Search

Whole-organ pancreas, pancreatic-kidney and islet transplantation are surgical therapeutic options for the treatment of type 1 diabetes. They can enable effective glycemic control, improve quality of life and delay/reduce the secondary complications of type 1 diabetes mellitus. Radiologists are integral members of the multidisciplinary transplantation team involved in these procedures, with multimodality imaging serving as the mainstay for early recognition and management of transplant related complications. This review highlights the transplantation procedures available for patients with type 1 Diabetes Mellitus with a focus on the imaging appearance of transplantation-related complications. [ABSTRACT FROM AUTHOR]

Insulin resistance (IR) being the major cause behind different metabolic disorders, has attracted a lot of attention. Epidemiological data shows marked rise in the cases over a period of time. Nitric oxide (NO), produced from nitric oxide synthases (NOS), is involved in a variety of biological functions, alteration in which causes various disorders like hypertension, atherosclerosis, and angiogenesis-associated disorders. IR has been found to be a contributing factor, which is associated with abnormal NO signalling. Skeletal muscle is essential for metabolism, both for its role in glucose uptake and its importance in metabolic disease. In this article, we give an overview of the significance of NO in oxidative stress (OS) mediated IR, describing its role in different conditions that are associated with skeletal muscle IR. NO is found to be involved in the activation of insulin receptor downstream pathway, which suggests absence of NO could lead to reduced glucose uptake, and may ultimately result in IR. [ABSTRACT FROM AUTHOR]

Introduction: Patients with localized pancreatic adenocarcinoma (PDAC) benefit from multi-modality therapy. Whether care patterns and oncologic outcomes vary if a patient was seen through a pancreatic multi-disciplinary clinic (PMDC) versus only individual specialty clinics is unclear. Methods: Using institutional Pancreatic Cancer Registry, we identified patients with localized PDAC from 2019-2022 who eventually underwent resection. It was our standard practice for borderline resectable (BRPC) patients to undergo =4 months of neoadjuvant chemotherapy, ± radiation, followed by exploration, while locally advanced (LAPC) patients were treated with 4-6 months of chemotherapy, followed by radiation and potential exploration. Descriptive and multivariable analyses (MVA) were performed to examine the association between clinic type (PMDC vs individual specialty clinics i.e. surgical oncology, medical oncology, or radiation oncology) and study outcomes. Results: A total of 416 patients met inclusion criteria. Of these, 267 (64.2%) had PMDC visits. PMDC group received radiation therapy more commonly (53.9% versus 27.5%, p=0.001), as compared to individual specialty clinic group. Completion of neoadjuvant treatment (NAT) was far more frequent in patients seen through PMDC compared to patients seen through individual specialty clinics (69.3% vs 48.9%). On MVA, PMDC group was significantly associated with receipt of NAT per institutional standards (adjusted OR 2.23, 95% CI 1.46-7.07, p=0.006). Moreover, the average treatment effect of PMDC on progression-free survival (PFS) was 4.45 (95CI: 0.87-8.03) months. No significant association between overall survival (OS) and clinic type was observed. Discussion: Provision of care through PMDC was associated with significantly higher odds of completing NAT per institutional standards as compared to individual specialty clinics, which possibly translated into improved PFS. The development of multidisciplinary clinics for management of pancreatic cancer should be incentivized, and any barriers to such development should be addressed. [ABSTRACT FROM AUTHOR]

Introduction: Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. Conclusion: Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases. (a) Brown fat activation on F18-FDG PET. Axial fused PET image of the abdomen shows hypermetabolic foci in the bilateral perinephric fat (arrows). (b) Adrenal metastasis in a 78-year-old woman with serous ovarian carcinoma. Axial fused PET/CT of the abdomen shows intense uptake in the new left adrenal lesion (arrow), with FDG uptake intensity markedly higher than the liver. (c)Axial contrast-enhanced CT abdomen shows the lobulated mildly enhancing left adrenal metastasis (circle). [ABSTRACT FROM AUTHOR]

Purpose: Proactive nutrition screening and intervention is associated with improved outcomes for patients with pancreatic adenocarcinoma (PDAC). To better optimize nutrition amongst our PDAC population, we implemented systematic malnutrition screening in the Johns Hopkins pancreas multidisciplinary clinic (PMDC) and assessed the effectiveness of our nutrition referral system. Methods: This was a single institution prospective study of patients seen in the PMDC, screened for malnutrition using the Malnutrition Screening Tool (MST) (score range=0 to 5, score > 2 indicates risk of malnutrition), and offered referrals to the oncology dietitian. Patients that requested a referral but did not attend a nutrition appointment were contacted by phone to assess barriers to seeing the dietitian. Univariate (UVA) and multivariable (MVA) analyses were carried out to identify predictors of referral status and appointment completion status. Results: A total of 97 patients were included in the study, of which 72 (74.2%) requested a referral and 25 (25.8%) declined. Of the 72 patients who requested a referral, 31 (43.1%) attended an appointment with the oncology dietitian. Data on information session attendance was available for 35 patients, of which 8 (22.9%) attended a pre-clinic information session in which the importance of optimal nutrition was highlighted. On MVA, information session attendance was significantly associated with requesting a referral (OR: 11.1, 95% CI 1.12-1.0E3, p=0.037) and successfully meeting with the oncology dietitian (OR: 5.88, 95% CI 1.00-33.3, p=0.049). Conclusion: PMDC teams should institute educational initiatives on the importance of optimal nutrition in order to increase patient engagement with nutrition services. [ABSTRACT FROM AUTHOR]

