What Should Students and Trainees Be Taught About and Where Patients Belong?

Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols, especially during inpatient admissions from a hospital's emergency department. This term and this practice are both clinically and ethically problematic because a patient is rarely, if ever, "turfed" to their advantage. Ethically speaking, turfing constitutes deferral of responsibility for a patient's admission or care to colleagues.

Activation of invasion by oncogenic reprogramming of cholesterol metabolism via increased NPC1 expression and macropinocytosis.

Cancer cells are dependent on cholesterol, and they possess strictly controlled cholesterol homeostasis mechanisms. These allow them to smoothly switch between cholesterol synthesis and uptake to fulfill their needs and to adapt environmental changes. Here we describe a mechanism of how cancer cells employ oncogenic growth factor signaling to promote uptake and utilization of extracellular cholesterol via Myeloid Zinc Finger 1 (MZF1)-mediated Niemann Pick C1 (NPC1) expression and upregulated macropinocytosis.

Anesthetic Considerations for Cesarean Delivery in a Parturient With Severe Gitelman Syndrome.

Gitelman syndrome is an autosomal recessive inherited disorder that impairs the function of thiazide-sensitive sodium-chloride cotransporters in the distal convoluted tubule of the nephron. During labor and delivery, avoidance of sympathetic overactivity, meticulous hemodynamic monitoring, and expedited repletion of potassium and magnesium are required to avoid adverse outcomes. We present a parturient with severe Gitelman syndrome, requiring continuous electrolyte and fluid infusions, who underwent successful cesarean delivery.

Elevated midtrimester maternal plasma cytokines and preterm birth in patients with cerclage.

Background: Cerclage is used for the prevention of spontaneous preterm birth; however, many patients at high risk of spontaneous preterm birth who have a cerclage in place eventually deliver before term. Although inflammation, measured by biomarkers (eg, cytokines), is a known risk factor for preterm delivery, evaluation of inflammation to determine pregnancy outcomes among patients with cerclage is poorly understood.

Objective: We sought to examine levels of maternal plasma inflammatory cytokines in the midtrimester among asymptomatic patients with a cervical cerclage (placed for any indication, including history, ultrasound, and examination indications) to evaluate the association between cytokine levels and preterm birth.

Identification of lysosome-targeting drugs with anti-inflammatory activity as potential invasion inhibitors of treatment resistant HER2 positive cancers.

Purpose: Most HER2 positive invasive cancers are either intrinsic non-responsive or develop resistance when treated with 1st line HER2 targeting drugs. Both 1st and 2nd line treatments of HER2 positive cancers are aimed at targeting the HER2 receptor directly, thereby strongly limiting the treatment options of HER2/ErbB2 inhibition resistant invasive cancers.

Methods: We used phenotypic high throughput microscopy screening to identify efficient inhibitors of ErbB2-induced invasion using 1st line HER2 inhibitor trastuzumab- and pertuzumab-resistant, p95-ErbB2 expressing breast cancer cells in conjunction with the Prestwick Chemical Library®.

Preoperative cefazolin rather than clindamycin or metronidazole is associated with lower postpartum infection among women with chorioamnionitis delivering by cesarean delivery.

Background: The optimal antibiotic regimen to prevent maternal postpartum infection among high-risk women treated for chorioamnionitis delivering by cesarean delivery remains to be defined. Emerging data suggest that cefazolin decreases the risk of cesarean surgical site infection.

Objective: To investigate whether intrapartum antibiotic therapy with cefazolin versus the current standard clindamycin or metronidazole decreases the risk of postpartum infectious morbidity among women delivering by cesarean delivery who were receiving a base regimen of ampicillin or penicillin with gentamicin for chorioamnionitis.

Association of chorioamnionitis and patent ductus arteriosus in a national U.S. cohort.

Objective: To estimate the effect of clinical chorioamnionitis on the risk of patent ductus arteriosus (PDA).

Study Design: A secondary analysis of all deliveries >23 gestational weeks from the U.S.

Nitrous oxide analgesia for external cephalic version: A randomized controlled trial.

Study Objective: Our study sought to determine whether or not nitrous oxide analgesia decreases pain compared to oxygen placebo during external cephalic version for breech presentation. Procedural success may be limited by pain and anxiety. Although neuraxial anesthesia has been studied extensively for these procedures, many centers lack resources for routine use.

SPT6-driven error-free DNA repair safeguards genomic stability of glioblastoma cancer stem-like cells.

Glioblastoma cancer-stem like cells (GSCs) display marked resistance to ionizing radiation (IR), a standard of care for glioblastoma patients. Mechanisms underpinning radio-resistance of GSCs remain largely unknown. Chromatin state and the accessibility of DNA lesions to DNA repair machineries are crucial for the maintenance of genomic stability.

