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Castleman disease (CD) is a rare hematologic disorder characterized by pathologic lymph node changes and a range of symptoms due to excessive cytokine production. While uncontrolled infection with human herpesvirus-8 (HHV-8) is responsible for the cytokine storm in a portion of multicentric CD (HHV-8-associated MCD) cases, the etiology of unicentric CD (UCD) and HHV-8-negative/idiopathic MCD (iMCD) is unknown. Several hypotheses have been proposed regarding the pathogenesis of UCD and iMCD, including occult infection given the precedent established by HHV-8 infection. To investigate potential active infections in UCD and iMCD, we implemented Viral-Track, a computational method that identifies viral mRNA sequences from next-generation sequencing data. We applied Viral-Track to short sequencing reads from a cohort of UCD (n = 22), iMCD (n = 19), and controls (n = 86). While viral sequences for several unusual viruses were identified in individual CD patients,  sequences for the same virus were not found across multiple CD patients or they were not specific to CD samples and were also found in non-CD samples. These results suggest that active viral infection is unlikely to be a pathological driver of UCD or iMCD., Competing Interests: Decelarations. Competing interests: D.C.F. has received consultancy fees and research funding from EUSA Pharma. All remaining authors report no conflicts of interest with the research reported in this manuscript., (© 2025. The Author(s).)

Background: Recent research has shown beneficial effects of bariatric surgery (BaS) on the risk of developing acute exacerbations of chronic obstructive pulmonary disease (COPD). However, this patient population may be at increased risk of complications, especially postoperative pulmonary complications (PPC)., Objectives: To analyze the incidence of PPC in patients with COPD undergoing BaS., Setting: Academic Hospital, United States., Methods: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass during 2015-2019. The primary outcome of the study was any PPC, defined as a composite variable including postoperative pneumonia, mechanical ventilation >48 hours and unplanned endotracheal intubation. A univariate analysis was performed to compare patients with and without COPD, and a multivariate logistic regression was performed to adjust for confounders. A subgroup analysis was performed to compare endpoints in patients with COPD with or without home oxygen requirements., Results: A total of 752,722 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.2%, Roux-en-Y gastric bypass = 26.8%). PPC occurred in 2390 patients, 0.3% without COPD versus 1.3% with COPD (P < .001). Multivariable analysis confirmed that COPD independently increases the risk of PPC (OR = 1.7, CI = 1.4-2.1). Subgroup analysis showed that patients who are oxygen dependent had a much higher risk for PPC (2.4% versus 1.1%, P < .001)., Conclusion: PPC are higher among patients with obesity and concomitant COPD. Oxygen dependency confers an even higher complication rate. The risk and benefits of BaS in this population must be carefully addressed., (Copyright © 2025 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is associated with a higher incidence of fatty liver disease, intrahepatic triglyceride content, and hepatic fibrosis. These abnormalities could progress to severe liver disease., Objectives: To evaluate the effects of bariatric surgery (BaS)-induced weight loss on liver volume, hepatic function tests, and lipid profile., Setting: Academic Hospital, United States., Methods: We conducted a retrospective review of an institutional review board (IRB)-approved database on patients who underwent BaS from 2006 to 2018. To determine changes in liver volume, we reviewed abdominal computed tomography scans before BaS (Group 1) and up to 18 months after (Group 2). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lipid profiles were collected before and after BaS., Results: Seventy-three patients met the inclusion criteria. Patients were predominantly females 78.1% (57), with an average age of 51.29+12.54 years. The liver volume was 1870.73 + 638.5 mm 3 before and 1555.15 + 464.8 after BaS (P = .004). ALT was 36.9 + 25.3 before versus 23.8 + 19.3 after BaS (P = .024).Triglyceride levels changed from 135.62 + 69.98 before to 97.50 + 47.33 after BaS (P = .009). Low-density lipoprotein decreased from 107.9 + 38.1 to 89.6 + 32.8 (P = .048)., Conclusions: BaS-induced weight loss determines significant liver shrinkage by reducing liver volume, and coincides with improvements in hepatic function tests and lipid profile. Our results suggest that BaS might contribute to reduction of the progression of fatty liver disease to fibrosis., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for several hematological diseases. Prospective and retrospective studies have associated myeloablative conditioning regimens with increased non-relapse mortality and less intense regimens with disease relapse, leading to similar overall survival rates. Objectives: Analyze the experience with the different RIC schemes in patients transplanted for AML/MDS in our program. Methods: We retrospectively analyzed our program's reduced-intensity conditioning regimens (RIC) between 2012 and 2022 in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Results: During this period, 450 allogeneic stem cell transplantations were performed, of which 52 patients were treated with RIC for AML, mostly in men. The 3-year overall survival/progression-free survival rates were 52/53%, 51/57%, and 57/55% in the fludarabine-reduced intensity with total-body irradiation, Melphalan, and Busulfan, respectively ( p = 0.89). The composite incidences of aGVHD III-IV, cGVHD, and admission to the critical patient unit were 21%, 25%, and 30%, respectively, without statistically significant differences according to the type of conditioning, but with a trend of greater ICU admission in patients who used melphalan-based conditioning. Conclusion: Our study found no differences in overall survival, progression-free survival, and complications between the most commonly used reduced-intensity conditioning regimens.

Background: Idiopathic multicentric Castleman disease (iMCD) is a rare inflammatory disorder mediated by excessive proinflammatory cytokine signaling, most notably by interleukin 6 (IL-6). IL-6-induced extramedullary hematopoiesis (EMH) has been reported in murine models of iMCD. Herein we present four cases of iMCD with EMH in humans., Case Series: The index case is a 24-year-old white woman who presented with pancytopenia, hepatosplenomegaly, and diffuse lymphadenopathy (LAD) with EMH in core lymph node biopsies. We then searched ACCELERATE, a Castleman disease (CD) natural history registry, and identified three additional CD cases with EMH reported in biopsies: A 23-year-old Asian man with fatigue, edema, LAD, and splenomegaly; a 20-year-old white man with fever, dyspnea, LAD, and hepatosplenomegaly; and a 50-year-old white man with constitutional symptoms, LAD, and myelodysplastic syndrome in bone marrow with a KRAS mutation., Results: All four patients presented with thrombocytopenia and fever and/or markedly elevated C-reactive protein. Patient 1 had iMCD-NOS (not otherwise specified) with severe thrombocytopenia, reticulin fibrosis in bone marrow, small volume LAD and organomegaly but no anasarca. The other three patients had iMCD-TAFRO (thrombocytopenia, anasarca, reticulin fibrosis, renal dysfunction, organomegaly). Two had mixed CD and two had hypervascular CD in lymph nodes. All four had bone marrow hypercellularity and megakaryocyte hyperplasia and two had reticulin fibrosis., Conclusions: This case series demonstrates that EMH can be seen in CD, particularly in iMCD-TAFRO. Given the similarity of this finding to previous murine models of IL-6-induced marrow and lymph node changes we hypothesize that this is an IL-6-mediated phenomenon., (© 2024 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.)

Adequate stem cell harvesting is required for autologous hematopoietic transplantation. In deficient mobilizer patients, the collection of stem cells can be challenging because of the impossibility of achieving satisfactory CD34 cell counts with GCSF + - chemotherapy. Plerixafor is a potent and expensive drug that promotes the release of stem cells from the medullary niche to the peripheral blood and allows satisfactory harvests. We performed a retrospective analysis of 370 patients with myeloma and lymphoma harvested at our institution. 99 % of patients achieved satisfactory apheresis using Plerixafor in 45 %. Satisfactory harvests were obtained in patients mobilized with GCSF or plerixafor. In patients who used plerixafor, it was necessary to perform fewer apheresis procedures (P = 0.05). In multivariate analysis, the only factor that predicted the need for plerixafor was the presence of less than 30,000 CD34 / ul on the day of apheresis (OR 0.3. p < 0.001). Since we adopted the plerixafor protocol guided by CD34 counts, the number of patients with harvest failure has decreased. In conclusion, the rational and standardized use of plerixafor favors satisfactory harvest in patients who require autologous transplantation in South-American patients., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Allogeneic transplantation (HSCT) is a curative option for several hematological diseases. Our center has privileged the use of identical family donors (IFD) or haploidentical (HD) donors. However, the chances of finding family donors may be challenging in small families or unsuitable donors. In these cases, there is the possibility of obtaining hematopoietic precursors from unrelated donors (URD) with complete or almost complete HLA compatibility., Aim: this work analyzes the results of a historical cohort of patients with allogeneic transplantation in our institution., Methods: a retrospective analysis of data base and clinical records of patients with allogeneic transplantation in our adult transplantation program., Results: between 2005 and 2023, 370 TPH were performed, of which 150 were IFD (40%), 167 HD (45%) and 53 URD (15%). The median age of the patients was 37 years (range 16-76), the majority were transplanted for acute leukemia (60%) and 41% were women. With a median follow-up of 8 years, the overall survival was 64, 67, and 65% for IFD, HD or URD. Subgroup analysis showed more severe cases of graft versus host disease in HD group (p= 0.001)., Conclusion: our experience shows that the results of DNR, DFI, and DFH are similar. 15% of patients were transplanted with URD because of the absence of suitable family donors.

