The Effect of Bleach, Hydrogen Peroxide, and Iodine on Mycobacterium Species

The laboratory zebrafish, Danio rerio, is a model organism used in numerous area of biological research, and is also subject to its own diseases. A common disease in zebrafish is mycobacteriosis, caused by Mycobacterium species. Elimination of Mycobacterium spp. is crucial in both preserving research studies as well as preventing the spread of the zoonotic pathogens to humans. Because of the common practice of exchanging fish between facilities, as well as a lack of a standard protocol for disinfection, these infections have become commonplace. In order to investigate the efficacy of disinfectants, this study tested the germicidal effect of sodium hypochlorite, hydrogen peroxide, and iodine on Mycobacterium chelonae and Mycobacterium abscessus. Concentrations of 100 ppm and 150 ppm sodium hypochlorite (from bleach),1.5% and 3% hydrogen peroxide, and 100 ppm iodine were tested. Statistically significant decreases in growth were observed in the treatments of M. abscessus with hydrogen peroxide, sodium hypochlorite, and iodine and M. chelonae with hydrogen peroxide and iodine. When treated with 1.5% hydrogen peroxide, M. abscessus showed a 14-­‐fold germicidal effect and M. chelonae showed a 6–fold germicidal effect when treated with 3% hydrogen peroxide. When treated with 150 ppm sodium hypochlorite, M. abscessus showed an 11–fold germicidal effect. When treated with 100 ppm iodine, both M. chelonae and M. abscessus were completely eliminated. Therefore, the current protocol for the application of bleach to zebrafish eggs cannot be relied upon for complete disinfection of mycobacteria, but the use of iodine shows promise as the basis for a new method

The structural properties and star formation history of Leo T from deep LBT photometry

We present deep, wide-field g and r photometry of the transition type dwarf galaxy Leo T, obtained with the blue arm of the Large Binocular Telescope. The data confirm the presence of both very young (5 Gyr) stars. We study the structural properties of the old and young stellar populations by preferentially selecting either population based on their color and magnitude. The young population is significantly more concentrated than the old population, with half-light radii of 104+-8 and 148+-16 pc respectively, and their centers are slightly offset. Approximately 10% of the total stellar mass is estimated to be represented by the young stellar population. Comparison of the color-magnitude diagram (CMD) with theoretical isochrones as well as numerical CMD-fitting suggest that star formation began over 10 Gyr ago and continued in recent times until at least a few hundred Myr ago. The CMD-fitting results are indicative of two distinct star formation bursts, with a quiescent period around 3 Gyr ago, albeit at low significance. The results are consistent with no metallicity evolution and [Fe/H] ~ -1.5 over the entire age of the system. Finally, the data show little if any sign of tidal distortion of Leo T.Comment: 8 pages, 9 figures, some small textual changes, accepted for publication in the Astrophysical Journa

Comparison of Radiation Exposure During Thoracolumbar Fusion Using Fluoroscopic Guidance versus Anatomic Placement of Pedicle Screws

Introduction: There are multiple accepted surgical techniques for placing thoracolumbar pedicle screws. Some surgeons use fluoroscopy to aid in placement of instrumentation, while others use fluoroscopy as confirmation of positioning after anatomic placement of screws. The purpose of this study is to evaluate the difference in radiation exposure imparted to the patient using a fluoroscopic-guided technique versus anatomic placement of screws. Methods: A retrospective study evaluated 185 adult patients with non-percutaneous, posterior instrumented fusions over a four-year time period. For each patient, the fluoroscopy report was reviewed and the method of fluoroscopy utilization was ascertained from the patient’s operative report. Average seconds per screw inserted for each method was compared using a student’s t-test. Results: 82 patients underwent thoracolumbar fusion by an anatomic technique, with an average of 5.72 screws (range 2-26) placed. The mean fluoroscopy time was 11.85 seconds (median 6 sec.) and the average time for placement of a single screw was 2.65 seconds. 103 patients underwent fluoroscopic-guided surgery. An average of 5.1 screws (range 2-12) were placed and the mean fluoroscopy time was 83.26 seconds per operation. The average time for placement of a single screw was 17.08 seconds. Conclusion: Patients undergoing thoracolumbar fusion using the fluoroscopic-guided technique have increased radiation exposure, reaching 6.5 times the amount imparted using an anatomic technique, which is statistically significant (p\u3c0.01). Surgeons performing a large number of fluoroscopic-guided operations may have the potential to exceed annual radiation dose limits

