs and contrasted.Results60 patients were identified as outlined in the study protocol. There were no differences in baseline demographics. Coronal alignment calculated from SL and LL radiographs differed significantly (median difference 2.1°, p < 0.001). Alignment values from weightbearing SL radiographs demonstrated markedly greater agreement with LL values than those from NWB radiographs (intraclass correlation coefficient 0.878 vs 0.657), with the NWB cohort also exhibiting greater outlier and extreme outlier incidence.ConclusionOur data adds to the growing evidence that SL radiographs are inadequate in the interpretation of knee alignment. In addition, we demonstrate that NWB radiographs (and by extension other NWB modalities such CT scanograms) demonstrate poorer agreement to gold-standard than WB methods. Coronal alignment of the knee cannot be reliably measured from non-weightbearing imaging modalities.Implications for practiceThough potentially useful as an adjunct, non-weightbearing cross-sectional imaging and standard knee radiographs should not be used as a proxy for formal weightbearing long-leg radiographs in osteotomy planning.     

Prognostic tools for hypertrophic scar formation based on fundamental differences in systemic immunity

Unpredictable hypertrophic scarring (HS) occurs after approximately 35% of all surgical procedures and causes significant physical and psychological complaints. Parallel to the need to understanding the mechanisms underlying HS formation, a prognostic tool is needed. The objective was to determine whether (systemic) immunological differences exist between patients who develop HS and those who develop normotrophic scars (NS) and to assess whether those differences can be used to identify patients prone to developing HS. A prospective cohort study with NS and HS groups in which (a) cytokine release by peripheral blood mononuclear cells (PBMC) and (b) the irritation threshold (IT) after an irritant (sodium lauryl sulphate) patch test was evaluated. Univariate regression analysis of PBMC cytokine secretion showed that low MCP‐1, IL‐8, IL‐18 and IL‐23 levels have a strong correlation with HS (P < .010‐0.004; AUC = 0.790‐0.883). Notably, combinations of two or three cytokines (TNF‐a, MCP‐1 and IL‐23; AUC: 0.942, Nagelkerke R²: 0.727) showed an improved AUC indicating a better correlation with HS than single cytokine analysis. These combination models produce good prognostic results over a broad probability range (sensitivity: 93.8%, specificity 86.7%, accuracy 90,25% between probability 0.3 and 0.7). Furthermore, the HS group had a lower IT than the NS group and an accuracy of 68%. In conclusion, very fundamental immunological differences exist between individuals who develop HS and those who do not, whereas the cytokine assay forms the basis of a predictive prognostic test for HS formation, the less invasive, easily performed irritant skin patch test is more accessible for daily practice.     

Sleeping with the Enemy: Everything You Need to Know about the Biology,Clinical Significance,and Laboratory Identification of Bed Bugs

The world has experienced a major global resurgence of bed bug infestations over the past 2 decades. While bed bugs do not serve as vectors of disease, their bites and household infestations result in significant psychological distress, clinical manifestations, and economic costs. Most human bed bug infestations are caused by the “common bed bug,” Cimex lectularius, or the “tropical bed bug,” C. hemipterus. Zoonotic cimicids also occasionally feed on humans. Bites are the most commonly reported manifestation of infestations, although findings may be subtle and overlooked for some time. The bugs can be submitted to the laboratory for identification, and therefore, clinical microbiologists should be familiar with their key identifying features and how they can be differentiated from similar-appearing arthropods. This review covers the biology and epidemiology of bed bugs; aspects of laboratory collection, identification, and reporting; and the clinical implications of bed bug infestations.