Does partial nephrectomy at an academic institution result in better outcomes?

Purpose

Partial nephrectomy (PN) outcomes may be better at academic institutions than at non-academic centers. Peer-review, sub-specialized practice profile, higher individual surgeon and institutional caseload may explain this observation. To the best of our knowledge, the role of institutional academic affiliation has not been examined with regard to PN postoperative outcomes.

Methods

Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed within the 10 most contemporary years (1998–2007). We explored the effect of academic status on three short-term PN outcomes (intraoperative and postoperative complications, as well as in-hospital mortality). Multivariable logistic regression analyses further adjusted for age, race, gender, Charlson Comorbidity Index (CCI), surgical approach, hospital region, annual hospital caseload and insurance status.

Results

Overall, 8,513 PNs were identified. Of those, 5,906 (69.4%) were recorded at academic institutions. Academic institution patients had lower CCI, were less frequently Caucasian and more frequently had private insurance (all P?P?=?0.018). In multivariable analyses, institutional academic status did not affect the three short-term PN outcomes.

Conclusions

Patient selection explains better PN postoperative outcomes at academic institutions. Control for these biases removes the outcome differences, at least when the three short-term PN outcomes are considered. However, the interpretation of these findings needs to take into account the lack of adjustment for case complexity.     

Gauging recovery after hemorrhagic stroke in rats: implications for cytoprotection studies.

Successful clinical translation of prospective cytoprotectants will likely occur only with treatments that improve functional recovery in preclinical (rodent) studies. Despite this assumption, many rely solely on histopathologic end points or the use of one or two simple behavioral tests. Presently, we used a battery of tests to gauge recovery after a unilateral intracerebral hemorrhagic stroke (ICH) targeting the striatum. In total, 60 rats (N=15 per group) were stereotaxically infused with 0 (SHAM), 0.06 (MILD lesion), 0.12 (MODERATE lesion), or 0.18 U (SEVERE lesion) of bacterial collagenase. This created a range of injury akin to moderate (from SEVERE to MODERATE or MODERATE to MILD lesion size approximately 30% reduction) and substantial cytoprotection (SEVERE to MILD lesion size--51% reduction). Post-ICH functional testing occurred over 30 days. Tests included the horizontal ladder and elevated beam tests, swimming, limb-use asymmetry (cylinder) test, a Neurologic Deficit Scale, an adhesive tape removal test of sensory neglect, and the staircase and single pellet tests of skilled reaching. Most tests detected significant impairments (versus SHAM), but only a few (e.g., staircase) frequently distinguished among ICH groups and none consistently differentiated among all ICH groups. However, by using a battery of tests we could behaviorally distinguish groups. Thus, preclinical testing would benefit from using a battery of behavioral tests as anything less may miss treatment effects. Such testing must be based on factors including the type of lesion, the postoperative delay and the time required to complete testing.     

Histological analysis of achilles tendons in an overuse rat model

The purpose of this study was to design an animal model that induces histological changes in Achilles tendons consistent with those cited in the literature for human Achilles tendon disease. Sprague‐Dawley rats were subjected to 10° uphill treadmill running on a custom‐designed rodent treadmill and at a speed of 17 meters per minute for 1 h, five times per week, over a 12‐week treatment period. Subsequent histological analysis revealed alterations in the rat Achilles tendon that were generally consistent with those described in the literature for diseased human tendon tissues. These features include: decreased collagen fiber organization, more intense collagen staining, and increased cell nuclei numbers. Interestingly, though, immunohistochemical cell typing suggests that the observed increased cellularity does not include a significant inflammatory component but is secondary to increased numbers of endothelial cells (i.e., vascularization) and fibroblasts. These histological features likely represent a biological repair/remodeling response resulting from overuse running. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:840–846, 2008     

Mossy fiber lesion reduces the probability that kainic acid will provoke CA3 hippocampal pyramidal cell bursting

A retrograde tracing study in the mole using wheat germ-agglutinated horseradish peroxidase (WGA-HRP) indicated that the medial superior olivary nucleus (MSO) projects to the inferior colliculus (IC) bilaterally. Considering the strict ipsilateral projections from the MSO to the IC in all other eutherian species ever reported, the bilateral projection in the mole is quite unique. This may reflect specializations of the peripheral auditory apparatus of the underground dwellers and/or primitiveness of the insectivorous brains.     

Sexual dysfunctions in depression

The incidence of sexual dysfunctions in a group of 51 drug-free depressed patients and in age- and sex-matched controls was studied. Three groups of sexual dysfunction were assessed: alterations of libido, genital symptoms, and menstrual irregularities. The Beck Rating Scale for Depression, the Eysenck Personality Inventory (EPI), and the State-Trait Anxiety Inventory were completed on each participant. Depressed patients obtained significantly higher scores on anxiety, depression, and alterations of libido than controls. Rating scale scores for anxiety and depression were strongly inter-correlated, making the separation of depression-related symptoms from anxiety difficult. In males, the genital symptoms correlated inversely with the L (lie) score of the Eysenck Personality Inventory. There were no inter-relationships between the three groups of sexual dysfunction.