Lung volume reduction surgery since the National Emphysema Treatment Trial: Study of Society of Thoracic Surgeons Database

ObjectivesThe National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial.MethodsAggregate statistics on lung volume reduction surgery reported in the Society of Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to assess procedure volume, preoperative and operative characteristics, and outcomes. Comparisons with published data from the National Emphysema Treatment Trial were made using chi-square and 2-sided t tests.ResultsIn 8.5 years, 538 patients underwent lung volume reduction surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons Database per year. When compared with subjects in the National Emphysema Treatment Trial, subjects in the Society of Thoracic Surgeons Database were younger (P < .001), a larger proportion underwent the procedure thoracoscopically (P < .001), and forced expiratory volume in 1 second was 31% versus 28% of predicted (P < .001). When mortality was compared between subjects in the Society of Thoracic Surgeons Database and all subjects in the National Emphysema Treatment Trial randomized to surgery, there were no significant differences. However, mortality was 3% higher in subjects in the Society of Thoracic Surgeons Database when compared with the non–high-risk National Emphysema Treatment Trial subset (P = .005).ConclusionsThis study demonstrates the importance of patient selection and the need to develop consensus on appropriate benchmarks for mortality rates after lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema

Methylation Profiling Defines an Extensive Field Defect in Histologically Normal Prostate Tissues Associated with Prostate Cancer

AbstractProstate cancer (PCa) is typically found as a multifocal disease suggesting the potential for molecular defects within the morphologically normal tissue. The frequency and spatial extent of DNA methylation changes encompassing a potential field defect are unknown. A comparison of non-tumor-associated (NTA) prostate to histologically indistinguishable tumor-associated (TA) prostate tissues detected a distinct profile of DNA methylation alterations (0.2%) using genome-wide DNA arrays based on the Encyclopedia of DNA Elements 18 sequence that tile both gene-rich and poor regions. Hypomethylation (87%) occurred more frequently than hypermethylation (13%). Several of the most significantly altered loci (CAV1, EVX1, MCF2L, and FGF1) were then used as probes to map the extent of these DNA methylation changes in normal tissues from prostates containing cancer. In TA tissues, the extent of methylation was similar both adjacent (2 mm) and at a distance (>1 cm) from tumor foci. These loci were also able to distinguish NTA from TA tissues in a validation set of patient samples. These mapping studies indicate that a spatially widespread epigenetic defect occurs in the peripheral prostate tissues of men who have PCa that may be useful in the detection of this disease

The number of inpatient consultations is negatively correlated with patient satisfaction in patients with prolonged hospital stays

Patient satisfaction is often measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Our aim was to examine the structural and clinical determinants of satisfaction among inpatients with prolonged lengths of stays (LOS)

Body mass Index does not impact long-term survival of patients with idiopathic pulmonary fibrosis undergoing lung transplantation

ObjectiveWe investigated the impact of body mass index (BMI) on post-operative outcomes and survival of patients with interstitial pulmonary fibrosis (IPF) undergoing lung transplantation.MethodsWe retrospectively reviewed 222 patients with IPF that underwent lung transplant (LT) at our institution from 2005 to 2019. Recipients were divided in 4 groups: group-1 consisted of underweight patients (BMI ≤18.5 kg/m2), group-2 of normal weight patients (BMI 18.5–25 kg/m2), group-3 of over-weight patients (BMI 25–29.9 kg/m2) and group-4 of obese patients (BMI ≥30 kg/m2).ResultsGroup-1 consisted of 13 (6%) patients, group-2 of 67 (30%) patients, group-3 of 79 (36%) patients, group-4 consisted of 63 (28%) patients. Median BMI for group-1 was 17 [interquartile range (IQR): 17, 18], for group-2 was 23 (22, 24), for group-3 was 29 (28, 29.5) and group-4 was 32 (31, 33). Patients in group-1 were significantly younger (p &lt; 0.01). Single LT comprised the majority of operation type in group-2 to group-4 and it was significantly higher than group 1 (p &lt; 0.01). Median follow-up time was 39 months (13–76). A total of 79 (35.5%) patients died by the end of study. Overall, five deaths occurred in group-1, 17 in group-2, 33 in group-3, and 24 in group-4. Kaplan–Meier analysis showed that mortality was not statistically significant between the groups (p = 0.24). Cox-regression analysis was used to assess other possible risk factors that could influence the effect of BMI on mortality, including transplant type (single, double), lung allocation score, and age, diabetes and creatinine levels at surgery. None of these factors were shown to affect patient mortality (p &gt; 0.05). Overall reasons for death included graft failure (24%), infection (23%), respiratory failure (14%), and malignancy (13%).ConclusionsBody mass index does not impact long-term survival of patients with IPF undergoing lung transplantation