Cerebral blood volume mapping can characterize hemodynamic changes within brain tissue, particularly after stroke. This study aims to quantify blood volume changes in the perihematomal parenchyma and pericavity parenchyma after minimally invasive intracerebral hemorrhage evacuation (MIS for ICH). Thirty-two patients underwent MIS for ICH with pre- and post-operative CT imaging and intraoperative perfusion imaging (DynaCT PBV Neuro, Artis Q, Siemens). The pre-operative and post-operative CT scans were segmented using ITK-SNAP software to calculate hematoma volumes and to delineate the pericavity tissue. Helical CT segmentations were registered to cone beam CT data using elastix software. Mean blood volumes were computed inside subvolumes by dilating the segmentations at increasing distances from the lesion. Pre-operative perihematomal blood volumes and post-operative pericavity blood volumes (PBV) were compared. In 27 patients with complete imaging, post-operative PBV significantly increased within the 6-mm pericavity region after MIS for ICH. The mean relative PBV increased by 21.6 and 9.1% at 3 mm and 6 mm, respectively (P = 0.001 and 0.016, respectively). At the 9-mm pericavity region, there was a 2.83% increase in mean relative PBV, though no longer statistically significant. PBV analysis demonstrated a significant increase in pericavity cerebral blood volume after minimally invasive ICH evacuation to a distance of 6 mm from the border of the lesion., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Galectin-3 (Gal-3) is a multifunctional protein that plays a pivotal role in the initiation and progression of various central nervous system diseases, including cancer. Although the involvement of Gal-3 in tumour progression, resistance to treatment and immunosuppression has long been studied in different cancer types, mainly outside the central nervous system, its elevated expression in myeloid and glial cells underscores its profound impact on the brain's immune response. In this context, microglia and infiltrating macrophages, the predominant non-cancerous cells within the tumour microenvironment, play critical roles in establishing an immunosuppressive milieu in diverse brain tumours. Through the utilisation of primary cell cultures and immortalised microglial cell lines, we have elucidated the central role of Gal-3 in promoting cancer cell migration, invasion, and an immunosuppressive microglial phenotypic activation. Furthermore, employing two distinct in vivo models encompassing primary (glioblastoma) and secondary brain tumours (breast cancer brain metastasis), our histological and transcriptomic analysis show that Gal-3 depletion triggers a robust pro-inflammatory response within the tumour microenvironment, notably based on interferon-related pathways. Interestingly, this response is prominently observed in tumour-associated microglia and macrophages (TAMs), resulting in the suppression of cancer cells growth., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Manuel Sarmiento Soto reports financial support was provided by Ministry of Scientific Research and Innovation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Introduction: the aim of this study is to compare the changes in anthropometry, dynamometry and bioelectrical impedance analysis (BIA) of patients undergoing autologous and allogeneic hematopoietic stem cell transplantation (HSCT) after the conditioning period and one-week post-transplantation, and to assess whether these early changes are associated with the development of later complications. Methods: prospective cohort study. Nutritional status was assessed by anthropometry, dynamometry and BIA at three different defined times: T1, time of admission; T2, after the myeloablative conditioning period; and T3, day + 8 post-HSCT. Results: forty patients were evaluated, 17 received autologous HSCT (TAU) and 23 received allogeneic HSCT (TAL). Patients with TAL had higher mortality and hospital stay compared to patients with TAU. Those who developed graft versus host disease (GVHD) presented a lower phase angle (PA) than those who did not develop this complication (T2: TAL PA with GVHD 4.8° vs TAL PA without GVHD 5.5°, p = 0.007). The patients who died during the hospital stay are all from the TAL group and had PA less than 5° at T3. Weight, body mass index (BMI) and fat-free mass index (FMI) did not show a significant impact, and all of them were influenced by total body water. Conclusions: early nutritional evaluation of these patients by phase angle seems promising, since it is not altered by water retention and can be evaluated before anthropometric changes occur.

Background: The 5-factor frailty index (5-mFI), validated frailty index with Spearmen rho correlation of .95 and C statistic >.7 for predicting postoperative complications, can be preoperatively used to stratify patients prior to parastomal hernia repairs., Methods: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. 5-mFI scores were calculated by adding one point for each comorbidity present: diabetes mellitus, congestive heart failure (CHF), hypertension requiring medication, severe chronic obstructive pulmonary disease (COPD), non-independent functional status. Primary endpoint was 30-day overall complications; secondary endpoints were 30-day readmission, reoperation, and discharge to care facility., Results: 2924 (52.2% female) patients underwent elective parastomal hernia repair. Univariate analysis showed 5-mFI > 2 had higher rates of overall ( P = .008), pulmonary ( P = .002), cardiovascular ( P = .003)), hematologic ( P = .003), and renal ( P = .002) complications and higher rates of readmission ( P = .009), reoperation ( P = .001), discharge to care facility ( P < .001), and death ( P < .001). Multivariate analysis identified a 5-mFI of 2 or more as an independent risk factor for overall complications [OR: 1.40, 1.03-1.78; P = .032], pulmonary complications [2.97, 1.63-5.39; P < .001], hematological complications [1.60, 1.03-2.47; P = .035], renal complications [2.04, 1.19-3.46; P = .009], readmission [1.54, 1.19-1.99; P < .001], and discharge to facility [2.50, 1.66-3.77; P < .001]. Reoperation was not signification on multivariate analysis., Conclusions: Parastomal hernia repair patients with 5-mFI score of > 2 had higher risk of renal, cardiovascular, pulmonary, and hematologic complications, readmissions, longer hospitalization, discharge to care facility, and mortality, and can be useful during preoperative risk stratification., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: None of the authors have relevant financial conflicts of interest to disclose. Dr Wexner reports received consulting fees from ARC/Corvus, Astellas, Baxter, Becton Dickinson, GI Supply, ICON Language Services, Intuitive Surgical, Leading BioSciences, Livsmed, Medtronic, Olympus Surgical, Stryker, Takeda and receiving royalties from Intuitive Surgical and Karl Storz Endoscopy America Inc.

