Establishment of a Regional Virtual Tumor Board Program to Improve the Process of Care for Patients With Hepatocellular Carcinoma.

Purpose: Multidisciplinary evaluation (MDE) of hepatocellular cancer (HCC) is the current standard, often provided through a tumor board (TB) forum; this standard is limited by oncology workforce shortages and lack of a TB at every institution. Virtual TBs (VTBs) may help overcome these limitations. Our study aim was to assess the impact of a regional VTB on the MDE process for patients with HCC.

The effect of a regional hepatopancreaticobiliary surgical program on clinical volume, quality of cancer care, and outcomes in the Veterans Affairs system.

Importance: Malignant neoplasms of the hepatopancreaticobiliary (HPB) system constitute a significant public health problem worldwide. Treatment coordination for these tumors is challenging and can result in substandard care. Referral centers for HPB disease have been used as a strategy to improve postoperative outcomes, but their effect on accomplishing regionalization of care and improving quality of cancer care is not well known.

Postoperative transitional care needs in the elderly: an outcome of recovery associated with worse long-term survival.

Objective: To characterize transitional care needs (TCNs) after colorectal cancer (CRC) surgery and examine their association with age and impact on overall survival (OS).

Background: TCNs after cancer surgery represent additional burden for patients and are associated with higher short-term mortality. They are not well-characterized in CRC patients, particularly in the context of a growing elderly population, and their effect on long-term survival is unknown.

AAP principles concerning retail-based clinics.

The American Academy of Pediatrics views retail-based clinics (RBCs) as an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care. This statement updates the original 2006 American Academy of Pediatrics statement on RBCs, which flatly opposed these sites as appropriate for pediatric care, discussing the shift in RBC focus and comparing attributes of RBCs with those of the pediatric medical home.

Trapezial resection arthroplasty for osteoarthritis: use of abductor pollicis longus tendoplasty with interpositional material.

In this series, 45 patients had 54 trapezial resection arthroplasties for carpometacarpal osteoarthritis, with nine of the patients having bilateral arthroplasties. A major slip of the abductor pollicis longus tendon was used as a sling, with the underlying flexor carpi radialis tendon as stabilizer. Palmaris longus tendon, when present (42 cases), and absorbable gelatin sponge, when palmaris was absent (12 cases), served as interpositional material.

Triceps tendon rupture in weight lifters.

Triceps tendon avulsion injuries are rare. We report four weight lifters with triceps tendon raptures, two of whom had received local steroid injections for pain in the triceps. All four patients had taken oral anabolic steroids before injury.

Modulation of protein kinase C activity in Plasmodium falciparum-infected erythrocytes.

Infection of human erythrocytes with the malaria parasite Plasmodium falciparum induces many morphological and biochemical changes in the host cell. Host serine/threonine protein kinases could be involved in some of these processes. The aim of this study was to determine the effect of infection on red blood cell protein kinase C (PKC) and establish the importance of this enzyme in parasite growth and sexual stage differentiation.

Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites.

Background/aims: Cirrhotic patients are predisposed to develop spontaneous bacteremias and/or peritonitis, mainly caused by enteric bacteria. The aim of this study was to investigate if bacterial translocation, which is the passage of bacteria from the intestinal lumen to regional lymph nodes and/or the systemic circulation, is increased in a rat model of cirrhosis.

Methods: Rats were studied after 12-16 weeks of CCl4 inhalation, when samples of mesenteric lymph nodes, blood, liver, and spleen for standard bacteriologic cultures and a fragment of colon and liver for histology were obtained.

First reported case of Aspergillus granulosus infection in a cardiac transplant patient.

We report a case of disseminated infection with Aspergillus granulosus in a cardiac transplant recipient on immunosuppressive therapy. This is the first reported case in which this organism has been described as a pathogen. This organism bears morphological features different from those of more common Aspergillus species and should be considered a potential pathogen in immunocompromised patients.

Bacterial translocation in acute and chronic portal hypertension.

