Rapid metastatic recurrence after pancreatic cancer resection: a multi-center, regional analysis of trends in surgical failure over two decades.

Background: Pancreatic ductal adenocarcinoma (PDAc) is a lethal malignancy, attributed in part to high rates of rapid recurrence (rrPDAc) following resection. We sought to characterize recurrence rates over time and investigate factors predictive of rrPDAc.

Methods: A regional multi-institutional cancer registry, augmented with data from the National Surgical Quality Improvement Program database, was queried for patients with PDAc from 1996 to 2020.

Adjuvant imatinib in high-risk resected gastrointestinal stromal tumors: Merely delaying the inevitable?

Introduction: Patients with high-risk resected gastrointestinal stromal tumors (GIST) receiving adjuvant imatinib have improved recurrence-free survival (RFS), however whether a complete cytocidal effect exists is unknown. We investigated this using a normalized recurrence timeline measured from end of oncologic treatment (EOOT), defined as the later of resection or end of adjuvant therapy.

Methods: We reviewed patients with resected high-risk GIST at our cancer center from 2003 to 2018.

Presurgical pulmonary function tests in the first few days of life in neonates with congenital heart disease, a pilot study.

Objective: To compare early pulmonary function tests (PFTs) in neonates with critical congenital heart disease (CHD) compared to a historical reference group.

Design: Infants ≥ 37 weeks gestation with critical CHD were studied within the first few days of life, prior to cardiac surgery, and compared to data from a published reference group of healthy term neonates without CHD, studied at the same institution. Passive respiratory resistance (Rrs) and compliance (Crs) were measured with the single breath occlusion technique following specific acceptance criteria.

Hospital Care for Adult Patients with Congenital Heart Diseases.

Objective: The ideal type of hospital to care for adult congenital heart disease (ACHD) patients is not well known. Hospital competitiveness, clinical volume and market structure can influence clinical outcomes. We sought to understand how hospital competitiveness affects clinical outcomes in ACHD patients in the era prior to the Adult Congenital Heart Association accreditation program.

γ' fibrinogen levels as a biomarker of COVID-19 respiratory disease severity.

Coronavirus disease 2019 (COVID-19) is characterized by a pro-inflammatory state associated with organ failure, thrombosis, and death. We investigated a novel inflammatory biomarker, γ' fibrinogen (GPF), in 103 hospitalized patients with COVID-19 and 19 healthy controls. We found significant associations between GPF levels and the severity of COVID-19 as judged by blood oxygen saturation (SpO).

Referral and treatment patterns in pancreatic acinar cell carcinoma: A regional population-level analysis.

Background: Pancreatic acinar cell carcinoma (PACC) is a rare exocrine tumor of the pancreas. We evaluated the effect disease stage, surgical intervention, and institutional volume status plays in survival.

Methods: We queried the Oregon State Cancer Registry for patients with PACC from 1997 to 2018.

High-volume centers are associated with higher receipt of combined therapy in stage III pancreatic cancer.

Background: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at a locally advanced stage with vascular involvement which was previously viewed as a contraindication to resection. However, high-volume centers are increasingly capable of resecting complex tumors. We aimed to explore patterns of treatment that are uncharacterized on a population level.

Socioeconomic and Geographic Disparities in the Referral and Treatment of Pancreatic Cancer at High-Volume Centers.

Importance: Treatment at high-volume centers (HVCs) has been associated with improved overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC); however, it is unclear how patterns of referral affect these findings.

Objective: To understand the relative contributions of treatment site and selection bias in driving differences in outcomes in patients with PDAC and to characterize socioeconomic factors associated with referral to HVCs.

Design, Setting, Participants: A population-based retrospective review of the Oregon State Cancer Registry was performed from 1997 to 2019 with a median 4.

Gamma' fibrinogen levels as a biomarker of COVID-19 respiratory disease severity.

Coronavirus disease 2019 (COVID-19) is characterized by a pro-inflammatory state associated with organ failure, thrombosis, and death. We investigated a novel inflammatory biomarker, γ' fibrinogen (GPF), in 103 hospitalized patients with COVID-19 and 19 healthy controls. We found significant associations between GPF levels and the severity of COVID-19 as judged by blood oxygen saturation (SpO ).

Disagreement in Readmission Rates After Total Hip and Knee Arthroplasty Across Data Sets.

Background: In 2014, the Affordable Care Act Hospital Readmissions Reduction Program began penalizing hospitals for excessive readmission rates 30 days after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Various data sets with nonstandardized validation processes report readmission data, which may provide conflicting outcome values for the same patient populations.

Methods: We queried 4 separate data sets: the American Joint Replacement Registry, Centers for Medicare and Medicaid Services billing data, the Vizient data set, and an advanced analytics integration (Cognos) report from our electronic medical record.

Directional Reflectivity of the Ellipsoid Zone in Dry Age-Related Macular Degeneration.

Background And Objective: Ellipsoid zone (EZ) reflectivity on optical coherence tomography (OCT) is affected by the orientation of the scanning beam. The authors sought to determine how directional reflectivity changes in dry age-related macular degeneration (AMD).

Patients And Methods: Retrospective image analysis included 17 control and 20 dry AMD subjects.

Marrow Stimulation Has Relatively Inferior Patient-Reported Outcomes in Cartilage Restoration Surgery of the Knee: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background: Multiple cartilage repair techniques are available for chondral defects in the knee. Optimal treatment is controversial.

