Search

Background Older adults may have new care needs and functional limitations after surgery. Many rely on informal caregivers (unpaid family or friends) after discharge but the extent of informal support is unknown. We sought to examine the role of informal postoperative caregiving on transitions of care for older adults undergoing routine surgical procedures. Materials and methods We performed a retrospective cohort study using ACS NSQIP Geriatric Pilot Project data, 2014-2018. Patients were ≥65 years and underwent an inpatient surgical procedure. Patients who lived at home alone were compared with those who lived with support from informal caregivers (family and/or friends). Primary outcomes were discharge destination (home vs. post-acute care) and readmission within 30 days. Multivariable logistic regression was used to determine the association between support at home, discharge destination, and readmission. Results Of 18,494 patients, 25% lived alone before surgery. There was no difference in loss of independence (decline in functional status or new use of mobility aid) after surgery between patients who lived alone or with others (18.7% vs. 19.5%, p = 0.24). Nevertheless, twice as many patients who lived alone were discharged to a non-home location (10.2% vs. 5.1%; OR: 2.24, CI: 1.93-2.56). Patients who lived alone and were discharged home with new informal caregivers had increased odds of readmission (OR: 1.43, CI: 1.09-1.86). Conclusion Living alone independently predicts discharge to post-acute care, and patients who received new informal caregiver support at home have higher odds of readmission. These findings highlight opportunities to improve discharge planning and care.

To prepare for the increasing numbers of older adults undergoing surgery, the American College of Surgeons (ACS) has recently launched the Geriatric Surgery Verification Program with the goal of encouraging the creation of centers of geriatric surgery. Meanwhile, the Society for Perioperative Assessment and Quality Improvement (SPAQI) has published recommendations for the preoperative management of frailty, which state that teams should actively screen for frailty before surgery and that pathways, including geriatric comanagement, shared decision-making, and multimodal prehabilitation, should be embedded in routine care to help improve patient outcomes. Both SPAQI and the ACS advocate for a multidisciplinary approach to improve the value of care for older adults undergoing surgery. However, the best way to implement geriatric services in the surgical setting is yet to be determined. In this statement, we will describe the SPAQI recommendations for launching a geriatric surgery center and the process by which its value should be assessed over time.

Centromere-binding protein F (CENP-F) is a large and complex protein shown to play critical roles in mitosis and various other interphase functions. Previous studies have shown that the disruption of CENP-F function leads to detrimental effects on human development. Still, it is important to note the lack of studies focusing on the effects that the loss of this essential protein may have on specific adult organs. In the current study, we used a novel global knockout murine model to analyze the potential consequences deletion of CENP-F has on adult kidney structure and function. We discovered several structural abnormalities including loss of ciliary structure, tubule dilation, and disruption of the glomerulus. Along with these structural irregularities, renal dysfunction was also detected suggesting hydronephrosis and acute kidney injury in these knockout organs. Importantly, this is the first study linking CENP-F to kidney disease and hopefully these data will serve as a platform to further investigate the molecular mechanisms disrupted in the kidney by the loss of CENP-F. Anat Rec, 302:163-170, 2019. © 2018 Wiley Periodicals, Inc.

Regional differences in vascular physiology and disease response exist throughout the vascular tree. While these differences in physiology and disease correspond to regional vascular environmental conditions, there is also compelling evidence that the embryonic origins of the smooth muscle inherent to the vessels may play a role. Here, we review what is known regarding the role of embryonic origin of vascular smooth muscle cells during vascular development. The focus of this review is to highlight the heterogeneity in the origins of vascular smooth muscle cells and the resulting regional physiologies of the vessels. Our goal is to stimulate future investigation into this area and provide a better understanding of vascular organogenesis and disease. .