Patients with cirrhosis are predisposed to develop spontaneous bacteremias and peritonitis, mainly by enteric bacteria. Portal hypertension, by producing congestion and edema of the bowel wall, could increase the passage of bacteria from the intestinal lumen to regional lymph nodes to the systemic circulation or to both, a process termed bacterial translocation. The aim of this study was to investigate bacterial translocation at two stages of experimental portal hypertension: (a) acute (when shunting is minimal); and (b) chronic (when shunting is extensive and mimics the portal hypertension of cirrhosis).

Human monoclonal antibodies specific for blood group antigens demonstrate multispecific properties characteristic of natural autoantibodies.

A panel of 72 human monoclonal antibodies with specificities for blood group antigens, A, Rh D, Rh C, Rh c, Rh E, Rh e, Rh G, Jka and Jkb, has been established from the peripheral blood of deliberately immunized donors. Previous work has established that the antibodies are highly specific for their respective blood group antigens, and a number of them are in routine clinical use as blood grouping reagents. This panel was screened for reactivity against six unrelated foreign and autoantigens by ELISA, for rheumatoid factor activity by ELISA and agglutination techniques, and for reactivity with a number of different tissues by immunofluorescence.

Human monoclonal antibodies against blood group antigens preferentially express a VH4-21 variable region gene-associated epitope.

An anti-idiotypic antibody has been raised which recognizes human immunoglobulins with cold agglutinin activity of anti-I/i specificity. The pattern of reactivity of the antibody indicates that the structural basis for the epitope is located in the VH4-21 gene segment of the VHIV family, which is preferentially utilized by these cold reactive antibodies. Using this antibody, epitope expression was investigated in a panel of 72 human monoclonal allo-antibodies specific for human blood group antigens, as compared with a control panel of 39 randomly selected human monoclonal IgM antibodies of unknown specificities.

Human monoclonal antibodies to human blood group antigens Kidd Jka and Jkb.

Three IgM human monoclonal antibodies to Jkb, and one IgM human monoclonal antibody to Jka were produced from the lymphocytes of two immunized donors. Two of the anti-Jkb monoclonal antibodies (MS-7 and MS-9) are of the IgM (kappa) isotype and one (MS-8) is an IgM(lambda). The anti-Jka monoclonal antibody (MS-15) is of the IgM(kappa) isotype.

Ability of unstimulated and phorbol-ester-stimulated human blood-monocyte-derived macrophages to metabolize drugs and its implications.

Solutions containing 5,5-diphenyl[4-14C]hydantoin (15 micrograms/ml) or pheno[2-14C]barbital (20 micrograms/ml) were incubated for 0.5-6 h with monolayers of unstimulated and phorbol-ester-stimulated human blood-monocyte-derived macrophages and suspensions of K562 cells. The incubated solutions were centrifuged and the cell-free supernatants subjected to chromatography on Q-Sepharose Fast Flow anion exchange resin.

Human monoclonal antibodies to C, c, E, e and G antigens of the Rh system.

A panel of heterohybridomas secreting human IgG and IgM monoclonal antibodies to the C, c, G, E, and e antigens of the Rh system has been established. Both classes of antibody have been shown to react with red blood cells carrying their respective antigens; those of the IgM class being able to directly agglutinate unmodified red blood cells in saline. The heterohybridomas have been shown to be suitable for bulk culture and produce levels of antibody in the range of 15-73 micrograms/ml in the spent culture supernatant.

Differences in the nature and kinetics of the ethanol-related circulating cytotoxic proteins in normal subjects and patients with alcohol-induced cirrhosis.

The kinetics and nature of the nondialyzable cytotoxic activity which appeared in the serum after the consumption of 1.2 g ethyl alcohol per kilogram body weight over 45 min was studied in six healthy volunteers and eight patients with histologically proven alcohol-related cirrhosis of the liver. Whereas the cytotoxic activity in the dialyzed serum showed a single peak with a maximum value 8 hr after the start of ethanol consumption in the healthy volunteers, it showed two peaks with maximum values at 2 and 8 hr in the patients with cirrhosis.

