Background Contemporary EUS-guided FNA techniques involve the use of a needle, with an air column within the lumen, with or without suction. We describe a novel technique with an aim to improve the ...quality of the aspirate. Objective To compare a novel “wet suction” technique (WEST) with the conventional FNA technique (CFNAT) of EUS-guided FNA using a 22-gauge FNA needle. Design Prospective, single-blind, and randomized trial. Setting Two large tertiary-care hospitals. Patients All consecutive adult patients presenting for EUS with possible FNA of solid lesions were offered the chance to participate in the study. Methods All lesions were sampled with the same needle by using alternating techniques. Patients were randomized to the WEST versus the CFNAT for the first pass. If the first pass was made with the WEST, the second pass was made with the CFNAT, and subsequent passes were made in an alternating manner by using the same sequence. All FNAs were performed using 22-gauge needles. Main Outcome Measurements Specimen adequacy, cellularity, and blood contamination of EUS-guided FNA aspirates graded on a predefined scale. Results The WEST yielded significantly higher cellularity in a cell block compared with the CFNAT, with a mean cellularity score of 1.82 ± 0.76 versus 1.45 ± 0.768 ( P < .0003). The WEST cell block resulted in a significantly better specimen adequacy of 85.5% versus 75.2% ( P < .035). There was no difference in the amount of blood contamination between the 2 techniques. Limitations Lack of cross check and grading by a second cytopathologist. Conclusion The novel WEST resulted in significantly better cellularity and specimen adequacy in cell blocks of EUS-guided FNA aspirate of solid lesions than the CFNAT.
Background Data from the Patient Safety in Surgery Study were used to compare preoperative risk factors, intraoperative variables, and surgical outcomes of adrenalectomy procedures performed in 81 ...Veterans Affairs (VA) hospitals with those performed in 14 private-sector (PS) hospitals. Study Design This study is a retrospective review of prospectively collected data on all patients undergoing adrenalectomy in the VA and PS for fiscal years 2002 through 2004. Bivariate analysis compared VA and PS preoperative risk factors, intraoperative variables, and 30-day morbidity and mortality. Regression risk-adjustment analysis was used to compare 30-day postoperative morbidity in the VA and PS. Results During the 3 years studied, 178 VA patients and 371 PS patients underwent adrenalectomy procedures with a median per site of 2 (range 1−9) and 21 (range 8−70) procedures per VA and PS hospital, respectively. The VA patients had considerably more comorbidities than PS patients. The unadjusted 30-day morbidity rate was significantly higher in VA (16.29%) than PS (6.74%) hospitals (p = 0.0003); after controlling for the higher rate of comorbidities, the adjusted odds ratio for morbidity in the VA versus the PS hospitals was no longer significant (odds ratio = 1.328; 95% CI, 0.488−3.613). Unadjusted mortality rate was VA 2.81%, PS 0.27%, p = 0.0074. The low event rate overall precluded risk adjustment for mortality. Conclusions The VA adrenalectomy population has more preoperative risk factors and substantially higher unadjusted 30-day postoperative morbidity and mortality rates than the PS population. After risk adjustment, there is no significant difference in morbidity between the VA and the PS. A larger study population is needed to compare risk-adjusted mortality between the VA and PS.
Introduction Medical students demonstrate decreased interest in surgical residencies and resident attrition after entry into programs has been reported at 14% to 20%. This study surveyed surgery ...residents regarding working conditions and how those conditions influenced their job satisfaction. Methods A new survey was developed to measure residents' working conditions. Questions generated from literature review were expanded and validated through focus groups at 2 academic medical centers. The resulting survey was administered on general/vascular surgery services at 52 hospitals along with a job-satisfaction scale. Questions were grouped into composite measures using factor analysis. Correlations were calculated between working conditions and job satisfaction at the individual and the hospital level. Results In 844 returned surveys, resident job satisfaction did not correlate with age, sex, or postgraduate year. Perceived quality of patient care was the strongest (R = .51) of 68 items that did correlate ( P < .01). Duty hours correlated less strongly (R = −.17). At the aggregate hospital level, effective ancillary staff/services (R = .77), empathetic nurses (R = .69), and attending teaching, appreciation and openness to suggestions (R = .49) correlated positively; scutwork (R = −.63) and erroneous paging (R = −.37) correlated negatively. Conclusions Our data confirm prior studies indicating that the teaching skills of the attending and the duty hours influence resident satisfaction. More important than these factors, however, were the effectiveness of systems and staff that facilitate the residents' job—care of the patient. Resident satisfaction and student recruitment efforts could be enhanced by the Program and Hospital Director's correction of deficiencies in these areas.
To analyze the temporal trend in enrollment rates in a COVID-19 platform trial during the first three waves of the pandemic in the United States.
Secondary analysis of data from the I-SPY COVID ...randomized controlled trial (RCT).
Thirty-one hospitals throughout the United States.
Patients who were approached, either directly or via a legally authorized representative, for consent and enrollment into the I-SPY COVID RCT.
None.
