Trends in regionalization of radical cystectomy in three large northeastern states from 1996 to 2009

ObjectivesTo assess regionalization trends and short-term clinical outcomes in patients undergoing radical cystectomy for urothelial carcinoma.Materials and methodsUsing 1996–2009 discharge data from New York (NY), New Jersey (NJ) and Pennsylvania (PA), all patients ≥18 years with urothelial carcinoma undergoing cystectomy were identified using ICD-9 coding. We assigned hospital volume status by quintiles based on relative proportions of cystectomies performed on a per hospital basis in 1996; very low volume hospitals: 0–2 (VLVH), low: 3–4 (LVH), moderate: 5–8 (MVH), high: 9–31 (HVH), and very high: ≥32 (VHVH). Changes in the proportion of procedures performed by volume categories were assessed over time, and patient characteristics were compared between groups.ResultsA total of 14,404 patients met inclusion criteria. For each year increase from 1996 to 2009, the odds of having surgery performed at a VHVH increased by 22% (odds ratio [OR] 1.22, confidence interval [CI] 1.04–1.44). Patients undergoing surgery at a VHVH were less likely to be African American (OR 0.59 [CI 0.39–0.91]), or insured through Medicaid (OR 0.65 [CI 0.50–0.84]) or Medicare (OR 0.84 [CI 0.75–0.94]). Controlling for year treated, total procedures performed, and patient characteristics, median hospital length of stay (HLOS) was shorter (median difference ?0.89 days [CI ?1.12 to ?0.66]), and patients were significantly less likely to die during their hospital stay if treated at a VHVH compared with a VLVH (OR 0.33 [CI 0.22–0.49]).ConclusionsThere has been extensive regionalization of cystectomy to VHVHs in NY, NJ, and PA since 1996. Despite apparent improvements in mortality and HLOS in patients treated at higher volume centers in our sample, future investigations more rigorously adjusting for hospital structural characteristics and patient severity are necessary to confirm these findings. Disparities in access to VHVH care are still evident and must be addressed.     

Species of the Colletotrichum gloeosporioides complex associated with anthracnose diseases of Proteaceae

Anthracnose disease of Proteaceae has in the past chiefly been attributed to infections by C. acutatum, C. boninense and C. gloeosporioides. In the present study, a multi-locus phylogenetic analysis (ACT, CAL, CHS-1, GAPDH, GS, ITS, TUB2) revealed that strains of the C. gloeosporioides complex associated with Proteaceae belong to at least six species. These include C. alienum, C. aotearoa, C. kahawae (subsp. ciggaro), C. siamense, and two new taxa, C. proteae and C. grevilleae. The most economically important pathogen of Proteaceae seems to be C. alienum, and not C. gloeosporioides as previously reported. All taxa associated with Proteaceae are morphologically described on different media in culture, except strains of C. siamense, which proved to be sterile. Furthermore, C. populi is synonymised with C. aenigma.     

Current Concepts in the Treatment of Gouty Arthritis

Gouty arthritis is an extremely painful condition that causes functional impairment. Gouty arthritis has become increasingly complex because of multiple comorbidities, iatrogenic factors and hyperuricemia that is refractory to treatment. In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares.     

Oral bone loss induced by mineral deficiency in a rat model: Effect of a synthetic bone mineral (SBM) preparation

Osteoporosis affects the craniofacial and oral structures and has been associated with periodontal bone loss, tooth loss and reduced jaw bone mass.ObjectiveThis study aimed to test the therapeutic efficacy of synthetic bone mineral (SBM) in minimizing alveolar bone loss induced by mineral deficiency in a rat model. SBM consists of a calcium carbonate apatite (similar to bone apatite) matrix incorporating magnesium, zinc, and fluoride ions.DesignThirty female Sprague Dawley rats (2 months old) were randomly distributed into 3 groups (10 rats per group): GA (control), on basic diet; GB, on mineral deficient (MD) diet; and GC, on MD + SBM. The rats were sacrificed after 3 months, the jawbones were isolated and the soft tissues removed. Bone density was determined using X-ray radiography (Faxitron); mandibular cortical width, panoramic mandibular index, and alveolar resorption degree (M/M ratio) using BioquantOsteo; and bone micro-architecture micro-computed tomography and scanning electron microscopy.ResultsCompared to control (GA), the rats on MD diet (GB) experienced significant mandibular bone loss while the rats on MD + SBM diet (GC) experienced significantly less bone loss compared to the GB group.ConclusionSBM, administered orally, may have the potential as an osteoporosis therapeutic agent in minimizing or preventing alveolar bone loss induced by mineral deficiency.     