A long and productive history in biomedical research defines the chick as a model for human biology. Fundamental discoveries, including the description of directional circulation propelled by the heart and the link between oncogenes and the formation of cancer, indicate its utility in cardiac biology and cancer. Despite the more recent arrival of several vertebrate and invertebrate animal models during the last century, the chick embryo remains a commonly used model for vertebrate biology and provides a tractable biological template. With new molecular and genetic tools applied to the avian genome, the chick embryo is accelerating the discovery of normal development and elusive disease processes. Moreover, progress in imaging and chick culture technologies is advancing real-time visualization of dynamic biological events, such as tissue morphogenesis, angiogenesis, and cancer metastasis. A rich background of information, coupled with new technologies and relative ease of maintenance, suggest an expanding utility for the chick embryo in cardiac biology and cancer research.

The purpose of this study was to examine workplace friendships among 536 employees of Wahda Bank in four cities in Eastern Libya. In this study, a Workplace Friendship Scale (WFS) was used to assess opportunities for and the presence of friendships. Participants in this study reported mainly positive friendships at the workplace. Participants of different gender, ages, education levels, cities, and durations of work in different departments reported various opportunities for workplace friendships. However, marital status and type of occupation were not significantly related to friendships at the workplace. Findings suggest both similar and unique patterns of friendships compared to those studied outside Libya.

Mesothelium is the simple squamous epithelium covering all abdominal organs and the coeloms in which those organs reside. While the structural characteristics of this cell type were documented a century ago, its potential in development, disease, and wound healing is only now becoming apparent. In the embryo, mesothelia provide vasculogenic cells for the developing heart, lungs, and gut. Furthermore, adult mesothelial cells can be reactivated using thymosin β4 and mobilized to aid in tissue repair. Despite their positive role in development and repair, mesothelia are also susceptible to adhesion and tumor formation. With knowledge that the mesothelium is an important mediator of tissue repair as well as disease, it will be important to identify other factors like thymosin β4 that have the ability to potentiate these cells. Future use of chemical and genetic agents in conjunction with mesothelial cells will lead to enhanced therapeutic potential and mitigation of deleterious outcomes.

Genome-wide association studies have identified common variants associated with common diseases. Most variants, however, explain only a small proportion of the estimated heritability, suggesting that rare variants might contribute to a larger extent to common diseases than assumed to date. Here, we use next-generation sequencing to test whether such variants contribute to the risk for anxiety disorders by re-sequencing 40 kb including all exons of the TMEM132D locus which we have previously shown to be associated with panic disorder and anxiety severity measures. DNA from 300 patients suffering from anxiety disorders, mostly panic disorder (84.7%), and 300 healthy controls was screened for the presence of genetic variants using next-generation re-sequencing in a pooled approach. Results were verified by individual re-genotyping. We identified 371 variants of which 247 had not been reported before, including 15 novel non-synonymous variants. The majority, 76% of these variants had a minor allele frequency less than 5%. While we did not identify additional common variants in TMEM132D associated with panic disorders, we observed an overrepresentation of presumably functional coding variants in healthy controls as compared to cases as well as a higher rate of private coding variants in cases, with one non-synonymous coding variant present in four patients but not in any of the matched controls nor in over 5,500 individuals of different ethnic origins from publicly available re-sequencing datasets. Our data suggest that not only common but also putatively functional and/or rare variants within TMEM132D might contribute to the risk to develop anxiety disorders.

Rationale, aims and objectives At present, the range of services delivered in a health system is not known. Currently there are no accepted methods for defining the scope of ambulatory care. Therefore we used data from the electronic medical record and billing system of a large non-profit multi-specialty group practice to measure the number of different diagnoses that clinicians managed as well as the number of different medications, laboratory tests, imaging studies, referrals and procedures ordered. Methods All patient encounters and clinicians in the group practice in 2008 were eligible for inclusion in the analysis. Data were analysed cumulatively for the practice and by specialty. Quantile regression models were used to adjust for differences in full-time equivalents (FTE) among physicians at the practice. Results In one year for this practice, with 324 229 patients who made 3 193 917 office visits to 578 physicians and 248 other clinicians, patients presented with 5638 primary and 6411 secondary diagnoses. Overall, patient management resulted in unique orders for 9481 medications, 1182 laboratory tests, 613 referrals, 284 imaging studies and 1701 procedures. After adjusting for FTE, physicians managed a median of 249 primary diagnoses and 347 secondary diagnoses. They ordered a median of 278 medications, 128 laboratory tests, 51 referrals, 29 imaging studies and 39 procedures. Conclusion Physicians routinely manage a substantial variety of diagnoses, medications, and other tests and procedures. Quality improvement and health services researchers have generally focused on individual services but also must consider the wide variety and range of services delivered.