Validation of a new prognostic model to easily predict outcome in renal cell carcinoma: The GRANT score applied to the ASSURE trial population

Background: Prognostic scores have been developed to estimate the risk of recurrence and the probability of survival after nephrectomy for renal cell carcinoma (RCC). The use of these tools, despite being helpful to plan a customized schedule of follow-up, to the patient's tailored counselling and to select individuals who could potentially benefit from adjuvant treatment, currently is not routine, due to their relative complexity and to the lack of histological data (i.e. necrosis).Patients and methods: We developed a simple score called GRade, Age, Nodes and Tumor (GRANT) based on four easily obtained parameters: Fuhrman grade, age, pathological nodal status and pathological tumor size. Patients with 0 or 1 factor are classified as favorable risk, whereas patients with two or more risk factors as unfavorable risk. The large population of RCC patients from the ASSURE adjuvant trial was used as independent dataset for this external validation, to investigate the prognostic value of the new score in terms of disease-free survival and overall survival and to evaluate its possible application as predictive tool. Statistical analyses were carried out by the Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute (Boston, USA) for the ASSURE trial patients' population.Results: The performance of the new model is similar to that of the already validated score systems, but its strength, compared with the others already available, is the ease and clarity of its calculation, with great speed of use during the clinical practice. Limitations are the use of the Fuhrman nuclear grade, not valid for rare histologies, and the TNM classification modifications over time.Conclusion: The GRANT score demonstrated its potential usefulness for clinical practice

Use of the Spine AdVerse Events Severity (SAVES) System to Categorize and Report Adverse Events in Spine Surgery.

Introduction: Analysis of adverse events (AEs) in spine surgery has historically been retrospective, utilizing hospital administrative data. Our objective was to determine the incidence, severity and effect on hospital length of stay (LOS) for AEs in spine surgery using the Spine AdVerse Events Severity (SAVES V2) system. Methods: AEs for all surgical spine patients at our institution were prospectively collected for 18 months and correlated with retrospective data from operative reports and H&Ps. Statistical analyses compared patient demographics, diagnoses, and surgical characteristics to hospital length of stay and likelihood of adverse events. Results: This system captured 75% (765/977) of surgical cases for all indications over the study period. 73% (541/743) of patients experienced at least one AE, with an average of 1.2 AEs per patient (range 0-5). The most common AEs were pain control (31%), urinary retention (9.7%), wound infection (6.3%), and incidental durotomy (5.8%). For patients experiencing at least one AE, 30% had no effect on LOS, 48% increased LOS by 1-2 days, 15% increased LOS by 3-7 days, and 7% had prolonged LOS greater than 8 days. Our system captured 25.4% more adverse events (60.0% vs. 34.6%) than hospital administrative data. Univariate analysis revealed patient age, emergent surgery, diagnostic and surgical categories, and spine region to be predictors of both AEs and LOS. Instrumentation was predictive of increased LOS but not AEs. The type of AE was strongly associated with LOS. Multivariable analysis of AE likelihood demonstrated emergent surgery to be the strongest independent predictor with an adjusted odds ratio of 8.5 versus elective surgery. Discussion: Spine surgery is associated with a high incidence of adverse events, which often prolong hospital length of stay. Better characterization of adverse events and their predictors could lead to improved management strategies that reduce patient morbidity and mortality

Predictors of Improved Pain, Quality of Life, and Physical Function after Surgical Treatment of Lumbar Spinal Stenosis