Acetaldehyde-modified serum proteins inhibit mitogen-stimulated human lymphocyte transformation.

Sera obtained from healthy volunteers immediately before and 8 h after the rapid consumption of 1.2 g ethanol/kg body weight were dialysed against RPMI 1640 and added ab initio to microcultures of normal human lymphocytes containing 1-3 micrograms phytohaemagglutinin (PHA)/ml or 2-8 micrograms pokeweed mitogen (PWM)/ml. When compared with the pre-alcohol sera, the post-alcohol sera inhibited lymphocyte transformation after 48 h incubation with either mitogen.

A nosocomial outbreak of Branhamella catarrhalis confirmed by restriction endonuclease analysis.

An outbreak of respiratory illness due to Branhamella catarrhalis occurred in the intermediate care unit of a Veterans Administration hospital and involved patients and staff members. Four patients had pneumonia and four had bronchitis. Infected patients were placed in a cohort separated from noninfected patients and were treated.

Circulating cytotoxic protein generated after ethanol consumption: identification and mechanism of reaction with cells.

Serum obtained from healthy volunteers 6-7 h after consumption of 60-95 g of ethanol contained cytotoxic activity against mouse A9 cells and all of six human cell lines tested. Affinity chromatography of such sera demonstrated that at least some of the cytotoxic molecules consisted of altered albumin. Complexes formed by the reaction of 14C-acetaldehyde with 125I-labelled human serum albumin in vitro were also cytotoxic.

The capacity of macrophages from different murine tissues to metabolise ethanol and generate an ethanol-dependent non-dialysable cytotoxic activity in vitro.

Tissue macrophages obtained from liver, bone marrow, spleen and thymus of C57 BL/6 mice closely resembled blood-monocyte-derived human macrophages in three characteristics. These were: the rate of metabolism of ethanol to acetate, the biochemical pathways involved in ethanol metabolism and the ability to generate an ethanol-dependent non-dialysable cytotoxic activity in vitro. The metabolism of ethanol by all four types of murine tissue macrophage was only slightly suppressed by pyrazole, 4-iodopyrazole and 3-amino-1,2,4-triazole, which are known to inhibit alcohol dehydrogenase (ADH), pi ADH and catalase respectively.

Cytotoxic protein molecules generated as a consequence of ethanol metabolism in vitro and in vivo.

A non-dialysable cytotoxic activity developed in the supernatants of human blood-monocyte-derived macrophages cultured in the presence of ethanol and in the serum of three healthy volunteers who drank 500-700 ml wine over 20-35 min. On 'Sephacryl S-300' gel filtration of the culture supernatants and the serum samples from the subjects who took alcohol, the cytotoxic activity eluted together with albumin molecules. Studies of human serum and of various commercially purchased human serum protein fractions treated with carbon-14-labelled acetaldehyde and non-radioactive acetaldehyde, respectively, provided strong circumstantial evidence that the cytotoxic proteins were albumin molecules that had become complexed with acetaldehyde generated by the metabolism of ethanol.

Hospital-acquired gangrenous mucormycosis.

A post-operative diabetic patient who had been treated for Serratia marcescens bacterial sepsis developed recurrent thrombosis of the left femoral artery following intra-arterial instrumentation. Pathological examination of arterial thrombus ultimately demonstrated invasive mucormycosis of the femoral artery and cultures of this material grew Rhizopus oryzae. The occurrence of cutaneous and subcutaneous mucormycosis is reviewed, as well as recently recognized nosocomial risk factors for mucormycosis, such as elasticized bandages and wound dressings.

Pneumococcal pneumonia in hospitalized patients. Clinical and radiological presentations.

The clinical and radiological features of pneumococcal pneumonia were studied in 94 hospitalized patients. Fifty-seven (61%) had a bronchopneumonic pattern on roentgenogram, and 37 (39%), a lobar pattern. Eighty-two (87%) of the patients in both roentgenographic classifications had one or more underlying disease states.