Splenic Artery Embolization after Delayed Splenic Rupture Following Blunt Trauma: Is Nonoperative Management Still an Option in This Cohort?

Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and the patients were followed up for a median of 11 months (interquartile range = 31). There were 3 occurrences of rebleeds, and 2 patients required splenectomy (5.9%). This study showed that treatment with SAE after DSR results in splenic salvage in 94.1% of patients.     

Numerical simulation for a wind dust event in the US/Mexico border region

Soil-derived dust represents one of the major components of the natural atmospheric aerosols. Arid and semiarid areas with unpaved and non-vegetated land cover are particularly vulnerable to windblown dust, which results in high particulate matter pollution. To understand, predict, and mitigate the impact of dust aerosol on air quality and climate, it is necessary to parameterize the emission rate of dust particles from the wind erosion processes accurately. However, windblown dust emission is poorly represented in existing air quality models. In this paper, a windblown dust emission model has been developed based on a parameterization of threshold wind friction velocity depending on the roughness of surface, vegetation type, soil type, soil moisture content, and on the size distribution of aerosols. The proposed dust model incorporates into a region air quality modeling system to simulate a North American dust storm episode occurring near the border of southwestern USA and northwestern region of Mexico on 23 February 2007. It is shown that the implementation of a windblown dust model in an air quality model can significantly improve the model capability for capturing the dust episode. The simulation of the model is in good agreement with the evolution of dust distribution. The modeled dust spatial patterns matched dust cloud patterns appearing on satellite images. Implementation of the windblown dust model successfully captured the time of peak particulate matter (PM) concentrations for both PM₁₀ and PM_2.5, as well as the peak value of the PM_2.5 concentration. The modeled results clearly demonstrate an improved ability to predict PM events by applying the windblown dust emission scheme.     

Nasal Inhalation Challenge Studies with Sidestream Tobacco Smoke

Environmental tobacco smoke (ETS) exposure is associated with rhinitis symptoms (i.e., runny nose and congestion) in some people. In an effort to better understand these symptoms, we recruited 18 historically ETS-sensitive subjects from the community and exposed them for 15 min to clean air and for 15 min to sidestream tobacco smoke (STS, 45 ppm carbon monoxide). Symptoms were recorded (0 = absent, 5 = severe), and posterior rhinomanometry was performed. There were significant changes in rhinitis symptoms (1.3 ± 0.4 pre- versus 6.1 ± 0.5 post-STS, p < .05); nasal airway resistance (2.86 ± 0.2 pre- versus 4.49 ± 0.6 post-STS, p < .05), and maximum inspiratory flow (2.74 ± 0.3 pre- versus 2.14 ± 0.3 post-STS, p < .05). A spectrum of individual responsiveness to ETS was observed, and nasal resistance increased from 0% to 265%. Increased nasal resistance occurred primarily at the upstream or flow-limiting segment of the nasal airway.     

Impact of a prognostic 40-gene expression profiling test on clinical management decisions for high-risk cutaneous squamous cell carcinoma

Abstract

Objective: To determine how results from a prognostic 40-gene expression profiling (40-GEP) test would impact clinician management decisions and how their choices would align with a National Comprehensive Cancer Network (NCCN) compliant, risk-directed management plan for high-risk cutaneous squamous cell carcinoma (cSCC).

Methods: Clinicians attending a national dermatology conference were presented with 40-GEP test validation data. They were asked to rate clinicopathological features and molecular test results to assess their opinion of how concerning each is to cSCC prognosis. When presented with vignettes describing patients with NCCN-defined high-risk features, clinicians were asked to select a treatment plan using pre-test (no 40-GEP results), then, post-test (40-GEP Class 1, 2A, or 2B results) methodology along with corresponding metastasis rates for each test group.

Results: Risk factors deemed of highest concern for metastatic outcomes were a Class 2B 40-GEP result, perineural invasion, immunosuppression, invasion beyond subcutaneous fat, and tumor diameter >1?cm on the scalp. When presented with a 40-GEP result that indicated reduced risk of metastasis (Class 1), clinicians altered their treatment management plan accordingly. Specifically, there was significant reduction in the recommendations for sentinel lymph node biopsy, adjuvant radiation or chemotherapy, follow-up time, and nodal imaging. By comparison, when a 40-GEP result indicated an increased risk of metastasis (Class 2B), significant risk-appropriate increases in management intensity was observed for the aforementioned clinical decisions.

Conclusion: Integration of 40-GEP results impacted management decisions in a significant and risk-appropriate manner for high-risk cSCC patient scenarios, while remaining aligned with national guidelines for patient management.     

What Can I Do With a Doctoral Degree in Gerontology? Expanding Your Options

An endless number of career trajectories are possible for gerontologists. With a growing aging population, our skills and areas of expertise are of high value to numerous industries. The purpose of this study is to describe the professional development and career trajectories of alumni of U.S. doctoral gerontology programs obtained through the Gerontology Education Longitudinal Study (GELS). Specifically, the authors examine how professional identification, doctoral program career preparation, and perception of job prospects affect alumni decisions to pursue “traditional” (i.e., academic) versus “nontraditional” (i.e., non-academic) careers. Results from the GELS revealed a fairly even split in the alumni sample of careers in traditional and nontraditional settings. The decision to pursue a traditional versus nontraditional career was not significantly associated with personal identification, doctoral program career preparation, or perception of employment options. These results suggest that the skill set obtained in doctoral gerontology programs is useful and is in demand in a variety of careers; therefore, doctoral programs may want to consider tailoring training to meet students’ future career goals in both academic and non-academic settings.     

Desflurane/fentanyl compared with sevoflurane/fentanyl on awakening and quality of recovery in outpatient surgery using a Laryngeal Mask Airway: a randomized,double-blinded controlled trial

Study ObjectiveTo compare time to awakening and upper airway morbidity between desflurane and sevoflurane using a Laryngeal Mask Airway (LMA) and a balanced anesthetic regimen inclusive of opioids.DesignRandomized, double-blinded, placebo-controlled clinical trial.SettingAmbulatory surgery unit of a university hospital.Patients80 subjects receiving general anesthesia for outpatient gynecological surgery using a LMA.InterventionsDesflurane/fentanyl or sevoflurane/fentanyl were used for anesthetic maintenance.MeasurementsPatients were randomly assigned to receive desflurane or sevoflurane. The primary outcome was time to awakening as determined by an observer who was blinded to study group allocation. Secondary outcomes included the frequency of sore throat, cough, and pain perioperatively and at 2 and 24 hours postoperatively. Quality of recovery (QoR; via QoR-40 questionnaire) at 24 hours also was determined.Main ResultsThe median (IQR) time to eye opening following desflurane was 6.8 (5.0 - 9.8) minutes versus 11.8 (8.8 - 14.6) minutes following sevoflurane (P < 0.001), or a difference of 5.0 (99% CI 2.3 - 6.8) minutes. The median difference in response to verbal commands was 5.3 (99% CI 2.4 - 7.1) minutes. The frequency of cough, laryngospasm, sore throat, and hoarseness did not differ between groups. Quality of recovery at 24 hours was better in the desflurane group: difference in medians 6 (99% CI 0 – 12; P = 0.003).ConclusionsDesflurane retains faster awakening properties than does sevoflurane when used in combination with fentanyl as part of anesthetic maintenance in outpatient surgery with a LMA. The balanced anesthetic maintenance regimen seems to reduce the potential airway reactivity properties of desflurane.