Problem: Similarity measures are widely used as an approved method for spectral discrimination or identification with their applications in different areas of scientific research. Even though a range of works have been presented, only a few showed slightly promising results for human tissue, and these were mostly focused on pathological and non-pathological tissue classification. Methods: In this work, several spectral similarity measures on hyperspectral (HS) images of in vivo human tissue were evaluated for tissue discrimination purposes. Moreover, we introduced two new hybrid spectral measures, called SID-JM-TAN(SAM) and SID-JM-TAN(SCA). We analyzed spectral signatures obtained from 13 different human tissue types and two different materials (gauze, instruments), collected from HS images of 100 patients during surgeries. Results: The quantitative results showed the reliable performance of the different similarity measures and the proposed hybrid measures for tissue discrimination purposes. The latter produced higher discrimination values, up to 6.7 times more than the classical spectral similarity measures. Moreover, an application of the similarity measures was presented to support the annotations of the HS images. We showed that the automatic checking of tissue-annotated thyroid and colon tissues was successful in 73% and 60% of the total spectra, respectively. The hybrid measures showed the highest performance. Furthermore, the automatic labeling of wrongly annotated tissues was similar for all measures, with an accuracy of up to 90%. Conclusion: In future work, the proposed spectral similarity measures will be integrated with tools to support physicians in annotations and tissue labeling of HS images. [ABSTRACT FROM AUTHOR]

Acute appendicitis secondary to amoebic infestation is a rare possibility, especially in endemic areas. If left untreated, significant postoperative morbidity and mortality can result from the spread of amoebic trophozoites and subsequent tissue reaction. Histopathological examination of the resected appendix with demonstration of invasion by the parasite is mandatory for establishing a diagnosis. Careful examination of the specimen is thus of paramount importance. [ABSTRACT FROM AUTHOR]

The present study deals with the effects of Biosolid (animal manure), Spent Mushroom Compost (SMC), and Leaf Compost on the vegetative growth and yield of pea (Pisum sativum L.). We have examined the physicochemical properties and fungal flora of soil (control) and different composts (amendments). The composts (amendments) were taken in four concentrations, i.e., 25, 50, 75, and 100%, along with complete loam soil as a control. The result reveals the differential response of compost (amendments), showing that Biosolid gives a higher yield at 25%, whereas SMC with 50% and Leaf compost best results at 75% concentrations, respectively. The other parameters of the test plant, such as height, numbers of leaflets, numbers of pods, 100 seeds weight, are found in accordance with respective yields in all the amendments. However, SMC found better fertilizers compared to other test organic substances. [ABSTRACT FROM AUTHOR]

Involvement of NOX-dependent oxidative stress in the pathophysiology of metabolic disorders as well as in the maintenance of metabolic homeostasis has been demonstrated previously. In the present study, the metabolic profile in p47phox–/– and WT mice fed on a chow diet was evaluated to assess the role of metabolites in glucose intolerance and dyslipidemia under altered oxidative stress conditions. p47phox–/– mice displayed glucose intolerance, dyslipidemia, hyperglycemia, insulin resistance (IR), hyperinsulinemia, and altered energy homeostasis without any significant change in gluconeogenesis. The expression of genes involved in lipid synthesis and uptake was enhanced in the liver, adipose tissue, and intestine tissues. Similarly, the expression of genes associated with lipid efflux in the liver and intestine was also enhanced. Enhanced gut permeability, inflammation, and shortening of the gut was evident in p47phox–/– mice. Circulating levels of pyrimidines, phosphatidylglycerol lipids, and 3-methyl-2-oxindole were augmented, while level of purine was reduced in the serum. Moreover, the cecal metabolome was also altered, as was evident with the increase in indole-3-acetamide, N-acetyl galactosamine, glycocholate, and a decrease in hippurate, indoxyl sulfate, and indigestible sugars (raffinose and melezitose). Treatment of p47phox–/– mice with pioglitazone, marginally improved glucose intolerance, and dyslipidemia, with an increase in PUFAs (linoleate, docosahexaenoic acid, and arachidonic acid). Overall, the results obtained in p47phox–/– mice indicate an association of IR and dyslipidemia with altered serum and cecal metabolites (both host and bacterial-derived), implying a critical role of NOX-derived ROS in metabolic homeostasis. [ABSTRACT FROM AUTHOR]

