ASO Visual Abstract: Chemotherapy After Diagnosis of Malignant Bowel Obstruction is Associated with Greater Survival for Medicare Patients with Advanced Malignancy

Annals of Surgical Oncology -     

Drivers of Cost for Pancreatic Surgery: It’s Not About Hospital Volume

Background

Outcomes for pancreatic resection have been studied extensively due to the high morbidity and mortality rates, with high-volume centers achieving superior outcomes. Ongoing investigations include healthcare costs, given the national focus on reducing expenditures. Therefore, we sought to evaluate the relationships between pancreatic surgery costs with perioperative outcomes and volume status.

Methods

We performed a retrospective analysis of 27,653 patients who underwent elective pancreatic resections from October 2013 to June 2017 using the Vizient database. Costs were calculated from charges using cost–charge ratios and adjusted for geographic variation. Generalized linear modeling adjusting for demographic, clinical, and operation characteristics was performed to assess the relationships between cost and length of stay, complications, in-hospital mortality, readmissions, and hospital volume. High-volume centers were defined as hospitals performing?≥?19 operations annually.

Results

The unadjusted mean cost for pancreatic resection and corresponding hospitalization was $20,352. There were no differences in mean costs for pancreatectomies performed at high- and low-volume centers [??$1175, 95% confidence interval (CI) ??$3254 to $904, p?=?0.27]. In subgroup analysis comparing adjusted mean costs at high- and low-volume centers, there was no difference among patients without an adverse outcome (??$99, 95% CI ??$1612 to 1414, p?=?0.90), one or more adverse outcomes (??$1586, 95% CI ??$4771 to 1599, p?=?0.33), or one or more complications (??$2835, 95% CI ??$7588 to 1919, p?=?0.24).

Conclusions

While high-volume hospitals have fewer adverse outcomes, there is no relationship between surgical volume and costs, which suggests that, in itself, surgical volume is not an indicator of improved healthcare efficiency reflected by lower costs. Patient referral to high-volume centers may not reduce overall healthcare expenditures for pancreatic operations.

     

The significance of crystallographic texture of titanium alloy substrates on pre-osteoblast responses

The aim of this study is to investigate the effects of grain orientation in polycrystalline materials on cell-substrate interactions. Samples are prepared from rods and sheets of Ti-6Al-4V substrates with predominately two distinct crystallographic orientations. X-ray diffraction analysis indicates that 36% of the surfaces of rod samples consist of (1010) plane, while the predominant orientation in the surface of the sheet samples is (1120) plane (29%). Morphological studies and cell biological experiments including cell attachment, proliferation and differentiation are conducted using MC3T3 pre-osteoblast cells cultured on these two different samples. The number of attached cells on the rod Ti-(1010) samples (70% after 1 h and 50% after 2 h) is higher than on the sheet Ti-(1120) samples. Cell proliferation after 3 days is also significantly higher on the Ti-(1010) samples. Alkaline phosphatase activity, however, shows no significant difference between the two samples. Scanning electron microscopy (SEM) analysis of MC3T3 cells grown on samples with different crystallographic texture demonstrate significant differences in morphology with respect to attachment and growth pattern. This study shows that crystal orientation of the substrate can influence cell responses and, therefore, substrate engineering can be used to improve and control cell-substrate interactions.     

Assessment of atorvastatin effectiveness on serum PSA level in hypercholesterolemic males

