Anxiety and depression in patients with non-site-specific cancer symptoms: data from a rapid diagnostic clinic.

Background: Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression.

Real-world data evaluating Guy's rapid diagnostic clinic as an alternate pathway for patients with FIT levels below 10.

Objective: To analyse the effectiveness of rapid diagnostic clinics (RDCs) as an alternative pathway for patients with concerning symptoms and a faecal immunochemical test (FIT) result <10. Our primary endpoint was rate of colorectal cancer (CRC) detection. Second endpoints were rates of other cancers and gastrointestinal (GI) serious benign conditions.

Implementation of a Holistic Review Process of US Allopathic Medical Students Eliminates Non-Comparable Metrics and Bias in General Surgery Residency Interview Invitations.

Objective: Use of traditional scoring metrics for residency recruitment creates racial and gender bias. In addition, widespread use of pass/fail grading has led to noncomparable data. To adjust to these challenges, we developed a holistic review (HR) rubric for scoring residency applicants for interview selection.

The structure of the human LACTB filament reveals the mechanisms of assembly and membrane binding.

Mitochondria are complex organelles that play a central role in metabolism. Dynamic membrane-associated processes regulate mitochondrial morphology and bioenergetics in response to cellular demand. In tumor cells, metabolic reprogramming requires active mitochondrial metabolism for providing key metabolites and building blocks for tumor growth and rapid proliferation.

Reengineering the specificity of the highly selective Clostridium botulinum protease via directed evolution.

The botulinum neurotoxin serotype A (BoNT/A) cuts a single peptide bond in SNAP25, an activity used to treat a wide range of diseases. Reengineering the substrate specificity of BoNT/A's protease domain (LC/A) could expand its therapeutic applications; however, LC/A's extended substrate recognition (≈ 60 residues) challenges conventional approaches. We report a directed evolution method for retargeting LC/A and retaining its exquisite specificity.

The use of ultrasound in establishing COVID-19 infection as part of a trauma evaluation.

Purpose: The use of lung ultrasound for diagnosis of COVID-19 has emerged during the pandemic as a beneficial diagnostic modality due to its rapid availability, bedside use, and lack of radiation. This study aimed to determine if routine ultrasound (US) imaging of the lungs of trauma patients with COVID-19 infections who undergo extended focused assessment with sonography for trauma (EFAST) correlates with computed tomography (CT) imaging and X-ray findings, as previously reported in other populations.

Methods: This was a prospective, observational feasibility study performed at two level 1 trauma centers.

The surgical debrief: Just another checklist or an instrument to drive cultural change?

Introduction: Post-procedural debrief is recommended to improve patient safety. We examined operating room (OR) clinicians' perceptions of the impact of a multi-disciplinary debrief on OR culture.

Methods: A survey was administered to 182 OR clinicians at a major academic medical center.

Disparities in Emergency Versus Elective Surgery: Comparing Measures of Neighborhood Social Vulnerability.

Background: Several composite measures of neighborhood social vulnerability exist and are used in the health disparity literature. This study assesses the performance of the Social Vulnerability Index (SVI) compared with three similar measures used in the surgical literature: Area Deprivation Index (ADI), Community Needs Index (CNI), and Distressed Communities Index (DCI). There are advantages of the SVI over these other scales, and we hypothesize that it performs equivalently.

OnabotulinumtoxinA Displays Greater Biological Activity Compared to IncobotulinumtoxinA, Demonstrating Non-Interchangeability in Both In Vitro and In Vivo Assays.

Differences in botulinum neurotoxin manufacturing, formulation, and potency evaluation can impact dose and biological activity, which ultimately affect duration of action. The potency of different labeled vials of incobotulinumtoxinA (Xeomin; 50 U, 100 U, or 200 U vials; incobotA) versus onabotulinumtoxinA (BOTOX; 100 U vial; onabotA) were compared on a unit-to-unit basis to assess biological activity using in vitro (light-chain activity high-performance liquid chromatography (LCA-HPLC) and cell-based potency assay (CBPA)) and in vivo (rat compound muscle action potential (cMAP) and mouse digit abduction score (DAS)) assays. Using LCA-HPLC, incobotA units displayed approximately 54% of the protease activity of label-stated equivalent onabotA units.

Novel Native and Engineered Botulinum Neurotoxins.

Botulinum neurotoxins (BoNTs), produced by Clostridia and other bacteria, are the most potent toxins known. Their cleavage of the soluble N-ethylmaleimide-sensitive factor activating protein receptor (SNARE) proteins in neurons prevents the release of neurotransmitters, thus resulting in the muscle paralysis that is characteristic of botulism. This mechanism of action has been exploited for a variety of therapeutic and cosmetic applications of BoNTs.

Cholecystectomy: Exploring the Interplay Between Access to Care and Emergent Presentation.

Background: The burden of emergency general surgery leads to higher cost and less compensation to institutions; cholecystectomy accounts for >150,000 cases/y, the highest number of emergency general surgery cases that have a potentially elective course. We hypothesize that our cholecystectomy patient pool has unique characteristics informing health care access in our area.

Methods: We retrospectively identified cholecystectomy patients at our academic hospital over a 6-mo period from January to June of 2018 and classified them as emergent or elective.