Social and health disparities among transgender people may result in increased rates of incarceration, particularly among Black transgender women. The World Professional Association for Transgender Health states that all recommendations for gender-affirming care made in the Standards of Care-8 be applied equally to people living in institutions. Understanding the structural challenges to gender-affirming care in the corrections environment will allow the endocrinologist to navigate the complex correctional health care system. The barriers to gender-affirming care and surgery will be highlighted in this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Idiopathic multicentric Castleman disease (iMCD) is a rare hematologic disorder with an unknown etiology. Clinical presentation is heterogeneous, ranging from mild constitutional symptoms with lymphadenopathy to life-threatening multiorgan dysfunction. International, consensus treatment guidelines developed in 2018 relied upon a limited number of clinical trials and small case series; however, to our knowledge, real-world performance of these recommendations has not been subsequently studied. Siltuximab, a monoclonal antibody against interleukin 6 (IL6), is approved for the treatment of iMCD and recommended first-line, and tocilizumab, a monoclonal antibody directed against the IL6 receptor, is recommended when siltuximab is unavailable. Chemotherapy, rituximab, and immunomodulators are recommended as second- and third-line treatments based on limited evidence. Corticosteroid monotherapy is used by clinicians, although not recommended. Here, we draw upon the ACCELERATE Natural History Registry to inventory regimens and evaluate regimen response for 102 expert-confirmed iMCD cases. Siltuximab with/without (w/wo) corticosteroids was associated with a 52% response, whereas corticosteroid monotherapy was associated with a 3% response. Anti-IL6-directed therapy with siltuximab or tocilizumab demonstrated better response and more durability than was observed with rituximab w/wo corticosteroids. Cytotoxic chemotherapy was associated with a 52% response and was predominantly administered in patients characterized by thrombocytopenia, anasarca, fever, renal failure/reticulin fibrosis, and organomegaly. Our results provide evidence in support of current recommendations to administer anti-IL6 as first-line treatment, to administer cytotoxic chemotherapy in patients with severe refractory disease, and to limit corticosteroid monotherapy. Evidence remains limited for effective agents for patients who are refractory to anti-IL6-directed therapy. This trial was registered at www.clinicaltrials.gov as #NCT02817997., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Background: Acute kidney injury (AKI) after surgery increases long-term risk of kidney dysfunction. The major risk factor for AKI after bariatric surgery is having preoperative renal insufficiency. Little is known about the outcomes and risk factors for developing AKI in patients undergoing bariatric surgery with normal renal function., Objective: We aimed to describe factors that may increase risk of AKI after primary bariatric surgery in patients without history of kidney disease., Setting: Academic hospital, United States., Methods: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. Patients with diagnosis of chronic kidney disease were excluded. The primary outcome was incidence of AKI. Secondary outcomes included 30-day complications, readmissions, reoperations, and mortality. Univariate and multivariate analyses were performed to identify differences between patients with and without AKI., Results: A total of 747,926 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.1%, LRYGB = 26.8%). Mean age was 44.40 ± 11.94 years, with female predominance (79.7%). AKI occurred in 446 patients (.05%). Patients with postoperative AKI had higher rates of complications, readmissions, reoperations, and mortality. Significant predictors of AKI were male sex, history of venous thromboembolism, hypertension, limitation for ambulation, and LRYGB. High albumin levels and White race were protective factors., Conclusions: New-onset AKI was associated with adverse 30-day outcomes in patients undergoing bariatric surgery. Male sex, venous thromboembolism, hypertension, limited ambulation, and LRYGB were independent predictors of AKI. Prospective studies are needed to better describe these results., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: The COVID-19 pandemic brought unprecedented changes to oral care and dental education delivery. To date, the vast majority of studies focus on the impact COVID-19 had on the well-being and wellness of patients, practitioners, and students; however, limited literature addresses the pandemic's impact on dental educators., Purpose: The aim of this study was to investigate the wellness, well-being, and fulfillment of dental educators in the years following the onset of the COVID-19 pandemic., Methods: Following Institutional Review Board approval, an anonymous electronic Qualtrics survey was emailed to full-time and adjunct faculty across five (5) dental education institutions in the US. Faculty self-reported on their wellness, general well-being, physical well-being, mental well-being, fulfillment, and work-life balance. Group differences were examined using analysis of variance and the Tukey-Kramer test for multiple comparisons at the p < 0.05 level., Results: The results revealed females and younger dental faculty members reported statistically significantly lower levels of wellness (F 2, 123  = 11.16, p < 0.001, F 3, 121  = 8.53, p < 0.001), physical (F 2, 123  = 11.53, p < 0.001, F 3, 121  = 5.54, p = 0.001) and mental well-being (F 2, 123  = 12.49, p < 0.001, F 3, 121  = 8.63, p < 0.001), fulfillment (F 3, 121  = 5.01, p < 0.003), and higher levels of burnout (F 2, 123  = 5.53, p = 0.005, F 3, 121  = 4.85, p < 0.003). Those who expressed higher levels of burnout also had statistically lower mean well-being scores (F 4, 119  = 10.54, p < 0.001). Females also reported a significantly lower work-life balance score compared to male respondents (F 2, 121  = 10.37, p < 0.002)., Conclusion: Despite the social and environmental challenges faced over the last couple of years post-pandemic, dental educators demonstrate a quick ability to adapt, however, disproportional differences in gender and age groups were identified as being significantly correlated to dental educators' self-reports on wellness, well-being, and fulfillment. Insight into these variables can help inform strategies in the academic setting to help support and strengthen the academic workforce., (© 2023 American Dental Education Association.)

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is performed worldwide to treat blood cancer and other life-threatening blood disorders. As successful transplantation requires an HLA-compatible donor, unrelated donor centers and registries have been established worldwide to identify donors for patients without a family match. Ethnic minorities are underrepresented in large donor registries. Matching probabilities are higher when donors and patients share the same ethnic background, making it desirable to increase the diversity of the global donor pool by recruiting donors in new regions. Here, we report the establishment and the first 5 years of operation of the first unrelated stem cell donor center in Chile, a high-income country in South America with a population of over 19 million., Methods: We used online and in-person donor recruitment practices through patient appeals and donor drives in companies, universities, the armed forces, and public services. After confirmatory typing donors were subjected to medical work-up and cleared for donation., Results: We recruited almost 170,000 donors in 5 years. There were 1,488 requests received for confirmatory typing and donor availability checks, of which 333 resulted in medical work-up, leading to 194 stem cell collections. Products were shipped to Chile (48.5%) and abroad. Even when the COVID-19 pandemic challenged our activities, the number of donors recruited and shipped stem cell products remained steady. In Chile there was an almost 8-fold increase in unrelated donor transplantation activity from 16 procedures in 2016-2018 to 124 procedures in 2019-2021, mainly for pediatric patients following the center's establishment. We estimate that 49.6% of Chilean patients would find at least one matched unrelated donor in the global DKMS donor pool., Discussion: Establishing a DKMS donor center in Chile has significantly increased donor availability for Chilean patients and contributed to an increase of unrelated donor stem cell transplant activity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Barriga, Solloch, Giani, Palma, Wietstruck, Sarmiento, Carvallo, Mosso, Ramirez, Sanchez, Rojas, Alfaro, Saldaña, Ende, Flaig, Pattillo and Schmidt.)

Background: Severe obesity could be an independent risk factor for peripheral artery disease (PAD) and critical limb ischemia (CLI). Bariatric surgery reduces cardiac risk factors, decreasing cardiovascular morbidity and mortality in subjects with severe obesity., Objectives: We aimed to describe the impact of bariatric surgery on risk of hospitalization due to PAD and CLI., Setting: Academic hospital., Methods: The National Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment was defined as patients with a previous history of bariatric surgery, and control was defined as patients with a body mass index ≥35 without a history of bariatric surgery. The primary outcome was hospitalization due to PAD; secondary outcomes were CLI, revascularization, major amputation, length of hospital stay (LOS), and total cost of hospitalization. Univariate and multivariate analyses were performed to assess the differences between groups., Results: There were a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatment patients. Hospitalization rate for PAD was significantly lower compared to the control group (.10% versus .21%, P < .0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio= 1.20, confidence interval: 1.15-1.47). Subgroup analysis showed patients without a history of bariatric surgery had a higher prevalence of CLI (59.3% versus 52.4%, P < .0219) and a higher mean LOS (6.7 versus 5.7 days, P = .0023) and cost of hospitalization (78.756 versus 72.621$, P = .0089), with no significant differences in other outcomes. After multivariate analysis, only LOS and total costs were significantly different., Conclusions: Bariatric surgery may decrease the risk of hospitalization due to PAD, similarly to the LOS and total cost of hospitalization. Prospective studies should be performed to describe this relationship., (Copyright © 2023. Published by Elsevier Inc.)