Public health researchers have begun to map the neighborhood “food environment” and examine its association with the risk of overweight and obesity. Some argue that “food deserts”—areas with little or no provision of fresh produce and other healthy food—may contribute to disparities in obesity, diabetes, and related health problems. While research on neighborhood food environments has taken advantage of more technically sophisticated ways to assess distance and density, in general, it has not considered how individual or neighborhood conditions might modify physical distance and thereby affect patterns of spatial accessibility. This study carried out a series of sensitivity analyses to illustrate the effects on the measurement of disparities in food environments of adjusting for cross-neighborhood variation in vehicle ownership rates, public transit access, and impediments to pedestrian travel, such as crime and poor traffic safety. The analysis used geographic information systems data for New York City supermarkets, fruit and vegetable markets, and farmers' markets and employed both kernel density and distance measures. We found that adjusting for vehicle ownership and crime tended to increase measured disparities in access to supermarkets by neighborhood race/ethnicity and income, while adjusting for public transit and traffic safety tended to narrow these disparities. Further, considering fruit and vegetable markets and farmers' markets, as well as supermarkets, increased the density of healthy food outlets, especially in neighborhoods with high concentrations of Hispanics, Asians, and foreign-born residents and in high-poverty neighborhoods.

The adult heart has been reported to have an extensive lymphatic system, yet the development of this important system during cardiogenesis is still largely unexplored. The nuclear-localized transcription factor Prox-1 identified a sheet of Prox-1-positive cells on the developing aorta and pulmonary trunk in avian and murine embryos just prior to septation of the four heart chambers. The cells coalesced into a branching lymphatic network that spread within the epicardium to cover the heart. These vessels eventually expressed the lymphatic markers LYVE-1, VEGFR-3, and podoplanin. Before the Prox-1-positive cells were detected in the mouse epicardium, LYVE-1, a homologue of the CD44 glycoprotein, was primarily expressed in individual epicardial cells. Similar staining patterns were observed for CD44 in avian embryos. The proximity of these LYVE-1/CD44-positive mesenchymal cells to Prox-1-positive vessels suggests that they may become incorporated into the lymphatics. Unexpectedly, we detected LYVE-1/PECAM/VEGFR-3-positive vessels within the embryonic and adult myocardium which remained Prox-1/podoplanin-negative. Lymphatic markers were surprisingly found in adult rat and embryonic mouse epicardial cell lines, with Prox-1 also exhibiting nuclear-localized expression in primary cultures of embryonic avian epicardial cells. Our data identified three types of cells in the embryonic heart expressing lymphatic markers: (1) Prox-1-positive cells from an extracardiac source that migrate within the serosa of the outflow tract into the epicardium of the developing heart, (2) individual LYVE-1-positive cells in the epicardium that may be incorporated into the Prox-1-positive lymphatic vasculature, and (3) LYVE-1-positive cells/vessels in the myocardium that do not become Prox-1-positive even in the adult heart.

Bves (blood vessel/epicardial substance) is a transmembrane protein postulated to play a role in cell adhesion. While it is clear that Bves and gene products of the same family are expressed in adult striated muscle cells, the distribution of these proteins during development has not been critically examined. An understanding of the expression pattern of Bves is essential for a determination of protein function and its role in embryogenesis. In this study, we present an expression analysis of Bves during chick gastrulation and germ layer formation. Our data show that Bves is expressed in epithelia of all three germ layers early in development. Furthermore, Bves protein is observed in epithelial tissues during organogenesis, specifically the developing epidermis, the gut endoderm, and the epicardium of the heart. These data support the hypothesis that Bves may play a role in cell adhesion and movement of epithelia during early embryogenesis.