Background: The effect of varying severity and timing of complications after hepatic resection on 30-day mortality has not been thoroughly examined. Methods: National Surgical Quality Improvement Program Patient User Files (NSQIP-PUF) were used to identify patients who underwent elective hepatic resection between 2014 and 2019. The impact of number, timing, and severity of complications on 30-day mortality was examined. Results: Among 25,084 patients who underwent hepatic resection, 7436 (29.9%) patients developed at least one NSQIP complication, while 2688 (10.7%) had multiple (≥2) complications. Overall, 30-day mortality was 1.7% (n=424), among whom 81.4% (n=345) patients had ≥2 complications. The 30-day mortality was highest among patients with three consecutive severe complications (47.8%), as well as patients with one non-severe and two subsequent severe complications (47.6%). The adjusted probability of 30-day mortality was 35.5% (95%CI: 29.5–41.4%) when multiple severe complications occurred within the first postoperative week and 16.2% (95%CI: 7.2–25.1%) when the second severe complication occurred at least one week apart. The adjusted risk of 30-day mortality after even two non-severe complications was as high as 5.3% (95%CI: 3.7–6.9%) when the second complication occurred within a week postoperatively. Conclusion: Approximately 1 in 10 patients developed multiple complications following hepatectomy. Timing and severity of complications were independently associated with 30-day mortality. [ABSTRACT FROM AUTHOR]

The role of oxidative and nitrosative stress has been implied in both physiology and pathophysiology of metabolic disorders. Inducible nitric oxide synthase (iNOS) has emerged as a crucial regulator of host metabolism and gut microbiota activity. The present study examines the role of the gut microbiome in determining host metabolic functions in the absence of iNOS. Insulin-resistant and dyslipidemic iNOS−/− mice displayed reduced microbial diversity, with a higher relative abundance of Allobaculum and Bifidobacterium , gram-positive bacteria, and altered serum metabolites along with metabolic dysregulation. Vancomycin, which largely depletes gram-positive bacteria, reversed the insulin resistance (IR), dyslipidemia, and related metabolic anomalies in iNOS−/− mice. Such improvements in metabolic markers were accompanied by alterations in the expression of genes involved in fatty acid synthesis in the liver and adipose tissue, lipid uptake in adipose tissue, and lipid efflux in the liver and intestine tissue. The rescue of IR in vancomycin-treated iNOS−/− mice was accompanied with the changes in select serum metabolites such as 10-hydroxydecanoate, indole-3-ethanol, allantoin, hippurate, sebacic acid, aminoadipate, and ophthalmate, along with improvement in phosphatidylethanolamine to phosphatidylcholine (PE/PC) ratio. In the present study, we demonstrate that vancomycin-mediated depletion of gram-positive bacteria in iNOS−/− mice reversed the metabolic perturbations, dyslipidemia, and insulin resistance. [ABSTRACT FROM AUTHOR]

Most primary adrenal lymphomas are diffuse large B-cell lymphomas with non-germinal center B-cell phenotype, BCL6 gene rearrangement and poor prognosis. Primary adrenal plasmablastic lymphoma presenting as lymphomatous meningitis - A diagnostic perplexity Keywords: adrenal; HIV; plasmablastic lymphoma EN adrenal HIV plasmablastic lymphoma 123 126 4 12/22/21 20220101 NES 220101 A rare presentation of primary plasmablastic lymphoma (PBL) of the adrenal gland, as lymphomatous meningitis in a patient living with HIV. In a large series of 112 cases of PBL in a HIV cohort, none of the patients had a primary adrenal lesion.1 Xu et al.7, Bishnu S et al.9 and Noy et al.8 have previously documented PBL of the adrenal gland in HIV patients, and in the first two reports the diagnosis of PBL was incidental, as in our case. [Extracted from the article]

Background: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children's and community hospitals. Methods: We purposefully sampled participants from both community and children's hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2–3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes. Results: We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians' mental health, and they stressed the importance of mental health resources and wellness activities/spaces. Conclusions: We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians' expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians' mental health and well-being, re-evaluating trainees' skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises. [ABSTRACT FROM AUTHOR]