An increase in the incidence of inflammatory arthritis after COVID-19 has been reported. Since many diseases exhibit population-specific causal effect sizes, we aimed to evaluate the incidence trends of inflammatory arthritis, including rheumatoid arthritis (RA), after COVID-19 in a large admixed Colombian population. Data analysis for this retrospective, population-based cohort study was carried out using the COOSALUD EPS registry. The following codes were selected for analyses: M059, seropositive RA, M069, unspecified RA, M060 seronegative RA, and other RA-related diagnoses: M064, M139, M068, M058, M130 and M053. The study period was limited to January 01, 2018, through December 31, 2022. Incidence rates (IRs) and incidence rate ratios (IRRs) were assessed. A Cox survival model was built to evaluate the influence of age, gender, and COVID-19 vaccination status on the development of inflammatory arthritis. A bioinformatic analysis was performed to evaluate the homology between SARS-CoV-2 and autoantigen peptides related to RA. The entire population study comprised 3,335,084 individuals. During the pandemic period (2020-2022) the total IIR for seropositive and unspecified RA were 1.60 (95% CI, 1.16-2.22) and 2.93 (95% CI, 2.04-4.19), respectively, and the IIR for overall RA-related diagnosis was 2.01 (95% CI 1.59-2.53). The age groups hazard ratios (HRs) were increased until the age group of 51-60 years (HR: 9.16; 95% CI, 7.24-11.59) and then decreased slightly in the age group 61 years or older (HR: 5.364; 95% CI, 4.24-6.78) compared to those within 18-30 years. Men were less at risk than women to develop inflammatory arthritis (HR: 0.21; 95% CI, 0.18-0.24). The greater time since COVID-19 diagnosis was associated with a lower likelihood of developing inflammatory arthritis (HR: 0.99; 95% CI:0.998-0.999). Vaccination (all types of COVID-19 vaccines included) did not prevent the development of inflammatory arthritis after COVID-19. Low identity was found between the SARS-CoV-2 ORF1ab antigen and the human antigens Poly ADP-ribose polymerase 14 and Protein mono-ADP-ribosyltransferase PARP9 isoform D (39% and 29%, respectively). In conclusion, our study confirms increased incidence of inflammatory arthritis, including RA, after COVID-19, with the greatest increase occurring before the first year post-covid. Women in their fifties were more susceptible. Further research is required to examine the effectiveness of vaccination in preventing post-COVID inflammatory arthritis and the mechanisms implicated in the development of RA after COVID-19., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Juan-Manuel Anaya reports financial support was provided by Coosalud EPS. Juan Sebastian Marin reports a relationship with Coosalud that includes: employment., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Study Design: Literature review and meta-analysis., Objectives: Single-center series may be underpowered to detect whether high-dose (HD) tranexamic acid (TXA) confers a higher risk of complications. We sought to determine the safety and efficacy of HD TXA as compared to low-dose (LD) or placebo., Methods: A systematic literature review was performed to find studies where spine surgery patients were given HD TXA (loading dose ≥30 mg/kg). Complication rates were pooled, and meta-analyses performed on outcomes of interest. Articles were evaluated for risk of bias and a strength of evidence assessment was given for each conclusion., Results: Twenty three studies (n = 2331) were included. The pooled medical complication rate was 3.2% in pediatric patients, 8.2% in adults. Using lower dose TXA or placebo as the reference, meta-analysis showed no difference in medical complications (n = 1,723, OR 1.22 [95% CI, .78 to 1.22]; P = .388; I 2 = 0%) or thrombotic events (n = 1158 patients, OR 1.27 [95% CI, .71 to 2.63]; P = .528; I 2 = 0%). Compared to LD, HD TXA was associated with less intraoperative blood loss (823 patients, WMD = -285 [95% CI, -564 to -5.90]; P = .0454; I 2 = 86%), fewer perioperative transfusions (n = 505, OR .28 [95% CI, .082 to .96]; P = .043; I 2 = 76%) and lower perioperative transfusion volumes (n = 434, WMD -227.7 mL [95% CI, -377.3 to -78.02]; P = .0029; I 2 = 0%)., Conclusion: Compared to LD TXA or placebo, there is moderate evidence that HD is not associated with an increased risk of medical complications. Compared to LD, there is moderate evidence that HD reduces transfusion requirements. High-Dose TXA can be safely utilized in healthy patients undergoing major spine surgery.

Introduction: Hodgkin Lymphoma (HL) is a prevalent hematological cancer in the world and Chile., Objectives: Show the experience of 10 years treating HL in a Chilean academic center. Additionally, it exposes the diagnostic performance of PET CT and Bone Marrow Biopsy., Material and Methods: We conducted a retrospective cohort study to collect data and outcomes of patients treated in our center., Results: 82 patients were analyzed (Average age, 35 years old; the ratio between men and women was 1.9:1). Progression-free survival was 88.6% and 66.4% for localized and advanced stages, respectively. PET as a staging strategy had better sensitivity than Marrow Biopsy., Conclusions: The clinical results of the patients treated in this Chilean teaching center were comparable to the international literature. Additionally, PET CT proved to be a superior tool in diagnosis and staging compared to biopsy in our patients.

Background: Hematopoietic autologous stem cell transplantation (ASCT) is a validated therapeutic strategy for lymphoma treatment and precise well-tolerated conditioning. Several conditioning methods are available, but the most commonly used are CVB, BEAM, and ICE, which are conventionally administered in 6 to 7 days. Since 2015, our program has moved toward noncryopreserved platforms that require concise times; therefore, we have modified the conditioning by reducing it to 4 to 5 days. In this study, we show our experience., Methods: We compared ASCT performed in our program before and after 2015 in lymphoma patients. Between 2000 and 2014 and from 2015 to 2022, we performed 46 and 61 ASCT procedures, respectively., Results: Since 2015, we observed a greater number of infused stem cells, fewer episodes of febrile neutropenia (60% vs. 37% P = .008), shorter hospitalizations (30 vs. 18 days P = .001), faster engraftment (20 vs. 14 days P = .001) and better progression-free survival (72 vs. 44 months P = .002). Additionally, a prolonged overall survival was observed at these results, and this prolonged survival is difficult to interpret due to the short follow-up., Conclusion: In conclusion, conditioning adjusted for a noncryopreserved strategy offers at least similar or even better results than the cryopreserved strategy. Prospective studies are warranted., Competing Interests: Disclosure The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: The study aims to identify the correlation between human papillomavirus (HPV) infection and sociodemographic and sexual reproductive health factors in Ecuadorian women from March to August 2019., Methods: 120 women were randomly selected from two gynecological clinics to complete a questionnaire and provide a biospecimen. PCR-Hybridization was used to genotype 37 HPV serotypes in samples obtained by endo-cervical brushing for liquid-based cytology. Sociodemographic and sexual health data were collected through a validated questionnaire during a medical consultation. Mathematical modeling of HPV infection was done using bivariate logistic regression., Results: 65.0% of the women sampled had an HPV infection; 74.3% of these women had co-infections with other HPV genotypes. Out of the women who were HPV positive, 75.6% were diagnosed with high-risk genotypes from HPV strains 18, 35, 52, and 66. Parity, immunosuppression, and use of oral contraception/intrauterine devices (IUDs) were identified as associated variables. The explanatory model had a sensitivity of 89.5% and a specificity of 73.8%., Conclusion: The predominant strains of HPV among Ecuadorian women are diverse. The risk of HPV infection is a complex phenomenon where biological and psychosocial variables are integrated into a model. In populations with limited access to health services, low socioeconomic status, and negative sociocultural beliefs about sexually transmitted infections (STIs), surveys can be used as a pre-screening step for HPV infections. The diagnostic value of the model should be tested in multicenter studies that include women from all over the country., Competing Interests: CR and JB were employed by Diagnostic Department, MEDsan, Inc., Saint Petersburg, FL, United States. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Roman, Andrade, Hernández, Salazar, Espinosa, Campoverde, Guallaizaca, Merchán, Sarmiento and Brenner.)

One of the biggest challenges in developing effective therapies against glioblastoma is overcoming the strong immune suppression within the tumor microenvironment. Immunotherapy has emerged as an effective strategy to turn the immune system response against tumor cells. Glioma-associated macrophages and microglia (GAMs) are major drivers of such anti-inflammatory scenarios. Therefore, enhancing the anti-cancerous response in GAMs may represent a potential co-adjuvant therapy to treat glioblastoma patients. In that vein, fungal β-glucan molecules have long been known as potent immune modulators. Their ability to stimulate the innate immune activity and improve treatment response has been described. Those modulating features are partly attributed to their ability to bind to pattern recognition receptors, which, interestingly, are greatly expressed in GAMs. Thus, this work is focused on the isolation, purification, and subsequent use of fungal β-glucans to enhance the tumoricidal response of microglia against glioblastoma cells. The mouse glioblastoma (GL261) and microglia (BV-2) cell lines are used to test the immunomodulatory properties of four different fungal β-glucans extracted from mushrooms heavily used in the current biopharmaceutical industry: Pleurotus ostreatus, Pleurotus djamor, Hericium erinaceus, and Ganoderma lucidum. To test these compounds, co-stimulation assays were performed to measure the effect of a pre-activated microglia-conditioned medium on the proliferation and apoptosis activation in glioblastoma cells.