Purpose: To evaluate change from baseline in the 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales among different cartilage repair techniques of the knee.

Spinal anesthesia in a designated block bay for total joint arthroplasty: improving operating room efficiency.

Background: Creating highly efficient operating room (OR) protocols for total joint arthroplasty (TJA) is a challenging and multifactorial process. We evaluated whether spinal anesthesia in a designated block bay (BBSA) would reduce time to incision, improve first case start time and decrease conversion to general anesthesia (GA).

Methods: Retrospective cohort study on the first 86 TJA cases with BBSA from April to December 2018, compared with 344 TJA cases with spinal anesthesia performed in the OR (ORSA) during the same period.

Sex Differences in the Effect of Nucleus Accumbens Volume on Adolescent Drinking: The Mediating Role of Sensation Seeking in the NCANDA Sample.

Objective: In adolescence, sensation seeking is associated with earlier onset of alcohol use, which is a risk factor for a variety of negative consequences later in life. Individual differences in sensation seeking are related to brain function in the nucleus accumbens (NAcc), a brain region that undergoes considerable structural development during adolescence. Therefore, the goal of this study was to determine whether NAcc volume in alcohol-naive adolescents was associated with future sensation seeking and alcohol use and whether these associations differed by sex.

Do hardened femoral heads reduce blood metal ion concentrations after hip resurfacing?

Background: Elevated cobalt and chromium ion concentrations have been associated with the use of metal-on-metal bearings in hip arthroplasty. The use of a differential hardness bearing may reduce metal particle release. The aim of our study was to compare circulating cobalt (Co) and chromium (Cr) ion levels between patients treated with a standard all 'as-cast' heat treated bearing and a differential hardness bearing.

Does femoral neck to cup impingement affect metal ion levels in hip resurfacing?

Background: Impingement of the femoral neck with the acetabular component after metal-on-metal hip resurfacing arthroplasty (HRA) is a possible cause of edge loading and accelerated bearing wear. No attempt has been made to correlate radiographic impingement signs and blood metal ion levels.

Questions/purposes: We (1) compared serum cobalt (CoS) and chromium (CrS) concentrations between patients with and without radiographic impingement signs treated with unilateral HRA, (2) determined whether divot depth on the femoral neck correlated with CoS and CrS, and (3) assessed the predictive value of radiographic impingement signs for high levels of CoS and CrS.

Metal ion levels in total hip arthroplasty versus hip resurfacing.

Recent studies suggest that the tapered interface between stem and femoral head may be a substantial source of cobalt and chromium ion release after metal-on-metal (MOM) total hip arthroplasty (THA). This study compared patient ion levels after MOM hip resurfacing (HR) and MOM THA performed with identical acetabular components. 110 HRs were compared with 22 THAs.

The results of metal-on-metal hip resurfacing in patients under 30 years of age.

Degenerative hip conditions most commonly affect older patients. However, many cases occur in younger patients. Total hip arthroplasty is the conventional approach; however, hip resurfacing is a viable option.

Childhood development after maternal metal-on-metal hip resurfacing.

Metal-on-metal (MoM) hip resurfacing has been used in many young, active patients, including women of childbearing age. While ion levels have been measured in mothers with MoM hip resurfacing and their babies, little is known about how these ions affect child development. Out of 1300, MoM hip resurfacing surgeries, we had 48 women of childbearing age (defined as 40 years of age or younger at the time of surgery).

Contact patch to rim distance predicts metal ion levels in hip resurfacing.

Background: Component design, size, acetabular orientation, patient gender, and activity level have been suggested as factors leading to elevated metal ion concentrations after-on-metal hip resurfacing arthroplasty (MMHRA). The calculation of the contact patch to rim (CPR) distance integrates component size, design, and acetabular orientation and may be a good predictor of elevated metal ion levels.

Questions/purposes: We evaluated the effects and the predictive value of the CPR distance on serum cobalt (CoS) and chromium (CrS) ion levels.

Do ion concentrations after metal-on-metal hip resurfacing increase over time? A prospective study.

Thirteen male and five female patients received a Conserve Plus hip resurfacing and prospectively provided blood samples to measure cobalt and chromium levels for up to 11 years. Trends in metal levels over time in unilateral and bilateral patients were studied. A multi-variate regression model was used to account for potential covariates.

Results of Conserve Plus® metal-on-metal hip resurfacing for post-traumatic arthritis and osteonecrosis.

The safety and efficacy of metal-on-metal surface arthroplasty in post-traumatic arthritis and post-traumatic osteonecrosis (PT OA and PT ON) cases has not previously been thoroughly investigated. This study compared the outcomes of metal-on-metal hip resurfacing (HR) in patients performed for an indication of OA secondary to trauma to compared to PT ON. Metal-on-metal resurfacing arthroplasties were performed on 62 hips, 43 with PT OA and 19 with PT ON with secondary osteoarthritis.

Socket position determines hip resurfacing 10-year survivorship.

Background: Modern metal-on-metal hip resurfacing arthroplasty designs have been used for over a decade. Risk factors for short-term failure include small component size, large femoral head defects, low body mass index, older age, high level of sporting activity, and component design, and it is established there is a surgeon learning curve. Owing to failures with early surgical techniques, we developed a second-generation technique to address those failures.