The association of skin incision placement during cesarean delivery with wound complications in obese women: a systematic review and meta-analysis.

Objective: To determine the risk of wound complications by skin incision type in obese women undergoing cesarean delivery. Electronic databases (MEDLINE, Scopus, and Ovid) were searched from their inception through August 2018. We included all randomized controlled trials and cohort studies reporting the placement of skin incision during cesarean section in obese women, defined as those with BMI ≥30 kg/m.

The effect of orthognathic surgery on facial recognition algorithm analysis.

Introduction: The purpose of this study was to evaluate the ability of a publicly available facial recognition application program interface to calculate similarity scores for presurgical and postsurgical photographs of patients who underwent orthognathic surgeries. Our primary objective was to identify which surgical procedure(s) had the greatest effect(s) on the similarity score.

Methods: Existing photographs for 25 orthodontic-orthognathic patients were analyzed using the application program interface to calculate similarity scores between the presurgical and postsurgical photographs.

Is Group B Streptococcus Colonization Associated with Maternal Peripartum Infection in an Era of Routine Prophylaxis?

Objective: This study aimed to assess whether colonization with group B streptococcus (GBS) is associated with maternal peripartum infection in an era of routine prophylaxis.

Study Design: This study presented a secondary analysis of women delivering ≥37 weeks who underwent a trial of labor from the U.S.

Association Between Maternal Obesity and Group B Streptococcus Colonization in a National U.S. Cohort.

To investigate the association between maternal obesity as measured by prepregnancy body mass index (BMI) and group B streptococcus (GBS) colonization. We conducted a secondary analysis from the Consortium on Safe Labor Study (CSL) in the United States cohort study (2002-2008). Pregnant women with deliveries at ≥37 weeks of gestation who attempted labor were included (115,070 assessed deliveries).

Machine Learning and Statistical Models to Predict Postpartum Hemorrhage.

Objective: To predict a woman's risk of postpartum hemorrhage at labor admission using machine learning and statistical models.

Methods: Predictive models were constructed and compared using data from 10 of 12 sites in the U.S.

Antihistamines and Ovarian Cancer Survival: Nationwide Cohort Study and in Vitro Cell Viability Assay.

Antihistamines with cationic amphiphilic drug (CAD) characteristics induce cancer-specific cell death in experimental studies. Epidemiologic evidence is, however, limited. In a Danish nationwide cohort of ovarian cancer patients diagnosed during 2000-2015 (n = 5075), we evaluated the association between filled antihistamine prescriptions and cancer mortality.

Ongoing and Focused Provider Performance Evaluations in Emergency Medicine: Current Practices and Modified Delphi to Guide Future Practice.

The Joint Commission requires ongoing and focused provider performance evaluations (OPPEs/FPPEs). The authors aim to describe current approaches in emergency medicine (EM) and identify consensus-based best practice recommendations. An online survey was distributed to leaders in EM to gain insight into current practices.

Perturbation of mitochondrial bioenergetics by polycations counteracts resistance to BRAF inhibition in melanoma cells.

Acquired resistance to the oncogenic BRAF inhibitor vemurafenib is a major clinical challenge in the treatment of melanoma. Vemurafenib resistance is poorly understood; however, available evidence indicates that reprogrammed mitochondrial metabolism could contribute to the resistance mechanism. Here we show that synthetic polycations, such as polyethylenimines and poly(l-lysine)s, prevent vemurafenib resistance in melanoma cells through induction of mitochondrial bioenergetic crisis.

A needle in a haystack: Report of a retained archwire fragment in the pterygomandibular space.

This clinical report describes a retained archwire fragment, discovered during a new-patient examination of a young woman seeking orthodontic retreatment. The diagnostic process, care coordination, and patient management decisions are discussed, along with a brief exploration of clinical considerations associated with this incident. A suggested emergency prevention and response protocol is also presented.

High speed of fork progression induces DNA replication stress and genomic instability.

Accurate replication of DNA requires stringent regulation to ensure genome integrity. In human cells, thousands of origins of replication are coordinately activated during S phase, and the velocity of replication forks is adjusted to fully replicate DNA in pace with the cell cycle. Replication stress induces fork stalling and fuels genome instability.

Postural Preference and Musculoskeletal Complaints in Oral and Maxillofacial Surgeons.

Purpose: Oral and maxillofacial surgeons traditionally have musculoskeletal pain. The aim of this study was to determine the postural preferences of oral and maxillofacial surgeons and their effect on musculoskeletal pain.

Materials And Methods: The authors designed and implemented a cross-sectional study.