The aim of this prospective study was to evaluate the usefulness of fetal weight estimation in a prospective study, based on formulae derived from a previous retrospective study, using forward stepwise multiple regression analysis. Three-dimensional ultrasound was used to make reproducible measurement of limb circumferences, which formed the basis of our models. A total of 213 women with singleton pregnancies were scanned in the week prior to delivery and the following variables were measured: biparietal diameter, head circumference, transverse abdominal diameter, abdominal circumference, femur length, thigh circumference and arm circumference. The whole population was divided in to three subgroups according to the abdominal circumference ( 90th centile). We demonstrated the need for only two models for accurate fetal weight estimation, one for the small-for-dates fetuses and a second for the others. The most accurate results were obtained for the macrosomic fetuses with a standard deviation of 8.8%. Our data confirm the usefulness of measurement of fetal thigh circumference for the small-for-dates-fetuses and arm circumference for the other groups. We concluded that the use of three-dimensional ultrasound could facilitate the accurate prediction of fetal weight. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology

The distribution of sarcomeric myosin heavy chain (MyHC) has been examined immunocytochemically in the presumptive myocardial cells of chicken embryos (stages 6-10) prior to the onset of the heart beat. Embryos were stained with monoclonal antibody MF20, a reagent which recognizes all chicken sarcomeric MyHCs (Bader et al., 1982), and then examined both in whole mount by immunofluorescence and in semithin, plastic-embedded sections following immunoperoxidase labeling. We observed that myosin could be detected as early as stage 7 (0-2 pairs of somites) in 29% of the 31 embryos examined, and by stage 8 (4 pairs of somites) more than 80% of the embryos were MF20+. Every embryo with 5 pairs of somites (stage 8+) labeled strongly with MF20. Labeling was first detected at stage 7 to 7+ as a diffuse fluorescent signal within pleomorphic cells of the splanchnic mesoderm located in two crescent-shaped regions bordering each side of the anterior intestinal portal (AIP). With progressive development, the two crescent-shaped regions merged at the apex of the AIP, and as the two heart tubes began fusion at stage 9, the MyHC+ regions extended cranially and medially. By somite stages 9-10, the myosin-positive cells completely encircled the heart tube. From stages 7 to 9 the myosin signal had no sarcomeric distribution; i.e., there were no MyHC striations nor periodic repeats evident in the presumptive myocytes until late stage 9 and stage 10. Semithin sections revealed that myosin was first distributed in apical regions of the myocytes, adjacent to the pericardial coelom. The implications of these findings for myocyte determination, differentiation and morphogenesis are discussed.

Mesothelia comprise the epithelial covering of coelomic organs and line the cavities in which they are housed. Mesothelia contribute to the vasculature of the heart and the intestinal tract by developmental processes of epithelial-mesenchymal transition (EMT), migration, and differentiation into endothelial cells, vascular smooth muscle cells, and pericytes. Here, we establish a novel in vitro system to analyze the differentiative potential of mesothelia. Using explants from serosal mesothelium (the mesothelial covering of the gut), we demonstrate that much of the developmental program observed in embryonic mesothelia is retained in the adult structure. Namely, processes of epithelial spreading, EMT, and differentiation into smooth muscle cells from these cells are observed. Interestingly, we were unable to stimulate endothelial cell differentiation using serum or various signaling factors. Taken together, these data reveal that differentiated serosal cells retain vasculogenic potential and provide a generalizable model for future studies on the developmental and differentiative capacity of the mesothelial cell type.