Background: Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults., Objective: We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery., Setting: Academic hospital, United States., Methods: Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment)., Results: A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group., Conclusions: After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results., (Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Gluten-free bread is an important product that is under development using different sources, such as rice and starchy plants. Teosinte seeds are utilized by ethnic groups in Honduras to produce gluten-free flour to prepare traditional baked goods and beverages. The quality of gluten-free products could vary depending on flour properties, such as amylose content, particle size, and water absorption capacity. A good strategy for developing baked goods is to mix different cereal grain sources to optimize their physicochemical properties. As a result, the current study aimed to develop bread from novel flours including teosinte (TF), high-protein brown rice (BRF), and high-protein white rice (WRF). Breads were analyzed for hardness, specific volume, and color utilizing a Simplex-Centroid mixture design coupled with the desirability function. Pasting, and rheological characteristics of the flours, were also analyzed. For flour characteristics, TF addition to BRF or WRF decreased the peak, trough, breakdown, setback, and final viscosities, which would result in a more stable bread and decrease the flow index of rice flour dispersions. BRF and WRF had similar pasting properties, except that BRF had a lower breakdown viscosity. For bread characteristics, TF addition to BRF or WRF increased the specific volume and hardness of the bread compared to rice flour alone. L* of the crust and crumb a* values were increased with greater TF in the mixture, whereas TF decreased the crust a*and b* values and crumb L* values when mixed with BRF or WRF compared to rice flours alone. WRF and BRF were similar in crumb color (L* and a*), except that BRF had greater crumb yellowness (b*). Teosinte flour can be used in combination with rice flour to produce bread with good quality.

Background: Pulmonary hypertension (PH) can be associated with obesity. The excessive production of proinflammatory mediators by dysfunctional adipocytes may enhance remodeling of the pulmonary vasculature and worsen pulmonary hemodynamics. This study aimed to describe the changes in pulmonary arterial pressures and systemic inflammation in patients with obesity with PH after bariatric surgery (BaS)., Study Design: In this retrospective cohort study, we compared patients with PH who underwent BaS from 2008 to 2018 at our institution (group 1) to a group of severely obese patients with PH (group 2). Echocardiographic right ventricular systolic pressure (RVSP) was used as an indirect measurement of pulmonary arterial pressures. Red blood cell distribution width (RDW) was used as a marker of systemic inflammation., Results: A total of 40 patients were included, 20 per group. In group 1, the RVSP decreased from 44.69 ± 7.12 mmHg to 38.73 ± 12.81 mmHg (p = 0.041), and the RDW decreased from 15.22 ± 1.53 to 14.41 ± 1.31 (p = 0.020). In group 2, the RVSP decreased from 60.14 ± 18.08 to 59.15 ± 19.10 (0.828), and the RDW increased from 15.37 ± 1.99 to 15.38 ± 1.26 (0.983). For both groups, we found a positive correlation between RVSP and RDW changes, although the correlation was not statistically significant., Conclusions: Previous studies suggest BaS could be a safe and effective procedure to achieve weight loss in obese patients with PH, with an additional modest improvement in pulmonary hemodynamics. The results of this study reinforce this observation and suggest that such improvement could be related to a decrease in systemic inflammation. Further prospective studies with bigger samples are needed to better understand these findings., (Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Previous work indicated that deep brain stimulation (DBS) of the nucleus accumbens shell in male rats attenuated reinstatement of cocaine seeking, an animal model of craving. However, the potential differential impact of DBS on specific populations of neurons to drive the suppression of cocaine seeking is unknown. Medium spiny neurons in the nucleus accumbens are differentiated by expression of dopamine D1 receptors (D1DRs) or D2DRs, activation of which promotes or inhibits cocaine-related behaviors, respectively. The advent of transgenic rat lines expressing Cre recombinase selectively in D1DR-containing or D2DR-containing neurons, when coupled with Cre-dependent virally mediated gene transfer of channelrhodopsin (ChR2), enabled mimicry of DBS in a selective subpopulation of neurons during complex tasks. We tested the hypothesis that high frequency DBS-like optogenetic stimulation of D1DR-containing neurons in the accumbens shell would potentiate, whereas stimulation of D2DR-containing neurons in the accumbens shell would attenuate, cocaine-primed reinstatement of cocaine seeking. Results indicated that high frequency, DBS-like optogenetic stimulation of D2DR-containing neurons attenuated reinstatement of cocaine seeking in male rats, whereas DBS-like stimulation of D1DR-containing neurons did not alter cocaine-primed reinstatement. Surprisingly, DBS-like optogenetic stimulation did not alter reinstatement of cocaine seeking in female rats. In rats which only expressed eYFP, intra-accumbens optogenetic stimulation did not alter cocaine reinstatement, indicating that the effect of DBS-like stimulation to attenuate cocaine reinstatement is mediated specifically by ChR2 rather than by prolonged light delivery. These results suggest that DBS of the accumbens may attenuate cocaine-primed reinstatement in male rats through the selective manipulation of D2DR-containing neurons., (© 2022. The Author(s), under exclusive licence to American College of Neuropsychopharmacology.)