Among 1,338 patients approached for the I-SPY COVID trial from July 30, 2020, to February 17, 2022, the number of patients who enrolled (
= 1,063) versus declined participation (
= 275) was used to calculate monthly enrollment rates. Overall, demographic and baseline clinical characteristics were similar between those who enrolled versus declined. Enrollment rates fluctuated over the course of the COVID-19 pandemic, but there were no significant trends over time (Mann-Kendall test,
= 0.21). Enrollment rates were also comparable between vaccinated and unvaccinated patients. In multivariable logistic regression analysis, age, sex, region of residence, COVID-19 severity of illness, and vaccination status were not significantly associated with the decision to decline consent.
In this secondary analysis of the I-SPY COVID clinical trial, there was no significant association between the enrollment rate and time period or vaccination status among all eligible patients approached for clinical trial participation. Additional studies are needed to better understand whether the COVID-19 pandemic has altered clinical trial participation and to develop strategies for encouraging participation in future COVID-19 and critical care clinical trials.
To quantify resting lumbar erector myofascial stiffness in younger patients with ankylosing spondylitis (AS) and age-comparable healthy control subjects using a handheld mechanical impulse-based ...myotonometric device.
A case-control study of 24 patients with AS and 24 age-comparable healthy control subjects.
University physical therapy department.
Patients with AS (men: n=19; women: n=5; total: N=24) and healthy volunteers (men: n=19; women: n=5; total: N=24) without low back pain (age range, 18-46y).
Not applicable.
Lumbar myofascial stiffness.
At the initial measurements, median stiffness (Nm) of the averaged right- and left-sided values was greater (P=.021) in 24 patients with AS than 24 control subjects (268.9 vs 238.9, respectively). Repeated measurements after a 10-minute prone resting period were also greater (P=.007) in patients with AS than control subjects (281.0 vs 241.4, respectively). The 48 averaged right- and left-sided values from baseline and 10-minute measurements were compared in each subject group. The patients with AS more frequently (P=.012) had stiffness values >250 Nm (35 72.9% vs 22 45.8% in control subjects).
Lumbar myofascial stiffness was greater in 24 patients with AS than in the control subjects. A hypothesized biomechanical concept of increased resting lumbar myofascial stiffness in AS may be supported by this preliminary controlled study.
Summary This study aimed to non-invasively quantify passive stiffness of superficial myofascia at a lower lumbar (L3-L4) anatomical level in young healthy male and female subjects and investigate its ...possible morphological variation. Resting prone lumbar myofascial measurements were quantified using MyotonPro® and statistically analyzed in 20 young healthy individuals over 3-weekly intervals, concurrently with surface electromyography (sEMG). Averaged mean ± SE stiffness (Newton/meter) over three weeks was significantly (p < 0.001) greater in males (247.8 ± 11.3) than females (208.4 ± 11.3), on the right (237.7 ± 12.8) than left sides (218.5 ± 12.3), at 10-min (231.4 ± 9.1) than initial baseline (224.8 ± 9.1) values. A polymorphism of stiffness values in 10 male and 10 female subjects was suggested by box plot analyses of the 3 weekly measurements and greater inter-individual than intra-individual variances. Greater knowledge of lumbar myofascial stiffness can improve understanding of their contributions in health and chronic low back disorders.
The internalizing anti-Le(y) monoclonal antibody (MAb) BR64 was conjugated to the anticancer drug doxorubicin (DOX) using an acid-labile hydrazone bond to the DOX and either a disulfide or thioether ...bond to the MAb. The resulting disulfide (BR64-SS-DOX) and thioether (BR64-S-DOX) conjugates were evaluated for stability, potency, and antigen-specific activity in both in vitro and in vivo model systems. The BR64-SS-DOX conjugates demonstrated antigen-specific activity both in vitro and when evaluated against antigen-expressing, DOX-sensitive human carcinoma xenografts. However, the stability and potency of disulfide conjugates were poor, and in vivo activity superior to unconjugated DOX was seen only at doses approaching the maximum tolerated dose. Furthermore, BR64-SS-DOX conjugates were not active against antigen-expressing, DOX-insensitive colon tumor xenografts. In contrast, the BR64-S-DOX conjugates demonstrated good stability both in vitro and in vivo. The increased stability of the BR64-S-DOX conjugates resulted in the delivery of more biologically active DOX to tumors with a concomitant increase in potency and efficacy over that which could be achieved with either unconjugated DOX or BR64-SS-DOX conjugates. Delivery of DOX by BR64-SS-DOX conjugates resulted in complete regressions and cures of both DOX-sensitive lung xenografts and DOX-intensitive colon tumor xenografts. These results demonstrate the importance of linker stability when delivering drugs such as DOX to carcinomas via internalizing antibodies and are likely to have direct relevance to the clinical utility of MAb-directed delivery.
Reaction of VX and GD with gaseous ozone Wagner, George W.; Bartram, Philip W.; Brickhouse, Mark D. ...
Perkin 2 : an international journal of physical organic chemistry,
2000
6
Journal Article
