Partial nephrectomy should be classified as an inpatient procedure: Results from a statewide quality improvement collaborative

ObjectivesTo examine length of stay (LOS) and readmission rates for all minimally-invasive partial nephrectomy (MIPN) and MI radical nephrectomy (MIRN) performed for localized renal masses ≤7 cm in size (cT1RM) within 12 Michigan urology practices. Both RN and PN are commonly performed in treating cT1RM. Although technically more complex and associated with higher complication rates, Centers for Medicare & Medicaid Services considers MIPN an outpatient procedure and MIRN is inpatient.MethodsWe collected data for renal surgeries for cT1RM at MUSIC-KIDNEY practices between May 2017–February 2020. Data abstractors recorded clinical, radiographic, pathologic, surgical, and short-term follow-up data into the registry for cT1RM patients.ResultsWithin MUSIC-KIDNEY, 807 patients underwent MI renal surgery at 12 practices. Median LOS for cT1RM patients after MIPN (n = 531, 66%) was 2 days and after MIRN (n = 276, 34%) was also 2 days. Among patients undergoing laparoscopic or robotic PN, 171 (32%), 230 (43%), and 130 (24%) stayed ≤1, 2, ≥3 days. Among patients undergoing laparoscopic or robotic RN, 81 (29%), 112 (41%), and 83 (30%) stayed ≤1, 2, ≥3 days. No significant difference was observed between MIPN and MIRN on LOS commensurate with outpatient surgery (≤1-day, OR = 0.97, P = 0.87).ConclusionsLess than one-third of patients had a LOS ≤1-day and LOS was comparable for MIPN and MIRN. Centers for Medicare & Medicaid Services should be advised that MIPN is a more complex surgery than MIRN, most patients receiving a MIPN will require a ≥2-day hospital stay and it would be more appropriate to classify MIPN an inpatient procedure with MIRN.     

The impact of SARS-CoV-2 on the cystic fibrosis foundation therapeutics development network

The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) global pandemic significantly impacted CF clinical research within the Cystic Fibrosis Foundation Therapeutics Development Network (CFF TDN). A Research Electronic Data Capture (REDCap) survey was developed and sent to network sites to monitor and understand the impact on research teams, ongoing and anticipated clinical research, and specific clinical and research procedures. Key findings indicated an early impact on participant enrollment, research team stability, and procedures such as spirometry and sputum induction. These trends steadily improved over the months as research activities began to recover across the TDN. While SARS-CoV-2 created a significant challenge it also highlights new opportunities to expand CF research with greater focus on data collection outside of research centers and increased access for remote participation.     

Rapid changes in the expression of a gene encoding a calcium-binding protein in Schistosoma mansoni

Genes expressed in a stage-specific manner may help us understand the molecular events controlling the complex life cycle of schistosomes. cDNA and genomic clones encoding a calcium-binding protein (CaBP) were obtained from cercariae and their sequence determined. The encoded protein (69 amino acids long) shows clear resemblance to the domain structure and organization of CaBP molecules. It contains two typical calcium-binding loops, the distance between which is identical to the length conserved in other CaBP molecules. In addition, the schistosome CaBP shows Ca2+-dependent electrophoretic mobility (increased with Ca2+-ions and decreased with EGTA). Northern blots revealed expression of the CaBP gene in cercariae but not in sporocyst or worm (developmental stages preceding and following cercaria). The preferential expression of this CaBP in the cercaria raises questions as to what cercaria-specific function(s) it performs. The structure of the gene is similar to that in other eukaryotes, and one intron interrupts the coding sequence. The region of the cap site was determined, and there was no evidence of the spliced leader sequence found in the mRNAs of other parasites. The CaBP reveals a rapid change in gene expression, since the mRNA is missing in the parasite residing in infected snails, but is readily detected in cercariae 1 h after shedding. We identified other genes which are turned on (like the CaBP) or shut off within the short period of transition from cercariae in the snail to free-swimming cercariae.     

Immunoregulatory properties of the proteins present in human milk

The immunoregulatory properties of several proteins, isolated from human milk, were investigated. Secretory component and galactothermin exhibited immunoregulatory activities in the in vivo and in vitro assays, generating helper cells, changing the ARFC levels and the resistance of thymocytes to hydrocortisone (HC). In addition, the immunoregulatory action of the P protein and its four fractions was studied. The bulk of the activity was found in the fraction II and III. The results suggest that the postneonatal development of the mammalian immune system is under the surveillance of various immunoregulatory proteins contained in maternal secretory fluids.     

Osteoinductivity and biomechanics of a porous ceramic with autogenic periosteum

Twenty-one dogs were used to study the osteoinductivity and biomechanical properties of a biphasic porous ceramic with autogenic periosteum implanted in muscle. The ceramic implants were swathed in fresh periosteum derived from the same animals and implanted in the femur muscles. The other two groups of animals served as controls using the same material implanted in the femur bones and muscles without periosteum. Biomechanical measurements showed that, in the muscles, the experimental group had a higher bending strength than the unswathed group by the time the samples were harvested. Six months postoperatively, the strength of the samples in the experimental group had almost reached that of normal bones. The results of X-ray diffraction and infrared spectrometric analysis suggested that the degradation rate and speed of tricalcium phosphate (TCP) of the ceramic in the experimental group were faster than in the unswathed samples, but slower than in samples implanted in bones. The bone replacement and bone-inducing activity were excellent in the periosteum-swathed samples. Histologically, satisfactory bone repair was seen in the experimental samples. All results indicate that autogenic periosteum could increase bioactivity of ceramics in heterosites and improve bone formation in the surroundings of porous calcium phosphate ceramics. The data also infer that the complicated procedure of culturing bone growth factors with biomaterials in vitro to obtain bioactive grafts could be replaced by this relatively simple method.