Background: Inter-hospital transfer (IHT) may help reduce failure-to-rescue (FTR) by transferring patients to centers with a higher level of expertise than the index hospital. We sought to identify factors associated with an IHT and examine if IHT was associated with improved outcomes after complex gastrointestinal cancer surgery.Methods: Medicare Inpatient Standard Analytic Files were utilized to identify patients with >1 postoperative complication following resection for esophageal, pancreatic, liver, or colorectal cancer between 2013 and 2017. Multivariable logistic regression was used to examine the association of different factors with the chance of IHT, as well as the impact of IHT on failure-to-rescue (FTR) and expenditures.Results: Among 39,973 patients with >1 postoperative complications, 3090 (7.7%) patients were transferred to a secondary hospital. The median LOS at the index hospital prior to IHT was 10 days (IQR, 6-17 days). Patients who underwent IHT more often had experienced multiple complications at the index hospital compared with non-IHT patients (57.7% vs. 38.9%) (p<0.001). Transferred patients more commonly had undergone surgery at a low-volume index hospital (n=218, 60.2%) compared with non-IHT (n=10,351, 25.9%) patients (p<0.001). On multivariate analysis, hospital volume remained strongly associated with transfer to an acute care hospital (ACH) (OR 5.53; 95% CI 3.91-7.84; p<0.001), as did multiple complications (OR 2.01, 95% CI 1.56-2.57). The incidence of FTR was much higher among IHT-ACH patients (20.2%) versus non-IHT patients (11.5%) (OR 1.51, 95% CI 1.11-2.05) (p<0.001). Medicare expenditures were higher among patients who had IHT-ACH ($72.1k USD; IQR, $48.1k-$116.7k) versus non-IHT ($38.5k USD; IQR, $28.1k-$59.2k USD) (p<0.001).Conclusion: Approximately 1 in 13 patients had an IHT after complex gastrointestinal cancer surgery. IHT was associated with high rates of FTR, which was more pronounced among patients who underwent surgery at an index low-volume hospital. IHT was associated with higher overall CMS expenditures. [ABSTRACT FROM AUTHOR]

Pancoast syndrome is a commonly seen manifestation of lung malignancies, and benign causes are uncommon. We report a case of a patient without any known cause of immunosuppression who presented with Pancoast syndrome and a radiological mass like lesion in the lung apex, that was revealed be due to aspergillosis. [ABSTRACT FROM AUTHOR]

Oxidative stress due to enhanced production or reduced scavenging of reactive oxygen species (ROS) has been associated with diet (dyslipidemia) induced obesity and insulin resistance (IR). The present study was undertaken to assess the role of p47phox in IR using wild type (WT) and p47phox−/− mice, fed with different diets (HFD, LFD or Chow). Augmented body weight, glucose intolerance and reduced insulin sensitivity were observed in p47phox−/− mice fed with 45% HFD and 10% LFD. Further, body fat and circulating lipids were increased significantly with 5 weeks LFD feeding in p47phox−/− mice, while parameters of energy homeostasis were reduced as compared with WT mice. LFD fed knockout (KO) mice showed an enhanced hepatic glycogenolysis, and reduced insulin signalling in liver and adipose tissue, while skeletal muscle tissue remained unaffected. A significant increase in hepatic lipids, adiposity, as well as expression of genes regulating lipid synthesis, breakdown and efflux were observed in LFD fed p47phox−/− mice after 5 weeks. On the other hand, mice lacking p47phox demonstrated altered glucose tolerance and tissue insulin sensitivity after 5 weeks chow feeding, while changes in body weight, respiratory exchange ratio (RER) and heat production are non-significant. Our data demonstrate that lack of p47phox is sufficient to induce IR through altered glucose and lipid utilization by the liver and adipose tissue. [ABSTRACT FROM AUTHOR]

Tufted angioma (TA) is a rare benign vascular tumor that may be congenital or acquired and generally presents as an asymptomatic or painful solitary erythematous to violaceous poorly defined plaque. Hyperhidrosis and hypertrichosis may be associated. The lesions have tendency to resolve spontaneously, in majority, within 2 years of disease onset. However, occurrence of Kassbach-Merritt phenomenon should be looked for. We present a case of 8-months-old infant with TA over the right forearm with classical clinical, histoptahological and immunohistochemistry features. [ABSTRACT FROM AUTHOR]

With cloud computing, new facilities in the information technology (IT) emerge from the convergence of occupational and technology viewpoints which furnish users entrance to IT resources anywhere and any time by pay-per-use fashion. Consequently, it should source eminent operative gain to the user and instantaneously ought to be beneficial for the cloud service provider. To achieve this goal, several challenges have to be confronted, where load balancing is single of them. The optimal choice of a resources for a specific job does not mean that the nominated resource persists enhanced for the entire execution of the job. The supply under loading/over-loading must be avoided which could be enlarged by appropriate load balancing mechanisms. But, to the best of our knowledge, in spite of the significance of load balancing methods and appliances, there is not any comprehensive and systematic review about and analyzing and studying its significant techniques. In this paper we study about cloud architecture or different load balancing technique at the end of our paper we compare four optimization based load balancing technique and gives the idea about new technique over existing ones. [ABSTRACT FROM AUTHOR]