Balance As a Predictor of Ankle Injuries in High School Basketball Players

OBJECTIVEThe purpose of this study was to determine if a preseason measurement of balance while in a unilateral stance could predict susceptibility to ankle injury in a cohort of high school basketball players. Predicting risk for ankle injury could be important in helping to reduce the risk of these injuries and furthermore save health care costs. DESIGNCohort study. SETTINGData were collected at five high schools during the first 2 weeks of the 1997–1998 and 1998–1999 basketball seasons. SUBJECTS210 (119 male, age = 16.1 ± 1.1 yr; height = 182.98 ± 7.4 cm; weight = 76.4 ± 10.9 kg; and 91 female, age = 16.3 ± 1.3 yr; height = 170.9 ± 7.8 cm; weight = 63.4 ± 8.4 kg) high school basketball players who did not sustain a time loss ankle or knee injury within the previous 12 months served as subjects. Subjects did not use prophylactic ankle taping or bracing during the season. ASSESSMENT OF RISK FACTORSBalance was quantified from postural sway scores measured while subjects performed unilateral balance tests with eyes both open and closed. Logistic regression analysis was carried out to determine if gender, dominant leg, and balance scores were related to ankle sprain injuries. In addition, Fischer's exact test was used to determine if the rate of ankle injuries was the same whether the subject had poor, average, or good balance. Balance was assessed by measuring postural sway with the NeuroCom New Balance Master version 6.0 (NeuroCom International, Clackamas, OR, U.S.A.). Testing to determine postural sway consisted of having subjects stand on one leg for three trials of 10 seconds with their eyes open, then repeated with their eyes closed. Subjects then underwent the same assessment while standing on the other leg. Postural sway was defined as the average degrees of sway per second (°S/S) for the 12 trials producing a compilation (COMP) score. OUTCOME MEASURESAnkle injury resulting in missed participation. RESULTSSubjects who sustained ankle sprains had a preseason COMP score of 2.01 ± 0.32 (Mean ± SD), while athletes who did not sustain ankle injuries had a score of 1.74 ± 0.31. Higher postural sway scores corresponded to increased ankle sprain injury rates (p = 0.001). Subjects who demonstrated poor balance (high sway scores) had nearly seven times as many ankle sprains as subjects who had good balance (low sway scores) (p = 0.0002.) CONCLUSIONIn this cohort of high school basketball players, preseason balance measurement (postural sway) served as a predictor of ankle sprain susceptibility

Augmenting College Students’ Study of Speech-Language Pathology using Computer-Based Mini Quiz Games

This study examined whether undergraduate college students\u27 immediate recall and longer-term retention of introductory voice disorder concepts improved by using mini quiz games (MQGs; interactive knowledge tests in game format) compared with (a) traditional study alone, (b) MQGs and traditional study together, or (c) a no-study control condition

Anthropometric and Performance Measures for High School Basketball Players

OBJECTIVE: To determine possible anthropometric and performance sex differences in a population of high school basketball players. DESIGN AND SETTING: Measurements were collected during the first week of basketball practice before the 1995-1996 season. Varsity basketball players from 4 high schools were tested on a battery of measures chosen to detect possible anthropometric and performance sex differences. SUBJECTS: Fifty-four female and sixty-one male subjects, from varsity basketball teams at high schools enrolled in the athletic training outreach program at the University of Wisconsin Hospital Sports Medicine Center in Madison, WI, volunteered to take part in this study. MEASUREMENTS: We took anthropometric measurements on each of the 115 subjects. These included height, weight, body composition, ankle range of motion, and medial longitudinal arch type in weightbearing. Performance measures included the vertical jump, 22.86-m (25-yd) shuttle run, 18.29-m (20-yd) sprint, and single-limb balance time. RESULTS: We compared anthropometric and performance characteristics using a 2-sample t test. The only exception to this was for medial longitudinal arch type, where the 2 groups were compared using a 2-tailed Fisher's exact test. The male subjects were significantly taller and heavier, while the females had a significantly higher percentage of body fat. There were no significant differences found for ankle plantar flexion and dorsiflexion, but the females had significantly more inversion and eversion range of motion. Analysis of medial longitudinal arch type found females to have a higher percentage of pronated arches and males to have a higher percentage of supinated arches. Performance testing revealed that the males were able to jump significantly higher and run the 22.86-m (25-yard) shuttle run and 18.29-m (20-yard) sprint significantly faster than the female subjects. There was no significant difference between the groups for single-limb balance time. CONCLUSIONS: We found significant anthropometric and performance sex differences in a cohort of high school basketball players. Further study of these measures is necessary to determine if these differences can predict the risk for ankle injuries in this particular population

A nonlinear rheological assessment of muscle recovery from eccentric stretch injury

To better understand the mechanical behavior of healing skeletal muscle; specifically the tissue's response after acute eccentric stretch injury. Rabbit tibialis anterior (TA) muscle tendon units were subjected to an in vivo single stretch (eccentric) injury and mechanically evaluated (constant rate elongation to failure) at 1, 3, and 7 d postinjury. In addition to a traditional linear analysis (linear stiffness and failure load), an existing nonlinear rheological model was modified to interpret the experimental load-to-failure data. The models' performance were evaluated and discussed. No significant injury effect was observed, either within or between groups, across the 7-d healing interval, using the linear analysis. However, interpretation of the data using our nonlinear phenomenological model identified significant changes in mechanical behavior that went undetected by linear analyses. Percent differences, between injured and contralateral control limbs, of model parameter estimates were analyzed. Nonparametric statistical analysis illustrated significant changes in the first-order stiffness (k1) throughout the 7-d healing interval. Model simulations using mean values of each parameter revealed increased low-load tissue compliance after injury, with a decrease in linear slope that recovered steadily toward control values by day 7. At 7 d postinjury, virtually no differences were observed between injured and sham control tissues. Our findings suggest that acute eccentric injury increases the muscle's compliance 24 h after injury, with a steady recovery to uninjured values by the 7th day, yet these changes went undetected by linear analysis. Therefore, nonlinear analysis is necessary to recognize valuable information contained in the low-load region and to quantify important biomechanical phenomena of stretch-injured healing skeletal muscle