Purpose: There is controversy about the necessity of nighttime appendectomy. The aim of this study was to determine whether timing of appendectomy performance plays a role on postoperative complications., Methods: A retrospective single-center comparative study was performed in children who underwent surgery for acute appendicitis between 2017 and 2021. Patients were divided into groups based on the time slot in which surgery was performed: morning (8:00 h-15:00 h), afternoon (15:00 h-22:00 h) and night (22:00 h-08:00 h). Demographics, intraoperative data, length of hospital stay, and postoperative complications were analyzed and compared., Results: A total of 1643 patients were included: 337 were operated in the morning, 751 in the afternoon and 555 at night. We found no demographic differences. When comparing the intraoperative data, no differences were observed in the percentage of complicated appendicitis. Night group patients presented a higher percentage of open appendectomies (64.5%) when compared to afternoon (49.6%) and morning (46.2%) groups (p < 0.001). Surgery time was also significantly shorter in the night group (45.2 min ± 18.9 min) (p < 0.001). There were no differences in length of hospital stay, postoperative complications rate or readmission rate., Conclusion: These results show that in our institution time slot in which the appendectomy is performed has no consequences in postoperative outcomes and complications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: Retrospective comparison., Objective: The aim was to determine whether a previously developed magnetic resonance imaging (MRI)-derived bone mineral density (BMD) scoring system can differentiate between healthy and osteoporotic vertebrae and to validate this scoring system against quantitative computed tomography measurements., Summary of Background Data: BMD is an important preoperative consideration in spine surgery. Techniques to measure BMD are subject to falsely elevated values in the setting of spondylosis (dual-energy X-ray absorptiometry) or require significant exposure to radiation [quantitative computed tomography (QCT)]. Previous studies have shown that MRI may be utilized to measure bone quality using changes in the bone marrow signal observed on T1-weighted MRIs., Materials and Methods: Retrospective study of patients who underwent operative lumbar procedures at a single tertiary institution between 2016 and 2021 (n=61). Vertebral bone quality (VBQ) scores were measured by dividing the median signal intensities of L1-L4 by the signal intensity of cerebrospinal fluid on noncontrast T1W MRI. Demographic data, comorbidities, VBQ scores, and QCT-derived T scores and BMD of the lumbar spine were compared between healthy ( T score ≥-1; n=21), osteopenic (-2.5 < T score < -1; n=21), and osteoporotic ( T score ≤-2.5; n=19) cohorts using analysis of variance with post hoc Tukey test. Linear regression and receiver operating characteristic curve analyses were performed to assess the predictive value of VBQ scores. Pearson correlation test was used to evaluate the association between VBQ scores and QCT-derived measurements., Results: VBQ differentiated between healthy and osteoporotic groups ( P =0.009). Receiver operating characteristic curve analysis revealed that a greater VBQ score was associated with presence of osteoporosis (area under the curve=0.754, P =0.006). Cutoff VBQ for osteoporosis was 2.6 (Youden index 0.484; sensitivity: 58%; specificity: 90%). VBQ scores weakly correlated with QCT-derived BMD ( P =0.03, r =-0.27) and T scores ( P =0.04, r =-0.26)., Conclusion: This study attempted to further validate a previously developed MRI-based BMD scoring system against QCT-derived measurements. VBQ score was found to be a significant predictor of osteoporosis and could differentiate between healthy and osteoporotic vertebrae., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Gastric cancer is one of the most important malignancies in the world due to the high burden of disease and lethality. In this work, we compared the main characteristics of gastric cancer between different regions of the world. We reviewed public repositories to retrieve epidemiological, molecular, clinicopathological, and risk factor data. Eastern Asia presents the highest incidence of gastric cancer, followed by eastern and central Europe. Intestinal histology was more frequent in Caucasians, while gastric tumors located in the cardias were less frequent in Africa and Latin America. TP53, LRP1B, and ARID1A are consistently the most frequently altered genes in all population groups. Gastric cancer is most frequent in men. African patients tend to be younger and have a higher proportion of women patients. Different patterns can be observed in the presentation of gastric cancer between different regions of the world. More research is needed in Latin America and Africa since these populations are underrepresented., Competing Interests: Conflicts of interest The authors declare they have not a conflict of interest with this manuscript., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Solid-organ transplant (SOT) recipients have worse COVID-19 outcomes than general population and effective immunisation in these patients is essential but more difficult to reach. We aimed to determine the immunogenicity of an mRNA SARS-CoV-2 vaccine booster in SOT recipients previously immunised with either inactivated or homologous SARS-CoV-2 mRNA vaccine., Methods: Prospective cohort study of SOT recipients under medical care at Red de Salud UC-CHRISTUS, Chile, previously vaccinated with either CoronaVac or BNT162b2. All participants received a BNT162b2 vaccine booster. The primary study end point was anti-SARS-CoV-2 total IgG antibodies (TAb) seropositivity at 8-12 weeks (56-84 days) post booster. Secondary end points included neutralising antibodies (NAb) and specific T-cell responses., Findings: A total of 140 (50% kidney, 38% liver, 6% heart) SOT recipients (mean age 54 [13.6] years; 64 [46%] women) were included. Of them, 62 had homologous (three doses of BNT162b2) and 78 heterologous vaccine schedules (two doses of CoronaVac followed by BNT162b2 booster). Boosters were received at a median of 21.3 weeks after primary vaccination. The proportion achieving TAb seropositivity (82.3% vs 65.4%, P  = 0.035) and NAb positivity (77.4% vs 55.1%, P  = 0.007) were higher for the homologous versus the heterologous group. On the other hand, the number of IFN-γ and IL-2 secreting SARS-CoV-2-specific T-cells did not differ significantly between groups., Interpretation: This cohort study shows that homologous mRNA vaccine priming plus boosting in SOT recipients, reaches a significantly higher humoral immune response than inactivated SARS-CoV-2 vaccine priming followed by heterologous mRNA booster., Funding: School of Medicine, UC-Chile and ANID.ClinicalTrials.gov ID: NCT05124509., Competing Interests: S.M.B., N.L.C. and A.K. reported having participated as leading scientists for design of CoronaVac clinical trials sponsored in Chile by Pontificia Universidad Católica de Chile and in collaboration with Sinovac Biotech (NCT04651790 and NCT04992260)., (© 2022 The Author(s).)

This pilot study was designed to investigate the feasibility of incorporating validated McMaster-Ottawa Team Observed Structured Clinical Encounters (TOSCEs) as a behavioral assessment in an interprofessional education (IPE) program using Zoom Communications. First- and second-year students from 11 health professional programs (e.g., audiology, dental hygiene, graduate psychology, healthcare administration and leadership, occupational therapy, pharmacy, physical therapy and athletic training, and physician assistant studies) at a single university participated and were assessed on the four Interprofessional Education Collaborative (IPEC) core competencies. Students completed three McMaster-Ottawa TOSCE stations (20 mins per station), followed by a large group debriefing for all participants to discuss the process and provide feed¬back. A validated, abbreviated version of the McMaster-Ottawa scoring rubric was utilized by faculty observers, and individual student scores were submitted using a Google form. Kruskal Wallis tests were used to analyze student performance related to the IPEC core competencies to deter¬mine whether significant differences existed between mean performance scores as compared by year in program (first year vs. second), and between case types. Kruskal-Wallis tests suggested differences on the collaborative patient performance item between the pediatric and diabetes cases only. There were no significant differences in performance across academic year in health professional programs, p > 0.05. Qualitative feedback highlighted the timely telehealth approach to collaborative practice and effective delivery of the interprofessional (IP) OSCE event across all of the student focus groups. The virtual IP OSCEs were feasible and recommended as a valuable IPE initiative at our institution.