Research Objective: The COVID‐19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. This study aims to identify major changes in inpatient pediatric healthcare delivery and potential lessons learned. Study Design: In this study, we conducted semi‐structured video interviews. We analyzed interview data using constant comparative methods to identify major healthcare delivery changes for hospitalized children during the COVID‐19 pandemic. Population Studied: We purposefully sampled clinicians from both community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 participants from each hospital to interview (mix of administrators, physicians, and nurses). Principal Findings: We interviewed 24 participants from 12 hospitals and identified several themes [Table 1]. They described how hospital leaders rapidly developed policies to: 1) ensure adequate staff for surges of COVID‐19 patients, 2) provide adequate care spaces and supplies, 3) direct use of personal protective equipment, and 4) guide medical management of COVID‐19 patients. Hospital leaders optimized communication by conducting regular meetings to discuss the current state of the pandemic, hospital operations, and policy changes. In the setting of declining volumes of hospitalized children, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, educational resources, and telehealth supports. Participants described negative impacts of the pandemic on clinicians' mental health, as well as helpful supports for clinician well‐being, including mental health resources, wellness activities and spaces, and housing. Finally, participants described experiences managing multisystem inflammatory syndrome in children including diagnostic uncertainty and evolving management for this novel disease. 1 TABLE: : Theme Exemplary Quote Developing and evolving COVID‐related hospital policies "We have eight separate COVID related pathways. One for outpatient, one for ED, one for inpatient, and one for therapeutics. Pretty rigorous." Successful communication with clinicians and staff "One of the things that went really well was... daily town halls and transparency for the rapidly evolving situation." Newly providing care for hospitalized adults "They had what they called a super hospitalist, who was an adult hospitalist who would oversee...five or six different [mixed specialty care] teams and help out with some of the decision making." Organizing spaces for COVID‐19 patient care "As [the only freestanding] children's hospital [in the city], our role ended up being kind of a referral center for all the other centers to offload their pediatric patients." Conclusions: We identified several changes in inpatient pediatric care delivery and potential lessons learned during the COVID‐19 pandemic: 1) optimizing communication aided in rapidly changing hospital policies, 2) developing new team models and educational resources helped clinicians in newly caring for hospitalized adults, and 3) providing wellness resources was helpful for supporting clinicians' mental health. Implications for Policy or Practice: This study's findings will assist hospital leaders to plan for safe and high‐quality care for hospitalized children, in this ongoing pandemic and in future disaster planning. Primary Funding Source: Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]

Research Objective: The COVID‐19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. This study aims to identify major changes in inpatient pediatric healthcare delivery and potential lessons learned. Study Design: In this study, we conducted semi‐structured video interviews. We analyzed interview data using constant comparative methods to identify major healthcare delivery changes for hospitalized children during the COVID‐19 pandemic. Population Studied: We purposefully sampled clinicians from both community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 participants from each hospital to interview (mix of administrators, physicians, and nurses). Principal Findings: We interviewed 24 participants from 12 hospitals and identified several themes [Table 1]. They described how hospital leaders rapidly developed policies to: 1) ensure adequate staff for surges of COVID‐19 patients, 2) provide adequate care spaces and supplies, 3) direct use of personal protective equipment, and 4) guide medical management of COVID‐19 patients. Hospital leaders optimized communication by conducting regular meetings to discuss the current state of the pandemic, hospital operations, and policy changes. In the setting of declining volumes of hospitalized children, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, educational resources, and telehealth supports. Participants described negative impacts of the pandemic on clinicians' mental health, as well as helpful supports for clinician well‐being, including mental health resources, wellness activities and spaces, and housing. Finally, participants described experiences managing multisystem inflammatory syndrome in children including diagnostic uncertainty and evolving management for this novel disease. 1 TABLE: : Theme Exemplary Quote Developing and evolving COVID‐related hospital policies "We have eight separate COVID related pathways. One for outpatient, one for ED, one for inpatient, and one for therapeutics. Pretty rigorous." Successful communication with clinicians and staff "One of the things that went really well was... daily town halls and transparency for the rapidly evolving situation." Newly providing care for hospitalized adults "They had what they called a super hospitalist, who was an adult hospitalist who would oversee...five or six different [mixed specialty care] teams and help out with some of the decision making." Organizing spaces for COVID‐19 patient care "As [the only freestanding] children's hospital [in the city], our role ended up being kind of a referral center for all the other centers to offload their pediatric patients." Conclusions: We identified several changes in inpatient pediatric care delivery and potential lessons learned during the COVID‐19 pandemic: 1) optimizing communication aided in rapidly changing hospital policies, 2) developing new team models and educational resources helped clinicians in newly caring for hospitalized adults, and 3) providing wellness resources was helpful for supporting clinicians' mental health. Implications for Policy or Practice: This study's findings will assist hospital leaders to plan for safe and high‐quality care for hospitalized children, in this ongoing pandemic and in future disaster planning. Primary Funding Source: Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to investigate the incidence of sleep disturbance and insomnia in patients with primary hyperparathyroidism (PHPT), and to evaluate the effect of parathyroidectomy. Methods: A questionnaire was prospectively administered to adult patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire, administered preoperatively and 6 months postoperatively, included the Insomnia Severity Index (ISI) and eight additional questions regarding sleep pattern. Total ISI scores range from 0 to 28, with >7 signifying sleep difficulties and scores >14 indicating clinical insomnia. Results: Of 197 eligible patients undergoing parathyroidectomy for PHPT, 115 (58.3 %) completed the preoperative and postoperative questionnaires. The mean age was 60.0 ± 1.2 years and 80.0 % were women. Preoperatively, 72 patients (62.6 %) had sleep difficulties, and 29 patients (25.2 %) met the criteria for clinical insomnia. Clinicopathologic variables were not predictive of clinical insomnia. There was a significant reduction in mean ISI score after parathyroidectomy (10.3 ± 0.6 vs 6.2 ± 0.5, p < 0.0001). Postoperatively, 79 patients (68.7 %) had an improved ISI score. Of the 29 patients with preoperative clinical insomnia, 21 (72.4 %) had resolution after parathyroidectomy. Preoperative insomnia patients had an increase in total hours slept after parathyroidectomy (5.4 ± 0.3 vs 6.1 ± 0.3 h, p = 0.02), whereas both insomnia patients and non-insomnia patients had a decrease in the number of awakenings (3.7 ± 0.4 vs 1.9 ± 0.2 times, p = 0.0001). Conclusions: Sleep disturbances and insomnia are common in patients with PHPT, and the majority of patients will improve after curative parathyroidectomy. [ABSTRACT FROM AUTHOR]