Introduction: Degenerative lumbar stenosis is common in adults and is frequently managed by surgical intervention after non-operative measures fail to relieve pain. Limited evidence-based information regarding optimal selection of patients for surgery exists. Current reform in healthcare policy has sparked significant interest in comparative effectiveness research with the goal of optimizing treatment strategies for common conditions such as degenerative lumbar stenosis. The purpose of this study is to quantify the effectiveness of surgical treatment of lumbar stenosis and to identify patient predictors of greatest improvement using patient reported measures of pain, physical function and quality of life. Methods: A retrospective study evaluated 229 adult patients who underwent decompression with or without posterior lumbar fusion for treatment of lumbar stenosis over a two year time period. Patient reported outcomes were measured using the SF36 health survey. 146 patients had 6 month follow-up and 106 patients had one year follow-up. Variations in scores of the SF36 pain, mental component summary (MCS), and physical component summary (PCS) subscales were analyzed by multivariate linear regression analysis. Results: At 6-12 months post-surgery, patients reported an improvement of 8 points in average pain (32.3 to 40.4), physical function (28.6 to 36.9), and PCS (29.0 to 36.9) subscales of the SF36. There was a 6 point average improvement in MCS scores (41.8 to 48.10). Greater post-operative pain was significantly associated with smoking (p In regards to improvements in quality of life, older age (p Conclusion: In general, surgical treatment for lumbar stenosis improves patient pain, quality of life, and physical function as indicated by substantial improvement in all subscales of the SF36 health survey. Predictive factors associated with poor pain relief after surgery include smoking, diabetes, the presence of instrumentation, and re-operation within a 12 month time period. Higher MCS scores are seen in older patients and those with an increase in physical function post-operatively. Predictive factors for poor MCS scores include revision surgery and mental health diagnosis. No specific predictors of PCS score were identified, most likely due to the complicated nature of the patient population with lumbar spinal stenosis. Further work is necessary to determine the ideal surgical candidate

Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology

Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes

U.S. Inhibitor Pilot Project: Study Design And Methods Validation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106090/1/jth01876.pd

Clinical actionability of comprehensive genomic profiling for management of rare or refractory cancers

Background. The frequency with which targeted tumor sequencing results will lead to implemented change in care is unclear. Prospective assessment of the feasibility and limitations of using genomic sequencing is critically important. Methods. A prospective clinical study was conducted on 100 patients with diverse-histology, rare, or poor-prognosis cancers to evaluate the clinical actionability of a Clinical Laboratory Improvement Amendments (CLIA)-certified, comprehensive genomic profiling assay (FoundationOne), using formalin-fixed, paraffin-embedded tumors. The primary objectives were to assess utility, feasibility, and limitations of genomic sequencing for genomically guided therapy or other clinical purpose in the setting of a multidisciplinary molecular tumor board. Results. Of the tumors from the 92 patients with sufficient tissue, 88 (96%) had at least one genomic alteration (average 3.6, range 0–10). Commonly altered pathways included p53 (46%), RAS/RAF/MAPK (rat sarcoma; rapidly accelerated fibrosarcoma; mitogen-activated protein kinase) (45%), receptor tyrosine kinases/ligand (44%), PI3K/AKT/mTOR (phosphatidylinositol-4,5-bisphosphate 3-kinase; protein kinase B; mammalian target of rapamycin) (35%), transcription factors/regulators (31%), and cell cycle regulators (30%). Many low frequency but potentially actionable alterations were identified in diverse histologies. Use of comprehensive profiling led to implementable clinical action in 35% of tumors with genomic alterations, including genomically guided therapy, diagnostic modification, and trigger for germline genetic testing. Conclusion. Use of targeted next-generation sequencing in the setting of an institutional molecular tumor board led to implementable clinical action in more than one third of patients with rare and poor-prognosis cancers. Major barriers to implementation of genomically guided therapy were clinical status of the patient and drug access. Early and serial sequencing in the clinical course and expanded access to genomically guided early-phase clinical trials and targeted agents may increase actionability. Implications for Practice: Identification of key factors that facilitate use of genomic tumor testing results and implementation of genomically guided therapy may lead to enhanced benefit for patients with rare or difficult to treat cancers. Clinical use of a targeted next-generation sequencing assay in the setting of an institutional molecular tumor board led to implementable clinical action in over one third of patients with rare and poor prognosis cancers. The major barriers to implementation of genomically guided therapy were clinical status of the patient and drug access both on trial and off label. Approaches to increase actionability include early and serial sequencing in the clinical course and expanded access to genomically guided early phase clinical trials and targeted agents