Art at the Living Museum

A visit to the Creedmoor Psychiatric Center’s Living Museum, a gallery that showcases art made by past and current patients of the institution, demonstrates the therapeutic functions art can serve. Art can be a method of coping with and processing events of the past, a scaffold for mending and rebuilding one’s life, a means of economic support, and a form of connection with the outside world. Therefore, therapeutic art can provide a model for adjunctive care for patients suffering from mental illness, one that can add meaning and satisfaction to traditional models of care in long-term care facilities and psychiatric hospitals. The process of reflection on individual works of art and meditation on the relationship between creativity and illness, function as a level of therapy itself for the mentally ill, and provides justification for continued funding and allocation of resources to the arts and humanities

Is participation in a clinical trial associated with a survival benefit in patients with bladder cancer?

Bladder cancer that is unresponsive to intravesical therapies is difficult to treat. Patients with this disease usually have to try salvage therapies, partial cystectomy, or radical cystectomy. Unfortunately, the population afflicted by bladder cancer is older and frailer than those afflicted by other cancers with mortality approaching 1.5% and readmission rates approaching 64%. These patients are left with no other options aside from participating in a clinical trial to delay or avoid surgery. We hypothesized that participation in a clinical trial provides survival benefits when controlling for tumor stage and pathology in the case of non-muscle invasive bladder cancer that is refractory to intravesical Bacillus Calmette-Guérin (BCG). Using our Institutional Review Board (IRB) approved Columbia Urologic Oncology Database, 55 patients with BCG-refractory NMIBC (29 clinical trial patients, 26 non-clinical trial patients) were identified between 2008 and 2012. Clinical characteristics, demographics, and outcomes were obtained from the medical records. Non-clinical trial patients had fewer mean BCG instillations than their clinical trial counterparts (7.8 versus 11.5 doses, p < .01). Kaplan Meier (KP) curves for Overall Survival (OS) and Cancer Specific Survival (CSS) indicate an increased survival benefit for patients enrolled in a clinical trial (OS: χ2 = 8.802, p< 0.01, median of 6.68 years versus 3.15 years; CSS: χ2 = 10.205, p < 0.01, mean 5.6 years versus 2.65 years). The data support the notion that there may be an inherent survival benefit gained by virtue of being included in a clinical trial. The drivers of this survival benefit may include more interactions with the hospitals and clinics, greater patient involvement in their health care, and increased surveillance by clinicians

Use of G-Protein-Coupled and -Uncoupled CCR5 Receptors by CCR5 Inhibitor-Resistant and -Sensitive Human Immunodeficiency Virus Type 1 Variants

Small-molecule CCR5 inhibitors such as vicriviroc (VVC) and maraviroc (MVC) are allosteric modulators that impair HIV-1 entry by stabilizing a CCR5 conformation that the virus recognizes inefficiently. Viruses resistant to these compounds are able to bind the inhibitor-CCR5 complex while also interacting with the free coreceptor. CCR5 also interacts intracellularly with G proteins, as part of its signal transduction functions, and this process alters its conformation. Here we investigated whether the action of VVC against inhibitor-sensitive and -resistant viruses is affected by whether or not CCR5 is coupled to G proteins such as Gαi. Treating CD4^(+)T cells with pertussis toxin to uncouple the Gαi subunit from CCR5 increased the potency of VVC against the sensitive viruses and revealed that VVC-resistant viruses use the inhibitor-bound form of Gα_(i)-coupled CCR5 more efficiently than they use uncoupled CCR5. Supportive evidence was obtained by expressing a signaling-deficient CCR5 mutant with an impaired ability to bind to G proteins, as well as two constitutively active mutants that activate G proteins in the absence of external stimuli. The implication of these various studies is that the association of intracellular domains of CCR5 with the signaling machinery affects the conformation of the external and transmembrane domains and how they interact with small-molecule inhibitors of HIV-1 entry

Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

BACKGROUND AND OBJECTIVES: Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population. METHODS: The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was \u3c 0.05. RESULTS: A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p \u3c 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386-2.673). CONCLUSION: Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery

Renal functional outcomes after surgery for renal cortical tumors

Historically, radical nephrectomy represented the gold standard for the treatment of small (≤ 4cm) as well as larger renal masses.  Recently, for small renal masses, the risk of ensuing chronic kidney disease and end stage renal disease has largely favored nephron-sparing surgical techniques, mainly partial nephrectomy. In this review, we surveyed the literature on renal functional outcomes after partial nephrectomy for renal tumors. The largest randomized control trial comparing radical and partial nephrectomy failed to show a survival benefit for partial nephrectomy. With regards to overall survival, surgically induced chronic kidney disease (GFR &lt; 60 ml/min/ 1.73m2) caused by nephrectomy might not be as deleterious as medically induced chronic kidney disease. In evaluating patients who underwent donor nephrectomy, transplant literature further validates that surgically induced reductions in GFR may not affect patient survival, unlike medically induced GFR declines.  Yet, because patients who present with a renal mass tend to be elderly with multiple comorbidities, many develop a mixed picture of medically, and surgically-induced renal disease after extirpative renal surgery.  In this population, we believe that nephron sparing surgery optimizes oncological control while protecting renal function. </div

Multiple CCR5 Conformations on the Cell Surface Are Used Differentially by Human Immunodeficiency Viruses Resistant or Sensitive to CCR5 Inhibitors ▿ †

Resistance to small-molecule CCR5 inhibitors arises when HIV-1 variants acquire the ability to use inhibitor-bound CCR5 while still recognizing free CCR5. Two isolates, CC101.19 and D1/85.16, became resistant via four substitutions in the gp120 V3 region and three in the gp41 fusion peptide (FP), respectively. The binding characteristics of a panel of monoclonal antibodies (MAbs) imply that several antigenic forms of CCR5 are expressed at different levels on the surfaces of U87-CD4-CCR5 cells and primary CD4+ T cells, in a cell-type-dependent manner. CCR5 binding and HIV-1 infection inhibition experiments suggest that the two CCR5 inhibitor-resistant viruses altered their interactions with CCR5 in different ways. As a result, both mutants became generally more sensitive to inhibition by CCR5 MAbs, and the FP mutant is specifically sensitive to a MAb that stains discrete cell surface clusters of CCR5 that may correspond to lipid rafts. We conclude that some MAbs detect different antigenic forms of CCR5 and that inhibitor-sensitive and -resistant viruses can use these CCR5 forms differently for entry in the presence or absence of CCR5 inhibitors