Till date, no bioartificial liver (BAL) procedure has obtained FDA approval or widespread clinical acceptance, mainly because of multifactorial limitations such as the use of microscale or undefined biomaterials, indirect and lower oxygenation levels in liver cells, short-term undesirable functions, and a lack of 3D interaction of growth factor/cytokine signaling in liver cells. To overcome preclinical limitations, primary rat liver cells were cultured on a naturally self-assembling peptide nanoscaffold (SAPN) in a clinically relevant bioreactor for up to 35 days, under 3D interaction with suitable growth factors and cytokine signaling agents, alone or combination (e.g., Group I: EPO, Group II: Activin A, Group III: IL-6, Group IV: BMP-4, Group V: BMP4 + EPO, Group VI: EPO + IL-6, Group VII: BMP4 + IL-6, Group VIII: Activin A + EPO, Group IX: IL-6 + Activin A, Group X: Activin A + BMP4, Group XI: EPO + Activin A + BMP-4 + IL-6 + HGF, and Group XII: Control). Major liver specific functions such as albumin secretion, urea metabolism, ammonia detoxification, phase contrast microscopy, immunofluorescence of liver specific markers (Albumin and CYP3A1), mitochondrial status, glutamic oxaloacetic transaminase (GOT) activity, glutamic pyruvic transaminase (GPT) activity, and cell membrane stability by the lactate dehydrogenase (LDH) test were also examined and compared with the control over time. In addition, we examined the drug biotransformation potential of a diazepam drug in a two-compartment model (cell matrix phase and supernatant), which is clinically important. This present study demonstrates an optimized 3D signaling/scaffolding in a preclinical BAL model, as well as preclinical drug screening for better drug development. J. Cell. Physiol. 227: 313-327, 2012. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Oxidative and nitrosative stress plays a pivotal role in the incidence of metabolic disorders. Studies from this lab and others in iNOS-/- mice have demonstrated occurrence of insulin resistance (IR), hyperglycemia and dyslipidemia highlighting the importance of optimal redox balance. The present study evaluates role of nitrite, L-arginine, antidiabetics (metformin, pioglitazone) and antibiotics (ampicillin-neomycin combination, metronidazole) on metabolic perturbations observed in iNOS-/- mice. The animals were monitored for glucose tolerance (IPGTT), IR (insulin, HOMA-IR, QUICKI), circulating lipids and serum metabolomics (LC-MS). Hyperglycemia, hyperinsulinemia and IR were rescued by nitrite, antidiabetics, and antibiotics treatments in iNOS-/- mice. Glucose intolerance was improved with nitrite, metformin and pioglitazone treatment, while ampicillin-neomycin combination normalised the glucose utilization in iNOS-/- mice. Increased serum phosphatidylethanolamine lipids in iNOS-/- mice were reversed by metformin, pioglitazone and ampicillin-neomycin; dyslipidemia was however marginally improved by nitrite treatment. The metabolic improvements were associated with changes in selected serum metabolites-purines, ceramide, 10-hydroxydecanoate, glucosaminate, diosmetin, sebacic acid, 3-nitrotyrosine and cysteamine. Bacterial metabolites-hippurate, indole-3-ethanol; IR marker-aminoadipate and oxidative stress marker-ophthalmate were reduced by pioglitazone and ampicillin-neomycin, but not by nitrite and metformin treatment. Results obtained in the present study suggest a crucial role of gut microbiota in the metabolic perturbations observed in iNOS-/- mice. [ABSTRACT FROM AUTHOR]