The previous large retrospective studies demonstrated that treatment with Statins reduces both the incidence of prostate cancer by 50% and serum Prostate Specific Antigen (PSA) level up to 40%. However the main problem in those studies was the absence of control groups of men with hypercholesterolemia without Statin treatment. We performed a small prospective controlled clinical trial to assess the influence of the treatment with Atorvastatin on serum PSA in men with hypercholesterolemia referred to our educational and treatment center from October 2007 to March 2008. In this study, among the newly diagnosed males with hypercholesterolemia (LDL > 130 mg/dl), 40 patients with LDL more than 190 mg/dl were selected as a case group and were treated with Atorvastatin (20 mg/day). Among the same population and in the same period, another 40 patients with LDL between 130 and 190 mg/dl were selected as first control group and were treated only with low fat diet. Another 40 patients with normal serum cholesterol and without any treatment were selected as second control group. The lipid profile and serum PSA level of patients of all groups were tested at the first and third months after the therapy. After completion of data, the mean serum lipids and PSA level were measured in both visits and compared with each other by paired t-test. Also the mean PSA change in two visits between three groups was compared by ANOVA and Tukey HSD test. There was not any significant difference in mean baseline PSA between hypercholesterolemic and normocholesterolemic patients (P=0.547). In case group, mean PSA and LDL was reduced by 14.1% (P=0.0001) and 30% (P=0.0001) respectively by second visit. In first control group, mean PSA was not changed significantly (P=0.337), whereas mean LDL in this group was reduced by 9.6% (P= 0.0001). Similarly in the second control group mean PSA was not changed significantly (P=0.309) by second visit. In addition, mean change of PSA in case group was compared with first and second control groups that was significantly different (P=0.0001) whereas mean change of PSA between two control groups was not significantly different (P=0.615). The results of this study showed that: 1) Short term treatment with Atorvastatin can reduce serum PSA level, and 2) This reduction is more likely to be due to direct effect and is not related to lowering serum cholesterol levels. Thus, if results of this study are confirmed by large prospective randomized clinical trials with longer follow up period, it will be possible that Atorvastatin could be used in long term as a safe chemoprophylactic agent against prostate cancer in high risk patients.     

“Knuckle Cracking”: Can Blinded Observers Detect Changes with Physical Examination and Sonography?

Clinical Orthopaedics and Related Research® - Voluntary knuckle cracking is a common habit, with a reported prevalence of 25% to 45%. Habitual knuckle cracking also is a frequent source of...     

Assistive devices for balance and mobility: benefits, demands, and adverse consequences

OBJECTIVES: To provide information on the advantages and possible disadvantages of using canes and walkers. DATA SOURCES: English-language articles were identified by searching MEDLINE and PubMed (1966-May 2003) for key words cane or walker , excluding articles unrelated to mobility aids. Bibliographies were reviewed and ISI Web of Science citation searches were run to identify additional references. Over 1000 articles were selected for further evaluation. STUDY SELECTION: We extracted all studies of single-tip canes or pickup walkers addressing: (1) functional, biomechanic, or neuromotor benefits; (2) biomechanic, attentional, neuromotor, metabolic, or physiologic demands; and (3) falls, injuries, or other problems. We included approximately 10% of the articles originally identified. DATA EXTRACTION: The methodology of each selected article, and findings relevant to the benefits, demands, or adverse effects of cane or walker use were summarized. DATA SYNTHESIS: Findings were synthesized by considering their relation to basic biomechanic principles. Some biomechanic findings appear to support the clinical view that canes and walkers can improve balance and mobility for older adults and people with other clinical conditions. However, a large proportion of users experience difficulties, and the use of such devices is associated with increased risk of falling. A small number of studies have characterized some of the specific demands and problems associated with using mobility aids. CONCLUSIONS: Clinical and biomechanic evaluations of canes and walkers confirm that these devices can improve balance and mobility. However, they can also interfere with ones ability to maintain balance in certain situations, and the strength and metabolic demands can be excessive. More research is needed to identify and solve specific problems. Such research may lead to improved designs and guidelines for safer use of canes and walkers.     

Diced ear cartilage with perichondrial attachment in rhinoplasty: a new concept

Background: Diced cartilage is a valuable material that has recently been added to the graft options in rhinoplasty. Shaping, fixation, and resorption are the main concerns with this material. Perichondrially attached diced conchal cartilage may be a new possibility to solve some of these problems. Objectives: The authors evaluate the outcome of perichondrially attached diced cartilage in a rabbit model and compare the results with injectable cartilage grafting. Methods: Ear cartilage was removed from 1 auricle in each of the 16 rabbits included in this study; samples were divided in 2 pieces. After precise weighing, both segments were diced. The perichondrium was left attached to 1 of the pieces. Both segments were inserted in 2 separate pockets in the dorsum of the animal. After a 3-month period, both samples were removed and measured for growth/resorption. Results: At the beginning of this study, the difference in weight between groups was statistically insignificant (P = .213), but 3 months after insertion, significant growth was observed in the perichondrial group (P = .019). Conclusions: The vascularization and significant growth in weight of the perichondrially attached diced cartilage samples are evidence of the viability of this material. The structural integrity and solid framework afforded by this option suggest that the material should be used more frequently in nasoskeletal augmentation.