Using the Social Vulnerability Index to Examine Local Disparities in Emergent and Elective Cholecystectomy.

Background: The Social Vulnerability Index (SVI) is a composite scale formulated by the Centers for Disease Control and is geocoded as a percentile ranking at the census tract level. SVI is potentially applicable to assess risk and target populations that are likely to present emergently for disease that could have been treated electively and target local disparities. We applied the SVI to compare cholecystectomy patients presenting emergently versus electively.

Preventable death and interpersonal violence in the United States: Who can be saved?

Background: Public health initiatives to reduce mortality from penetrating trauma have largely developed from patterns of injury observed in military casualties, with a focus on hemorrhage control and use of tourniquets. Recent efforts show that injury patterns differ between civilian mass casualty events and combat settings, and no studies characterize wounding patterns in all types of civilian homicide. We hypothesize that many homicide deaths are due to nonsurvivable injuries, and that an effective strategy to reduce mortality must focus on both primary prevention as well as improvement in trauma prehospital care.

Delayed Presentation of a Vertex Epidural Hematoma Following High-Voltage Electrical Injury to the Head.

We present the case of a man who suffered a high-voltage electrical injury followed by a delayed presentation of an epidural hematoma. CT of the brain demonstrated hyper dense material along the anterior and frontal region consistent with an epidural hematoma at the vertex. The patient underwent serial computed tomography scans of his brain which demonstrated stability of the hematoma and no operative intervention was required.

Oxytocin attenuates phencyclidine hyperactivity and increases social interaction and nucleus accumben dopamine release in rats.

The pituitary neuropeptide oxytocin promotes social behavior, and is a potential adjunct therapy for social deficits in schizophrenia and autism. Oxytocin may mediate pro-social effects by modulating monoamine release in limbic and cortical areas, which was investigated herein using in vivo microdialysis, after establishing a dose that did not produce accompanying sedative or thermoregulatory effects that could concomitantly influence behavior. The effects of oxytocin (0.

Contact networks structured by sex underpin sex-specific epidemiology of infection.

Contact networks are fundamental to the transmission of infection and host sex often affects the acquisition and progression of infection. However, the epidemiological impacts of sex-related variation in animal contact networks have rarely been investigated. We test the hypothesis that sex-biases in infection are related to variation in multilayer contact networks structured by sex in a population of European badgers Meles meles naturally infected with Mycobacterium bovis.

Seasonal variation in daily patterns of social contacts in the European badger .

Social interactions among hosts influence the persistence and spread of infectious pathogens. Daily and seasonal variation in the frequency and type of social interactions will play an important role in disease epidemiology and, alongside other factors, may have an influence on wider disease dynamics by causing seasonal forcing of infection, especially if the seasonal variation experienced by a population is considerable. We explored temporal variation in within-group contacts in a high-density population of European badgers naturally infected with (the causative agent of bovine tuberculosis).

Diversity oriented biosynthesis via accelerated evolution of modular gene clusters.

Erythromycin, avermectin and rapamycin are clinically useful polyketide natural products produced on modular polyketide synthase multienzymes by an assembly-line process in which each module of enzymes in turn specifies attachment of a particular chemical unit. Although polyketide synthase encoding genes have been successfully engineered to produce novel analogues, the process can be relatively slow, inefficient, and frequently low-yielding. We now describe a method for rapidly recombining polyketide synthase gene clusters to replace, add or remove modules that, with high frequency, generates diverse and highly productive assembly lines.

Mammograms on-the-go-predictors of repeat visits to mobile mammography vans in St Louis, Missouri, USA: a case-control study.

Objectives: Among women, breast cancer is the most common non-cutaneous cancer and second most common cause of cancer-related death. The purpose of this study was to determine the extent to which women use mobile mammography vans for breast cancer screening and what factors are associated with repeat visits to these vans.

Design: A case-control study.

Synaptotagmin II and gangliosides bind independently with botulinum neurotoxin B but each restrains the other.

Botulinum neurotoxin type B (BoNT/B) initiates its toxicity by binding to synaptotagmin II (SytII) and gangliosides GD1a and GT1b on the neural membrane. We synthesized two 27-residue peptides that carry the BoNT/B binding sites on mouse SytII (mSytII 37-63) or human SytII (hSytII 34-60). BoNT/B bound to these peptides, but showed substantially higher binding to mSytII peptide than to hSytII peptide.

Predictive factors and patterns of recurrence in patients with triple negative breast cancer.

Background: We investigated the outcomes of patients with triple negative breast cancer ([TNBC] = estrogen receptor negative, progesterone receptor negative, and HER2 nonamplified).

Methods: We identified 414 patients with stage I-III TNBC treated between 1999 and 2008. Data included patient/tumor characteristics, surgical, systemic, and radiation treatment received, and breast cancer-specific survival.

Impact of radiation therapy on survival in patients with triple-negative breast cancer.

Triple-negative breast cancer (TNBC) has a poorer prognosis compared with other sub-groups. In the current study, survival associated with locoregional treatment of females with TNBC was investigated. Specifically, 468 patients with stage I-III TNBC treated between 2002 and 2009 were identified.