Abstract: BACKGROUND: Nurses play an essential role in coordinating the care of patients with multiple sclerosis (MS) throughout their disease trajectory in a complex treatment landscape. The aim of this study was to assess nurses' preferences toward different disease-modifying therapy attributes. METHODS: We conducted a multicenter, noninterventional, cross-sectional study in collaboration with the Sociedad Española de Enfermería Neurológica. Nurses actively involved in MS care were invited to participate in the study. Prevention of disability progression, preservation of cognitive function, side effect profile and safety monitoring, and method of administration were the treatment attributes tested. Conjoint analysis was used to assess preferences in 8 simulated treatment options and rank them from most to least preferred. RESULTS: A total of 98 nurses were included in the study. The mean (SD) age was 44.7 (9.8) years, and 91.8% were female with a mean (SD) time of experience in MS care of 7.5 (5.4) years. Participants prioritized preservation of cognition (38.6%), followed by preventing disability progression (35.2%) and side effect risk and safety monitoring (13.5%). Route and frequency of administration were the least preferred attributes (7.4% and 5.3%, respectively). Estimated utilities were consistent across the sample according to sociodemographic and professional practice characteristics. CONCLUSIONS: Nurses' preferences toward treatments were mainly driven by efficacy attributes. This information may support the role of nurses in the multidisciplinary management of MS facilitating shared decision making., Competing Interests: This study was funded by Roche Medical Department, Spain (SL42129). Guillermo Bueno-Gil, Nicolás Medrano and Jorge Maurino are employees of Roche Farma Spain. The rest of authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been widely implemented in low- and middle-income countries. However, immunogenicity in immunocompromised patients has not been established. Herein, we aimed to evaluate immune response to CoronaVac vaccine in these patients., Methods: This prospective cohort study included 193 participants with 5 different immunocompromising conditions and 67 controls, receiving 2 doses of CoronaVac 8-12 weeks before enrollment. The study was conducted between May and August 2021, at Red de Salud UC-CHRISTUS, Santiago, Chile. Neutralizing antibody (NAb) positivity, total anti-SARS-CoV-2 immunoglobulin G antibody (TAb) concentrations, and T-cell responses were determined., Results: NAb positivity and median neutralizing activity were 83.1% and 51.2% for the control group versus 20.6% and 5.7% (both P < .001) in the solid organ transplant group, 41.5% and 19.2% (both P < .0001) in the autoimmune rheumatic diseases group, 43.3% (P < .001) and 21.4% (P<.01 or P = .001) in the cancer with solid tumors group, 45.5% and 28.7% (both P < .001) in the human immunodeficiency virus (HIV) infection group, 64.3% and 56.6% (both differences not significant) in the hematopoietic stem cell transplant group, respectively. TAb seropositivity was also lower for the solid organ transplant (20.6%; P < .0001), rheumatic diseases (61%; P < .001), and HIV groups (70.9%; P = .003), compared with the control group (92.3%). On the other hand, the number of interferon γ spot-forming T cells specific for SARS-CoV-2 tended to be lower in all immunocompromising conditions but did not differ significantly between groups., Conclusions: Diverse immunocompromising conditions markedly reduce the humoral response to CoronaVac vaccine. These findings suggest that a boosting vaccination strategy should be considered in these vulnerable patients., Clinical Trials Registration: NCT04888793., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background: Obesity can worsen outcomes in patients with chronic respiratory diseases., Objectives: The objective of the study was to determine the impact of bariatric surgery (BaS) on risk of hospitalization due to acute exacerbation (AE) of chronic obstructive lung diseases (OLDs)., Setting: Academic, University-affiliated Hospital; United States., Methods: Nationwide Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a previous history of BaS, and control subjects, as patients with a body mass index ≥35 kg/m 2 and without a history of BaS. The primary outcome was hospitalization due to AE of any OLD (chronic obstructive pulmonary disease, asthma, and bronchiectasis), and the secondary outcome was the total length of stay (LOS). Univariate analysis and multivariate regression model were performed to assess the difference in outcomes between groups., Results: We included a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatments. Univariate analysis showed that the hospitalization rate was significantly lower for the treatment group than that for the control group (3.7% versus 9.8%, P < .0001), confirmed after adjusting for covariates (control versus treatment: odds ratio [OR] = 2.46, P < .0001). Subgroup analysis showed that the treatment group had a lower risk of LOS ≥3 days than controls (69.8% versus 77.4%, P < .0001), confirmed by multivariate analysis (control versus treatment: OR = 1.40, P < .0001)., Conclusions: BaS-induced weight loss may decrease the risk of hospitalization due to AE in patients with OLD, also decreasing the LOS. We acknowledge that this comparison is limited by the nature of the database; hence, further prospective studies are needed to better understand these results., (Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is commonly associated with increased sympathetic tone, changes in heart geometry, and mortality. The aforementioned translates into a higher and potentially modifiable mortality risk for this specific population., Objectives: The aim of the study was to analyze the extent of changes in the heart ventricular structure following rapid weight loss after bariatric surgery., Setting: Academic, university-affiliated hospital., Methods: We retrospectively reviewed all the patients that underwent bariatric surgery at our institution between 2010 and 2015. Data analyzed included demographics, BMI, and associated medical problems. Preoperative and postoperative echography readings were compared looking at the heart geometry, cardiac volumes, and wall thickness., Results: Fifty-one patients who had bariatric surgery and had echocardiography before and after the surgery were identified. There were 33 females (64.7%). The mean age was 63.4 ± 12.0 years with an average BMI of 40.3 ± 6.3. The mean follow-up was 1.2 years after the procedure. At 1 year follow-up 25 patients (49%, p = 0.01) showed normal left ventricular geometry. The left ventricular mass (229 ± 82.1 vs 193.2 ± 42.5, p<0.01) and the left ventricular end diastolic volume (129.4 ± 53 vs 96.4 ± 36.5, p = 0.01) showed a significant modification following the procedure. There was a significant improvement in the interventricular septal thickness (p = 0.01) and relative wall thickness (p < 0.01) following surgery., Conclusion: The patients with obesity present a significant cardiac remodeling from concentric remodeling to normal geometry after bariatric surgery. The decrease in BMI has a direct effect on improvement of the left ventricular structure. Further studies must be carried out to define the damage of obesity to diastolic function., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Acute myeloid leukemia (AML) is the most common leukemia in adults., Aim: To Describe our population of patients with AML and report the outcomes of our treatments., Material and Methods: Review of electronic clinical records of 114 patients with AML with a median age of 57 years (59% men)., Results: Seventeen percent of patients were classified as low risk, 38% as intermediate risk and 33% as high risk. Seventy-six percent of patients were treated with intensive chemotherapy. Five years overall survival according to cytogenetic risk was 59, 41, and 12% in low, intermediate, and high-risk patients, respectively. The outcomes were better in patients under 60 years. The median survival of patients treated with intensive chemotherapy aged less than 60 years and 60 years and above was 3.4 and 1 year, respectively., Conclusions: Our results are comparable to those reported in developed countries. Improving the survival of patients 60 years and older is our main challenge.

Paternal environmental perturbations can influence the physiology and behavior of offspring. For example, our previous work showed reduced cocaine reinforcement in male, but not female, progeny of rat sires that self-administered cocaine. The information transfer from sire to progeny may occur through epigenetic marks in sperm, encompassing alterations in small noncoding RNAs, including microRNAs (miRNAs) and/or DNA methylation. Here, no reliable changes in miRNAs in the sperm of cocaine- relative to saline-experienced sires were identified. In contrast, 272 differentially methylated regions were observed in sperm between these groups. Two hypomethylated promoter regions in the sperm of cocaine-experienced rats were upstream of cyclin-dependent kinase inhibitor 1a ( Cdkn1a ). Cdkn1a mRNA also was selectively increased in the NAc of cocaine-sired male (but not female) offspring. Cocaine self-administration also enhanced Cdkn1a expression in the accumbens of cocaine-sired rats. These results suggest that changes in Cdkn1a may play a role in the reduced cocaine reinforcing efficacy observed in cocaine-sired male rats. Introducing a 90 d delay between sire self-administration and breeding reversed both cocaine resistance and the increase in accumbens Cdkn1a mRNA in male offspring, indicating that cocaine-induced epigenetic modifications are eliminated with sperm turnover. Collectively, our results indicate that cocaine self-administration produces hypomethylation of Cdkn1a in sperm and a selective increase in the expression of this gene in the NAc of male offspring, which is associated with blunted cocaine reinforcement. SIGNIFICANCE STATEMENT The relatively new field of transgenerational epigenetics explores the effects of environmental perturbations on offspring behavior and physiology. Our prior work in rats indicated that male, but not female, progeny of sires that self-administered cocaine displayed reduced cocaine reinforcement. The information transfer from sire to progeny may occur through heritable epigenetic marks in sperm, including DNA methylation. The present findings revealed two hypomethylated promoter regions upstream of the Cdkn1a gene in sire sperm. Remarkably, Cdkn1a expression was selectively decreased in offspring NAc, a brain region that regulates cocaine reinforcement., (Copyright © 2022 the authors.)

Purpose The aim of this study is to describe the safety and effectiveness of laparoscopic ventral hernia repair with intraperitoneal fascial closure using a barbed suture prior to mesh placement. Materials and methods Patients who underwent laparoscopic ventral hernia repair were included in this retrospective review. Patients were divided into two groups. In the first group, primary fascial closure was performed with a 2-polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh. In the second group, the mesh was fixed intraperitoneally using tacks without closing the fascial defect. Results A total of 148 patients who underwent laparoscopic primary ventral hernia repair were included. A total of 72 (48.6%) patients were included in the barbed suture with mesh group and 76 (51.4%) patients in the mesh-only group. The mean fascial defect size was 25 cm 2 in the first group and 64 cm 2  in the second group. The median suturing time for fascial closure was 15 minutes. The average surgery time was 98 minutes in the first group and 96 minutes in the second group. The mean follow-up period was 80 days for Group 1 and 135 days for Group 2. No hernia recurrence or mortality occurred in this study. Conclusion The barbed suture closure technique is a fast, safe, and effective technique for fascial closure during laparoscopic ventral hernia repair in combination with mesh placement. Further evidence to support these findings and longer follow-up periods are warranted to evaluate long-term outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Montorfano et al.)