Research Objective: The COVID‐19 pandemic has necessitated rapid changes in healthcare delivery, including surge planning and modifying healthcare delivery environments and practices. Our objective was to identify the major resulting challenges for quality and safety of pediatric inpatient care. Study Design: We conducted semi‐structured video interviews. Using constant comparative methods, we iteratively coded data to identify themes related to pediatric inpatient quality and safety challenges during the pandemic. Population Studied: We purposefully sampled from community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 front‐line clinicians per site (mix of administrators, nurses, physicians). Principal Findings: Twenty‐four participants from 12 hospitals were interviewed. The most commonly encountered themes are detailed in Table 1. Changes in healthcare delivery practices potentially impacting quality and safety of inpatient pediatric care included: 1) limits on family and caregiver visitation, which may have hindered gathering important details for diagnosis and engaging in shared‐decision making about management; 2) personal protective equipment and isolation practices, which may have compromised effective communication with caregivers and interpreters; 3) changes in quality improvement (QI) infrastructure and activities, with potential decreases in monitoring and safety efforts; 4) difficulties defining and providing high‐quality care for children with COVID‐19 and multi‐system inflammatory syndrome in children, both novel diagnoses; and 5) potential increases in safety events due to decreased direct contact with patients and monitoring (e.g., wound infections, central line‐associated bloodstream infections and catheter‐associated urinary tract infections). 1 TABLE: : Theme Exemplary Quote Limiting family or caregiver visitation "In challenging diagnoses, even if it wasn't COVID‐related, you couldn't have both parents there at the same time." Experiencing personal protective equipment or isolation status as a barrier to communication "With non‐English speaking parents, we were trying to use an interpreter phone with an N9, an extra mask, the negative pressure circulator running in the background. Trying to get a good history and to provide quality care was really brutal." Difficulty maintaining high‐quality care "These people would not have any care. They would be sitting in the ED in the hallway, one ED doc taking care of 50 patients. No, you were not qualified to take care of this patient, but this is a pandemic." Changes in QI operations (staffing, data monitoring, QI activities) "Everything non‐essential stopped. Meetings canceled, research on hold, IRB halted, labs shut down. We have mandatory reporting on things like sepsis. There was too much else going on, we stopped measuring certain things." Increasing healthcare‐associated safety events or harms "We had an uptake in our CLABSI, in every healthcare‐associated condition we were capable of tracking. After the fact, because that was not the priority." Conclusions: This national qualitative study of early COVID‐19 epicenters described changes in several domains of healthcare delivery affecting quality and safety of pediatric inpatient care. Implications for Policy or Practice: The several potential areas of focus identified can help clinicians and hospital leaders plan for safe and high‐quality care for hospitalized children, during this ongoing crisis and for future pandemics. Primary Funding Source: Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]

Research Objective: The COVID‐19 pandemic has necessitated rapid changes in healthcare delivery, including surge planning and modifying healthcare delivery environments and practices. Our objective was to identify the major resulting challenges for quality and safety of pediatric inpatient care. Study Design: We conducted semi‐structured video interviews. Using constant comparative methods, we iteratively coded data to identify themes related to pediatric inpatient quality and safety challenges during the pandemic. Population Studied: We purposefully sampled from community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 front‐line clinicians per site (mix of administrators, nurses, physicians). Principal Findings: Twenty‐four participants from 12 hospitals were interviewed. The most commonly encountered themes are detailed in Table 1. Changes in healthcare delivery practices potentially impacting quality and safety of inpatient pediatric care included: 1) limits on family and caregiver visitation, which may have hindered gathering important details for diagnosis and engaging in shared‐decision making about management; 2) personal protective equipment and isolation practices, which may have compromised effective communication with caregivers and interpreters; 3) changes in quality improvement (QI) infrastructure and activities, with potential decreases in monitoring and safety efforts; 4) difficulties defining and providing high‐quality care for children with COVID‐19 and multi‐system inflammatory syndrome in children, both novel diagnoses; and 5) potential increases in safety events due to decreased direct contact with patients and monitoring (e.g., wound infections, central line‐associated bloodstream infections and catheter‐associated urinary tract infections). 1 TABLE: : Theme Exemplary Quote Limiting family or caregiver visitation "In challenging diagnoses, even if it wasn't COVID‐related, you couldn't have both parents there at the same time." Experiencing personal protective equipment or isolation status as a barrier to communication "With non‐English speaking parents, we were trying to use an interpreter phone with an N9, an extra mask, the negative pressure circulator running in the background. Trying to get a good history and to provide quality care was really brutal." Difficulty maintaining high‐quality care "These people would not have any care. They would be sitting in the ED in the hallway, one ED doc taking care of 50 patients. No, you were not qualified to take care of this patient, but this is a pandemic." Changes in QI operations (staffing, data monitoring, QI activities) "Everything non‐essential stopped. Meetings canceled, research on hold, IRB halted, labs shut down. We have mandatory reporting on things like sepsis. There was too much else going on, we stopped measuring certain things." Increasing healthcare‐associated safety events or harms "We had an uptake in our CLABSI, in every healthcare‐associated condition we were capable of tracking. After the fact, because that was not the priority." Conclusions: This national qualitative study of early COVID‐19 epicenters described changes in several domains of healthcare delivery affecting quality and safety of pediatric inpatient care. Implications for Policy or Practice: The several potential areas of focus identified can help clinicians and hospital leaders plan for safe and high‐quality care for hospitalized children, during this ongoing crisis and for future pandemics. Primary Funding Source: Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]