The regenerative response of minced cardiac muscle grafts in the adult newt was studied using autoradiography and electron microscopy. One-sixteenth to one-eighth of the newt ventricle was amputated, minced, and returned to the wounded ventricle. At five days after grafting, no reorganization of graft msucle pieces was apparent and there was degeneration of much of the muscle graft. Another, smaller population of 5-day myocytes had euchromatic nuclei and intact sarcolemmae. In 10- and 16-day grafts, continuity between ventricular and graft lumina was established and coalescence of graft pieces was apparent. Ultrastructurally, 10- and 16-day graft myocytes appeared to have fewer myofibrillae and increased amounts of rough endoplasmic reticulum, polyribosomes, Golig complexes, and dense bodies when compared to uninjured ventricular myocytes. The peak of proliferative activity of graft cells was observed at 16 days. Electron microscopic autoradiography revealed breadkdown of myofibrillar structure in labeled myocytes, whereas in myocytes in the later stages of mitosis only scattered myofilaments and no Z bands were present. By 30 days, grafts appeared as an integrated structure composed primarily of cardiac muscle. Myocytes of 30-day grafts were observed in various stages of myofibrillogenesis and contained numberous 10-nm filaments. Seventy-day graft mycoytes had numberous well organized myofibrillae and intercellular junctions similar to those seen in uninjured ventricular myocytes.

PONTANEOUS nipple discharge, unrelated to S pregnancy or lactation, is usually regarded as a sign of mammary disease or endocrine dysfunction. The discharge may be serous, serosanguineous, or sanguineous; however, its macroscopic appearance does not constitute a reliable indicator of its underlying cause. In view of the fact that spontaneous secretion may occur in the absence of any palpable localized change in the mammary tissue that would pinpoint an area for biopsy or needle aspiration, a microscopic examination of the secretion might be reasonably expected to serve as a valuable aid in diagnosis. Microscopic examination of smeaxx of spontaneous nipple discharge was begun in this laboratory by the senior author in 1947. Preliminary observations were sufficiently encouraging to warrant further exploration of this application of the smear technique, particu

This study presents the clinician with information on the natural history of a lesion which if left undisturbed or treated with a minimum of therapy may progress to invasive cancer of the cervix. The 93 patients included in the study were asymptomatic and cervical lesions were discovered on routine cytological examination. A minimum of 6 months observation was required. Surgical treatment was undertaken when a lesion proved firmly established without regression or when invasive development was suspected. 49 of the original group were followed over 3 years. Lesions persisted in 22 and 27 regressed. There was variation noted in histologic findings and behavior of cases shown to be carcinoma in situ. The histological pattern and behavior were not correlated. It is thought that in some cases biopsies eradicated the carcinoma in situ in some fragments of residual carcinoma were dislodged by the inflammatory reaction and granulation tissue following biopsy and that obstetric trauma may have had the same effect in some. This would explain reported cases of disappearing carcinoma in situ following delivery. Topical use of oxytetracycline caused changes in cervical cytology; in some cancer cells disappeared temporarily and in few a desquammation of the abnormal epithelium resulted in temporary cure. The presence of Trichomonas was not correlated with this effect. In 2 cases douches with Trichotine caused disappearance of carcinoma in situ. A long interval of cytological negativity may occur especially following biopsy or drugs before recurrence is shown. It is suggested these presumed recurrences may represent new lesions. Borderline lesions were more prone to disappear than cancer in situ and those of the portio of the cervix more apt to disappear than those of the endocervical canal. Of 12 cases of progressive borderline lesions 1 progressed to invasive cancer after 13 years 8 to carcinoma in situ after 14 months to 5 years and 3 from dyskaryotic type to carcinoma in situ after 6 years. Diagnostic tampering with a lesion may cause its ap pearance to alter or its course to change. 4 cases of carcinoma in situ progressed to invasive cancer and 5 to possible invasion. It is believe d that without surgical treatment more would have progressed. Carcinoma in situ is regarded as preinvasive cancer which may be eradicated by minor procedures and its course modified by biopsy drugs and possibly the trauma of delivery. Dysplasias behave similarly and may develop into carcinoma in situ and later to invasive carcinoma.