Sustained outcomes of a peer‐taught family education program on mental illness

Objective: This study examines 6‐month follow‐up data from participants in a randomized trial of a peer‐driven 12‐session family support and education program, called family‐to‐family (FTF) and offered by the US National Alliance on Mental Illness, to determine whether improvements in distress, family functioning, coping and empowerment were sustained. Method: Individuals randomized to the FTF condition were assessed after program completion and then 3 months later on measures of distress, family functioning, coping, and empowerment. We used a multilevel regression model (sas proc mixed ) to test for significant changes over time (baseline, 3 and 9 months). Results: All significant benefits that FTF participants gained between baseline and immediately post‐FTF were sustained at 9 months including reduced anxiety, improved family problem‐solving, increased positive coping, and increased knowledge. Greater class attendance was associated with larger increases in empowerment and reductions in depression and displeasure with ill relative. Conclusion: Evidence suggests that benefits of the FTF program were sustained for at least 6 months without any additional boosters or supports. Peer‐based programs may produce sustained benefits for individuals seeking help in addressing challenges and stresses related to having a family member with a mental illness.     

Electrophysiological subtypes and prognosis of Guillain–Barré syndrome in Northeastern China

Introduction: The dystrophic features in hindlimb skeletal muscles of female mdx mice are unclear. Methods: We analyzed force‐generating capacity and force decline after lengthening contraction‐induced damage (fragility). Results: Young (6‐month‐old) female mdx mice displayed reduced force‐generating capacity (?18%) and higher fragility (23% force decline) compared with female age‐matched wild‐type mice. These 2 dystrophic features were less accentuated in young female than in young male mdx mice (?32% and 42% force drop). With advancing age, force‐generating capacity decreased and fragility increased in old (20 month) female mdx mice (?21% and 57% force decline), but they were unchanged in old male mdx mice. Moreover, estradiol treatment had no effect in old female mdx mice. Conclusions: Female gender–related factors mitigate dystrophic features in young but not old mdx mice. Further studies are warranted to identify the beneficial gender‐related factor in dystrophic muscle. Muscle Nerve, 2013     

Antiseptic phobia in a patient experiencing anesthesia awareness during cleft palate repair surgery: a case report

Specific phobia is an excessive and irrational fear often triggered by a stressor. Among different types of phobias arising in medical settings, we could not find any case reported for exclusively antiseptic fluids without any medical–surgical intervention. The term “anesthesia awareness” (AA) signifies the specific surgical period of time when an individual, in spite of being under intended general anesthesia, remains aware of the sensory stimuli and the memories of which also remain available for his subsequent explicit recall in the future. According to the “American Society of Anesthesiologists Practice Advisory”, it is explicit recall during general anesthesia. Its hallmark is the presence of awareness of the events going on during the surgical procedure while being under a general anesthesia. AA is a distressing condition with immediate and long-term consequences. In spite of an estimated prevalence of 0.1%–0.2% of all the surgeries, our knowledge about this condition is limited. The most commonly reported consequences of AA are acute painful flashbacks of surgical events along with the emotional turmoil and a sense of helplessness followed later by posttraumatic stress disorder. Here, we report a unique case of occurrence of “antiseptic-phobia” in a patient following the experience of anesthesia awareness during cleft palate repair surgery.     

Conditioned medium from human amniotic epithelial cells may induce the differentiation of human umbilical cord blood mesenchymal stem cells into dopaminergic neuron‐like cells

Dopaminergic (DA) neuron therapy has been established as a new clinical tool for treating Parkinson's disease (PD). Prior to cell transplantation, there are two primary issues that must be resolved: one is the appropriate seed cell origin, and the other is the efficient inducing technique. In the present study, human umbilical cord blood‐derived mesenchymal stem cells (hUCB‐MSCs) were used as the available seed cells, and conditioned medium from human amniotic epithelial cells (ACM) was used as the inducing reagent. Results showed that the proportion of DA neuron‐like cells from hUCB‐MSCs was significantly increased after cultured in ACM, suggested by the upregulation of DAT, TH, Nurr1, and Pitx3. To identify the process by which ACM induces DA neuron differentiation, we pretreated hUCB‐MSCs with k252a, the Trk receptor inhibitor of brain‐derived neurotrophic factor (BDNF) and nerve growth factor (NGF), and found that the proportion of DA neuron‐like cells was significantly decreased compared with ACM‐treated hUCB‐MSCs, suggesting that NGF and BDNF in ACM were involved in the differentiation process. However, we could not rule out the involvement of other unidentified factors in the ACM, because ACM + k252a treatment does not fully block DA neuron‐like cell differentiation compared with control. The transplantation of ACM‐induced hUCB‐MSCs could ameliorate behavioral deficits in PD rats, which may be associated with the survival of engrafted DA neuron‐like cells. In conclusion, we propose that hUCB‐MSCs are a good source of DA neuron‐like cells and that ACM is a potential inducer to obtain DA neuron‐like cells from hUCB‐MSCs in vitro for an ethical and legal cell therapy for PD. © 2013 Wiley Periodicals, Inc.