The article discusses the occurrence of the colonic mural redundancy or wrinkling at the right part of the colon. Also mentioned is the potential association of the wrinkled colon with cystic fibrosis. Presented are computed tomography images of the abdomen and pelvis depicting colonic wall thickening.

The objective of this study was to evaluate the antiepileptic activity of the leaves of Commiphora molmol in animal models. Acute toxicity studies were performed in rats after administration of the extract orally in graded doses. Antiepileptic activity was evaluated by using Maximum electroshock-induced convulsion and Pentylenetetrazole-induced convulsion at 250 mg/kg and 500 mg/kg dose. The phytochemical study of plant revealed the presence of carbohydrate, flavonoids, saponins and alkaloids and suggests that plant had antiepileptic property. The 500mg/kg dose showed more antiepileptic property than 250 mg/ kg of C. molmol. The present study concludes that leaf extract of Commiphora molmol showed more antiepileptic activity by Pentylenetetrazole-induced convulsion method in compared to Maximum electroshock-induced convulsion method. [ABSTRACT FROM AUTHOR]

iNOS, an important mediator of inflammation, has emerged as an important metabolic regulator. There are conflicting observations on the incidence of insulin resistance (IR) due to hyperglycemia/dyslipidemia in iNOS−/− mice. There are reports that high fat diet (HFD) fed mice exhibited no change, protection, or enhanced susceptibility to IR. Similar observations were also reported for low fat diet (LFD) fed KO mice. In the present study chow fed iNOS−/− mice were examined for the incidence of IR, and metabolic perturbations, and also for the effect of sodium nitrite supplementation (50 mg/L). In IR-iNOS−/− mice, we observed significantly higher body weight, BMI, adiposity, blood glucose, HOMA-IR, serum/tissue lipids, glucose intolerance, enhanced gluconeogenesis, and disrupted insulin signaling. Expression of genes involved in hepatic and adipose tissue lipid uptake, synthesis, oxidation, and gluconeogenesis was upregulated with concomitant downregulation of genes for hepatic lipid excretion. Nitrite supplementation restored NO levels, significantly improved systemic IR, glucose tolerance, and also reduced lipid accumulation by rescuing hepatic insulin sensitivity, glucose, and lipid homeostasis. Obesity, gluconeogenesis, and adipose tissue insulin signaling were only partially reversed in nitrite supplemented iNOS−/− mice. Our results thus demonstrate that nitrite supplementation to iNOS−/− mice improves insulin sensitivity and metabolic homeostasis, thus further highlighting the metabolic role of iNOS. [ABSTRACT FROM AUTHOR]

Carcinosarcoma of Prostate also known as Sarcomatoid carcinoma is a rare biphasic malignancy with a malignant epithelial component (carcinomatous) and a malignant mesenchymal component. We report a case of this rare and unusual histological variant of prostatic carcinoma. [ABSTRACT FROM AUTHOR]

On the basis of diet induced obesity and KO mice models, nitric oxide is implied to play an important role in the initiation of dyslipidemia induced insulin resistance. However, outcomes using iNOS KO mice have so far remained inconclusive. The present study aimed to assess IR in iNOS KO mice after 5 weeks of LFD feeding by monitoring body composition, energy homeostasis, insulin sensitivity/signaling, nitrite content and gene expressions changes in the tissues. We found that body weight and fat content in KO mice were significantly higher while the respiratory exchange ratio (RER), volume of carbon dioxide (VCO2), and heat production were lower as compared to WT mice. Furthermore, altered systemic glucose tolerance, tissue insulin signaling, hepatic gluconeogenesis, augmented hepatic lipids, adiposity, as well as gene expression regulating lipid synthesis, catabolism and efflux were evident in iNOS KO mice. Significant reduction in eNOS and nNOS gene expression, hepatic and adipose tissue nitrite content, circulatory nitrite was also observed. Oxygen consumption rate of mitochondrial respiration has remained unaltered in KO mice as measured using extracellular flux analyzer. Our findings establish a link between the NO status with systemic and tissue specific IR in iNOS KO mice at 5 weeks. [ABSTRACT FROM AUTHOR]