Background: Obesity is considered a major cardiovascular risk factor. The excess of pericardial fat (PF) in patients with obesity has been associated with a variety of electrocardiographic alterations. In previous studies, we demonstrated that rapid weight loss and bariatric interventions result in decreased PF., Objectives: The aim of this study is to report the changes in PF after bariatric surgery and its effect on ventricular conduction., Setting: US hospital, academic institution., Methods: A linear measurement of PF thickness on computed tomography scans was obtained for 81 patients, as well as a retrospective review of electrocardiographic changes before and after bariatric surgery. We compared the changes in PF thickness and electrocardiographic components before and after procedures. Common demographics and co-morbidities were collected along with lipid profiles preoperative and postoperative., Results: A total of 81 patients had electrocardiograms done before and 1 year after bariatric surgery. Females comprised 67.9% (n = 55), and the average age for our population was 55.07 ± 14.17 years. Pericardial fat thickness before surgery was 5.6 ± 1.84 and 4.5 ± 1.62 mm after surgery (P = .0001). Ventricular conduction (QT and QT corrected [QTc] intervals) showed a significant improvement from 438.7 + 29 before to 426.8 + 25.3 after bariatric surgery (P = .006). We found a statistically significant association between the decrease in PF and the decrease in QTc intervals (P = .002)., Conclusion: Obesity is a risk factor for arrhythmias and sudden cardiac death. Bariatric surgery and its effect on PF produce an improvement in ventricular conduction, which may reduce the ventricular electrical instability in patients with obesity., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The population undergoing bariatric surgery (BaS) has many cardiovascular risk factors that can lead to significant perioperative cardiovascular morbidity., Objectives: We aimed to examine trends in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) after BaS., Setting: Academic Hospital, United States METHODS: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. Data on demographics, co-morbidities, and type of procedure were collected. MACCE was defined as a composite variable including perioperative acute myocardial infarction (AMI), cardiac arrest requiring cardiopulmonary resuscitation, acute stroke, and all-cause mortality. We utilized the Cochrane-Armitage and Jonckheere-Terpstra tests to assess for significant trend changes throughout the years., Results: A total of 752,722 patients were included in our analysis (LSG = 73.2%, LRYGB = 26.8%). Postoperative MACCE occurred in 1058 patients (.14%), and was more frequent in patients undergoing LRYGB (.20%). The frequency of MACCE declined from .17% to .14% (P = .053), driven by a decline in the frequency of AMI (.04% to .02%, P = .002), cardiac arrest (.05% to .04%, P = .897), and all-cause death (.11% to .08%, P = .040), but with an increase in perioperative stroke (.01% to .02%, P = .057)., Conclusion: The overall risk of MACCE after BaS is .14% and has been declining in the last 5 years. This trend is likely multifactorial and further analysis is necessary to provide a detailed explanation., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity independently increases the risk of hospitalization due to viral respiratory infections, including influenza virus and, more recently, severe acute respiratory syndrome coronavirus 2. As an independent risk factor, obesity impairs the immune response to viral infections and decreases the effectiveness of immunizations., Objectives: Using influenza as a proxy, we aimed to determine the impact of bariatric surgery (BaS) on the risk of hospitalization due to viral respiratory infections., Setting: Academic hospital, United States., Methods: National (Nationwide) Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a history of BaS and control subjects as patients with a body mass index ≥35 kg/m 2 and without a history of BaS. Any hospitalization with influenza as a primary diagnosis was identified. Univariate analysis and multivariate regression models were performed to assess the differences between groups., Results: A total of 2,300,845 subjects were reviewed, of which 2,004,804 were control subjects and 296,041 were treated patients. Univariate analysis showed that the hospitalization rate in the treatment group was significantly lower than in the control group (.007% versus .019%, P < .0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio = 2.21, P = .0010)., Conclusions: BaS may decrease the risk of hospitalization due to influenza, but further prospective studies are needed to confirm these results. We also suggest that these results should be translated into the development of similar studies to determine the impact of BaS on the incidence and severity of the coronavirus disease 2019., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is a major risk factor for the development of metabolic syndrome, coronary artery disease, and heart failure (HF). Rapid weight loss following bariatric surgery can significantly improve outcomes for patients with these diseases., Objectives: To assess whether bariatric surgery improves ventricular ejection fraction in patients with obesity who have heart failure., Setting: Private practice, United States., Methods: We conducted a retrospective review of echocardiographic changes in systolic functions in patients with obesity that underwent bariatric surgery at our institution. Patients were divided into 2 groups, those (1) without known preoperative HF and (2) with preoperative HF. We compared the left ventricular ejection fraction (LVEF) before and after bariatric surgery in both groups. Common demographics and co-morbidities were also analyzed., Results: A total of 68 patients were included in the analysis: 49 patients in group 1 and 19 in group 2. In group 1, 59.2% (n = 29) of patients were female, versus 57.9% (n = 11) in group 2. The excess body mass index lost at 12 months was 52.06 ± 23.18% for group 1 versus 67.12 ± 19.27% for group 2 (P = .0001). Patients with heart failure showed a significant improvement in LVEF, from 38.79 ± 13.26% before to 48.47 ± 14.57% after bariatric surgery (P = .039). Systolic function in patients from group 1 showed no significant changes (59.90 ± 6.37 mmHg) before and (59.88 ± 7.85 mmHg) after surgery (P = .98)., Conclusion: Rapid weight loss after bariatric surgery is associated with a considerable increase in LVEF and a significant improvement of systolic function., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Graft-versus-host disease (GVHD) is a serious complication in allogeneic transplantation. The first-line treatment is high doses of corticosteroids. In the absence of response to corticosteroids, several immunosuppressive drugs can be used, but they entail an elevated risk of severe infections. Added to this, there are patients who do not improve on any immunosuppressive treatment, with subsequent deteriorated quality of life and high mortality. Ruxolitinib has been shown to induce responses in refractory patients. In this study we have presented our real-life experience., Methods: A retrospective analysis was performed on patients with severe GVHD refractory to corticosteroids. Demographic, previous treatment, response and mortality data were collected., Results: Since 2014, seventeen patients with GVHD were treated with ruxolitinib due to refractoriness to corticosteroids and immunosuppressants and a few to extracorporeal photopheresis, 8 with acute GVHD (1 pulmonary, 4 cutaneous grade IV and 3 digestive grade IV) and 9 with chronic GHVD (5 cutaneous sclerodermiform, 2 pulmonary and 1 multisystemic). The overall response to ruxolitinib treatment for acute GVHD was 80%, 40% with partial response and 40% with complete remission. Global response in chronic GVHD was 79%. The GVHD mortality was only seen in acute disease and was 40%. Causes of mortality in those patients were severe viral pneumonia, post-transplantation hemophagocytic syndrome and meningeal GVHD refractory to ruxolitinib., Conclusions: In our series, the use of ruxolitinib as a rescue strategy in acute or chronic GVHD was satisfactory. Ruxolitinib treatment in patients with a very poor prognosis showed encouraging results. However, the GVHD mortality remains high in refractory patients, showing that better therapeutic strategies are needed., (Copyright © 2020 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Obesity is a well-known risk factor for heart disease, resulting in a broad spectrum of cardiovascular changes. Left ventricular mass (LVM) and contractility are recognized markers of cardiac function., Objectives: To determine the changes of LVM and contractility after bariatric surgery (BaS)., Setting: University hospital, United States METHODS: To determine the cardiac changes in ventricular mass, ventricular contractility, and left ventricular shortening fraction (LVSF), we retrospectively reviewed the 2-dimensional echocardiographic parameters of patients with obesity who underwent BaS at our institution. We compared these results before and after BaS., Results: A total of 40 patients met the inclusion criteria. The majority were females (57.5%; n = 23), with an average age of 63.5 ± 12.1. The excess body mass index (BMI) lost at 12 months was 48.9 ± 28.9%. The percent total weight loss after BaS was 16.46 ± 9.9%. The left ventricular mass was 234.9 ± 88.1 grams before and 181.5 ± 52.7 grams after BaS (P = .002). The LVM index was 101.3 ± 38.3 g/m 2 before versus 86.7 ± 26.6 g/m 2 after BaS (P = .005). The LVSF was 31% ± 8.8% before and 36.3% ± 8.2% after BaS (P = .007). We found a good correlation between the decrease in LVM index and the BMI after BaS (P = .03)., Conclusion: Rapid weight loss results in a decrease of the LVM index, as well as improvement in the left ventricular muscle contractility. Our results suggest that there is left ventricular remodeling and an improvement of heart dynamics following bariatric surgery. Further studies are needed to better assess these findings., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Indocyanine green (ICG) angiography is a real-time imaging modality that can be used to assess intraoperative tissue perfusion. ICG dye has proven to be feasible, safe, and cost-effective, especially for muscle flaps during complex reconstructions. To our knowledge, we discuss the first use of ICG angiography for the real-time assessment of a tongue flap following left lateral hemiglossectomy. ICG angiography showed excellent perfusion of the tongue and tongue flap, which subsequently led to an uncomplicated postoperative recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Montorfano et al.)